Transfusion最新文献

Background: During the height of the COVID-19 pandemic (2020-2021), people were urged to minimize movements. Nevertheless, the Netherlands observed a huge increase in new donor registrations in early 2020. It is unclear whether such "pandemic" donors are willing to become repeat donors. The aim of this study was to analyze the donation behavior of these "pandemic" donors during 2 years after registration.

Methods: All donors registered in weeks 11-20 of 2020 were followed for 2 years and their turnout for the new donor screening (NDS), their first-time donation (FTD), their donation(s) in the follow-up period, and their availability at the end of the follow-up period was compared with donors registered in weeks 11-20 of the previous years, 2017-2019.

Results: Totally 26,463 donors registered during week 11-20 in 2020; more than double as in the same period in previous years. Their turnout for the NDS (80%) and FTD (60%) was like donors registered in 2017-2019. On the longer term, we saw lower donor availability with a shift in number of whole blood and plasma donations.

Discussion: During the first phase of the pandemic, more people registered than usual. Their show rates for the NDS and the FTD were comparable with previous years, suggesting that "pandemic" donors show identical behavior as regular donors. On the long term, however, donation behavior differed (lower return rates and shift in donation types). Further research is needed to disentangle impacts of the pandemic especially on the long-term changes as they happened simultaneously with policy and recruitment changes.

Background: Volume-reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out-of-group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD-A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue.

Study design and methods: This report compares corrected count increments (CCIs) from full-volume and ACD-A acidified volume-reduced human platelets in a retrospective study at a single hospital and in a mouse model.

Results: At a pediatric tertiary care hospital, 530 patients received conventional apheresis platelets during the 20-month study period. Among all patients, the expected 4-h mean CCI was 9.8 (95% CI: 8.7, 10.9) for full-volume platelets, and 8.8 (95% CI: 7.3, 10.6) for ACD-acidified volume-reduced platelets (p = .29). A statistically significant difference (p = .01) was identified in the expected 24-h mean CCI: 6.3 (95% CI: 5.5-7.0) with full-volume platelet, 4.7 (95% CI: 3.6-6.0) with ACD-acidified volume-reduced platelet. Limiting CCI calculations to patients with Hematology/Oncology/Hematopoietic Progenitor Cell Transplant diagnosis (n = 296, 56%) indicated a statistically significant difference in both 4- and 24-h predicted CCIs, showing lower CCIs in ACD-acidified volume-reduced platelet, although these were still similar to the CCIs observed in all patients and considered to be clinically acceptable responses similar to other volume reduction protocols. The recovery of count-adjusted, volume-reduced platelets was significantly lower in mice, suggesting a procedure-related defect.

Discussion: ACD-A acidification of platelets before volume reduction decreases turnaround time for platelet issue and provides clinically allowable 4-h and 24-h platelet increments.

Objective: Therapeutic plasma exchange (TPE) is a vital therapeutic modality in pediatric intensive care units (PICU) for various indications. Traditionally, pediatric TPE is performed via a large bore, double lumen catheter, whose insertion necessitates deep sedation, and poses risk of hemorrhagic and thrombotic complications. Building on our previous success utilizing percutaneous radial artery catheters (ALs) for apheresis procedures, we present our experience with ALs for TPE procedures in the PICU.

Methods: A retrospective cohort study, conducted in the PICU of a tertiary, university affiliated pediatric hospital, including all children aged 19 years and younger, who underwent TPE using an AL for vascular access, between 2018 and 2023. TPE procedures were evaluated for utility (the procedure was performed as planned) and safety.

Results: A total of 72 procedures were performed on 20 children, using ALs for inlet access and peripheral intra-venous catheters for blood return. Procedure success rate was 94%, with AL malfunction causing transient delays in 6%. All were successfully completed following AL replacement. ALs were mostly 20 and 22 gauge, predominantly located in the radial artery. AL gauge did not significantly affect flow rate or procedure duration.

Conclusions: Our findings support AL use for vascular access, as a viable alternative to the traditional large bore, double lumen catheters most often used for TPE in children. Benefits of AL use may include a decrease in sedation requirements and a lower risk of vascular complications. Further investigation is warranted, for consideration as routine practice in PICUs.

