Transfusion最新文献

Background: Guidelines for red blood cell transfusion recommend incorporating patient factors and clinical context beyond hemoglobin (Hb) levels. However, limited data exist on which factors clinicians consider important. Understanding these decision-making elements can clarify how guidelines are applied and inform future research. This study aimed to identify and prioritize factors that influence transfusion decisions among inpatient clinicians.

Study design and methods: Inpatient clinicians who are high utilizers of transfusion were administered a survey and asked to rate the importance of 30 decision-making factors using a 3-point Likert scale (very, somewhat, not important). Additional questions addressed transfusion practices and anemia management using a 5-point Likert scale (very much disagree to very much agree). Descriptive statistics were used to characterize study participants and survey responses, and regression models explored associations between responses and participant characteristics.

Results: Of 95 eligible clinicians, 85 (89%) completed the survey. Only 7 of the 30 factors were rated as "very important" by more than 66% of respondents; 5 of these were Hb-related. Importance assigned to other non-Hb-related factors varied. Most clinicians (85%) do believe that anemia can result in significant adverse consequences. Most clinicians further believe that restrictive transfusion is standard of care (88%) and optimal (68%), but also that transfusion decisions need to incorporate factors other than a patient's Hb level (84%) at the same time.

Conclusion: Despite guidelines suggestions, there is a lack of consensus on what clinical factors beyond Hb clinicians believe are important in making transfusion decisions.

Background: Liberal platelet transfusion practices increase neonatal morbidity and mortality. The mechanisms underlying this harm are unknown but may involve the immune rather than hemostatic functions of platelets, as well as the significant differences between adult (transfused) and neonatal platelets, particularly the higher P-selectin surface expression on activated adult platelets. In this study, we investigated the immune/inflammatory effects of transfusing adult platelets into newborn mice.

Study design and methods: Washed platelets from wild-type (WT) or P-selectin^-/- adult donors or Tyrode's buffer control were transfused into WT and thrombocytopenic c-MPL^-/- pups. Blood was collected 2- or 4-h post-transfusion to measure a panel of plasma inflammatory cytokines, neutrophil extracellular trap (NET) formation, and the percentage of circulating platelet-monocyte and platelet-neutrophil aggregates (PMAs and PNAs).

Results: Transfusion of adult WT platelets into post-natal Day 10 (P10) and 5 (P5) WT pups increased plasma concentrations of inflammatory cytokines 2- and 4-h post-transfusion, including interleukin-6 (IL-6) and Keratinocyte-derived chemokine (KC). Transfusion of WT platelets into P10 thrombocytopenic c-MPL^-/- pups similarly increased plasma inflammatory cytokines, PMA and PNA percentages, and NET formation. Compared to WT platelets, P-selectin^-/- platelets induced similar elevations in plasma cytokines, but NET formation was attenuated and PMA and PNA percentages were comparable to those of sham-transfused pups.

Discussion: In a murine model of neonatal thrombocytopenia, transfusion of adult platelets increased PMA and PNA percentages, plasma inflammatory cytokines, and NET formation through both P-selectin-dependent and -independent mechanisms. These effects may contribute to the negative outcomes seen with liberal neonatal platelet transfusion practices.

Background: Whole blood (WB) transfusions are being reevaluated because of their high hemostatic capacity and reduced volume. Fibrinogen γ-chain peptide-coated, adenosine 5'-diphosphate (ADP)-encapsulated liposomes are potent hemostatic adjuvants promoting platelet thrombi formation. This study aimed to elucidate the potential interactions between simultaneous WB transfusion and the administration of fibrinogen γ-chain peptide-coated ADP-encapsulated liposomes.

Study design and methods: We used a rabbit model of postcardiopulmonary bypass (CPB) coagulopathy. One hour after CPB, the rabbits were transfused with WB (WB group, n = 7) or H12-ADP-liposomes along with WB transfusion (WB + H12-ADP-liposome group, n = 7). Blood cell counts, coagulation activity, platelet function, and bleeding time were evaluated.

Results: Hemoglobin concentration, platelet count, activated clotting time, and ADP and collagen test results were comparable between the WB + H12-ADP-liposome and WB groups after transfusion. However, bleeding time was remarkably reduced in the WB + H12-ADP-liposome group (378 ± 150 s) compared with that in the WB group (551 ± 255 s, p < .01), suggesting that H12-ADP-liposomes further enhanced the hemostatic effect of WB transfusion in post-CPB coagulopathy.

Discussion: Administration of H12-ADP-liposomes along with WB transfusion had a synergistic effect on hemostatic performance, providing a greater therapeutic advantage than WB transfusion alone.

Background: Per the Association for the Advancement of Blood & Biotherapies (AABB) Standards and best practice, patients requiring crossmatched blood transfusions must have a current type & screen (TNS) on file. The blood type must be confirmed with a second independent blood specimen, called blood type verification (BTV), which is collected following an additional patient identification process. Our policy states that the TNS and BTV samples must be drawn at different time points with reconfirmation of patient identity. BTV samples are rejected if documented as collected at the same time as the TNS. This study describes utilizing an electronic enhancement to decrease the BTV rejection rate.

