Transfusion Medicine最新文献

Background: The Blood Bank at Oslo University Hospital implements restrictions when the stocks of blood groups O and A RhD negative packed red blood cell concentrates (PRBCCs) drop below 60 units due to high demand and low donor availability. Restrictions entail transfusing RhD negative male patients and women >50 years with RhD positive units, to provide RhD negative units to those who should not receive RhD positive units. Earlier studies have reported that up to 50% of RhD negative patients developed anti-D after RhD positive blood transfusion. We aimed to investigate the rate of anti-D alloimmunization using this restriction strategy in our population.

Study design and methods: This retrospective study was performed at Oslo University Hospital between 2006 and 2011. Antibody screen results were included throughout 2019 for the patients readmitted to the hospital.

Results: 607 RhD negative mostly cancer patients and patients having surgery for cardiovascular conditions received 1926 RhD positive PRBCCs. Post-transfusion antibody screen was available for 401 patients (66.1%), and 76 patients (22.2%) developed anti-D. In 15 of the 76 patients (19.7%), anti-D became evanescent in the follow-up.

Discussion: The proportion of anti-D immunisation in RhD negative patients receiving RhD positive PRBCCs in this study was consistent with findings from other reports. To our knowledge, this is the first study reporting a high proportion of evanescence of anti-D. Transfusing selected RhD negative patients with RhD positive PRBCCs when RhD negative stocks are low, contributed saving 1926 RhD negative PRBCCs during the study period of 64 months.

Background: The resuscitation of trauma patients with critical bleeding may follow a formulaic approach using high ratios of blood components or a viscoelastic haemostatic assay (VHA) guided approach. The aim of this study was to compare the two strategies for resuscitation of shocked trauma patients.

Methods: This was a registry-based cohort study including shocked trauma patients from two trauma centres-one practising a formulaic approach, with VHA unavailable during trauma resuscitation and the other practicing a VHA-guided resuscitation strategy. The primary outcome was the total units of blood components transfused in 24 h after adjusting for differences in baseline characteristics and time to death.

Results: Between 01 Jan 2020 and 31 Dec 2022, 152 eligible patients were categorised to the formulaic group and 40 to the VHA group. Prehospital times were longer in the formulaic group (2.0 vs. 1.4 h), and more patients in the VHA group (38% vs. 17%) were transfused prehospital blood components. Formulaic resuscitation was associated with significantly more blood components transfused (adjusted incidence rate ratio 1.5; 95%CI: 1.4-1.7, p < 0.001). Using a formulaic approach, patients were administered more red blood cells, plasma and platelets, but fewer cryoprecipitate. There was no significant association of the formulaic approach with in-hospital mortality (adjusted odds ratio 2.4; 95%CI: 0.7-8.0, p = 0.17).

Conclusions: Given the cost and potential adverse effects of blood component transfusions, VHA-guided transfusion strategies present an attractive option, particularly among centres managing high volumes of shocked patients. Further trials, enrolling the population most likely to benefit from precision transfusion strategies, are indicated.

In 2019 the For The Assessment Of Individualised Risk (FAIR) project began a review of UK blood donor selection policy to determine if a more individualised approach to donor selection could be safely implemented. An evidence base was required to inform selection policy to move from a population to a more individual based policy, specifically what sexual behaviours/indicators should be considered as screening questions to maintain the safety of the blood supply. Eight sexual behaviours/indicators were reviewed: history of bacterial sexually transmitted infections (STIs), chemsex, number of recent partners, condom use, type of sex, sexual health service (SHS) attendance, new sexual partner and exclusivity. We conducted searches in multiple databases to identify literature looking at the association between these behaviours/indicators and HIV/STI acquisition risk. A scoring system to determine strength of evidence was devised and applied to papers that passed screening. Key studies were identified which achieved the maximum score and more in-depth reviews were conducted for these. We identified 58 studies, including 17 key studies. Strong evidence was found linking a previous bacterial STI, chemsex and increasing numbers of sexual partners to acquisition risk. Condom use, type of sex and new partners were found to have some strength of evidence for this link. SHS attendance and exclusivity had minimal evidence. We recommended that the behaviours/indicators viewed as having strong or some strength of evidence should be considered as screening questions in a more individualised approach to donor selection criteria.

Background: The UK's Infected Blood Inquiry (IBI) highlighted a major public health scandal, with at least 30 000 people infected and more than 3000 deaths attributable to infected blood and blood products. This study investigates the impact of the IBI announcement on May 20, 2024, on public perceptions of blood supply risk, safety, and donation intentions in the UK compared to the USA.

Methods: A 2 (country: UK vs. USA) × 2 (time: pre-, post-IBI announcement) between-within-subject study was conducted with 1635 participants (888 UK, 747 USA). Pre-IBI data were collected from May 3 to 7, 2024, and post-IBI data from May 30 to June 30, 2024. Key measures were perceived infection risk from transfusion, transfusion safety, willingness to donate and encourage others. The impact was assessed using differences-in-differences (DiD) and reliable-change-indices (RCI).

Results: UK participants showed a significant but small decrease in perceived safety compared to USA participants, with 1 in 30 UK individuals perceiving a significant reduction in perceived transfusion safety. Decreases in perceived safety were associated with significant decreases in willingness to donate and encouragement of others in the whole sample and in USA participants and significant decreases in willingness to encourage others in UK participants. Older people reported a greater reduction in safety, and non-donors were more likely to be put off donating and not ask others to donate as a result of their perception that safety had been reduced.

