Transfusion Medicine最新文献

Background: Patient blood management (PBM) is an evidence-based, patient-centred standard of care that improves clinical outcomes. In Portugal, national modelling by the Anaemia Working Group Portugal (2017) estimated that comprehensive PBM implementation could benefit about 384 000 patients and reduce red blood cell transfusions by 51.2% within the first year. Despite a supportive legislative framework established in 2018, implementation has remained inconsistent and below expectations. The World Health Organisation's Implementation Guidance (2025) calls for decisive action, highlighting the need for renewed governance, structured education, and coordinated national efforts to translate policy into practice.

Methods: A multidisciplinary expert panel of national and international PBM leaders met at the Local Health Unit of Gaia-Espinho (ULSGE). Drawing on the WHO Implementation Guidance (2025), the WHO Policy Brief on PBM (2021), and national policy instruments, the panel identified key barriers, enablers, and strategic priorities for PBM implementation in Portugal.

Results: Four strategic domains were prioritised: (1) governance and leadership; (2) education and training across all professional levels; (3) implementation tools and processes, including standardised pathways and goal-directed haemostatic algorithms; and (4) monitoring, audit, and continuous improvement through clinical and economic indicators integrated into dashboards. These recommendations, collectively termed the Valadares Initiative, promote universal PBM adoption, systematic benchmarking, and alignment with national quality and safety frameworks.

Conclusion: Portugal has the legislative foundation and clinical expertise to advance PBM. Progress now requires stronger governance, adequate resourcing, and structured education. The Valadares Initiative offers a consensus-based roadmap to accelerate PBM implementation and provides transferable insights for other health systems.

Objective: This study aimed to investigate the incidence and risk factors associated with hypotension in critically ill patients undergoing double filtration plasmapheresis (DFPP) to improve treatment safety and optimise haemodynamic management strategies.

Methods: A retrospective analysis was conducted on critically ill patients who underwent DFPP in the intensive care unit between April 2022 and April 2024. Patients were classified into hypotension and non-hypotension groups based on blood pressure changes following DFPP. Clinical data including APACHE II and SOFA scores, DFPP treatment parameters, blood access methods, anticoagulation strategies and vasopressor usage were compared between the groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Time to hypotension onset during DFPP was also analysed.

Results: A total of 61 patients undergoing 190 DFPP sessions were included, with hypotension occurring in 86.8% of patients during one or more sessions. The APACHE II score was significantly higher in the hypotension group (p = 0.002). Logistic regression analysis identified systemic heparin anticoagulation (OR = 2.475, p = 0.013) and pre-existing vasopressor use (OR = 23.229, p = 0.002) as independent risk factors for hypotension. Additionally, single-needle blood access was associated with a higher incidence of hypotension (p = 0.023). Notably, 76.9% of hypotensive episodes occurred within the first 2 h of DFPP, with 41.7% occurring within the first hour.

Conclusion: Systemic heparin anticoagulation and prior vasopressor use were significantly associated with an increased risk of hypotension during DFPP. These associations may reflect both treatment-related physiological effects and the intrinsic haemodynamic fragility of severely ill patients. Optimising vascular access, anticoagulation strategies and vasopressor management may help improve haemodynamic stability during DFPP, particularly in high-risk individuals. However, prospective studies are still needed to determine whether such adjustments can meaningfully reduce the incidence of DFPP-related hypotension.

Background: Pulmonary complications of transfusion are a leading cause of morbidity and mortality. Transfusion-associated circulatory overload (TACO) is the most common, whereas transfusion-related acute lung injury (TRALI) is less frequent but potentially fatal.

Objective: To describe a pediatric case with overlapping features of TACO and TRALI following platelet transfusion and to highlight diagnostic and management challenges.

Methods: We report the case of a 15-year-old patient with acute myeloid leukemia who developed acute respiratory compromise after platelet transfusion. Clinical findings, laboratory data (including pro-BNP), imaging, and immunologic investigations were evaluated.

Results: Elevated pro-BNP levels and signs of fluid overload were consistent with TACO. However, chest radiography demonstrated non-cardiogenic pulmonary edema, and pre-existing pulmonary involvement supported a diagnosis of type II TRALI. Management included immediate cessation of transfusion, oxygen therapy, and comprehensive evaluation with cytokine profiling, antibody screening, and advanced immunologic testing.

Conclusion: This case illustrates the diagnostic complexity of transfusion-related pulmonary complications, particularly when TACO and TRALI features overlap, and underscores the importance of a multidisciplinary approach to management and investigation.

