Transfusion最新文献

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.

Background: This retrospective study investigated blood product transfusions and neonatal morbidity and mortality in preterm infants with birth weights <1500 g and gestational ages <32 weeks.

Study design and methods: We conducted a retrospective cohort study of 291 preterm infants admitted to our neonatal intensive care unit between January 2020 and December 2022. Data were collected on transfusion exposure, including packed red blood cells (RBC), fresh frozen plasma (FFP), and platelets. Clinical outcomes included mortality and major neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Univariate analyses were performed, followed by multivariable logistic regression to adjust for confounding factors including birth weight and gestational age.

Results: 80% of infants received RBC transfusion, 37.8% received FFP, and 16.1% received platelets. Transfused infants had lower gestational ages and birth weights. RBC, FFP, and platelet transfusions were associated with higher rates of BPD, IVH, NEC, and mortality in univariate analyses. In multivariable analysis, birth weight alone predicted mortality, suggesting extreme prematurity and illness severity were primary drivers. RBC transfusion independently predicted NEC and BPD, while FFP and platelet transfusions were linked to BPD. Total transfusions correlated with higher BPD, NEC, and mortality rates. Early transfusions were linked to impaired survival.

Discussion: These findings suggest transfusions may not be independently associated with mortality, but may instead reflect underlying illness severity. However, they remain associated with serious morbidities in extremely preterm infants. The results emphasize the importance of judicious transfusion practices, evidence-based thresholds, and research to clarify potential causal relationships.

Background: Hemorrhage remains the leading cause of preventable traumatic deaths, with many fatalities occurring before hospital arrival. Although geographic differences in prehospital time (PHT) are recognized, contemporary national estimates and their implications for resuscitation readiness are not well defined. This study aimed to characterize geographic variation in PHT among trauma patients at risk of hemorrhagic shock to inform strategies for earlier intervention.

Study design and methods: We analyzed 2020-2023 data from the National Emergency Medical Services (EMS) Information System (NEMSIS) and included trauma patients aged ≥16 years at risk of hemorrhagic shock, defined as shock index (heart rate/systolic blood pressure) ≥1 at the scene. PHT was defined as the interval from dispatch to hospital arrival and compared across urbanicity (urban, suburban, rural, wilderness) and transport mode (ground or air).

Results: Among 939,335 eligible encounters, the median prehospital time (PHT) differed significantly across urbanicity categories, increasing progressively from urban to wilderness regions (urban 39 min [IQR 30-51], suburban 45 [32-63], rural 50 [34-71], wilderness 56 [37-78]; p < .001). All three components of PHT-system response, scene, and transport time-were longer in rural and wilderness. Total PHTs remained stable, with only minor year-to-year variation. Air PHT was consistently longer than ground PHT (p < .001) and showed no temporal improvement across 2020-2023.

Discussion: National EMS data show persistently prolonged prehospital times for trauma patients at risk of hemorrhagic shock, especially in rural and wilderness areas. Bringing transfusion capability closer to patients through prehospital blood programs may be critical to reducing time-dependent mortality.