Transfusion最新文献

Background: Despite data supporting the safety of SARS-CoV-2 vaccination, concerns regarding the receipt of blood products from donors previously infected or vaccinated against SARS-CoV-2 persist. We assessed whether transfusions of plasma or platelet products from donors with prior SARS-CoV-2 infection or vaccination were associated with adverse outcomes in patients without COVID-19.

Methods: We linked donor SARS-CoV-2 spike and nucleocapsid antibody data and vaccination history to blood products transfused between June 1, 2020 and March 31, 2022. We used logistic regression, adjusting for demographics and comorbidities, to calculate odds ratios and 95% confidence intervals (CI) for posttransfusion thrombosis, increased respiratory requirement, and hospital mortality. Outcomes were assessed as per transfused unit from previously infected or vaccinated donors compared to units from uninfected or unvaccinated donors.

Results: Among 8715 hospitalizations of 7773 transfusion recipients linked to donor SARS-CoV-2 antibody data, there were 251 thromboses, 700 hospitalizations with increased respiratory requirements, and 1443 deaths. Among 15,167 transfused plasma units, 4993 and 1106 were from vaccinated donors and previously infected donors, respectively. Among 19,295 transfused platelet units, 8530 and 1368 were from vaccinated and previously infected donors, respectively. There were no associations between the transfusion of blood products from vaccinated or previously infected donors and thrombosis, increased respiratory requirements, or hospital mortality (all CI including 1). Nor were there associations between the receipt of blood products from recently infected or vaccinated donors or high SARS-CoV-2 antibody titers and adverse outcomes.

Discussion: Donor SARS-Cov-2 infection and vaccination were not associated with adverse patient outcomes and do not need to be considered in blood allocation.

Background: In England, blood donors with low hemoglobin concentration are deferred following on-session testing to prevent donations below regulatory thresholds, thereby protecting donors' health and blood supply quality. However, deferrals are costly, time-consuming and may discourage donors. Post-donation testing (PDT), where hemoglobin levels are measured after donation, offer potential alternatives as used in some European countries.

Study design and methods: We compared four PDT strategies to the current approach: (A) no on-session testing, (B) on-session testing if low hemoglobin at previous visit, (C) on-session testing if low/medium hemoglobin at previous visit, all with delayed reinvitation if low hemoglobin at previous donation, and (D) on-session testing if low/medium hemoglobin at previous visit without delayed reinvitations. We employed discrete event simulation modeling, informed by data collected from 16,941 donors returning under the current strategy in England, to simulate and compare total donations, under-threshold donations, and deferrals for each strategy over 18 months.

Results: Strategy A eliminated deferrals but led to increased under-threshold donations compared to the current strategy in men (6.5% vs. 2.3%) and women (11.8% vs. 4.5%). Strategies B-D reduced deferrals rates for men (1.0%-3.7% vs. 5.5%) and women (2.2%-6.3% vs. 8.9%) but showed slightly higher under-threshold donations in men (3.0%-5.1% vs. 2.3%) and women (5.3%-8.8% vs. 4.5%). Strategies with more on-session testing had lower under-threshold donations.

Discussion: PDT strategies incorporating on-session testing for low/medium hemoglobin at previous visits could reduce deferrals while maintaining a low proportion of under-threshold donations, thereby balancing donor safety with operational efficiency.

Background: Rural blood services with limited access to blood donors face challenges in supplying helicopter emergency medical services and local hospitals with leukoreduced whole blood. Extending the shelf life of whole blood can improve emergency preparedness during crises and conflicts and address critical transfusion needs and blood supply challenges. This study investigated whether the in vitro quality of stored leukoreduced whole blood in citrate-phosphate-dextrose (CPD) declined with extended storage for up to 35 days.

Study design and methods: Twenty units of whole blood were collected in CPD (Imuflex, BB*LGQ456E6, Terumo BCT), leukoreduced with a platelet-sparing filter, and stored (2-6°C) for 35 days. The units were sampled on days 1, 21, 28, and 35, and hematology parameters, hemolysis, blood gas, glucose, coagulation, and thromboelastography were analyzed. Results were compared to historical controls (n = 26).