Methods: An electronic enhancement was made that disallows the printing of the BTV label until the initial TNS sample is documented as collected within the electronic health record (EHR). The BTV will only be accessible after the first sample is collected to ensure a second independent patient verification.

Results: The overall number of rejections decreased from an average of 66 per month in the year prior to implementation to 37 per month in the year after. BTV rejections as a percentage of total specimen rejections were reduced from a monthly average of 45% to 2%.

Conclusion: A simple yet useful electronic enhancement rendered a drastic decrease in BTV rejections. This has improved patient safety by providing crossmatched blood products in a timely manner and reducing the number of redraws.

Background: Beliefs about how donation affects health and the impact of these on donor behavior are under-researched. We aimed to determine whether Australian donors consider the impact of blood donation on their health, identify these beliefs, and examine the influence of these on donation frequency.

Study design and methods: We surveyed 790 active whole-blood and 749 active plasma donors, stratifying donors into novice and established. Negative binomial regression analyses were used to determine which health beliefs are associated with 12-month donation frequency.

Results: Half of respondents (52.5%) had thought about the impact of donating blood on their physical health while a third (30.9%) had thought about mental health impacts. On a 5-point scale, the most endorsed mental health belief was Feeling good from the knowledge that you've helped others (4.71 ± 0.76) and the highest endorsed physical health belief was Refreshing of blood (2.00 ± 1.39). Greater endorsement of Feeling lightheaded, dizzy or nauseous (incidence rate ratio [IRR]: 0.938, 95% CI: 0.89-0.99), Feeling anxious or scared (IRR: 0.934, 95% CI: 0.88-0.99), and Becoming dehydrated (IRR: 0.948, 95% CI: 0.91-0.99) were significantly associated with reduced donation frequency while greater endorsement of Feeling happier (IRR: 1.031, 95% CI: 1.00-1.06) was significantly associated with increased donation frequency.

Discussion: Many donors consider the relationship between donation and their physical health, although fewer consider the relationship with mental well-being. Mental health impacts were highly endorsed, while endorsement of physical health impacts was low. Findings indicate a need to investigate how donors interpret health-related information provided throughout the donation process.

Background: Neonates with hemolytic disease of the fetus and newborn (HDFN) may require exchange transfusions (ET) for severe hyperbilirubinemia. We evaluated if ET in neonates with HDFN was associated with the maximum maternal titer and antibody-dependent cellular cytotoxicity (ADCC) and we determined the change in the number of hospitals performing ET in the Netherlands.

Study design and methods: National, multicenter analysis of neonates for whom an ET product (c.q. reconstituted whole blood) was ordered between Jan 1, 2011 and Dec 31, 2021 in the Netherlands. To quantify the ET risk, we retrieved maternal serological test results for cases with an ET for non-ABO HDFN (numerator) and from all alloimmunized pregnancies (denominator). Current and past ET practices were assessed with a questionnaire.

Results: Twenty-four participating centers ordered 1564 of the total 1824 (84%) ET products in the 11-year study period. We identified 627 patients for whom a product was ordered, among these 111 (17.7%) received ET for HDFN. We found increasing ET rates in D-mediated HDFN from 0.9% (5/558) when maximum titers were ≤ 1:32 to 19.6% (18/92) if titers were 1:512. Rates of ET increased from 1.1% (9/823) if the maximum ADCC was <50% to 18.7% (72/386) if the ADCC was ≥50%. The number of hospitals practicing ET nowadays was 36.7% (18/49), a 56.1% decline compared to before 2010 (41/49).

Discussion: Antenatal serological tests may aid caregivers to anticipate the need for ET in neonates with non-ABO HDFN. We found a substantially altered treatment landscape with considerably fewer Dutch hospitals performing ET.

Background: Platelet transfusions are an important tool to prevent and stop bleeding. Thresholds for pretransfusion platelet counts have been studied in various patient populations, yielding evidence-based guidelines. The Association for the Advancement of Blood and Biotherapies (AABB) collaborated with the International Collaboration for Transfusion Medicine Guidelines (ICTMG) to develop a platelet guideline with new and updated recommendations for different patient populations. The goal of this study was to determine platelet transfusion appropriateness in a large tertiary care hospital, identify common scenarios with deviations from guidelines, and assess the effect that the new AABB/ICTMG guidelines could have on platelet utilization.

Study design and methods: A retrospective 8-week audit of platelet transfusions at a university hospital was conducted using institution-specific adjudication criteria. A second audit applied the AABB/ICTMG recommendations. Patient demographics, laboratory values, and transfusion details were collected with an electronic audit tool. Each platelet (PLT) order was adjudicated through manual record review.

Results: A total of 1667 units of apheresis PLT were transfused to 312 patients. Using current hospital guidelines, 163 of 1288 adult (12.7%) and 44 of 379 pediatric orders (11.6%) were deemed inappropriate and 119 adult (9.2%) and 24 pediatric (6.3%) orders were indeterminate. The second audit, which applied recommendations from the 2025 AABB/ICTMG platelet guideline, found multiple PLT transfusions that would be newly noncompliant.

Discussion: There is an incongruency between clinical practice across various specialties and evidence-based platelet guidelines for platelet transfusions. The new AABB/ICTMG guidelines create an opportunity to reduce unnecessary platelet transfusions in several patient populations.