Transfusion最新文献

Introduction: SARS-CoV-2 infection is associated with hypercoagulability in patients with Coronavirus disease (COVID-19). We used a vein-to-vein database to examine the impact of transfusion of plasma units from blood donors with recent SARS-CoV-2 infection.

Study design and methods: We linked donor SARS-CoV-2 serology data with plasma transfusions occurring between 6/1/2020 and 3/31/2022. Using multivariable regression, we examined changes in the international normalized ratio (INR) and subsequent transfusion requirements following plasma transfusion relative to the timing of donor SARS-CoV-2 nucleocapsid antibody (anti-N Ab) positivity.

Results: We identified 2350 adults who received 5397 plasma units with donor SARS-CoV-2 serology data as part of 3721 plasma transfusion events. 8.1% (436/5397) of plasma units were from anti-N Ab positive donors, and median time from index seropositivity to donation was 89 days (interquartile range [IQR] 0-210). In recipients of plasma units from recently SARS-CoV-2 infected donors (<120 days), the adjusted odds of a 0.25 per unit lowering of the INR were increased (aOR 1.6 [1.1-2.5]; p = .03) and the odds of additional plasma transfusions within 24 h were decreased (aOR 0.6 [0.4-0.9]; p = .04).

Conclusion: Recipients of plasma units from blood donors with recent SARS-CoV-2 infection were more likely to have post-transfusion reductions in the INR and less likely to require additional plasma transfusions.

Introduction: The immunomodulatory consequences of blood transfusion, known as transfusion-related immune modulation (TRIM), are often not captured by hemovigilance systems. Changes to blood product manufacturing processes may impact patient outcomes.

Design and methods: We conducted a retrospective study of hospitalized adults (≥18 years) in Hamilton, ON, who received ≥1 red blood cell (RBC) transfusion(s) between 2010 and 2014. Primary outcome was in hospital mortality; TRIM outcomes included respiratory failure, organ dysfunction, and sepsis. We evaluated outcomes before and after the change made by Canadian Blood Services (2012) to consolidate manufacturing of blood products in Ontario. Exclusions included autologous, washed, or deglycerolized RBC transfusions, RBCs manufactured outside select regional sites, or patients who received both pre-/post-consolidation RBCs. Data was obtained from the TRUST database. Logistic regression adjusted for key covariates.

Results: A total of 9871 pre- and 7871 post-consolidation patients met inclusion criteria. Multivariate analysis demonstrated no change in in-hospital mortality (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.89-1.14, p = 0.95), respiratory failure (OR 0.83, CI 0.65-1.06, p = 0.14) or organ dysfunction (OR 0.95, 95% CI 0.84-1.08, p = 0.42) comparing post to pre-consolidation. However, hospital-onset sepsis was lower post-consolidation (OR 0.59, 95% CI 0.48-0.73, p < 0.001).

Conclusions: Consolidation of blood production in Ontario was not associated with changes in rates of in-hospital mortality, respiratory failure, or organ dysfunction among transfusion recipients, but may be associated with a lower risk of sepsis. TRIM and the clinical impacts of changes to blood processing require further study.

Background: Cell and gene therapies (CGTs) represent a paradigm shift in modern medicine, offering targeted and potentially curative options for complex and rare diseases. Their integration into health-system pharmacy practice requires alignment with the medication-use process to ensure safety, efficacy, and compliance.

Objective: To propose a practical framework for integrating CGTs into health-system pharmacy workflows, while addressing clinical, operational, and financial considerations.

Summary: The framework encompasses four domains: (1) evaluation-strategic assessment of pipeline therapies, including clinical, operational, and financial readiness; (2) clinical integration-formulary review, electronic medical record configuration, clinical pathways, and standard operating procedures development; (3) operational pharmacy integration-establishing infrastructure for receipt, storage, handling, and dispensing, supported by training and process improvement; and (4) financial integration-implementing reimbursement strategies, payment workflows, and budgeting to mitigate financial risk. These recommendations draw on the institutional experience of the authors and emerging standards from professional organizations.

