Transfusion Medicine最新文献

Background: Blood transfusion remains a cornerstone in the management of sickle cell disease (SCD); however, it is frequently complicated by red cell alloimmunisation. A significant debate persists within the scientific community regarding the optimal strategy to mitigate this risk: the traditional, pragmatic approach of serologic phenotyping versus molecular genotyping, which is technically superior yet more resource-intensive.

Objectives: This mini-review aims to map the framework of this scientific debate and synthesize current evidence through a dual methodology.

Methods and materials: A scientometric analysis was conducted on 224 articles indexed in Scopus and Web of Science using the Bibliometrix package for R, followed by a structured narrative review of 26 selected studies.

Results: The scientometric findings confirm growing interest in this topic, identifying two distinct yet interconnected research clusters that reflect the ongoing dialectic between phenotyping and genotyping, with the latter emerging as a 'hot topic' over the past decade. The narrative synthesis highlights a predominance of evidence supporting genotyping as the most accurate approach to preventing alloimmunisation, particularly given the high prevalence of RH system variants in individuals with SCD. In contrast, cost-effectiveness analyses and implementation studies underscore substantial financial and logistical barriers that favour a more pragmatic, stepwise approach.

Conclusion: We conclude that the future of transfusion safety in SCD does not lie in a binary choice but rather in a synergistic and stratified integration of both strategies. Implementing protocols that target genotyping for high-risk patients, while simultaneously optimising the use of extended phenotyping, represents the most promising pathway to balance safety, cost and accessibility-ultimately ensuring the best possible transfusion therapy for this vulnerable population.

Objectives: The aims of this study were to determine the performance of a large language model (LLM) with a zero-shot strategy for the classification of several factors relevant to the consideration of intravenous immunoglobulin (IVIg) weaning.

Background: In many cases, IVIg should be weaned to prevent excessive resource utilisation and adverse effects.

Methods and materials: A cohort study was conducted examining neurology outpatients receiving regular IVIg in a 2-month period. Prespecified criteria were used to determine how many individuals were suitable for IVIg weaning. A LLM was applied to determine the level of performance with which the model could provide answers to the prespecified criteria.

Results: In the inclusion period, 14 individuals were identified and four patients fulfilled the criteria for possible IVIg weaning. The total annual cost saving with IVIg weaning was conservatively estimated to be $84702.20 (1433.9 g of IVIg annually). The LLM achieved an overall classification accuracy of 78.6% (11/14) when a rule-based approach was applied to the individual criteria that it extracted from notes.

Conclusion: Further research is indicated to determine the frequency with which patients suitable for IVIg weaning are identified at other centres and the degree to which LLM may be able to assist with this process.

Introduction: Thrombocytopenia is common in neonates, managed with platelet transfusions at defined dose. The product type varies from neonatal-specific units using platelet additive solutions to adult products split into multiple paediatric units. In low-middle-income countries, whole blood-derived random donor platelets (RDP) are common while western countries use split adult single donor apheresis platelets (SDAP). We aimed to assess preliminary effectiveness of split, volume-reduced single donor apheresis platelets (NeoVRs-SDAP) in neonatal thrombocytopenia and observe early post-transfusion outcomes.

Methods: Study was conducted from August 2024 to January 2025 at a tertiary healthcare centre. Persistent thrombocytopenic neonates admitted to the NICU were transfused with NeoVRs-SDAP prepared using Spectra Optia® with modified program yielding an adult dose (300 × 10⁹) in a reduced 100 mL of product volume. These were split into 2-5 aliquots for transfusion. Post-transfusion platelet increments and percentage recovery were assessed after 20-24 h.

Results: Thirteen neonates' 77% preterm, 69.2% VLBW with sepsis received 46 NeoVRs-SDAP. 10 mL of this product contained nearly 3 times more platelets than RDP and 1.5 times more than adult SDAP of same volume. The mean transfused dose was 70.56 ± 14.21 × 10⁹ platelets. Median platelet increment was 64 500/μL versus 15 477/μL for RDP (p < 0.001). Platelet recovery ranged from 7.5%-52.5%. Split products reduced donor exposure by 56.5%. Survival was 62%, without any transfusion-related adverse events.

Conclusion: NeoVRs-SDAP may be potential alternative in persistent neonatal thrombocytopenia, offering better increments and recovery, reduced donor exposure, and leukoreduction. Further RCTs comparing NeoVRs-SDAP and RDP are recommended.

Objectives: Rapid and accurate identification of blood groups is the foundation of emergency blood support. We performed a complete assessment of a new solid-phase kit for ABO forward grouping and RhD grouping (ABD Kit, InTec Products, Xiamen, China) on the analytical performance, which was compared with those of traditional methods.

Methods: We analysed 1260 clinical samples using the ABD Kit, including weakly agglutinated samples of A, B and D antigen, and compared the test results with those via Gel card, test tube and slide methods. We also validated the results of typing blood samples containing weak antigens using first-generation gene sequencing.

Results: The ABO forward group and RhD group of 1260 samples was determined using ABD Kit, revealing that the inter-batch repeatability rate of the kit was 100%. The results of the kit were compared with those of the gel card method, revealing that the detection accuracy of the kit was also 100%, which was confirmed by comparing the detection of weak antigen samples with the results of first-generation gene sequencing. The accuracy of the test tube agglutination method was 100%. In contrast, the accuracy of the slide agglutination method was low, especially in the detection of weak A blood antigens (agglutination strength 1+), weak B blood antigens (agglutination strength 1+) and weak D blood antigens (agglutination strength 1+ or 2+).