Conclusion: Overall, perceived safety decreased marginally in the UK general population. Future research should explore the long-term impacts of the IBI.

The obstetrician James Blundell performed the first human-to-human blood transfusion in England during the early part of the 19th century arguing that it could be used as a treatment for post-partum haemorrhage. During this period, Blundell personally acknowledged two of his medical colleagues Charles Waller and Edward Doubleday as being strong supporters of the use of blood transfusion. This paper outlines the roles that these two men played in the early history of blood transfusion.

Objectives: The study aimed to assess the conditions for coating RBCs with penicillin and examine the anti-penicillin reactions of random Thai patients' sera against penicillin-coated RBCs and normal sera from Thai donors testing in the presence of the drug.

Background: Penicillin-induced immunologic haemolytic anaemia (IHA) is reportedly related to possessing antipenicillin antibodies, immunoglobulin G (IgG), which has been identified in testing penicillin-coated red blood cells (RBCs). In addition, low titre penicillin antibodies, often IgM, are detected in donors by testing in the presence of a solution of the penicillin.

Materials and methods: Penicillin-coated RBCs were produced, and antipenicillin was tested against those penicillin-coated RBCs amongst random Thai patients who had strongly positive direct antiglobulin (≥3+). Additionally, sera from Thai blood donors were tested in the presence of the penicillin. These relationships were determined by comparing the numbers of penicillin-antibody positive patients with their diagnosis, sex, age and blood type.

Results: Penicillin requires a high pH to optimally adhere to RBCs that showed validated reactions with controls. Enrolment of 304 random patients, of whom 17 (5.59%) had positive antipenicillin tests using penicillin-coated RBCs. Of the 246 donor samples, 3 (1.22%) displayed positive reactivities in the presence of soluble penicillin. Furthermore, no association was discovered between the patient's characteristics and antipenicillin positivity.

Conclusions: This is the first study to develop and report on the low percentage of patients' and donors' sera without IHA. Investigating suspected cases of penicillin-induced IHA requires following our suggested method to identify clinically significant antipenicillin.

Objectives: Fast thawing for emergency situations and reduction of plasma wastage.

Background: Evaluation of plasma units, pooled and pathogen reduced (PR) in "maxi-pools" with amotosalen and UVA light, and fast thawing.

Methods/materials: Per replicate, 10 WB-derived leukocyte depleted plasma units were frozen within 24 h at ≤ -25°C and stored for 7 days. After thawing, a maxi-pool was constituted from the 10 units. After splitting into 4 sub-pools of 650 mL, the sub-pools were PR treated then split into 3 units resulting in 12 PR plasma units at 200 mL. Hundred and twenty PR plasma units were produced in total. The units were frozen at ≤ -25°C for 1 week, then thawed either in a fast plasma thawer for 5 min or in other control devices (17 to 23 min).

Fviii: C, Fibrinogen, albumin, IgG, protein S and VWF were measured in plasma units, maxi-pools and plasmas after PR treatment and thawing.

Results: There was a statistically significant (p < 0.001) but still clinically acceptable (over the recommended levels of ≥0.5 IU/mL and ≥2 g/L) reduction of FVIII:C and Fibrinogen after PR with 69% and 87% recovery, respectively. Other proteins were not significantly affected by the processes.

Conclusion: Pooling 10 plasma units before the PR treatment standardises volume and protein content of plasma units. Besides the economic value of generating 12 products for transfusion, this procedure combined with a thawing time of about 5 min is of value in emergency situations and may reduce plasma wastage.

Background and objectives: Iron deficiency (ID) poses a prevalent concern among blood donors, especially impacting young donors, premenopausal females and frequent donors. In alignment with recommendations to address ID, routine ferritin testing was implemented in a hospital-based donor centre.

Materials and methods: Data set, encompassing 26 164 ferritin values from 16 464 blood donors over 33 months, were analysed retrospectively. Ferritin levels were assessed concerning donor characteristics such as sex, age, ethnicity and donation frequency.

Results: Ferritin testing revealed age, sex and ethnicity variations, emphasising the heightened risk of ID in young females meeting all donation criteria under 23 year of age who demonstrated the lowest mean baseline ferritin (41% [CI: 34%-48%] < 26 ng/mL; 20% [CI: 14%-25%] < 15 ng/mL). Postmenopausal females exhibited ferritin levels similar to similarly aged males. Irrespective of sex, donors showcased mean ferritin recovery within 6 months. Analysis of ferritin recovery post-donation showed a five-fold increase in risk (compared with first visit) of ID when donors return at a 2-month interval. 'Regular' donors (≥10 visits) approach a median steady ferritin level (~30-35 ng/mL) by the sixth visit.

Conclusion: As reliance on regular blood donors increases, donation policies must strike a balance between blood centre resources and the risks posed to both regular and at-risk donors. Frequent blood donation led to donors attaining a mean steady state ferritin level above the threshold for ID. At-risk groups, particularly premenopausal females, were several times more likely to experience ID after donation but demonstrated recovery rates similar to their group's baseline levels. This valuable information informed the development of new donor deferral policies.