Conclusion: Proactive planning and interdisciplinary collaboration are essential for successful CGT implementation. Health-system pharmacists are uniquely positioned to lead these efforts, ensuring patient safety, operational efficiency, and financial sustainability as advanced therapeutics reshape the healthcare landscape.

Background: Heparin combined with sodium citrate has been used in leukocytapheresis for pediatric patients. Since 2022, we have performed leukocytapheresis using a highly concentrated sodium citrate solution (HSC, 5.32%) instead of acid citrate dextrose solution A (ACD-A). We conducted this study to determine whether HSC use reduces run time and the total amount of anticoagulant solution in children.

Study design and methods: We retrospectively analyzed data from consecutive autologous peripheral blood stem cell harvests (auto-PBSCHs) between June 2012 and May 2025, including patient characteristics, mobilization methods, protocol used, anticoagulant type, run time, total anticoagulant solution volume, and collection efficiency.

Results: Auto-PBSCH was performed using the mononuclear cell collection (MNC) protocol in 28 procedures and the continuous MNC protocol in 20 procedures. ACD-A was used in 35 procedures and HSC in 13. The run time was significantly shorter (204 [range, 117-302] vs. 157 min [range, 103-227], p = .02) in the HSC group and also confirmed in multivariable regression analysis (coefficient, -55.6; 95% confidence interval, -106.2 to -5.04; p = .03). In a subgroup analysis of cMNC procedures, CD34⁺ collection efficiency showed a strong negative correlation with the proportion of run time devoted to establishing the initial interface (r = -.73, p = .0003).

Conclusion: Delays in establishing the initial interface can reduce the duration of the effective MNC collection phase and may negatively affect collection efficiency. Careful attention to the initial interface phase is therefore warranted when using HSC.

Background: Therapeutic plasma exchange (TPE) for thrombotic thrombocytopenic purpura (TTP) and auto-immune disorders involves repeated patient exposure to allogenic plasma with the risk of transfusion-transmitted infection (TTI). Amotosalen-UVA Pathogen Reduction technology is FDA approved to manufacture pathogen-reduced plasma, cryoprecipitate reduced (PRPCR), a form of cryoprecipitate poor plasma (CPP) with potentially improved TPE outcomes and reduced TTI risk.

Methods: PRPCR was manufactured from pathogen-reduced (PR) plasma. Thrombin generation, fibrinogen, Factors II, V, VII, VIII, IX, X, XI, XIII, VWF, ADAMTS13, Protein C, Protein S, α-2 plasmin inhibitor (α-2 PI), IgG, IgM, and IgA were measured. Microfluidic chamber assays at variable shear rates characterized PRPCR-mediated platelet adhesion and aggregation.

Results: Compared to PR plasma, fibrinogen, Factor VIII, and VWF levels were depleted in PRPCR. Factors II, V, VII, IX, X, XI, XIII, thrombin generation, Protein C, Protein S, α-2 PI, ADAMTS13, and immunoglobulins were conserved. At low wall shear rates (300 s^-1) PRPCR supported platelet adhesion. Perfusion of plasma-free blood containing PRPCR flowed over immobilized VWF binding peptide (100 μg/mL) and showed absence of platelet adhesion. Perfusion of plasma-free blood containing PRPCR flowed over immobilized collagen (200 μg/mL) at high wall shear rate (1500 s^-1) and demonstrated no platelet thrombus formation.

Conclusions: PRPCR retained hemostatic capacity, anti-thrombotic proteins, and ADAMTS13, but collagen induced platelet aggregation was negligible at high shear due to depletion of functional high molecular weight VWF. PRPCR is a CPP option for TPE with reduced platelet-mediated thrombotic risk and TTI risk, but with retention of plasma hemostatic capacity and immunoglobulins.

Background: Accurate quantification of residual leukocytes (rWBC) and red blood cells (rRBC) in leukoreduced blood components is essential to ensure product quality and transfusion safety. Conventional manual flow cytometry techniques are time-consuming and analyst-dependent. In this study, we validated the XN-1000 Blood Bank (BB) mode as an automated alternative and compared its performance with our standard quality control (QC) workflow.

