Transfusion最新文献

Background: The storage of red blood cells (RBCs) is essential for transfusion but leads to storage lesions that compromise RBC quality and increase the risk of transfusion-related adverse effects, including allergic transfusion reactions (ATRs). Understanding storage-induced metabolic change is crucial for enhancing transfusion safety.

Study design and methods: We conducted targeted metabolomic profiling of RBC supernatants stored in PAGGS-M over 42 days, collecting 161 weekly samples from 23 units. We analyzed 188 metabolites across six compound classes (hexoses, amino acids, biogenic amines, acylcarnitines, glycerophospholipids, and sphingolipids) along with 20 hematological parameters. Additionally, a mast cell degranulation assay evaluated the impact of these changes on ATR risk.

Results: Over 100 of the 188 metabolites changed significantly during storage, indicating diverse pathway alterations. Key findings include the accumulation of acylcarnitines and depletion of methionine, with mast cell degranulation significantly increased in supernatants from 42-day-old pRBCs versus fresh units. Notably, methionine depletion coincided with a critical transition phase in storage-associated metabolic aging. In addition, elevated levels of acylcarnitines correlated with increased markers of membrane damage, highlighting potential mechanisms underlying allergic transfusion reactions.

Discussion: This study highlights the impact of storage-induced metabolic changes in exacerbating transfusion-related complications. Therefore, optimization of additive solutions, such as stabilizing methionine levels during storage, may mitigate storage lesions and improve outcomes. Additionally, the storage-time-related increase in mast cell activation suggests a need for targeted interventions, particularly for patients vulnerable to ATRs.

Background: Tactical Emergency Medical Services (TEMS) encompasses the skillset of prehospital care that is required to support all phases of operations performed by tactical law-enforcement personnel. High-risk operations can result in critical injuries to those involved.

Object of the review: Although TEMS clinicians have been taught to address critical hemorrhage, airway, and breathing issues, there is a benefit in incorporating the use of prehospital blood to reverse hemorrhagic shock. Given the unique environment in which TEMS clinicians operate, this does require forethought, planning, and modification of civilian prehospital blood protocols.

Discussion: This narrative review discusses the unique considerations for this area of prehospital care and reviews current examples of successful blood incorporation from four separate law-enforcement agencies, identifying variations that agencies can adopt to successfully incorporate prehospital blood into TEMS operations.

Conclusion: We demonstrate that civilian prehospital blood protocols can be modified to allow incorporation into TEMS operations. Future research should review outcomes when blood is administered within the TEMS environment.

Background: Specimens contaminated with intravenous (IV) fluids can lead to considerable measurement errors in complete blood counts (CBCs), posing challenges for laboratory operations and clinical decision-making. There is no gold-standard method for retrospectively identifying these events, making it difficult to target quality improvement initiatives or optimize laboratory detection protocols.

Study design and methods: This study aimed to develop and validate machine learning (ML) models to retrospectively identify IV fluid contamination in CBC results at scale across two institutions. The models were trained on simulated contamination in CBCs using prior, current, and post hemoglobin concentrations, platelet counts, and white blood cell counts, then validated against expert-reviewed datasets. Real-world applicability was assessed using 1 year's worth of CBC results from each institution.

Results: The models effectively discriminated contaminated from non-contaminated results on real-world datasets, with areas under the receiver operating characteristic curve of 0.972 and 0.957, and areas under the precision-recall curve of 0.723 and 0.619. In 1 year of CBC data, ~2% of inpatient CBC trios were predicted as contaminated across both institutions. 6%-9% of inpatient transfusions for which a CBC trio was available were deemed potentially unnecessary using a rule set validated by expert chart review.

Discussion: The findings support the feasibility of using ML to identify IV fluid contamination in CBC results efficiently and effectively. Further work, including prospective real-world evaluations, targeted quality improvement initiatives, and development of real-time detection models, is necessary before realizing the potential benefits to patient safety, laboratory operations, and patient blood management.

Background: Rapid access to surgical care has demonstrated a survival benefit in trauma. We sought to describe a state's trauma system with a single Level one trauma center.

Study design and methods: All available trauma encounters from 2015 to 2023 were classified as direct from scene and transfer cohorts. To mitigate survival bias, only patients with >0 days in the trauma registry were selected for analysis.