Background: Sustaining a safe and sufficient blood supply requires not only recruiting first-time donors but also retaining them over time. In Saudi Arabia, donor retention remains poorly understood, with limited data on return behavior, demographic influences, and temporal trends. This study aims to evaluate patterns of donor return at a tertiary hospital in Saudi Arabia and explore implications for blood supply stability.

Materials and methods: This is a retrospective observational analysis of 48 241 blood donations by 38 562 unique blood donors at King Fahd Armed Forces Hospital from November 2019 to November 2024. Donors were classified as first-time or repeat donors based on donation frequency. Inter-donation intervals, monthly donation trends, and seasonal influences (Ramadan and Hajj) were assessed using descriptive statistics and chi-square tests.

Results: Only 13.2% of donors returned for a subsequent donation, yet these repeat donors contributed 30.6% of all blood units. The average inter-donation interval was 455 days, with 29.2% returning after more than 500 days. Significant seasonal variation was observed in which repeat donation rates declined during Ramadan (27.1%) and Hajj (29.5%) compared to other months (31.0%) (p < 0.0001). Demographically, older age was positively associated with repeat donation, while female participation remained low.

Conclusion: Donor retention in Saudi Arabia is low and characterized by wide variability in return timing. These findings underscore the need for structured, behaviorally informed retention strategies. We propose a relationship-centered strategic framework to improve donor engagement, leveraging personalized communication, cultural inclusivity, and temporal targeting to enhance blood supply resilience.

Background: Screening blood donations for HEV RNA mitigates the risk of transfusion-transmitted HEV infection (TT-HEV), a recognised blood safety issue in Europe. This study reports the findings of government-funded HEV RNA blood donation screening 2016-2022 and includes an estimate of residual risk.

Method: Donation samples were universally and individually tested for HEV RNA using the Procleix HEV assay. Repeat reactive samples were referred for further molecular (PCR, viral load, genotyping) and serological analyses. A previously described model was used for the estimation of residual risk.

Results: 229 HEV RNA positive donations were identified in 980 690 donations. Serological window period donations accounted for 148 (65%) of cases. HEV RNA donation positivity ranged from 1 in 6153 (0.016%) to 1 in 2314 (0.043%). In the absence of screening and with a residual plasma volume of 10 mL, >19% of the Hepatitis E virus positive Red Cell Concentrates (n = 42/220) could have resulted in transmission. The residual risk, based on a window period of 14 days was estimated at 51 per million donations. At least 15 components with infectious doses of >1 × 10⁶ IU were interdicted.

Conclusions: Autochthonous asymptomatic HEV infection continues to occur in Irish donors with relative frequency. As donors with higher viral loads can lead to infectious donations, the value of screening the blood supply for HEV is evident and supported by an absence of reported TT HEV cases. Interventions to control foodborne HEV may reduce the relative benefit of screening in the future.

Solid organ transplant is associated with high rates of anaemia and transfusion, but there is little comparative data on interventions such as erythropoietin-stimulating agents (ESAs) and intravenous (IV) iron. We conducted a systematic review examining the association of ESAs and IV iron with outcomes in adults undergoing solid organ transplant. This review was registered with PROSPERO (CRD42023474722). EMBASE and MEDLINE were searched from inception to April 11, 2025. Identified studies included adults (≥18 years of age) undergoing heart, liver, lung, or kidney transplant who received any ESA and/or IV iron before, during, or up to 1 month following solid organ transplant surgery compared to patients who did not. Article screening, full text review and data extraction were performed by two independent reviewers. The primary outcome of interest was transfusion volume, with secondary outcomes including haematological parameters, graft-related outcomes and rates of major morbidity and mortality. Results were analysed descriptively and compiled into tables, and the risk of bias was assessed using the CLARITY framework. From 1693 studies identified, 22 were included (kidney transplant, n = 16; heart transplant or Left Ventricular Assist Device as a bridge to transplant, n = 4; liver transplant, n = 2). Due to heterogeneity in design, interventions and outcomes, meta-analysis was not attempted. The quality of evidence was graded as Very Low. On the whole, a comprehensive strategy implementing ESAs and IV iron may improve haematological parameters and facilitate transfusion avoidance. High-quality prospective studies assessing the impact of protocols for haemoglobin optimisation and transfusion avoidance in solid organ transplant are needed.

