Transfusion Medicine最新文献

Introduction: Malaria is a health threat in sub-Saharan Africa, where Plasmodium is not tested in blood bags. Our objective was to determine the prevalence of plasmodial carriage in blood bags and the associated factors, and the involvement of these bags in the occurrence of malaria in recipients.

Methods: From 1st April to 30th November, 2020, we conducted a prospective cross-sectional study of 348 blood bags stored at 4°C in Bamako. Using SPSS 21.0 software, statistical analyses were performed using a binary logistic regression model with a significance threshold of p < 0.05 and the odds ratio (OR) framed by its 95% confidence interval (CI).

Results: During this period, 348 blood bags were transfused into 108/152 hospitalised patients, generating a transfusion frequency of 71.1%, with a prevalence of plasmodial carriage of 22%. Among the 54 initially malaria-negative recipients, all 20 (37%) who received malaria-positive blood bags and slept under long-acting insecticide-treated nets (LLINs) developed malaria. We recorded 33.3% deaths. Donor age ≤ 34 years (p = 0.011; OR = 2.55[CI.95% = 1.25-5.23]), replacement donation (p = 0.000; OR = 0.04[CI.95% = 0.0-0.19]) and not regular use of LLINs by donors (p = 0.048; OR = 0.53[CI.95% = 0.29-1]) were factors associated with plasmodial carriage of blood bags. CD4 count<200 cells/mm³ (p = 0.002; OR = 0.2[CI.95% = 0.10-0.52]), severe anaemia (p = 0.034; OR = 0.26[CI.95% = 0.10-0.90]) and decompensated anaemia (p = 0.034; OR = 3.88[CI.95% = 1.11-13.56]) were factors independently associated with recipient death.

Conclusion: The prevalence of plasmodial carriage among blood donors is increasing in Mali. Transfusion malaria is a reality to be feared, with the risk increasing with the level of malaria endemicity of the blood donor.

Introduction: Hospital-based transfusion involves hundreds of daily medical decisions. Medical decision-making under uncertainty is susceptible to cognitive biases which can lead to systematic errors of reasoning and suboptimal patient care. Here we review common cognitive biases that may be relevant for transfusion practice.

Materials and methods: Biases were selected based on categorical diversity, evidence from healthcare contexts, and relevance for transfusion medicine. For each bias, we provide background psychology literature, representative clinical examples, considerations for transfusion medicine, and strategies for mitigation.

Results: We report seven cognitive biases relating to memory (availability heuristic, limited memory), interpretation (framing effects, anchoring bias), and incentives (search satisficing, sunk cost fallacy, feedback sanction).

Conclusion: Pitfalls of reasoning due to cognitive biases are prominent in medical decision making and relevant for hospital transfusion medicine. An awareness of these phenomena might stimulate further research, encourage corrective measures, and motivate nudge-based interventions to improve transfusion practice.

Objectives: We asked how increasing age interacts with transfusion and mortality among older injured adults at our large regional trauma center.

Background: Older adults are increasing proportions of acute trauma care and transfusion, but the specific interactions of increasing age with blood product use are unclear.

Methods/materials: Trauma data (age, injury severity, mechanism, etc.) were linked with transfusion service data (type, timing and numbers of units) for all acute trauma patients treated at our center 2011-2022. Subsets of patients aged ≥55 years were identified by age decade and trends assessed statistically, p < 0.01.

Results: Of 73 645 patients, 25 409 (34.5%) were aged ≥55. Within increasing 10-year age cohorts, these older patients were increasingly female (32.2%-67.2%), transferred from outside facilities (55.2%-65.9%) and injured in falls (44.4%-90.3%). Overall, patients ≥55, despite roughly equivalent injury severity, were twice as likely to be transfused (24% vs. 12.8%) as younger patients and to die during hospitalisation (7.5% vs. 2.9%). Cohort survival at all ages and levels of transfusion intensity in the first 4 h of care were more than 50%. Through age 94, numbers of red cell and whole blood units given in the first 4 h of care were a function of injury severity, not age cohort.

Conclusions: In our trauma resuscitation practice, patients aged ≥55 years are more likely to receive blood products than younger patients, but numbers of units given in the first 4 h appear based on injury severity. Age equity in acute resuscitation is demonstrated.

Background: Proper thawing procedures are required to preserve the quality of human fresh frozen plasma (FFP). octaplasLG (Octapharma AG, Switzerland) is a frozen solution of solvent/detergent (S/D)-treated human plasma, produced to improve pathogen safety. This study aimed to validate the S/D plasma thawing process using the latest-generation of commercially-available thawing devices and to determine S/D plasma quality after thawing.

Study design and methods: Thawing of S/D plasma units was investigated using a microwave oven (Transfusio-therm 3000) and dry tempering systems (SAHARA 4 and Plasmatherm V). Times to defrost plasma and reach 30°C product temperature, using the 37°C thawing programmes, were defined for all devices. Thawed S/D plasma units were tested against product release parameters, as well as for hemostatic capacity tested indirectly via global coagulation parameters, coagulation factors, protease inhibitors and markers of activated coagulation.

