Transfusion最新文献

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.

Background: KEL1 antigen expression is routinely tested in blood donors in Switzerland. A donor sample with an apparent rare KEL:1,-2 phenotype was genotyped KEL*01.01/KEL*02. A series of detailed molecular analyses were performed to solve this discrepancy, and a novel variant KEL*02 allele was identified.

Materials and methods: Standard serological column agglutination and in-house adsorption-elution testing were used for the detection of KEL antigens. Genomic DNA was isolated and analyzed by commercial sequence-specific primer (SSP)-PCR, in-house multiplex SSP-PCR, and KEL exon sequencing. Total RNA was isolated from blood samples; polyadenylated RNA was reverse-transcribed, and cDNA was amplified with allele-specific primers and sequenced. SpliceAI and PolyPhen-2 were used to evaluate the impact of nucleotide variations and amino acid changes on splice effects and protein function, respectively.

Results: The donor sample was initially typed KEL:1,-2. However, SSP-PCR revealed the genotype KEL*01.01/KEL*02 and subsequent adsorption-elution testing indicated very weak KEL2 expression. Exon sequencing showed the heterozygous missense mutation c.139C>T leading to the amino acid substitution p.(Arg47Trp). PolyPhen-2 predicted this change to be benign, whereas SpliceAI analysis indicated a putative change in splice sites. Allele-specific amplification and sequencing revealed that the KEL*02 derived transcript lacks a significant portion of exon 3, causing a frameshift.

Conclusion: We identified a novel missense mutation c.139C>T in KEL*02. Although the variant nucleotide locates in the center of exon 3, far away from the exon/intron boundary, it leads to variant splicing of the transcript, resulting in very weak expression of a truncated protein only detectable by adsorption-elution testing.

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.

Background: Characterization of platelet gel (PG) from different blood sources and preparation methods remains incomplete.

Study design and methods: This study compared the weight, growth factor (GF) content, and gelation dynamics (via rotational thromboelastometry, ROTEM) of allogeneic PG prepared from adult blood (AB) and cord blood (CB) platelet concentrates (PC). ABPC were suspended in 100% plasma or 35% plasma/65% platelet additive solution (PAS), while CBPC were suspended in 100% plasma. PG was prepared in commercial BioNest D mini-bags using a method with calcium gluconate, locally made cryoprecipitate, and thrombin (CT), or a reference method with calcium gluconate and commercial batroxobin (BA). PG was analyzed at 30 min and 6 h.

Results: At 30 min, PG weights were higher with CT than BA across all conditions. With 5 mL ABPC in 100% plasma, weights were 7.20 ± 1.07 g (CT) versus 2.72 ± 0.19 g (BA); with 10 mL ABPC in PAS, 9.49 ± 2.86 g (CT) versus 3.87 ± 3.1 g (BA); and with 4.09 ± 0.45 mL CBPC, 5.62 ± 1.21 g (CT) versus 2.04 ± 0.78 g (BA). All PGs lost mass by 6 h, but CT consistently retained more weight. GF percent retention in the PG at 6 h was higher with CT. ROTEM results showed differences in clotting time and comparable values of maximum clot firmness between PG from AB and CB.

Discussion: The CT method is a promising alternative for producing allogeneic PG using affordable, locally sourced reagents.