Transfusion Medicine最新文献

A core focus of the blood services is to maintain the blood supply whilst simultaneously being vigilant for potential threats to blood safety. At present, West Nile virus (WNV), Usutu virus (USUV), Dengue virus (DENV) and Tick-borne encephalitis virus (TBEV) are considered primary arboviral threats to blood safety in the UK and Northern Europe. Climate change and globalisation have enhanced the frequency of WNV and DENV cases being reported in Europe, furthering the likelihood of their spread to the UK. Furthermore, both TBEV and USUV have already been identified in reservoir hosts in England and the first human cases of TBEV infections acquired in England have been recently documented. Existing policy to protect the blood supply against emerging viral risks is based on donor deferral or nucleic acid test (NAT) screening for those recently returning from WNV endemic areas, only. Constant evaluation of the current policy is necessary to assess the feasibility of donor deferral if the case numbers within Europe continue to increase, and to determine if selective screening for these viruses is needed. Regardless of the testing and prevention strategies decided upon by the blood services, frequent review of these policies will be necessary to reflect the national and wider disease epidemiology of these arboviral infections.

Objectives: We aimed to investigate the quality of platelets after storage following irradiation with ultraviolet C (UVC) light-emitting diodes (LED).

Background: Controlling transfusion-related infections, particularly bacterial contamination of platelet concentrates (PCs), is urgently required. UVC-LEDs have attracted considerable attention as potential solutions to this problem.

Methods: PCs (5.5 mL) were irradiated with 265 nm UVC-LED for up to 60 min and then stored at 22°C with shaking for 3 days. PC quality parameters, such as platelet count, biochemical profiles, including electrolytes and metabolism, activation markers and platelet aggregability, were analysed before and after storage. Prior to the storage study, to validate the appropriateness of the UVC-LED dose used, the PCs were inoculated with Staphylococcus aureus or Bacillus cereus, and their colony-forming ability was evaluated after irradiation with the same dose of UVC-LED.

Results: We confirmed that S. aureus and B. cereus colonies decreased with the irradiation dose (by 1.7 log and 1.2 log at 38.7 and 40.4 mJ cm^-2, respectively). Platelet count decreased immediately after 60-minute irradiation to 32.5 mJ cm^-2, reaching approximately 80% of the level in the control without irradiation, but no further decrease was recorded after storage. The biochemical profiles and activation markers showed little alterations.

Conclusion: These results indicate that UVC-irradiated platelets maintain sufficient quality for practical use even after storage. Although this was a bench-scale study, our findings suggest that irradiation of PCs with 265 nm UVC-LED may enhance the safety of blood transfusions while preserving their efficacy.

Background and objective: For many blood collection agencies (BCAs), meeting the transfusion needs of people living with sickle cell disease, a genetic condition that causes sickling of red blood cells, is a priority but also a challenge because of a lack of diversity in the donor base. To help address this challenge, this study aimed to understand systemic barriers to donation from the perspectives of African, Caribbean, and Black (ACB) community leaders.

Methods and materials: A qualitative study informed by a community-based participatory research approach was conducted with 10 ACB community leaders across Canada. Semi-structured interviews were conducted with key informants from February to March 2023. Topics explored included community involvement and priorities, perspectives on racism and discrimination, and perspectives on blood and other forms of donation including challenges to donation and recommendations for addressing challenges. Interviews were audio-recorded with participants' consent, transcribed, and uploaded to NVivo for analysis. Data analysis was guided by an interpretive descriptive and thematic analytic approach.

Results: Our analysis demonstrates how differing sociocultural views on blood donation, mistrusting BCAs as an extension of healthcare systems, and experiences of deferral criteria as exclusionary are constructed as barriers to donation for some ACB people and communities.

Conclusions: Easing deferral criteria was recommended by key informants as a necessary step towards addressing a significant barrier to donation; however, even with the removal of a permanent deferral, its legacy and impact on affected communities may remain. Recommendations include that BCAs collaborate with ACB community groups to address these barriers.

Background: The ABO gene encodes glycosyltransferase A and B enzymes. Reduced enzyme activity is primarily caused by variations in the coding region and splicing sites. Additionally, variations in regulatory regions like the CCAAT binding factor (CBF)/NF-Y binding site, proximal promoter, and + 5.8-kb site may also diminish enzyme activities.

Objective: This study enrolled 120 Chinese individuals (111 with abnormal serological phenotypes and 9 serologically normal family members of probands from five pedigree studies).

Materials and methods: The entire ABO gene of each participant was sequenced using PacBio third-generation sequencing technology. Complete ABO gene sequences (~27.2 kb) were aligned, and phylogenetic analyses were conducted using MEGA11 software.

Results: We identified 56 A-like (including cisAB), 85 B-like (including BA), 92 O, and 7 hybrid alleles. In the CBF/NF-Y region, all A-like alleles except A2.01 possessed one 43-bp repeat unit (nt.41A). A2.01, 42.3% of the O.01.01, and B-like alleles displayed four 43-bp repeats, with nt.41G in the first unit. Other O alleles had four 43-bp repeats, with the first repeat exhibiting nt.41C, except for one instance where an O.01.01 only contains the first three 43-bp repeats. Two instances of c.-35_-18del, cis-linked with the B.01 alleles, were detected in the proximal promoter. In the +5.8-kb region, six common variations forming five haplotypes were identified. Additionally, a rare variant in the RUNX1 binding region was observed. Regulatory region variations accounted for ~2.5% of serological abnormalities in our cohort. Additionally, seven recombinant ABO alleles were identified, representing 2.92% of the 240 total haplotypes.

Conclusion: Our findings have rendered the characteristics of the regulatory regions more intuitive, thereby providing foundational data for future research and enhancing the practical applications in transfusion medicine.

Background: Platelet transfusion is essential in managing thrombocytopenia in hemato-oncology patients. This study aimed to determine the prevalence of platelet refractoriness (PR) and to evaluate the efficacy of crossmatch-compatible single-donor platelet (SDP) transfusions in patients with suspected platelet refractoriness.

Materials and methods: A two-year quasi-experimental study comprised adult and paediatric hemato-oncology patients with two consecutive low corrected count increment (CCI) responses (<7500/μL) following SDP transfusions. Refractory patients with non-immune causes were tried to be excluded as far as possible. Platelet crossmatching was performed using solid-phase red cell adherence (SPRCA) technology. One-hour post-transfusion CCI and percentage platelet recovery (PPR) were evaluated between crossmatch-compatible and incompatible transfusions. Statistical analyses included descriptive statistics as mean ± standard deviation (SD), median with interquartile range (IQR), or frequencies (%). Multivariate regression analysis was used to identify predictors of transfusion response.

Results: Among 272 SDP transfused patients, 142 (52.2%) were refractory and of them, 101 were eligible for platelet crossmatching. Of the 166 SDP transfusions, 63.4% were crossmatch incompatible. Crossmatch-compatible transfusions yielded significantly higher mean CCI (17 788 vs. 11 913, p = 0.001) and PPR (44.8% vs. 28.7%, p < 0.001). Crossmatching demonstrated high sensitivity (84.8%) and NPV (86.4%) for detecting inadequate responses. Multivariate analysis identified platelet compatibility and age as significant predictors of transfusion efficacy.

Conclusion: Crossmatch-compatible platelet transfusions significantly improve post-transfusion CCI and PPR in alloimmunised hemato-oncology patients. Crossmatch compatibility and patient age were identified as two independent predictors of adequate early platelet transfusion response (1-h CCI, PPR and platelet increment).

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.