Results: The fastest thawing was observed using the microwave oven; S/D plasma units were defrosted after 2-3 min. All S/D plasma units thawed by the different devices using optimised thawing conditions were clear and free of solid and gelatinous particles, indicating no local overheating or protein denaturation. Coagulation factor and inhibitor activities and hemostatic capacity of S/D plasma were comparable when thawed by the three different devices. With each device, all product parameters were within product release specification levels after thawing.

Conclusions: S/D plasma can be thawed using the Transfusio-therm 3000, SAHARA 4 or Plasmatherm V thawing devices using the optimised settings defined for this plasma product, with no negative influence on plasma quality.

Background and objective: Patients undergoing cardiac surgery consume more than 50% of blood transfusions, and such transfusions have been associated with increased morbidity and mortality. Evidence in blood-saving techniques has increased the use of acute normovolemic haemodilution (ANH) in high-risk settings. The aim was to determine the incidence of allogeneic red blood cell transfusion perioperatively in acute normovolemic haemodilution (ANH) patients undergoing coronary artery bypass grafting (CABG).

Materials and methods: This prospective observational cohort study was conducted in the Cardiac OR and ICU over 6 months, involving elective CABG patients aged 35-70 with ASA status III and IV. Haemoglobin and haematocrit levels were assessed preoperatively, intraoperatively and 24 h postoperatively.

Results: In a cohort of 50 ANH patients, 44% (22/50) required allogeneic blood transfusion perioperatively, with 24% (12/50) intraoperatively, 14% (7/50) in the ICU and 6% (3/50) both intraoperatively and postoperatively. Lower intraoperative haemoglobin levels during CPB were significantly associated with increased transfusion odds in both univariable (OR, 0.25; 95% CI, 0.10-0.49, p = 0.001) and multivariable analyses (Adj. OR, 0.24; 95% CI, 0.09-0.62, p = 0.003), and prolonged surgical duration was a significant predictor in multivariable analysis (Adj. OR, 2.18; 95% CI, 1.01-4.73, p = 0.044). Additionally, prolonged wound healing was significantly more frequent in the patients requiring allogeneic blood transfusions (p = 0.044) highlighting potential postoperative complications.

Conclusion: Our study highlights the varying RBC transfusion rates in CABG patients, with lower intraoperative haemoglobin levels and prolonged surgical duration significantly increasing transfusion needs. These findings emphasise the importance of optimising intraoperative management to minimise transfusions and improve patient outcomes.

Background: At the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital of Southern Denmark, Aabenraa.

Case presentation: A 72-year-old male patient presented for pretransfusion testing prior to hernia surgery. He typed as O RhD negative without discrepancies, but the antibody screen showed weakly positive reactions. Routine investigations showed discrepancies, leading to further investigations.

Methods: Various serological tests were performed using in-house and commercial red test cells suspended in different suspension media and with different column agglutination cards and cassettes. Further investigations included washing of test cells, testing alternative saline solutions, varying incubation temperatures, testing without antihuman-globulin, and applying proteolytic enzymes.

Results: Reactivity was present with red cells suspended in ID-CellStab (BioRad) but not in Red Cell Diluent (Quidel-Ortho). Reactivity was abolished by using trypsin-treated cells, indicating either the presence of an antibody reacting with-or unspecific agglutination depending on-a trypsin-sensitive protein, in both cases enhanced by ID-CellStab.

Conclusion: This case highlights the importance of recognising reagent-dependent reactivity in serological testing. Adjustments to the suspension media resolved the incompatibility. Immunohematology laboratories should consider potential reagent interference when unexpected agglutination occurs.

Adequacy and safety are the twin prerogatives of the blood transfusion service which in turn is an indispensable component of public health delivery; however, many Caribbean countries have inadequate blood supply for the current and projected demands of their health care systems. Understanding blood donor motivators and barriers is crucial to improving the rate of voluntary non-remunerated blood donation (VNRD) to meet World Health Organisation (WHO) targets. The objective of this study was to review current research on the landscape of blood donation practices and attitudes in the Caribbean. We undertook a systematic search of electronic databases through September 2023 to identify studies of blood donation practices, knowledge and attitudes, including motivators and barriers to donation in the English-speaking Caribbean. We identified eight (8) relevant studies of observational study design. VNRD remain relatively uncommon; family replacement or remunerated donations were most common. Barriers to blood donation included lack of a known recipient such as a family member who needed blood, never having been asked to donate, presumed ineligibility to donate, and fear of needles or adverse reactions. Study participants indicated willingness to donate blood if provided more information about the importance of blood donation. There is a paucity of published research regarding blood donor knowledge, motivators and barriers in the Caribbean context. Such research could indicate the necessary interventions for achieving the goals of an adequate and safe blood supply.