Transfusion最新文献

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.

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.

Background: Immunomodulatory consequences of transfusion, known as transfusion-related immune modulation (TRIM), impact patients but are not captured by hemovigilance systems. This study's objective is to explore TRIM impacts of production changes made by the blood supplier.

Methods: We included all transfused and non-transfused adult inpatients from 2002 to 2022 in Hamilton, Canada. Non-transfused patients served as controls to identify confounding temporal trends. We captured data from the Transfusion Research Utilization Surveillance and Tracking (TRUST) database and recorded TRIM outcomes including: sepsis, respiratory failure, venous thrombosis, organ dysfunction and in-hospital mortality using International Classification of Diseases codes, Canadian Classification of Health Interventions codes, and laboratory parameters, where applicable. The blood supplier provided data on production changes and quality control assessments. We used time series trend graphs to summarize aggregate data and the rolling window E-Divisive with Medians to detect change. A transparent and replicable point system approach identified changes in blood production most likely to have TRIM impacts.

Results: A cohort of 568,991 non-transfused and 102,446 transfused hospital admissions were included. We generated 40 time series TRIM trend graphs for transfused (n = 35) and non-transfused patients (n = 5). The blood supplier independently identified 12 key product policy, collection, or production changes. Consolidation of production in Ontario and introduction of buffy coat manufacturing were identified as having high TRIM impacts for patients transfused with any blood components.

Conclusion: Using a novel hypothesis generating data mining design, consolidation of blood production and buffy coat manufacturing are identified as changes with possible TRIM impacts among transfused hospitalized patients.