Transfusion最新文献

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.

Background: Blood collection agencies are shifting to gender-neutral risk assessment for donor eligibility. Pre-implementation data on donor eligibility and acceptance rates are essential to understand the likely impact of these changes locally.

Study design and methods: A cross-sectional online survey was emailed to current Australian blood donors (donated in the last 12 months). Consistent with the recommendations of the United Kingdom's For the Assessment of Individualised Risk (FAIR) project and the United States of America (USA) Food and Drug Administration (FDA) gender-neutral screening criteria, participants were asked about sexual behaviors in the last 3 months (multiple partners, new partners, anal sex) and whether being asked about these would deter them from donating. Demographic characteristics and behavioral responses were analyzed using descriptive statistics and chi-square tests.

Results: Of 7938 respondents (11.3% response rate), only 0.6% (95% CI 0.4-0.8) would be ineligible under gender-neutral criteria (0.7%, 95% CI 0.2-1.8 of those who donated in the last 3 months). Those potentially ineligible were younger and less likely to identify as heterosexual. While tolerance for screening questions was generally high (≥70.0% indicated questions would not stop them donating), 12.7% (95% CI 12.0-13.4) indicated that one or more of the questions asked of all would stop or be quite likely to stop them attempting to donate. Some variation in tolerance was observed by demographic categories.

Discussion: Implementation of gender-neutral screening criteria in Australia would result in minimal donor loss due to ineligibility. While questions would be generally tolerated, careful implementation considering demographic variations is warranted.

Background: Use of low-titer O+ whole blood (LTOWB) in civilian trauma has increased in recent years. This project evaluated multiple patient-centered and resource-related outcomes related to the initiation of our facility's LTOWB program in November 2020.

Study design and methods: This retrospective cohort study examined patients receiving component therapy versus LTOWB within 4 h of arrival to our trauma center in November 2018 to 2022. Females were excluded due to ineligibility. After 1:1 matching, double-robust estimation was used to model outcomes.

Results: A total of 218 patients were included. LTOWB was associated with equivalent or better outcomes for all variables assessed. Overall mortality was similar between groups (hazard ratio = 1.05, 95% CI = 0.65-1.68). Emergency department mortality was lower in patients receiving LTOWB (12.7% vs. 20.9%, p = 0.006). Among survivors, lengths of stay were non-significantly shorter with LTOWB (13 ± 14 days vs. 17 ± 29 days, p = 0.096). Among non-survivors, patients who received LTOWB survived longer before succumbing (1.3 ± 3.1 days vs. 0.2 ± 0.6 days, p = 0.012). Total massive transfusion volumes, including LTOWB, were 40% lower with LTOWB (rate ratio = 0.60, 95% CI = 0.43-0.85).

Discussion: This evaluation of our LTOWB program indicates many outcomes are similar with LTOWB and component therapy. However, LTOWB patients survived longer during initial resuscitation and had lower massive transfusion requirements. This represents an opportunity to conserve blood products and provides opportunities for surgical rescue in severely injured patients.

Background: D-negative blood donors are rare (0.3%) in Thailand. Patients with Asian DEL are D-seronegative but can receive D-positive blood without anti-D alloimmunization. To improve blood management, this study aimed to determine screening methods for detecting RHD variant alleles in serologic D-negative Thai patients.

Study design and methods: Serologic D-negative blood samples were subjected to adsorption/elution for the DEL phenotype. The Hybrid Rhesus box, RHD exon 4, and RHD1227A were analyzed using polymerase chain reaction (PCR) and Sanger sequencing for RHD1227A. For inconclusive results, whole genome sequencing (WGS) was conducted. Genetic variants on RHD and RHCE genes were confirmed using deletion-spanning PCR and Sanger sequencing.

Results: Among 80 patients, 57 (71.3%) cases of total RHD gene deletion, 20 (25.0%) of Asian DEL hemizygosity, two (2.5%) of novel genetic variants, and one (1.2%) with an inconclusive result were identified. Two patients had a novel RHD exon 3 frameshift variant, c.441delG p.V147fs, producing a truncated protein. Serology of all patients with novel variants showed D-negative. The adsorption/elution testing showed 34.8% false positive and 9.4% false negative rates for Asian DEL.

Discussion: Our study suggests that PCR and Sanger sequencing for Asian DEL is helpful for serologic D-negative Thai patients, while adsorption/elution is unreliable. WGS, if available, is useful to identify rare and new variants, whereas its cost is not worth for routine testing in the Asian population.