Conclusions: The ABD Kit (InTec Products, Xiamen, China) showed high sensitivity, reproducibility and specificity, indicative of excellent analytical performance. It is a reliable, practical and promising solution for rapid and accurate identification of blood types.

Background: Every time a unit of blood is given to a patient, it is essential that all steps in the transfusion pathway are executed correctly to ensure that the right blood is transfused to the right patient. Bedside transfusion checks at the point of sampling for compatibility testing, sample labelling and blood administration are an essential part of the delivery of safe transfusion and avoidance of the wrong blood being given, which can have serious consequences. Implementation of bedside electronic transfusion systems that use barcode matching of patients' wristbands and blood units is now recommended as the best practice to ensure patients' safety in transfusion. However, there is limited information in the literature to guide hospitals on what aspects they should consider when introducing a bedside electronic transfusion system.

Aims and methods: This paper aims to support hospitals considering implementing a bedside electronic transfusion system by providing a comprehensive checklist addressing planning, stakeholder coordination, device integration, and compliance with national standards and safety requirements.

Results: The checklist is based on the experiences of two NHS Trusts in the UK and aims to provide organisations with a resource to support this change and reduce avoidable delays.

Introduction: Zika virus (ZIKV) is primarily transmitted through the bite of the Aedes aegypti mosquito, though transmission via blood transfusion has also been documented. During the 2015 ZIKV epidemic in Brazil, severe complications were observed in pregnant women, leading to fetal microcephaly. This study evaluated the persistence of ZIKV in blood donated by healthy individuals during the post-epidemic period from 2016 to 2020.

Methods: Blood donor samples from 109 296 individuals were screened for ZIKV RNA using nucleic acids extracted from plasma pools (six donors per pool). These samples had previously undergone routine nucleic acid testing (NAT) for HBV, HCV and HIV.

Results: Viral RNA (Ribonucleic Acid) was detected in a donor sample from the city of Santos in May 2016, resulting in a prevalence of 0.0009%. The positive donor was confirmed through viral sequencing using the Sanger method. Sequencing and phylogenetic analysis of an envelope gene amplicon revealed that the Zika virus RNA detected belonged to the Asian clade. This Asian lineage strain emerged in Brazil, Fortaleza, in 2015, isolated in northeastern Brazil in 2015, an area where most cases of microcephaly associated with ZIKV have been reported. A follow-up sample collected 1 month after donation showed seroconversion.

Conclusion: The detection of ZIKV RNA by NAT in a donated blood sample demonstrates that, although extremely rare, the virus is still present. Periodic active surveillance of blood donations for viruses associated with past outbreaks may help identify an incipient resurgence before it develops into a new epidemic.

Background: Extracorporeal photopheresis (ECP) is a safe immunomodulatory strategy that induces cell-type selective apoptosis through photodynamic processes. Despite decades of use, the mechanisms underlying ECP remain largely unexplored, particularly in studies examining specific immune cell subsets in ex vivo setups.

Aims: This proof-of-concept pilot study presents data on apoptosis and proliferation of T-lymphocytes following ex vivo ECP application to leukocyte concentrates (LC) and peripheral blood (PB) samples from healthy donors.

Methods: LC and PB were diluted to a haematocrit of 2% and treated with 8-methoxypsoralen, followed by ECP (ECP+) or no ECP (ECP-) in a discontinued system. Apoptosis of mononuclear cells was assessed 48 h post-ECP using annexin V and 7 Aminoactinomycin D (7-AAD) staining with flow-cytometric quantification. The proliferative capacity of non-apoptotic T-lymphocytes was measured after 72 h of post-ECP stimulation with anti-CD3/CD28 cross-linking, using Violet Proliferation Dye 450.

Results: ECP exposure significantly reduced the median T-cell receptor-induced proliferation of viable T-lymphocytes from both LC (4.6%, p = 0.02) and PB (4.2%, p = 0.03). However, 7-AAD staining 48 h post-ECP showed no significant differences in the proportions of apoptotic cells in this experimental model.

Conclusion: Ex vivo ECP treatment inhibited T-lymphocyte proliferation in both LC and PB from healthy individuals, suggesting this as a key mode of action. Our findings highlight ECP's potential applications, including its implications for modern immune therapies' adverse effects. Further analyses of functional characteristics of remaining vital cells are necessary.

Background: Transfusions of packed red blood cells (RBC) have long been used to correct postpartum anaemia. Given the ongoing shortage of packed RBC and transfusion reactions, we sought to determine if the use of IV iron sucrose infusions could decrease transfusions in the postpartum period.

Methods: We conducted a six-year quasi-experimental interrupted time series study from January 2016 to December 2021. The study was divided into three phases: 1. pre-intervention phase, 2. roll-out phase, and 3. post-intervention phase. Our intervention focused on a holistic transfusion prevention bundle that incorporated provider education regarding transfusion practices, antepartum optimization, and cell saver use. The main outcome was change over time from the use of IV iron sucrose over allogenic blood products in the setting of postpartum anaemia. Statistical process control (SPC) was used to explore the effect of our bundled intervention over time.

Results: 46 478 deliveries were recorded. The XmR control chart showed a shift between phases 1 and 3, as indicated with a special cause signal. The U control chart demonstrated that IV iron infusions increased from 5.6 per 1000 births in phase 1 to 136.4 per 1000 births in phase 3. On Poisson regression, the rate of IV iron sucrose infusions increased 19-fold [RI 19.65 (95% CI 16.00-24.14 p < 0.0001)], while the rate of transfusions decreased by 60% [RI 0.4 (95% CI 0.33-0.49 p < 0.001)] from pre- to post-intervention.

Conclusion: A holistic transfusion prevention bundle was associated with both a reduction in the number of patients transfused and the rate of multiple-unit RBC transfusions.