Transfusion最新文献

Background: Reports of cases of bacterial infection due to transfusion of red blood cell (RBC) components (RBC-TTBI) are relatively rare. Hence, the possibility of undetectable bacterial contamination in RBCs, especially by psychrotrophic bacteria, must be clarified.

Study design and methods: We assessed nine psychrotrophic bacterial species, including those implicated in bacteremia or RBC-TTBIs. They were cultured on plates from 4 to 37°C to determine their optimal growth temperatures. We also assessed the detection capabilities of the automated culture/alarm system BACT/ALERT VIRTUO (VIRTUO) using BPA (aerobic) and BPN (anaerobic) bottles. In addition, bacteria-inoculated RBCs were incubated at 4°C for 42 days, with samples assessed weekly for bacterial growth using plate culture, VIRTUO, visual inspection, and endotoxin production.

Results: Two Psychrobacter species exhibited weak or no proliferation at temperatures ≥30°C in plate cultures. Three Pseudomonas species, one Psychrobacter species, and one psychrotrophic lactic acid bacteria proliferated in RBCs at 4°C, reaching 10⁴-10⁸ colony-forming units/mL (growth count) and 15-39,230 pg/mL (endotoxin production) by day 14. VIRTUO, operating at 36°C, failed to consistently yield reliable results for any of the tested bacterial species. Notably, visual changes in bag appearance were observed from day 21 in four species that proliferated in RBCs.

Discussion: Each psychrotrophic bacteria demonstrated a specific temperature preference for optimal proliferation. Standard culture tests, typically conducted at 35-37°C, often fail to detect the growth of such bacteria, suggesting they may be overlooked in the cultural analysis of suspected RBC-TTBI cases.

Background: Extracorporeal photopheresis (ECP) product characteristics are not well established. The aim of this study was to compare mononuclear cells (MNCs) collection using the new Amicus blue (AB) In-line ECP system to our standard Off-line ECP system using the Optia apheresis device and the MacoGenic G2 inactivation system (OM).

Study design and methods: We assessed the ECP products and procedure parameters, patient characteristics, and adverse events for both AB and OM systems in paired patients. Comparisons were made with t-test for paired samples.

Results: Thirteen patients underwent 15 double, paired procedures using both ECP protocols and processing the same blood volume of 4000 mL. Total MNC collected in the product were 51.6 × 10⁸ (95% CI 30.0-73.1) and 42.2 × 10⁸ (95% CI 22.4-62.0) for the AB and OM, respectively (not significant). Both products were also similar regarding volume, MNC concentration, purity, and hematocrit. However, total platelet count (×10¹¹) was significantly lower in the AB products: 0.25 (95% CI 0.15-0.36) versus 1.2 (95% CI 0.9-1.5). The new AB system reduced significantly also the time invested and anticoagulant used per procedure compared with OM, albeit with similar collection efficiency and percentage of MNC captured per procedure. Hypocalcemia was the commonest adverse event with both systems, but it was not severe.

Conclusions: The new AB system collected MNC products comparable to our current experience with OM, although in a significantly shorter time, with a reduced use of anticoagulant and lower contamination with platelets, which are all valuable advantages of the new system.

Background: The application of a temporary deferral when attempting to donate has a negative impact on retention. Little has been done to reduce the likelihood of a donor attending to donate, only to be found to be ineligible. The aim of this study was to determine the effectiveness of pre-screening donors when making an appointment, to prevent in-center deferrals.

Study design and methods: Donation attempts were collated between July and December 2020. Two segments were identified: (1) those who had a deferral applied and (2) those who successfully donated. Donor and donation characteristics examined included age, sex, prior donation history, deferral history, and appointment booking channel (pre-screened vs. not pre-screened). We also explored the impact of pre-screening on the subsequent donation behavior of those who were deferred.

Results: Overall, 3.2% of donation attempts resulted in a deferral being applied. Most donors booked an appointment via a pre-screening channel (69.9%), with the mobile app being the most popular (31.9%). Donors who booked via a pre-screening channel had lower odds of receiving a deferral (aOR: 0.86). Strongest effects were observed for new donors (aOR: 0.79), those aged ≤40 years. (aOR: 0.84) and those deferred in the past (aOR: 0.87). Deferred donors who booked by a pre-screening channel were more likely to return at 6 months (aHR: 1.09) and 12 months (aHR: 1.12) compared to those who did not book through a pre-screening channel.

Discussion: Pre-screening donors is a simple and effective approach to reduce the number of donors deferred when presenting to donate in the donation center, with a longer-term impact on donor retention.

