Transfusion最新文献

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Brazil, time-based blood donation deferral policies for gay, bisexual, and other men who have sex with men (gbMSM) have been replaced by individual donor assessment (IDA).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.

Background: Since bleeding is a major cause of early mortality in trauma, there is continued interest in providing transfusion support as early as possible to trauma patients. Various approaches have been taken to accomplish this, including the rapid provision of blood products upon arrival at the hospital, as well as a variety of prehospital approaches. However, implementing prehospital blood availability statewide for use in all populations has been limited.

Study design and methods: The program described for prehospital transfusion identifies a direct partnership between state EMS providers and the local blood center. Predictive modeling is compared to early outcome data of the first 100 patients who received whole blood from this program. Additional discussion contains key elements of the program, including planning, validation, and implementation.

Results: Between May 2023 and July 2024, an average of 11 prehospital whole blood units were transfused per month against the projected average of 10-16 units administered per month, with the median time to transfusion of 29.2 min. The leading reason for blood administration was due to blunt trauma. Of the patients who were not in prehospital cardiac arrest prior to paramedic arrival or excluded for other reasons, approximately 95% survived to hospital discharge.

Discussion: Implementation of prehospital whole blood across the state has demonstrated effectiveness early within the first year of the program. Continued process improvements will be implemented with statewide ground paramedic agency utilization of whole blood as well as expansion into aviation divisions for more expedient whole blood administration times.

Background: People with hereditary hemochromatosis (HHC) require therapeutic phlebotomy on an ongoing basis. Little is known about the facilitators and barriers they experience in donating at a blood collection agency (BCA), nor how these impact their willingness to engage in an ongoing relationship with a BCA. This study explored the experiences of HHC donors undergoing therapeutic phlebotomy at the Australian Red Cross Lifeblood (Lifeblood) in Australia.

Study design and methods: All HHC donors who had made at least one donation at Lifeblood in the last 2 years were invited to complete a survey. In this paper, we report the findings on enablers and barriers to donating at Lifeblood, donor and patient identity, communication, knowledge of blood use and of plasma, interest in donating plasma, and engagement in positive word of mouth about donating.

Results: Data were obtained from 4350 therapeutic donors. Responders identified more enablers than barriers to donating at Lifeblood and 61.8% reported that Lifeblood used their blood. Responders were more likely to identify as donors than patients, and those with a stronger donor than patient identity were significantly more likely to report that their blood was used, had greater interest in donating plasma, and reported engaging in more positive word of mouth about donating.

Discussion: Findings indicate that BCAs can do more to educate donors with HHC about how their blood is used to help others. Doing so may help to retain them as donors and can be beneficial for the blood supply, as well as for the donors themselves.

Background: Historically, red cell concentrates (RCCs) have been manually glycerolized and deglycerolized using an open system (COBE 2991, Terumo). Implementation of a closed system cell processor (ACP-215, Haemonetics) for glycerolization and deglycerolization of RCCs creates a challenge for management of the historic cryopreserved RCC inventory. A study was undertaken to determine whether manually glycerolized frozen RCCs could be deglycerolized using the closed system processor, as the open system processors are being discontinued.

Study design and methods: Thirteen ABO/Rh matched RCCs were pooled and split to produce six large (approximately 354 mL) and six small (approximately 244 mL) RCCs. All units were stored for 14 days post-collection, manually glycerolized and frozen at ≤ -65°C for ≥72 h. Half of the units of each size were deglycerolized using the COBE 2991 and resuspended in 0.9% saline, and the remaining units were centrifuged, deglycerolized on the ACP-215, and resuspended AS-3. RBC quality was tested at 24 ± 2 h post-deglycerolization.

Results: All units deglycerolized on the ACP-215 had significantly lower hemolysis (p < .001) levels than those processed on the COBE2991. Large ACP-215 deglycerolized units had lower hematocrits (p < .05), hemoglobin (p < .01), and recovery (p = .001) than did large units deglycerolized on the COBE 2991. All ACP-215 units met the regulatory standards for hemolysis, hematocrit, hemoglobin, and recovery.

Discussion: The closed-system ACP-215 processor significantly reduced post-deglycerolization hemolysis in all units, and hemoglobin content in large units. The ACP-215, in combination with a centrifugation step, is suitable for processing cryopreserved RCCs that have been manually glycerolized.

Background: The XG blood group system comprises two antigens, Xg^a and CD99. CD99 is known to be carried on both the X and Y chromosomes in pseudoautosomal region 1. We identified five unrelated Japanese individuals with anti-CD99 and investigated their genomic background as well as the clinical significance of anti-CD99.

Study design and methods: Analysis of CD99 expression on RBCs and a modified monocyte monolayer assay was performed using flow cytometry. Genomic DNA was obtained from the five anti-CD99 producers to identify the deleted region responsible for the lack of CD99, and we conducted a long polymerase chain reaction using primer pairs specific for CD99 and GYG2.

Results: CD99 expression from the Y chromosome was higher than that from the X chromosome. The five anti-CD99 plasma samples gave varied agglutination strengths with the red blood cells (RBCs) expressing high and low CD99 levels, in the antiglobulin test. The phagocytosis rate of anti-CD99-sensitized RBCs was 76.6% in one case indicating a risk of hemolytic transfusion reactions (HTR), and it correlated with the level of CD99 expression. The deleted region spanned 115 kb, from CD99 exon 3 to GYG2 exon 1. All five anti-CD99 producers were homozygous for the large deletion allele.

Discussion: All five anti-CD99 producers were females with a history of pregnancy in Kyushu, Japan, and this deletion allele may thus be endemic. Our results indicated the possibility of HTR due to anti-CD99, and the risk is low when transfusing RBC products from Xg(a-) females with a low expression of CD99.