Results: A total of 20,221 met inclusion criteria, 14,564 were classified as direct and 5658 as transfers. Blunt injury was 79.5% in direct and 84.7% in transfers (p <.001). Injury severity score was similar. In the multivariate logistic regression analysis on the matched cohort, transfer patients were less likely to experience mortality. In transfer patients, Kaplan-Meier curves showed 30-day mortality benefit.

Conclusions: With only a single Level one trauma center in the state, mortality was lower in transferred patients than in those brought directly from the scene.

Background: A national transfusion history sharing service, such as the alloantibody exchange, should provide standardized data. However, red cell antigen profiles frequently exist as unstructured text. To reduce human curation and improve scalability, we evaluated whether large language models (LLMs) could standardize free-text antigen profiles.

Study design and methods: Using an academic center's antigen profiles, we compared open-weight LLMs run locally and commercial LLM accessed via the internet. Outputs were constrained to a prespecified format ("schema-guided decoding") and retries were allowed ("error-aware retries"). The primary outcome was an exact match of the antigen profile; secondary outcomes included antigen-level agreement, categorized error types, and processing cost. Differences were tested with Cochran's Q and pairwise McNemar tests with Holm correction.

Results: Of 908 deidentified red cell antigen profiles, a total of 10,547 antigens with 88 distinct antigens were noted. Performance differed significantly across LLMs (Cochran's Q = 3014.6, df = 10, p < 0.001). Commercial LLMs outperformed open source LLMs. Open-source models with a higher number of parameters outperformed smaller models. The top LLM matched 92.5% of the antigen profiles; antigen-level agreement reached 99.4%. Estimated API costs for commercial LLM were modest for the studied workload.

Discussion: Commercial LLMs can standardize unstructured antigen profiles with high accuracy when paired with schema-guided decoding and error-aware retries. The high accuracy shown by the LLMs suggests they would offer significant scalability while reducing manual curation for a national transfusion history sharing service like the alloantibody exchange. They represent a foundational technology for enabling such a service.

Background: Inadequate compaction of red blood cells (RBC) prior to glycerolization using the ACP® 215 system may lead to the rejection of cryopreserved units, a situation that poses particular challenges when dealing with rare phenotypes. While repeating the centrifugation step could correct this issue, no data currently exist regarding its impact on RBC quality.

Study design and methods: Pools of 3 ABO-isogroup red cell concentrates (RCC) were divided into three units and subjected to one (standard), two, or three centrifugations before glycerolization using the Valeri method. After storage at -80°C, units were thawed, deglycerolized, and stored for 7 days at 2-6°C in additive solution AS-3. Hemolysis, hematocrit, hemoglobin content, recovery, volume, and sterility were evaluated post-deglycerolization.

Results: No significant differences were observed in hemolysis, hematocrit, or hemoglobin content between single, double, or triple centrifugation groups. All values were within quality thresholds. While recovery and final volume showed a downward trend after a third centrifugation, the differences were not statistically significant for recovery, and volume remained operationally acceptable.

Conclusion: Repeating the initial centrifugation step up to two times before glycerolization does not adversely affect the quality of cryopreserved RBCs processed with the ACP® 215. These findings support updating standard operating procedures to reduce unnecessary rejection of rare donor units due to initial centrifugation issues.

Objectives: Public banking of umbilical cord blood (UCB) remains important as a source of donor cells for hematopoietic cell transplantation (HCT). Given reductions in global cord blood transplant activity, the economic value of UCB banking may be questioned. We performed a scoping review to gain a full and current understanding of economic evaluations of public UCB banking.

Methods: We conducted a systematic search to June 2024 in Medline, Embase, Cochrane Central, Health Technology Assessment, Econlit, Scopus, and cumulative index to nursing and allied health literature (CINAHL) databases.

Results: Our search identified 13 studies published between 1999 and 2019, predominantly from the United States and Europe. Of these, five are classified as full economic evaluations, with two employing cost-effectiveness analysis, one applying cost-utility analysis and two applying cost-benefit analysis. Key findings reveal a shift from evaluating the optimal inventory size and costs associated with establishing cord banks, to the evaluation of strategies that increase usage and reduce costs of bank operations. Only two studies considered the societal gain from transplant survivors, noting many cord blood transplant recipients are pediatric with significant gain in quality-adjusted life years that offset the high costs of operating public cord banks. Studies addressing the needs of underrepresented populations were lacking.

Conclusions: Our analysis highlights the evolving landscape of public UCB banking economic evaluations. Updated full economic studies are needed to understand the current landscape given potential usage by specific sub-groups of the population, reduced global usage for HCT, and the emergence of novel uses of cord blood.