Transfusion最新文献

Background: The implementation of metabolomics-based quality assessment of stored red blood cells (RBCs) has been limited by logistical constraints and the need for sterile, scalable sampling strategies. Sampling RBC segments, routinely used for compatibility testing, offers a practical alternative to direct unit interrogation, but the biochemical equivalence of segments and transfusates has not been systematically evaluated.

Study design and methods: We performed semi-targeted metabolomics on 51 paired segments and transfusates collected immediately after transfusion to determine concordance across sampling sources.

Results and discussion: Of the 250 metabolites detected in both matrices, approximately 70% showed significant positive correlations, spanning glycolytic, redox, lipid, and nucleotide pathways previously implicated in the RBC storage lesion. The top correlated metabolites displayed strong linear relationships independent of storage duration, confirming that segments reliably capture unit-level metabolic phenotypes. These results support the utility of segment-based omics profiling as a scalable, minimally disruptive approach for next-generation precision transfusion medicine.

Background: Fetal/neonatal alloimmune thrombocytopenia (FNAIT) caused by antibodies to human platelet antigen (HPA)-1a in white HPA-1a-negative mothers is the most frequent cause of intracranial hemorrhage (ICH) in otherwise healthy newborns.

Aims: To investigate the natural history of FNAIT and establish a biobank from HPA-1a-negative alloimmunized and nonimmunized pregnancies.

Methods: A total of 24,259 pregnant women were recruited to the study during 2013-2017 and 24,236 were screened for HPA-1a. Anti-HPA-1a antibodies were tested by Monoclonal Antibody Immobilization of Platelet Antigens (MAIPA) and some samples (MAIPA-negative), with Luminex bead-based immunoassay (PAKLx) if the neonate had thrombocytopenia and/or ICH. HPA-1 genotyping of fathers, fetuses (from maternal plasma), and newborns was performed. Biological material was stored in biobanks in Norway and Poland.

Results: Among 583/24,236 (2.4%) HPA-1a-negative women, samples were obtained from 529, of which 513 were examined during pregnancy. Anti-HPA-1a antibodies were detected in 48/529 (9.1%) women; whereof 34/513 (6.6%) during pregnancy, either by prospective MAIPA (n = 27) or in retrospect by PAKLx in MAIPA-negatives (n = 7). FNAIT was diagnosed in 11/34 (32%) neonates from alloimmunized pregnancies: in 6/11 cases by prospective MAIPA and in 5/11 by retrospective PAKLx. There were no neonates with FNAIT-associated ICH delivered by MAIPA-positive women, but 3 ICH/severe thrombocytopenia cases were diagnosed by PAKLx. Among nonimmunized HPA-1a-negative women, 28 newborns had thrombocytopenia and 2 others had ICH.

Conclusions: Feasibility of HPA-1 antenatal screening was demonstrated, and a comprehensive biobank was established. The FNAIT detection rate was improved by retrospective diagnostics by PAKLx, including 3 newborns with ICH not identified by prospective MAIPA.

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: In this pilot trial, we tested the feasibility of conducting a randomized controlled trial in cardiac surgery patients using extended-, 100% plasma-, cold-stored, and long-distance-shipped platelets (CSPs).

Study design and methods: We conducted a single center, controlled, double-blind pilot study in adult patients undergoing elective redo or complex cardiothoracic surgery. Patients were allocated in a week-based block randomization scheme to receive either room temperature-stored platelets (RTPs) or CSPs shipped from a Texas-based blood center and stored between 10 and 14 days. The primary outcome was defined as the feasibility of recruitment and accrual. Several other secondary endpoints were assessed. All platelet units were screened for aggregates using RTP release criteria.

Results: In a post-hoc "as treated" analysis, 15 patients received RTPs, and 9 received CSPs (including 3 who received both). We found that most CSPs (58%) were not usable for transfusion due to the presence of aggregates. This resulted in an excess of subjects receiving RTPs; consequently, the final nine transfused participants were allocated to receive CSPs without randomization. We accrued 0.7 evaluable subjects/month of active enrollment, which was below our desired primary outcome feasibility target of ≥1.2. One death within 28 days occurred in the RTP transfusion group, while none occurred in the CSPs group. In vitro testing yielded contradictory results.

Conclusion: Due to slow recruitment and the abundance of aggregates in CSPs, this pilot trial does not support the feasibility of the study protocol.

Background: Use of low titer group O whole blood (LTOWB) continues to increase in the United States (US). This survey sampled the quality control (QC) practices among the largest blood collectors in the US.

Methods: A survey on LTOWB collection, QC testing, and distribution was developed and electronically distributed to the chief medical officers of 16 large blood collectors in the US. Only complete survey responses were included.

Results: The response rate was 10/16 (63%) representing approximately 80% of the US blood supply as estimated by the respondents. All of the respondents collected LTOWB from males and 7/10 (70%) also collected from never pregnant females. Eight out of nine (89%) centers that repeat donor anti-A and -B titer testing do so on every donation, with 1/9 (11%) respondent testing previously low titer donors annually. The most common antibody titer threshold that defined low titer was <200 (6/10, 60%). The most common LTOWB collection method was with a platelet-sparing filter in CPD 5/10 (50%). 7/10 (70%) respondents performed QC testing on LTOWB units; all of these respondents collected leukoreduced LTOWB and performed residual leukocyte count testing following leukoreduction. 6/7 (86%) performed residual red blood cell (RBC) recovery counts in the laboratory, 4/7 (57%) measured the unit's weight/volume, while 1/7 (14%) center measured the time taken for leukoreduction. The most often frequency of QC testing was monthly.

Conclusion: Current practice at US blood suppliers for QC testing on LTOWB units was limited primarily to testing associated with leukoreduction and RBC counting.