Results: All units complied with European requirements throughout storage for 35 days, except one, which showed hemolysis of 0.9% on day 35. There was a decline in platelet count, hemostatic function, and plasma quality during storage. Comparisons with historical controls indicated few in vitro quality differences between CPD and CPDA-1 whole blood. Leukoreduction had a favorable effect on factor VIII concentration during storage.

Conclusion: When comparing to European requirements, our results indicate that the shelf life of whole blood in CPD can be extended beyond 21 days. A risk-benefit analysis should be done to evaluate if shelf life can be extended to improve the availability of blood products for patients with severe bleeding in remote regions, crises, and war.

Background: In many countries, including Brazil, time-based blood donation deferral policies for gay, bisexual, and other men who have sex with men (gbMSM) have been replaced by individual donor assessment (IDA). We examined HIV prevalence and incidence among first-time (FTD) and repeat donors (RD), comparing data from ~3.5 years before and after the IDA policy implementation in 2020.

Study design and methods: The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) Brazil component collects blood donor screening data from five public centers. From January 2017 to December 2023, we report frequencies, rates, and 95% confidence interval (CI) of confirmed HIV-positive donations among FTD, HIV NAT-yield rates for FTD and RD, and the incidence of confirmed HIV among RD before and after the policy change. We also report multivariable regression analysis results.

Results: Confirmed HIV prevalence in FTD was 79 per 100,000 (95% CI 72-87) before and 100 per 100,000 (95% CI 90-109) after the policy change, with differences between centers. HIV NAT-yield rates decreased for RD (p = .0025), with no change for FTD (p = .3). HIV incidence in RD did not increase (12.4 [95% CI: 11.1-13.9] vs. 10.3 [95% CI: 9-11.7] per 100,000 person-years).

Discussion: Our findings showed no significant difference in HIV incidence among RD. Although HIV prevalence among FTD increased, there was no rise in HIV NAT-yield donations. The analysis highlights challenges in interpreting changes within specific groups and blood centers, underscoring the importance of multicenter monitoring of transfusion-transmitted infections.

Background: The increasing population of older adults presents unique challenges in trauma care due to their reduced physiologic reserve compared to younger patients. Trauma-induced hemorrhage remains a leading cause of mortality, yet there is a significant gap in the optimal management of hemodynamically unstable older adults. This review aims to synthesize current literature on resuscitation strategies, coagulopathy, triage, and the impact of timely interventions in older adult trauma patients experiencing hemorrhagic shock.

Study design and methods: A comprehensive narrative review was conducted following PRISMA-Scr guidelines. A systematic literature search was performed using PubMed, Scopus, and Web of Science databases, yielding 380 titles. After removing duplicates, 287 unique articles were screened, of which 120 full-text articles were reviewed. A total of 45 studies met the inclusion criteria and were analyzed. Studies were categorized based on resuscitation protocols (14 studies), coagulopathy management (7 studies), frailty and aging physiology (10 studies), and timing/triage in trauma care (14 studies).

Results: Studies highlight the effectiveness of the shock index (SI) over traditional vital signs for identifying hemodynamic instability in older adults. Balanced transfusion ratios and whole blood resuscitation show potential benefits, though data specific to older adults remain limited. Goal-directed resuscitation protocols improve outcomes by addressing the unique physiological needs of this population. While trauma-induced coagulopathy rates are similar across age groups, older adults frequently present with pre-existing anticoagulation, complicating management. Standardized care pathways, early activation of massive transfusion protocols (MTP), and tailored resuscitation approaches are critical for optimizing care.

Discussion: The growing geriatric trauma population necessitates improved resuscitation strategies tailored to their unique physiological responses. While balanced transfusions and goal-directed protocols have demonstrated efficacy, further research is required to refine these interventions specifically for older adults. Establishing standardized resuscitation guidelines and defining futility criteria will enhance decision-making and improve outcomes for this vulnerable population.

Introduction: Data on the correlation between transfusion volumes and trauma mortality are limited. The association between the total number of red blood cell (RBC) and low titer group O whole blood (LTOWB) units, as well as the total volume of all transfused products that were administered up to 4-h after admission and 24-h mortality was determined.

