Transfusion最新文献

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.

Background: Transfusion demand is high in liver transplantation (LT), and thus RhD-positive (RhD+) red blood cell concentrates (RBCs) are sometimes given to RhD-negative (RhD-) patients. Due to immunosuppression, these patients rarely produce anti-D. We investigated the rate of anti-D formation in RhD- patients undergoing LT who were transfused with RhD+ RBCs as well as the number of transfused RhD- and RhD+ RBCs.

Study design and methods: RhD-type and transfusion history of all patients undergoing LT between 2010 and 2023 were reviewed retrospectively. In RhD- patients, who received RhD+ RBCs, the results of antibody screening test (indirect antiglobulin test and with papain-treated test cells) and direct antiglobulin test were evaluated.

Results: Five hundred and twenty-seven patients underwent 576 LT. Eighty-seven patients were RhD-, of whom 42 were transfused with RhD+ RBCs. In 34 of them, an antibody screening test result was available more than two weeks after the last RhD+ RBCs transfusion. In two of them, a transient, weak anti-D antibody was detectable, which disappeared in the further course. Overall, 1352 RBCs were transfused to the 87 RhD- patients, 543 of those were RhD+. Most RhD+ RBCs were provided to men and elder women.

Discussion: Transient weak anti-D occurred in two RhD- male patients during LT after transfusion of RhD+ RBCs without evidence for a hemolytic transfusion reaction. To save stocks of RhD- RBCs, early transfusion of RhD+ RBCs to RhD- men and women beyond the childbearing age should be considered during LT.

Background: While blood donation is generally safe, some donors experience vasovagal reactions (VVRs) that may lead to injury and reduce likelihood of future donation. Several risk factors for VVRs have been identified, but the consistency, magnitude, and validity of their associations have not been systematically evaluated. Therefore, this systematic review and meta-analysis synthesized evidence for VVR risk factors.

Methods: Database searches identified English-language studies published before February 2024 describing VVR risk factors in voluntary whole blood donors. Study characteristics, VVR and risk factor assessment methods, and effect sizes were extracted. Random-effects models pooled estimates across all studies and subgroups of geographical context, study quality, donation experience, and outcome severity. Inconsistently and infrequently reported risk factors were narratively synthesized.

Results: Totally 71 studies reporting a total of 19 million total donations were included. Female sex, new donor status, younger age, smaller blood volume, and lower blood pressure were positively associated with higher VVR risk. Donation-related fear, anxiety, and disgust were associated with higher VVR risk in narrative syntheses. Substantial between-study heterogeneity (I² > 90%) was observed for the majority of risk factors, while there was no clear evidence of subgroup variability and small study effects.

Conclusion: This systematic review and meta-analysis provides a comprehensive synthesis of risk factors for VVRs across wide-ranging blood service contexts and symptom severities, reinforcing evidence for previously identified factors. The heterogeneous associations of several risk factors motivate large-scale studies that enable comprehensive multivariable adjustment to evidence donor selection criteria and preventative intervention allocation.

Background: Adverse transfusion reactions (ATRs) represent undesired responses in patients. Different reports indicate that rates of ATRs are 1.3-2.6 times higher in pediatric populations compared with adults. The aim of this study was to investigate whether similar trends are observed within the pediatric population in Colombia.

Study design and methods: This retrospective study, conducted from January 1, 2018, to December 31, 2022, investigated transfusion occurrences and ATRs. Data were collected from the National Hemovigilance Information System. ATRs were reported by medical personnel using standardized forms following guidelines set by the International Society of Blood Transfusion.

Results: The study included 2,097,179 patients receiving 6,637,363 transfusions, with 6830 ATRs. In comparison with adult transfusions, pediatric transfusions exhibit a male bias, a higher rate of ATRs per 10,000 transfused patients (79.4 vs. 27.7), a greater prevalence of allergic reactions and a lower incidence of febrile nonhemolytic transfusion reactions (FNHTRs). The rate of ATRs varied across age groups: 17.1 for those aged 0-1 year, 120.5 for individuals aged 2-14 years, 42.5 for people aged 15-65 years, and 24.4 for those over 65 years. Among pediatric patients, 688 of 1126 allergic reactions were linked to platelet transfusions. Platelets obtained via apheresis had a higher ATR rate compared with those from the buffy coat method (OR: 1.44), while in adults, 960 of 3002 allergic reactions were attributed to platelet transfusions, with higher ATR rates for apheresis platelets compared with buffy coat platelets (OR: 1.41).

Conclusion: ATRs in the Colombian pediatric population were three times higher than adults.

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: Chronic red blood cell (RBC) transfusion is an established therapy to prevent stroke in patients with sickle cell anemia (SCA). It is unclear if adding daily hydroxyurea treatment to chronic transfusion is beneficial.

Study design and methods: We conducted a phase 2 clinical trial (NCT03644953) investigating the addition of dose-escalated hydroxyurea to chronic transfusion for patients with SCA receiving simple chronic transfusion for stroke prevention. Simple chronic transfusion therapy was administered as per the same protocol before and after hydroxyurea treatment in which the volume transfused was dependent on the pretransfusion hemoglobin (Hb).

Results: A total of 14 participants enrolled with nine completing one year of combination hydroxyurea and transfusion (HAT) therapy after reaching hydroxyurea target dose. No participant who discontinued the study prematurely had a serious adverse event attributed to HAT. Among the nine participants who completed the study, eight participants achieved a reduction in RBC transfusion volume with a median reduction of -19.4 mL/kg/year (interquartile range -31.8, -2.8 mL/kg/year), p = .02, when comparing pre- and post-HAT time periods. With the addition of hydroxyurea participants had a significant increase in pretransfusion Hb S% but this was balanced by an increased Hb F% and decreased lactate dehydrogenase. One participant developed a pretransfusion Hb >11 g/dL and Hb S > 45% that required holding hydroxyurea and changing to partial manual exchange transfusions. No patient had evidence of cerebrovascular disease progression.

Discussion: Hydroxyurea added to chronic transfusion therapy for patients with SCA is feasible and decreases RBC transfusion volume requirements.

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: 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.