Background: Homozygous inheritance of the R^N haplotype, characterized by the absence of the high frequency antigen Sec, as well as partial C and e antigens, is rare and is associated with potential for alloimmunization. Anti-Sec has been reported to be associated with a risk of delayed hemolytic transfusion reaction and hemolytic disease of the fetus and newborn (HDFN).

Results: We report the case of a 36-year-old pregnant woman with known sickle cell trait (SCT) and homozygous for the R^N haplotype with anti-Sec, anti-c, and anti-e. Morphological ultrasound identified dextro-transposition of the great arteries in the fetus. Neonatal cardiac surgery was planned with cardiopulmonary bypass support. Due to the rarity of this genotype, there were no compatible donors in our registry. For this reason, in addition to two previously glycerolized maternal donations, the mother donated three units during pregnancy and one unit postpartum.

Discussion: This case highlights the many complexities for the blood supplier pertaining to organizing blood donations during pregnancy, the risk of leukoreduction failure and jellification during the deglycerolization process of units from donors with rare blood carrying the SCT, as well as planning the rare-blood inventory and managing expiry dates to provide transfusion support during delivery, neonatal surgery, and the postoperative period. This case also exemplifies the importance of a strong partnership between blood suppliers and medical teams.

Background: Evaluation of additive solutions, storage containers, new collection and storage methods, and other potential modifications is resource intensive, resulting in diversion of platelets away from blood bank inventories and significant time to complete study recruitments. Our goal was to evaluate the feasibility of a small bag for the study of platelet storage, and, by using a standardized respirometry test, separate daily metabolic capacity from observations made in the dynamic storage environment of changing pH, fuels, and end products.

Methods: Single-donor apheresis platelets collected in 100% plasma had small volumes removed to meet secondary processing requirements. Small volumes (23 ± 1.4 mL) were placed in 50-mL bags constructed of platelet storage material, stored 7 days, and assessed with a panel of in vitro assays. Platelet bioenergetics (oxygen consumption and acid production rates) were measured with a respirometer.

Results: The patterns of platelet pH decline, activation, and potency by thrombin generation were consistent with historical reports. Lactate production rates (54.1 ± 11.3 μmol/10¹²plt/h) were significantly correlated with pH decrease, increased activation, and thrombin generation potency by Day 7. Respirometry revealed a reduction of the glycolytic capacity and accumulating damage to the oxidative system for ATP production over storage.

Discussion: Small bags present a storage profile of metabolic changes and activation consistent with historical data for full bag storage. Therefore, this system has promise to provide a platform for scaling experiments of platelet storage in a manner that maximizes platelets collected in research settings and does not compromise availability for patient treatment as exercised in this study.

Background: Whole blood (WB) is increasingly being used for resuscitation of trauma patients. Although platelet-, red blood cell (RBC)- and plasma-specific parameters in cold-stored WB are well characterized, there has been limited investigation of biological response modifiers (BRMs), which may induce adverse reactions in recipients. The aim of this study was to evaluate the quality and function of RBC, platelets, plasma proteins, and BRMs in cold-stored WB during storage.

Methods: WB (n = 24) was collected into collected into citrate-phosphate-dextrose (CPD) anticoagulant, held overnight, processed through a platelet-sparing filter, and stored at 2-6°C for 21 days. RBC, platelet, coagulation factor quality and function, and BRM concentrations were measured throughout the duration of storage.

Results: WB was effectively leukoreduced, with 99.98% reduction in leukocyte count and 81% platelet count recovery following filtration. Five WB units were significantly lipemic, with a visible lipid layer appearing after being cold storage overnight. These were more turbid with higher hemolysis compared to non-lipemic units (p = .023). Despite a decrease in platelet count during storage (p < .001), hemostatic function as measured by thromboelastography was maintained for at least 21 days (R time and maximum amplitude; both p < .001). There was a significant increase in PF4, CD62P, and RANTES during cold storage (all p < .001).

Discussion: WB retains hemostatic potential for at least 21 days of cold storage, and with further development, may be suitable for transfusion in Australia. Before implementation in Australia, quality control measures for lipemia and hemolysis would need to be defined as part of our manufacturing processes.

Background: Blood transfusions are the most common procedure performed in American hospitals. The steps required for blood product delivery are often misunderstood by providers, leading to numerous phone calls to the blood bank requesting order status. Distracting calls can lengthen turnaround time, especially during blood product or staff shortages. We sought a tool to address these questions and reduce distraction. This study highlights a novel blood tracker tool implemented in the electronic health record (EHR) that allows providers to see their blood order's status.