Background: As blood donation policies become more inclusive and men who have sex with men (MSM) become eligible, understanding non-donors will become increasingly important. MSM non-donors are often treated as a homogenous group, despite growing evidence that there is no universal non-donor profile. This oversimplification may obscure variation in behavioural risk parameters and does not optimally inform the development of effective recruitment or retention strategies. We aim to address this gap by identifying subgroups of MSM non-donors and examining how their behaviours and attitudinal profiles may inform targeted recruitment efforts.

Methods: We used data from a cross-sectional voluntary online community survey of HIV risk behaviour and blood donation history. Latent Class Analysis (LCA) was used to identify subgroups of MSM who had never donated blood. Attitudes towards the MSM deferral policy, blood service and how civically important they view blood donation were compared across groups.

Results: 1339/3838 participants were non-donors. LCA identified four distinct subgroups of non-donors: 'Sexually, but not socially engaged' (16.1%), 'Young and single' (22.1%), 'Monogamous' (28.1%) and 'Socially and sexually engaged' (33.5%). These groups differed in their demographic make-up, social connections, sexual lifestyles and in their attitudes towards blood donation.

Conclusion: This study highlights the heterogeneity within MSM non-donors. We propose that the 'Young and single' and 'Monogamous' MSM might be more readily recruited due to their favourable eligibility and attitudinal profile. Furthermore, there is potential need for tailored outreach to maximise future donor engagement and a safe blood supply under individualised donor assessment approaches.

Objective: To evaluate the incidence of haemoglobin (Hgb) values <10 g/dL and transfusion in children with severe traumatic brain injury (TBI).

Design: Non-prespecified secondary analysis using the Approaches and Decisions in Acute Paediatric TBI (ADAPT) trial (NCT04077411) that prospectively enrolled consecutive paediatric patients from February 2014 to September 2017.

Setting: U.S. and international sites with patient enrollment into ADAPT trial.

Patients: Patients less than 18 years old with a Glasgow Coma Scale (GCS) score less than or equal to 8 that had an intracranial (ICP) monitor and had at least one Hgb value recorded in the first 24 hours following ICP monitor placement.

Interventions: None.

Measurements and main results: Of the 997 patients included in the analysis, 895 (90%) had at least one Hgb value <10 g/dL during the study period. 607 (61%) patients received packed red blood cells (pRBCs) or whole blood transfusion, with 66% of transfusions occurring on ICU Day 1. The median blood transfusion volume (either pRBC or whole blood) in the study population was 15.2 mL/kg (IQR 10-27.1) within the first 7 days of ICU stay. In a multivariable logistic analysis, transfusion was associated with younger age, higher admission GCS score, increased clinical and injury severity at admission, and need for surgical intervention. However, neither nadir Hgb nor transfusion was associated with mortality or unfavorable neurologic outcome.

Conclusions: In a secondary analysis of ADAPT, both Hgb value <10 g/dL and transfusion were common in children with severe TBI. Nadir Hgb and transfusion were not associated with mortality or unfavourable neurologic outcomes. The optimal threshold for pRBC transfusion in children with severe TBI requires further study.

Background: Daratumumab is a monoclonal antibody therapy used to treat multiple myeloma. It has introduced challenges for blood transfusion laboratories to provide safe red cells for transfusion due to the cross-reactivity of daratumumab with red cell surface antigens on antibody screening cells, resulting in panreactivity and preventing the exclusion of alloantibodies. NHS Lothian transfusion protocol for patients on daratumumab involves pre-daratumumab extended patient phenotyping of significant RBC antigens and transfusion of RhD (CcEe) and K phenotype matched Red Cell Concentrate (RCC) without performing any pre-transfusion antibody screening.

Methods: To determine alloimmunisation rates following the current protocol the laboratory information management system (LIMS) was interrogated to determine if patients previously on daratumumab had developed antibodies in response to transfused RCCs. Grifols sCD38 was used to neutralise daratumumab in transfused patients. sCD38 was used to (1) assess alloimmunisation rates in patients on treatment (2) assess how it could be applied in a routine pre transfusion testing protocol.

Results: Since 2018, 185 patients started daratumumab therapy in Lothian. There was a record of RCC transfusion in 102 patients. From the LIMS, negative antibody screens were recorded in 21 patients post-daratumumab treatment. No alloimmunisation was detected from 34 transfused patients still on daratumumab.

Conclusion: Low alloimmunisation suggests NHS Lothian protocol for transfusion of daratumumab patients is safe. Extended phenotyping of patients pre-treatment may be extensive and unnecessary due to the low alloimmunisation rate. Implementation of sCD38 reagent into pre-transfusion testing can reduce extensive pre-treatment testing and improve the safety of transfusion by exclusion of alloantibodies in daratumumab patients.