Methods: The Trauma Quality Improvement Program (TQIP) datasets from 2020 to 2022 were reviewed to identify patients aged ≥15 who received any volume of blood products. Receiver operating characteristic (ROC) were constructed along with the calculated area under the ROC curve (AUROC) to determine the association between the quantity of transfusion and 24-h mortality.

Results: There were 144,379 encounters that met inclusion, with 22,467 patients who died within the first 24 h. There was a 90% probability of 24-h mortality following the transfusion of 56 RBC/LTOWB units (AUROC 0.673), with the 90% specificity, Youden's index, and 90% sensitivity surrounding this probability occurring after the transfusion of 8, 4, and 2 units, respectively. In terms of the volume of transfusion, there was a 90% probability of 24-h mortality following the transfusion of 36,000 mL of all blood products combined (AUROC 0.662), with the 90% specificity, Youden's index, and 90% sensitivity surrounding this probability occurring after the transfusion of 4400, 2000, and 500 mL, respectively.

Conclusions: Both the total number of RBC and LTOWB units transfused and the total volume of all blood products transfused demonstrated poor predictive association with the risk of 24-h mortality in the civilian trauma population.

Background: Since FDA approval in 2017, CAR-T therapy has seen rapid clinical adoption. Shifting clinical trends have emerged with increasing utilization of CAR-T therapies and a downward trend in HSCTs. Given the overlapping resources required for the manufacture and storage of these products, we sought to examine trends over a 6-year period.

Methods: The apheresis patient database and Lab database were reviewed to compile a list of patients that underwent either CAR-T or HSCT (autologous) collections, and/or received CAR-T or autologous HSCT infusions between January 1, 2018 and December 12, 2023. This was further examined by year and disease group.

Results: The total number of patients collecting for CAR-T increased from 52 in 2018 to 150 in 2023 (slope = 21.97; p = .0013), accompanied by a decrease in the number of patients collecting for HSCT, from 425 in 2018 to 341 in 2023 (slope = -21.2; p = .0177). Neither total number (calculated as number of HSCT + CAR-T) of patients collected (mean 476 + 20.4 per year), nor collection procedures (mean 972 ± 75.8 per year) changed significantly over the 6-year period. The total number of CAR-T infusions increased from 24 in 2018 to 111 in 2023 (slope = 17.7; p = .004), with a decrease in auto-HSCT from 400 to 289 (slope = -28.7; p = .008). The overall number of infusions (calculated as number of HSCT + CAR-T) did not change significantly (slope = -10.9; p = .13) over the 6-year period.

Discussion: Our findings confirm the increasing adoption of CAR-T therapy occurring alongside a decreasing stem-cell transplants, with stable overall resource utilization.

Background: Liquid plasma (LP) is isolated from whole blood donations, never frozen, and can be immediately transfused. Its primary indication is initial treatment of patients undergoing massive transfusion. To minimize wastage of this resource, we expanded the use of LP to include surgical and routine transfusions.

Methods: Our medical record was queried for plasma transfusions with at least one unit of LP issued. Chart review identified the indications for transfusion (emergency use, surgical use, or routine transfusion) and assessed effects of LP on coagulopathy, the use of additional blood products, and mortality. LP cases were categorized into two groups based on the fraction of LP transfused (≤50% or >50% LP). A control group of routine transfusion using only thawed plasma (TP) was reviewed and statistically compared to those cases where LP was included.

Results: Eight hundred ninety cases were studied including 34% emergency/massive transfusion events, 44% surgical cases, and 11% routine transfusions. In surgeries using LP, there were no significant differences in outcomes based on higher fractions of LP transfused. The correction of coagulopathy, the need for additional blood products, and the encounter-specific mortality were consistent across both routine transfusions with higher fractions of LP and comparing LP transfusion events to control TP transfusion events.

Conclusion: The utilization of LP in surgical cases and routine plasma transfusions was not associated with worse clinical outcomes and effectively prevented product waste. This report supports the broader use of and further study of LP in patient care.