Transfusion最新文献

Introduction: The immunomodulatory consequences of blood transfusion, known as transfusion-related immune modulation (TRIM), are often not captured by hemovigilance systems. Changes to blood product manufacturing processes may impact patient outcomes.

Design and methods: We conducted a retrospective study of hospitalized adults (≥18 years) in Hamilton, ON, who received ≥1 red blood cell (RBC) transfusion(s) between 2010 and 2014. Primary outcome was in hospital mortality; TRIM outcomes included respiratory failure, organ dysfunction, and sepsis. We evaluated outcomes before and after the change made by Canadian Blood Services (2012) to consolidate manufacturing of blood products in Ontario. Exclusions included autologous, washed, or deglycerolized RBC transfusions, RBCs manufactured outside select regional sites, or patients who received both pre-/post-consolidation RBCs. Data was obtained from the TRUST database. Logistic regression adjusted for key covariates.

Results: A total of 9871 pre- and 7871 post-consolidation patients met inclusion criteria. Multivariate analysis demonstrated no change in in-hospital mortality (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.89-1.14, p = 0.95), respiratory failure (OR 0.83, CI 0.65-1.06, p = 0.14) or organ dysfunction (OR 0.95, 95% CI 0.84-1.08, p = 0.42) comparing post to pre-consolidation. However, hospital-onset sepsis was lower post-consolidation (OR 0.59, 95% CI 0.48-0.73, p < 0.001).

Conclusions: Consolidation of blood production in Ontario was not associated with changes in rates of in-hospital mortality, respiratory failure, or organ dysfunction among transfusion recipients, but may be associated with a lower risk of sepsis. TRIM and the clinical impacts of changes to blood processing require further study.

Background: Plasma donation is critical for the production of plasma-derived medicinal products, yet donor recruitment and retention remains challenging within a volunteer system. This paper explores deterrents to plasma donation among current plasma donors, whole-blood donors, lapsed whole-blood donors, and non-donors in the United Kingdom, and self-reported post-donation symptoms in plasma donors.

Study design and methods: An online survey of the UK general public (current and lapsed blood donors, and non-donors: n = 2861) and English current plasma donors (n = 448), and one-to-one interviews (n = 25) with plasma donors were conducted. Participants identified deterrents to plasma donation, and plasma donors described post-donation symptoms.

Results: Plasma donors reported distinct deterrents around time constraints and ineligibility. There were differences by donor status. Blood, plasma, and non-donors all report pain, lack of travel compensation, involvement of private companies and incentives as concerns. Lack of awareness was salient for non-donors and blood donors, while non-donors had concerns about neurodiversity and donors about incentives to change. Being deferred on the day, described as an embarrassing "walk of shame," was a unique deterrent to plasma donors. 11.8% (53/488) of plasma donors reported symptoms of feeling ill after donation. Of these, 73% (n = 38) occurred and were managed in center (e.g., feeling faint, bruising) and 25% (n = 13) outside of the center (e.g., feeling faint) and managed by the donor (2% other).

Discussion: Different profiles of deterrents were observed for plasma donors compared to whole blood and non-donors. Recommendations for the recruitment and retention of plasma donors in England are discussed.

Background: Low-titer O whole blood (LTOWB) is increasingly used to improve trauma outcomes, but maintaining supplies remains challenging, particularly in austere environments. This study evaluated EnzAO1 (FpGalNAcDeAc) and EnzAO2 (FpGalNase) to generate enzyme-converted O type whole blood (ECO-WB) from A type swine whole blood (WB).

Study design and methods: WB from 16 A type and 4 O type swine were collected in Citrate Phosphate Dextrose Adenine-1 (CPDA-1). Type A WB was randomized to enzymatic conversion at either room temperature or 4°C. Each unit was divided into 45 mL aliquots and treated with no enzyme or one of four enzyme concentrations (1.75-17.5 μg/mL). Samples were analyzed at 15, 30, 60, and 120 min. A-antigen reduction was measured by flow cytometry. Blood counts, blood gases, rotational thromboelastometry, osmotic fragility, and free hemoglobin were used to assess blood post-conversion.

Results: Enzymatic treatment converted A type swine WB to ECO-WB in a concentration- and time-dependent manner. At the highest enzyme concentration (17.5 μg/mL), A antigen expression was reduced to 0.6% ± 0.2% by 15 min, comparable to the signal observed in type O controls (0.45% ± 0.45%). No significant differences in antigen conversion were observed between temperature conditions. ECO-WB demonstrated stable hematologic profiles compared to controls.

Discussion: This study demonstrates enzymatic conversion of type A swine WB into ECO-WB, reducing A antigen expression comparable to type O WB without compromising blood quality. The process is compatible with refrigerated and room temperature storage, supporting its application in diverse clinical and operational settings.

