Transfusion最新文献

Background: With chronic transfusion in sickle cell disease (SCD), equipoise exists regarding whether increasing the post-procedure hematocrit (Hct) suppresses endogenous erythropoiesis. Reticulocytosis predicts SCD morbidity and mortality, so this study's objective was to clarify the role of the post-procedure Hct in suppressing reticulocytosis and to identify other potential red cell exchange (RCE) parameters predictive of reticulocytosis.

Study design and methods: This retrospective analysis of 17 patients who underwent chronic RCE at a single institution between 2014 and 2022 examined both standard red cell exchanges (SRCE) and exchanges preceded by isovolemic hemodilution (IVH-RCE). Post-procedure parameters with biologic plausibility to influence the subsequent procedure's absolute reticulocyte count (sPre-ARC) were examined using regression modeling.

Results: Neither post-hematocrit, nor post-hemoglobin (Hb), nor ΔHb/day was associated with sPre-ARC or the change in HbS% per day (ΔHbS%/day). Concurrent Hb was predictive for SRCE but not IVH-RCE, where ARC trended lower than with SRCE. Male gender and post-procedure neutrophil and white cell counts were predictors of sPre-ARC, consistent with their associations with SCD morbidity and mortality. IVH-RCE had a stronger correlation than standard RCE between pre-Hct and neutrophil or white cell depletion.

Discussion: Although targeting a post-procedure Hct maintains a higher subsequent pre-procedure Hb and a lower sPre-HbS%, it does not lead to sustained suppression of reticulocytosis as measured by the sPre-ARC or the ΔHbS%/day. IVH-RCE or the addition of hydroxyurea could be considered in those patients with high reticulocyte, white blood cell, or neutrophil counts.

Background: Emergent transfusion is carried out without standard pre-transfusion serologic testing to detect alloantibodies in patient plasma. Transfusion of red blood cells positive for antigens incompatible with a patient's current or historical alloantibodies risks acute and delayed hemolysis, which may be fatal. Symptomatic and prophylactic treatment of hemolysis secondary to transfusion of incompatible non-ABO antigens using automated red cell exchange has been rarely reported.

Case report: A 77-year-old female with extensive hemorrhage from a femoral artery pseudoaneurysm received a massive transfusion of uncrossmatched blood. Although subsequent testing of a pre-transfusion sample was inconclusive, a search of a patient alloantibody registry showed a history of anti-E, anti-Fya, and anti-Jk(a) antibodies, which were subsequently confirmed and proven incompatible with all 10 transfused red blood cell units in various combinations. Prior to the completion of repeat serologic testing, the historical alloantibody profile was used to allocate antigen-negative units for automated red cell exchange to treat progressive transfusion-related hemolysis. Treatment was completed without complications, and hemolysis gradually resolved without progression of hemodynamic instability.

Conclusions: This case demonstrates successful automated red cell exchange following massive transfusion of red blood cells including a combination of three clinically significant incompatible antigens. Access to a patient alloantibody registry facilitates timely evaluation and management of transfusion-associated adverse events which may otherwise be unavoidable.

Background: It is uncertain how transfusion knowledge translates to practice. The purpose of the study was to determine if higher scores on a validated Transfusion Camp knowledge assessment test were associated with transfusion order appropriateness.

Study design and methods: Eligible participants included postgraduate trainees and faculty physicians who had prescribed at least four transfusion orders in the preceding 6 months at two hospitals. Participant data and knowledge were collected using a web-based questionnaire with a validated Transfusion Camp knowledge assessment tool. The most recent 4-10 consecutive transfusion orders per prescriber were independently dually adjudicated for appropriateness based on published criteria. The primary outcome was the correlation between the score on six questions on red blood cells (RBCs), platelets (PLTs), and plasma from the validated test and the percentage order appropriateness. Generalized linear regression was conducted to determine if factors (sex, specialty, participation in Transfusion Camp, previous transfusion education, self-rated knowledge) were associated with appropriate orders.

Results: Seventy-four participants (45 trainees, 29 faculty; 31 females, 43 males) completed the test. Median score was 66.7% (interquartile range [IQR]: 50.0, 83.3) for six questions on RBCs, PLTs, and plasma transfusions. Of 546 transfusion orders adjudicated, appropriateness was 90.7% (95% confidence interval [CI]: 87.9%-93.0%). The correlation between prescriber test scores and order appropriateness was very weak (r = -.08). In multivariable analysis, female prescribers (p = .02) and beginner (vs. intermediate) self-rated knowledge (p = .01) were associated with higher transfusion appropriateness.

Conclusion: Transfusion knowledge test scores did not correlate with order appropriateness. Factors other than knowledge are key to understanding how to improve appropriate blood use.

Background: Blood product constraints have increased the focus on inventory management as blood banks have faced challenges that impact supply chains and donor availability. Solutions often include a reduction in transfusion volumes through multidisciplinary improvements, but this is often coupled with a reduction in blood bank inventory to match reduced demand. We sought to improve inventory availability within the blood bank without modification of transfusion rates through solutions that prevented unnecessary RBC orders and crossmatching.

Study design and methods: Improvements were focused on reduction of duplicate orders, preoperative blood orders, excess volume of blood orders, and crossmatching in advance of perioperative needs. The study monitored the improvement of the crossmatch to transfusion ratio as the primary outcome and days of shelf life until expiration as a secondary outcome.

Results: The CT ratio of RBCs decreased from 2.03 (16,044/7922) pre-implementation to 1.67 (12,321/7375) post-implementation (p < 0.05). Our inventory was managed more efficiently following our interventions as demonstrated through the day of shelf life of RBCs issued. Pre-implementation, RBCs were issued an average of 17.5 days before expiration, which increased to 20.4 days post-implementation (p < 0.05).

Conclusion: Modification of preoperative order sets and education of clinical staff to ensure appropriate blood product ordering can significantly impact available inventory. Although this was also identified within our study, we found that the largest impact comes from a change in crossmatching workflow to reduce unnecessary reserving of RBCs. These changes can be implemented without significant impact to turnaround time.

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.

Introduction: In sub-Saharan Africa (SSA), an adequate supply of safe blood for transfusion is a major developmental challenge. In Ghana, deferral from blood donation for anemia accounts for nearly half of the ineligible blood donors. We conducted a longitudinal two-arm parallel-group non-inferiority trial to test if iron supplementation among blood donors with iron deficiency (ID) or anemia could increase their hemoglobin levels to near those without ID or anemia.

Materials and methods: A structured questionnaire was used to collect participants' sociodemographic and medical information after written informed consent was obtained. Blood samples were analyzed for full blood count (FBC), serum ferritin, malaria rapid test, and a peripheral blood smear. The primary outcome was hemoglobin level after 4 months comparing anemic donors who received iron supplementation to the standard of care participants, nonanemic donors who did not receive iron supplementation. All donors received nutritional counseling.

Results: Adherence to low-dose iron supplementation three times a week was poor. Hemoglobin levels in the iron supplementation arm were not close enough to those in the control group after 4 months of iron supplementation to declare non-inferiority. However, non-inferiority was met when the 4 month hemoglobin comparison was restricted to female donors.

Conclusion: After 4 months of iron supplementation, hemoglobin levels in the iron supplementation group did not sufficiently match those in the control group to declare non-inferiority. Data from this pilot trial informed and shaped the design of a larger randomized control type 1 pragmatic effectiveness implementation hybrid trial which is currently ongoing.