Study design and methods: With a multidisciplinary team of healthcare professionals, we constructed a user-friendly blood tracker highly visible in our EHR. It shows the status of a blood product in real time from "order printed" to "preparing" to "on its way." We surveyed blood bank technologists to determine if call volume and distraction changed.

Results: We counted the number of views per month as a surrogate of usage. The blood tracker was viewed 109,626 times per month on average from January through December 2023. The fraction of technologists who received 21 or more calls per shift decreased by 47%.

Discussion: We successfully constructed and implemented a novel blood tracker into our EHR that relays the status of a blood product. It is a highly viewed piece of information in our EHR and decreases blood bank call volume as reported by blood bank technologists. Its success demonstrates that closed-loop communication between the lab and providers regarding blood products is beneficial within our organization and potentially others.

Background: Intravenous immunoglobulin (IVIG) therapy is used in the treatment of pediatric diseases, although data about IVIG-related adverse events (IVIG-AEs) are limited. Objectives of this study were to document the incidence of IVIG-AEs in pediatric hospitalized patients and to identify risk factors for IVIG-AEs.

Methods: This retrospective cohort study included patients <18 years old who received IVIG therapy while admitted at a Canadian pediatric tertiary care center between 2016 and 2020. Patients and IVIG-perfusions characteristics were collected, as well as IVIG-AEs. Bivariate and multivariable logistic regressions were used to explore predictors of IVIG-AEs.

Results: We included 228 children, totaling 478 IVIG perfusions. Indications included treatment for inflammatory (52.6%), autoimmune disorders (35.5%), and immunoglobulin replacement (11.8%). A total of 213 IVIG-AEs were reported. Fever (13.6%) and headache (6.7%) were the most frequent IVIG-AEs. Most IVIG-AEs were mild (57%) or moderate (31%) in severity, but 12% were severe reactions. The following factors were predictive of IVIG-AEs in univariate analyses: older age (OR 1.14 [95% CI: 1.07-1.21]), dehydration (OR 2.55 [95% CI: 1.43-4.55]), concurrent allergies (OR 2.87 [95% CI: 1.26-6.56]), first perfusion (OR 1.53 [95% CI: 1.02-2.30]), and higher dosage (OR 2.14 [95% CI: 1.39-3.33]). Concurrent steroids decreased the risk of IVIG-AEs (OR 0.43 [95% CI: 0.19-0.96]). Older age and higher IVIG dose remained independent predictors of IVIG-AEs in multivariable analyses.

Conclusions: Mild IVIG-AEs are frequent in children, and serious reactions may occur. Prospective studies are needed to confirm risk factors for IVIG-AEs and to evaluate how to best prevent them.

Background: Health data comprise data from different aspects of healthcare including administrative, digital health, and research-oriented data. Together, health data contribute to and inform healthcare operations, patient care, and research. Integrating artificial intelligence (AI) into healthcare requires understanding these data infrastructures and addressing challenges such as data availability, privacy, and governance. Federated learning (FL), a decentralized AI training approach, addresses these challenges by allowing models to learn from diverse datasets without data leaving its source, thus ensuring privacy and security are maintained. This report introduces FL and discusses its potential in transfusion medicine and blood supply chain management.

Methods and discussion: FL can offer significant benefits in transfusion medicine by enhancing predictive analytics, personalized medicine, and operational efficiency. Predictive models trained on diverse datasets by FL can improve accuracy in forecasting blood transfusion demands. Personalized treatment plans can be refined by aggregating patient data from multiple institutions using FL, reducing adverse reactions and improving outcomes. Operational efficiency can also be achieved through precise demand forecasting and optimized logistics. Despite its advantages, FL faces challenges such as data standardization, governance, and bias. Harmonizing diverse data sources and ensuring fair, unbiased models require advanced analytical solutions. Robust IT infrastructure and specialized expertise are needed for successful FL implementation.

Conclusion: FL represents a transformative approach to AI development in healthcare, particularly in transfusion medicine. By leveraging diverse datasets while maintaining data privacy, FL has the potential to enhance predictions, support personalized treatments, and optimize resource management, ultimately improving patient care and healthcare efficiency.