Study design and methods: The BB mode was validated for precision, linearity, and carry-over in detecting residual cells in red blood cell concentrates, platelet concentrates, and plasma products. Results obtained were compared to those of manual flow cytometry (for rWBC and rRBC) and impedance-based hematology analysis (for platelet counts) across over 1000 blood components.

Results: Methods validation showed high linearity, acceptable precision at low cell concentrations, and no analytical interference. Comparison between workflows revealed similar results for hemoglobin, hematocrit, and leukocyte counts. rRBC values measured by BB mode were ~2.3-fold higher than those obtained by manual flow cytometry, although all values remained within product specifications. Platelet counts were consistently higher with BB mode (PLT-F) than with impedance, with a 15-51% increase depending on the product. Flow cytometry confirmed that PLT-F results better reflect the true platelet content than impedance.

Conclusion: The XN-1000 BB mode is a reliable and efficient alternative to manual methods for QC monitoring of blood components. It offers accurate residual cell quantification, increases laboratory throughput, and simplifies workflows.

Background: Low-titer group O whole blood (LTOWB) is increasingly used for prehospital hemorrhagic shock, yet real-world data from multi-agency EMS systems, particularly in medical hemorrhage, remain limited. This evaluation describes the first 11 months of a regional LTOWB program, focusing on operational timelines, physiologic response, protocol adherence, and product stewardship.

Study design and methods: In this quality-improvement evaluation, all prehospital blood activations in the Pierce County EMS (PCEMS) region of Washington State were reviewed. Operational metrics included dispatch-to-blood time, scene time, transfusion location, and dispatch-to-ED interval. Physiologic response was assessed using systolic blood pressure (SBP), heart rate, and shock index (SI), with shock resolution defined as SI <1 on ED arrival. Protocol adherence and stewardship (utilization and waste) were obtained from EMS documentation and transfusion-service logs.

Results: Eighty-nine activations occurred, and all patients received prehospital transfusion (47 trauma, 42 medical hemorrhage). Timelines demonstrated early initiation: median dispatch-to-blood 21.3 min, scene time 14.3 mins, and dispatch-to-ED 36.6 min. Protocol adherence was high, with frequent LTOWB-first transfusion, crystalloid avoidance, and TXA and calcium use. Among LTOWB recipients with serial vitals, SBP increased and SI decreased from initial assessment to post-transfusion and ED arrival. Across agencies, 189 units (LTOWB and components) were issued; of 182 with known disposition, 135 (74.2%) were transfused and 47 expired, yielding a utilization of 74% and waste rate of 26%.

Conclusions: A regional multi-agency EMS system achieved early LTOWB initiation, high protocol adherence, and physiologic improvement across trauma and medical hemorrhage, with stewardship metrics characteristic of early implementation.

Background: Filtration failures in sickle cell trait (SCT, AS) blood donations limit the availability of antigen-matched red blood cell concentrates (RBCCs) for transfusion. Carbon monoxide (CO), by stabilizing hemoglobin in its high-affinity relaxed state, may prevent filter clogging and restore leukofiltration efficiency. However, the storage quality and stability of CO-treated RBCCs remain to be evaluated.

Study design and methods: RBCCs from normal (AA) donors and AS donors with prior leukofiltration failure were categorized as AA-NC (untreated AA), AA-CO (CO-treated AA), and AS-CO (CO-treated AS). CO treatment consisted of exposing RBCCs to CO gas under controlled conditions before leukofiltration. Filtration success, hematological parameters, metabolic stability, oxidative stress markers, and hemolysis parameters were analyzed on days 0, 14, 28, and 42.

Results: CO treatment reversed filter clogging in AS RBCCs, enabling successful leukofiltration without significant hemolysis. It induced approximately 90% COHb, with a slight increase in MetHb due to the injection technique, which remained stable throughout the 42-day storage period. Hematological and metabolic parameters were preserved across groups. CO also reduced free Hb oxidation in both AA and AS RBCCs and limited storage lesions in AA RBCCs, whereas AS RBCs remained more prone to senescence at the end of storage.

Discussion: CO treatment enables successful leukofiltration of previously non-filterable AS RBCCs and helps preserve RBC quality during storage. This strategy could enhance the availability of antigen-matched RBCCs and improve transfusion safety in sickle cell disease.