Transfusion最新文献

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.

Background: Understanding factors that influence return for subsequent donation in new compared to repeat blood donors is essential to recruiting and maintaining the blood donor base.

Study design and methods: The current research assessed self-reported attitudes, social norms, perceived behavioral control, intentions to donate, experiences during a current donation, and subsequent blood donation during the next 6 months, in a Canadian sample that included both new and repeat donors.

Results: Both new and repeat donors had similar positive impressions of a novel blood donor questionnaire (DQ) that assessed individual sexual risk behavior as a basis for donor eligibility. Attitudes, norms, and perceived behavioral control predicted intentions and sureness to donate in the next 6 months, and intentions/sureness to donate were moderately predictive of subsequent donation within this time frame. New donors (compared to repeat donors) and participants who indicated that some aspect of their donation day experience could prevent them from returning for a subsequent donation, were significantly less likely to make a future donation within the next 6 months.

Discussion: Findings provide guidance for the support of new and repeat donors returning for subsequent blood donation.

Background: Vasovagal reactions (VVRs; faintness or fainting) can harm donor health and retention. Higher VVR rates are often observed in first-time donors and donors with VVR histories. We quantified associations between donation history (including donation experience, donation frequency, and VVR history) and VVR symptom reports in donors in England and assessed their mediation by venipuncture pain and donation anxiety.

Methods: In 60,026 STRIDES BioResource study participants recruited from 2019 to 2022, donation history was obtained from blood service records, while venipuncture pain, donation anxiety, and VVR symptoms were reported via post-donation questionnaires. We conducted causal mediation analyses estimating risk ratios (RRs) for indirect effects of donation history on VVR symptom reports through pain and anxiety while quantifying exposure-mediator interaction.

Results: Adjusted RRs for VVR symptoms were 1.24 (95% confidence interval: 1.19, 1.30) for newer/lapsed donors, 1.19 (1.13, 1.25) for less frequent donors, and 1.82 (1.71, 1.94) for donors with VVR histories. Pain and anxiety were associated with up to 1.28 and 1.60 times the risk of symptom reporting. Anxiety mediated 19.0% and 11.2% of associations with donation experience and frequency, whereas pain mediated no associations. Associations of pain and anxiety with VVR symptoms were only observed among donors without, not with, VVR histories.

Discussion: Our findings suggest that differences in venipuncture pain and donation anxiety do not primarily explain differences in VVR symptoms by blood donation history. While intervening on pain and anxiety may fail to equalize symptom disparities linked to donation history, interventions may reduce VVR burden in donors without VVR histories.