Background: The provision of ABO-incompatible fresh frozen plasma (FFP) in massive transfusion (MT) has become accepted to conserve AB FFP stock. There is an evidence gap in non-trauma settings. We compare characteristics of patients who received ABO-compatible or ABO-incompatible FFP during an MT episode due to any cause of critical bleeding, and assess the impact of incompatible FFP transfusion on inhospital mortality.

Methods: Using the Australian and New Zealand Massive Transfusion Registry, data were extracted for patients aged ≥18 years who received an MT (defined as ≥5 red cell units in 4 h) between April 2011 and October 2018. Incompatible FFP was defined as transfusion of ≥1 unit of FFP with a bidirectional or minor ABO-mismatch in the first 24 h from MT initiation.

Results: A total of 7340 patients from 28 hospitals were included. Seventy-seven (1%) patients received incompatible FFP (26 trauma, 51 non-trauma). Those who had incompatible FFP received a median of seven units of FFP, compared to those who only received compatible FFP receiving five units, p = .005. A total of 226 units of incompatible FFP were provided overall. Incompatible FFP provision was not independently associated with inhospital mortality in MT (HR of 1.40 [95% CI 0.84-2.26, p = .2]). Variables independently associated with inhospital mortality included increased FFP volume in the first 24 h, age, Charlson Comorbidity Index score, and lower pre-transfusion fibrinogen and peri-transfusion pH values.

Conclusion: Transfusion of incompatible FFP in MT in our cohort was not independently associated with higher inhospital mortality, although the number of patients who received incompatible FFP was small.

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study design and methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5.

Discussion: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

Background: Adverse transfusion reactions (ATRs) represent undesired responses in patients. Different reports indicate that rates of ATRs are 1.3-2.6 times higher in pediatric populations compared with adults. The aim of this study was to investigate whether similar trends are observed within the pediatric population in Colombia.

Study design and methods: This retrospective study, conducted from January 1, 2018, to December 31, 2022, investigated transfusion occurrences and ATRs. Data were collected from the National Hemovigilance Information System. ATRs were reported by medical personnel using standardized forms following guidelines set by the International Society of Blood Transfusion.

Results: The study included 2,097,179 patients receiving 6,637,363 transfusions, with 6830 ATRs. In comparison with adult transfusions, pediatric transfusions exhibit a male bias, a higher rate of ATRs per 10,000 transfused patients (79.4 vs. 27.7), a greater prevalence of allergic reactions and a lower incidence of febrile nonhemolytic transfusion reactions (FNHTRs). The rate of ATRs varied across age groups: 17.1 for those aged 0-1 year, 120.5 for individuals aged 2-14 years, 42.5 for people aged 15-65 years, and 24.4 for those over 65 years. Among pediatric patients, 688 of 1126 allergic reactions were linked to platelet transfusions. Platelets obtained via apheresis had a higher ATR rate compared with those from the buffy coat method (OR: 1.44), while in adults, 960 of 3002 allergic reactions were attributed to platelet transfusions, with higher ATR rates for apheresis platelets compared with buffy coat platelets (OR: 1.41).

Conclusion: ATRs in the Colombian pediatric population were three times higher than adults.

Background: Umbilical cord blood (CB) units stored in banks are an important source of hematopoietic stem cells for transplantation and other cell therapies. New applications, such as their use in transfusions, require rapid quality release as cord blood red blood cells (CB-RBC) have a shorter shelf life.

Study design and methods: This project aims to investigate the most prevalent microbial contaminants in CB preparations and validate a rapid sterility testing strategy for CB-RBC based on an automated system (BACT/ALERT®) in tandem with a molecular assay (real-time PCR) capable of detecting at least 100 CFU/mL of Cutibacterium acnes in CB-RBC to accelerate the detection of the most common slow-growing bacteria.

Results: Microbial contamination incidence was assessed by reviewing 4696 CB sterility tests, revealing a positivity rate of 3.4%, with C. acnes being the most common slow-growing pathogen. The BACT/ALERT® system, which was validated according to European Pharmacopeia guidelines, was an appropriate method for sterility testing of CB-RBC, although it required up to 14 days of culture to detect C. acnes when iFAPlus and iFNPlus bottles were used to neutralize antimicrobials. Interestingly, the BACT/ALERT® method detected C. acnes at 30 CFU/mL within 14 days, while real-time PCR identified concentrations ≥65 CFU/mL by Day 4.

Discussion: In conclusion, we developed a rapid sterility testing strategy that combines automated culture systems and real-time PCR for early microbial contamination, enhancing CB-RBC shelf life for transfusion and emphasizing the importance of combining detection methods.