Background: Red blood cell (RBC) transfusions are important interventions for anemia or blood loss but are accompanied by the risk of transfusion-associated adverse events (TAEEs). Patient blood management (PBM) offers a system-level, multidisciplinary approach to optimize transfusions through a variety of interventions. The impact of PBM in a pediatric hospital system is unclear, and this study sought to evaluate the impact of a PBM program before and after implementation in a large pediatric academic medical center.

Study design and methods: A retrospective cohort design was used to evaluate the impact of a PBM program in the year before implementation (2015) and after (2019). Children between 4 months and under 18 years at the time of admission were included, and clinical and demographic data were queried from the electronic health record. Transfusion utilization, RBC guideline adherence, and TAEEs were compared before and after the program was implemented.

Results: In the pre- and post-intervention years, a total of 35,245 hospitalizations were evaluated, with increasing patient volumes and complexity noted in the post-intervention year. The post-intervention year had fewer hospitalizations with a transfusion ordered during the stay (p = 0.02), lower pre-transfusion hemoglobin values (p < 0.01), and smaller volumes of RBC transfusions ordered (p < 0.01). No statistically significant difference in incidence of TAEEs was noted.

Discussion: This study suggests that PBM may be effective in reducing exposure to transfusion and related risks to hospitalized children. Future studies are needed to evaluate PBM programs and their cost-effectiveness in pediatric populations.

Background: Diversity Equity and Inclusion initiatives in blood donation have progressed for priority groups such as ethnic minorities, men who have sex with men, and trans and diverse donors. However, advocacy for persons with disabilities (PWDs) in healthcare, especially in blood donation, remains slow. This study sought international perspectives on how Blood Collection Agencies (BCAs) define and engage with PWDs.

Methods: A survey was circulated to members of the Alliance of Blood Operators (ABO) and the Asia Pacific Blood Network (APBN). Responses were received from 13/15 members, with 12 consenting for their data to be published.

Results: All respondents reported including information about at least one form of disability in donor information, most commonly vision impairment, hearing, and mobility-related disabilities. Physical and sensory disabilities were more frequently recognized than cognitive disabilities. Most BCAs did not collect disability data. More than half reported having standard operating procedures about disability, but most lacked disability access and inclusion plans (DAIPS). Only three BCAs allowed PWDs to donate in wheelchairs.

Conclusion: This study provides foundational insights into how BCAs conceptualize and respond to disability. Findings reveal discrepancies in definitions, accessibility implementations, and inclusion protocols. Despite some facilitating access for donors with mobility challenges or offering staff inclusion education, gaps remain in DAIPs, donor data on PWDs, and research. To promote equity and expand the donor pool, increased research focus on inclusive data tools and exploration of PWDs' lived experiences is recommended.

Background: The deferral period for men who have sex with men (MSM) in the US decreased over time from indefinite deferral to 12 to 3 months. In 2023, the US Food and Drug Administration permitted individual donor assessment (IDA), shifting from categorical exclusions to risk behavior-based screening.

Methods: Trends in HIV risk-based behavior deferrals in a large US collector over similar periods with indefinite MSM, 12-month, and 3-month deferrals versus IDA were analyzed. Rates of confirmed HIV, hepatitis B virus (HBV), and syphilis testing during corresponding pre- and post-IDA periods are reported.

Results: Among males, a significant decrease in HIV risk-based behavior deferrals occurred from indefinite deferral (0.150%) to 12-month (0.114%) to 3-month (0.085%) periods, to IDA (0.067%). For females, MSM contact deferrals significantly decreased from 12-month deferral periods (0.015-0.033%) to 3-month deferral periods (0.007%); post-IDA, rates significantly increased to 0.049%. IDA increased overall deferrals from 0.04% to 0.06% (p < 0.01) compared to the 3-month deferral period. Higher deferrals were seen in males (adjusted odds ratio [aOR] = 1.45 [95% CI = 1.24-1.69]), first-time versus active donors (aOR  = 2.54 [2.12-3.03]), and at ages 19-22 (aOR = 2.73 [2.12-3.52]) compared to 30- and 39-year-olds. IDA implementation did not increase the rates of confirmed HIV, HBV, or active syphilis; however, rates of RPR-negative confirmed syphilis reactivity rose significantly post-IDA.

Conclusion: Transition from indefinite MSM deferral to 12 and then 3 months significantly decreased deferral rates. Rates rose in female but not male donors with IDA. IDA implementation did not result in higher rates of confirmed HIV, HBV, or active syphilis. An increase in remote/treated syphilis may be confounded by broader epidemiological trends rather than IDA.