Transfusion最新文献

Background: Red blood cell (RBC) transfusion causes RBC alloimmunization in a st of patients. Factors that influence RBC alloimmunization risk are incompletely understood.

Study design and methods: We performed a matched case-control study of male intensive care unit (ICU) patients who did or did not develop a new RBC alloantibody after RBC transfusion. Demographic, clinical, and laboratory data were collected. Cases and controls were matched 1:2 on serological follow-up time (SFT) and the number of RBC units transfused. Conditional logistic regression analyses were performed to identify variables associated with the development of a new RBC alloantibody.

Results: One hundred and seventeen cases who developed a new RBC alloantibody during the SFT were matched with 234 controls who did not develop an alloantibody. The median SFT was 40 days among cases and 52 days among controls. The median number of RBC units transfused during the SFT was 7 in both groups. Although the total number of RBC units transfused was similar, cases were transfused RBC units in fewer transfusion episodes compared with controls. The median number of transfusion episodes, defined as a minimum time interval of 24 h between RBC transfusions, was higher in controls compared to cases. In multivariable analysis, each additional transfusion episode was associated with a 26% lower risk of RBC alloimmunization (odds ratio 0.74; 95% confidence interval 0.63-0.86; p < 0.001).

Conclusions: In a matched case-control study of male ICU patients who received a similar number of RBC transfusions, a greater number of transfusion episodes was associated with a decreased risk of developing a new RBC alloantibody.

Background: Cryoprecipitate Anti-Haemophilic Factor (CRYO-AHF) is enriched for fibrinogen, VWF, FVIII, FXIII and fibronectin, but has short post-thaw expiration due to risk of transfusion-transmitted infection (TTI) limiting availability for rapid treatment. Amotosalen-UVA pathogen reduction treatment (A-PRT) to manufacture pathogen-reduced cryoprecipitated fibrinogen complex (PRCFC) allows 5-day post-thaw expiration, reduces TTI risk, and facilitates early treatment of hemorrhage.

Aims: To evaluate adhesive protein functions in PRCFC and lyophilized PRCFC (LIFC).

Methods: CRYO-AHF, PRCFC, LIFC, and commercial fibrinogen concentrate (CFC) were evaluated for platelet adhesion and aggregation in variable shear microfluidic assays.

Results: Platelet adhesion kinetics to CRYO-AHF, PRCFC, and LIFC, under low shear flow (300 s^-1) were conserved. Platelet adhesion to CFC at low shear was reduced due to absence of functional VWF. αIIbβ3 integrin/fibrinogen and GPIb-IX-V/VWF platelet interactions with CRYO-AHF, PRCFC, and LIFC were confirmed by abciximab and caplacizumab inhibition, respectively. All fibrinogen sources promoted efficient platelet aggregation. Perfusion of reconstituted plasma-free blood (RBC + platelets + various cryoprecipitates) on immobilized VWF-binding peptide (1500 s^-1) showed impaired platelet adhesion to CFC compared to PRCFC and CRYO-AHF. Perfusion of reconstituted blood on collagen (3000 s^-1) indicated CRYO-AHF, PRCFC and LIFC formed thrombi to similar levels. Platelets treated with A-PRT combined with PRCFC or LIFC retained similar activity to CRYO-AHF for platelet aggregation and thrombus formation on collagen.

Conclusions: PRCFC and LIFC retained critical hemostatic functions of VWF and fibrinogen to support platelet adhesion and aggregation during physiologic shear. PRCFC and LIFC represent a therapeutic option for early treatment of massive hemorrhage.

Background: While plasma transfusion is a key resuscitation strategy, its mechanisms of benefit beyond coagulopathy correction remain unclear. Solvent detergent plasma, which contains high glycine levels and lacks inflammatory mediators, may offer advantages over fresh frozen plasma by preserving endothelial integrity and reducing inflammation. This study aimed to test whether plasma containing a high dose of glycine is superior to standard plasma in improving outcomes after traumatic shock by mitigating endothelial damage and inflammation.

Study design and methods: Anesthetized, fully instrumented Wistar rats (n = 11 per group) were randomly assigned to receive plasma, glycine-supplemented plasma, or crystalloid following polytraumatic injury and shock. The primary outcome was endothelial leakage of the lung. Inflammation and organ failure, as determined by biochemistry and histopathology, were secondary outcomes.

Results: Glycine-supplemented plasma, but not plasma, prevented an increase in pulmonary vascular leakage in comparison to crystalloid. Glycine-supplemented plasma resulted in lower systemic levels of syndecan-1 than crystalloid (p < .05). Glycine-supplemented plasma caused less lung injury compared with standard plasma (p < .001) and crystalloids (p < .001). Preservation of the endothelial barrier was associated with lower IL-6 levels and less acidosis in the glycine-supplemented plasma group than in the crystalloid group (p < .05).

Discussion: Glycine-supplemented plasma is superior to standard plasma in preventing endothelial permeability, glycocalyx shedding, and lung injury, which may be mediated via inhibition of IL-6 or improvement of acid-base balance. The use of solvent detergent plasma for trauma resuscitation may be more beneficial than standard plasma, partly due to glycine content.

Background: Little is known about how platelet shortages impact patient care and outcomes. In the summer of 2024, a ransomware event substantially impacted blood product processing capacity in South Florida, creating a natural experiment to evaluate such a shortage.

Study design and methods: We conducted a retrospective study of platelet test results-categorized as <10,000/μL (universal transfusion recommendation), 10,000-49,000/μL (equivocal transfusion indication), and ≥50,000/μL (transfusion rarely indicated)-from adults hospitalized at the University of Miami Hospital and Clinics during (July 29-August 4) versus pre- (July 1-July 28) or post- (August 5-September 1) shortage.

Results: We included 26,457 platelet results-46.3% pre-, 11.3% during, 42.3% post-shortage-from 3605 hospitalizations. Platelet counts of 10,000-49,000/μL in the pre- (odds ratio [95% confidence interval]: 3.05 [1.43, 6.51]) and post- (2.89 [1.27, 6.60]) periods were more often followed by transfusions within 6 h than during the shortage. No difference was observed following platelet counts <10,000/μL or ≥50,000/μL. We found no statistically significant difference in hospital mortality or hemorrhage across periods. However, during the shortage mortality was numerically higher (20.0% vs. pre: 15.2%, post: 18.3%) and hemorrhage was lower (0.0% vs. pre: 19.0%, post: 18.3%) for hospitalizations with nadir platelet counts of 10,000-49,000/μL.

Discussion: Shortage conditions were associated with fewer platelet transfusions following counts of 10,000-49,000/μL without significant patient harm. These findings suggest that, with sufficient resources, it is possible to change practice quickly and that guideline-concordant care for platelet transfusions may reduce waste while maintaining quality.

Background: Current interventions for CMV at-risk recipients include leukoreduction and CMV-antibody screening. We evaluated the CMV-DNA prevalence in United States (US) blood donors to estimate the residual risk from cell-free virus.

Methods: A highly sensitive, automated quantitative nucleic acid testing (NAT) assay assessed plasma samples in pools of 24 from CMV-seropositive or CMV-antibody not-tested donations. CMV-NAT-initial reactive (IR) samples were tested for CMV-IgG and IgM. CMV-NAT-reactive donors were invited to participate in follow-up (F/U) to confirm CMV seroconversion and DNA resolution.

Results: Of 240,115 CMV-DNA-tested samples, 23 were IR; titers ranged from 34.5 to 4020 IU/mL. Of 23 IR, 20 (87%) were CMV-NAT repeatedly reactive (RR); 3 (13%) were seroreactive only (repeat NAT-nonreactive/IgG-only positive). Of 20 CMV-NAT-RRs, 4 (20%) were CMV-IgG-only positive, 15 (75%) were IgM/IgG positive, and 1 (5%) was antibody-negative (i.e., window-period). F/U samples from 9 RR and 2 IR-only donors were collected at an 18-day mean after their IR donation. All F/U samples were NAT RR except those from the 2 IR-only donors, both NAT nonreactive. F/U IgG testing confirmed positivity in all 11 donors, with 8 of 11 also IgM positive. The mean age of CMV-NAT-reactive donors was 47 years; 16 (70%) were male, with 6 first-time donors. Previous donations (1999-2024) for 6 CMV-reactive donors were anti-CMV positive. A commercial infectivity assay yielded negative results for the 8 highest titer samples.

Conclusions: Sensitive NAT determined a CMV-NAT-IR prevalence of 1:10,440 in plasma samples from CMV-screened seropositive/serology-unscreened US blood donors. One identified window-period donor highlights the limitation of current CMV interventions.