Transfusion Medicine最新文献

Lifelong blood transfusions, crucial for severe cases of thalassaemia and sickle cell disease (SCD), contribute to a high risk of transfusion-transmitted infections (TTIs). The current systematic review and meta-analysis determined the prevalence of transfusion-transmitted infections (TTIs) among patients with thalassaemia and sickle cell anaemia in India. A systematic search was conducted in PubMed, Scopus, ProQuest, EMBASE and Web of Science for articles published up to September 13, 2025. Title abstract screening followed by full-text review and data extraction was done by two independent reviewers. Risk of bias was assessed for the included studies. Meta-analysis was conducted to estimate the pooled prevalence of TTIs. The systematic review and meta-analysis identified 397 unique articles, with 39 selected for full-text review. After exclusions, 24 studies spanning from 1990 to 2023 were included. All 24 studies included patients with beta thalassaemia, whereas only one study had data on sickle cell anaemia patients, so this review focuses mainly on the prevalence of TTI in patients with beta thalassaemia. The pooled prevalence of Hepatitis C was 22% (95% CI: 14%-30%; I² = 96%), Hepatitis B was 8% (95% CI: 2%-16%; I² = 96%) and HIV was 4% (95% CI: 2%-7%; I² = 77%) in beta-thalassaemia patients, all showing high heterogeneity. Meta-regression revealed a statistically significant decline over time in HBV (Beta = -0.0194, p = <0.01) while Hepatitis C prevalence (Beta = -0.0025, p = 0.6642) and HIV showed no significant trend (Beta = -0.0001, p = 0.9839). Significant burden of TTIs is present among transfusion-dependent thalassaemia and sickle cell anaemia patients in India. Strengthening screening protocols, improving vaccination coverage and implementing targeted healthcare interventions are essential to mitigate this preventable risk.

Background: Massive transfusion protocols (MTPs) are essential for managing substantial intraoperative bleeding. However, transfusion-related complications such as hypotensive transfusion reactions (HyTRs), although uncommon, can be overlooked during emergencies, particularly in patients with hepatic impairment.

Case presentation: A 56-year-old woman with compensated cirrhosis, hepatic metastases, hypertension (on carvedilol), and well-controlled type 2 diabetes presented with progressive lower limb weakness from a compressive extradural spinal lesion. Surgery required activation of an MTP. She received four units each of O-positive packed red blood cells (PRBCs), random donor platelets (RDPs), and Fresh Frozen Plasma (FFP). Haemorrhage was controlled and the patient stabilised; MTP was discontinued. Approximately 5 min after starting the fourth unit of FFP, she developed sudden, profound isolated hypotension without other signs of allergic reaction, hemolysis or volume overload. The transfusion was stopped and vasopressors restarted; blood pressure normalised within 10 min. Alternative causes were systematically excluded. Given the temporal relationship with FFP and underlying hepatic dysfunction, a bradykinin-mediated HyTR was considered. Histopathology later confirmed poorly differentiated pancreaticobiliary adenocarcinoma.

Conclusion: This case highlights the importance of recognising bradykinin-mediated HyTRs during FFP transfusion, especially in patients with liver dysfunction where impaired bradykinin degradation may contribute to accumulation. Prompt recognition, exclusion of alternative causes, and supportive management are crucial for favourable outcomes.

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.

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.

Background: This study aims to explore the prevalence, genotypes, and clinical applications of thalassaemia and glucose-6-phosphate dehydrogenase (G6PD) deficiency among blood donors, offering scientific support for the safety of clinical blood transfusions.

Materials and methods: Haematological and G6PD enzyme activity tests were conducted on 1028 blood donors from one coastal city in southern China. A detailed genotypic analysis was performed on samples potentially carrying thalassaemia and G6PD deficiency, and their clinical significance was subsequently explored.

Results: Among 1028 blood donors, 137 individuals were found to carry the thalassaemia gene (13.33%). The specific distribution is as follows: 111 cases of α-thalassaemia (10.80%), 21 cases of β-thalassaemia (2.04%), and five cases with both α- and β-thalassaemia (0.49%). The -^SEA/αα genotype was the most common thalassaemia genotype (8.17%). Additionally, 121 individuals (11.77%) carried the G6PD deficiency gene, with the c.1388G>A variant being the most prevalent (3.7%). Compared to recipients of blood from normal donors, patients who received transfusions from donors with thalassaemia or G6PD deficiency did not exhibit significant differences in the risk of adverse reactions or the extent of haemoglobin concentration elevation.

Conclusion: The -^SEA/αα genotype is the most prevalent in α-thalassaemia, while c.1388G>A is the most common genetic variant in G6PD deficiency. Individuals with G6PD deficiency exhibit higher MCV and MCH values. Additionally, blood donated by carriers of thalassaemia or G6PD deficiency does not increase the risk of adverse transfusion reactions. The transfusion of blood from donors with thalassaemia or G6PD deficiency showed no significant difference in haemoglobin elevation compared to that from normal donors.

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.

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.

Background and objectives: Rh is among the most important and highly polymorphic blood group systems due to the proximity of the RHD and RHCE genes, which encode numerous highly immunogenic antigens. However, in areas of Saudi Arabia with a high prevalence of hemoglobinopathy, the molecular characteristics of RHD and RHCE variations are lacking. This study focuses on characterizing the allelic and genotypic distributions of RHD and RHCE blood donors in Jazan, Saudi Arabia.

Materials and methods: All blood donors' records between June 2023 and December 2024 were reviewed. ID RHD XT was applied for 60 negative or weak RhD Saudi donors, while 354 Saudi and 110 non-Saudi donors received RHCE genotyping using the ID CORE XT.

Results: RHD deletion accounted for 76.7% of the RhD-negative donors. RHCE*Ce (44.1%) was the most common RHCE allele in Saudis, followed by RHCE*ce (31.9%) and RHCE*cE (12.3%). Variant alleles including RHCEce*(733G), RHCEce*(733G,1006T), RHCE*ceAR, RHCE*ce(712G), and RHDr's-RHCE*ce(733G,1006T) were detected in 11.72% in Saudi and 7.73% in non-Saudi, while low- and high-frequency antigens V, hrS, VS, and hrB were observed in Saudis with frequencies of 21.8%, 97.8%, 24.8%, and 93.2%, respectively. RHCE*ce/RHCE*Ce was the most prevalent genotype (26.8%). The non-Saudi group displayed similar profiles, with RHCE*Ce (48.2%), RHCE*ce (30.9%), and RHCE*cE (13.2%). There were no significant differences between Saudi and non-Saudi allele or genotype distributions using Fisher's exact test.

Conclusion: The study represents the first molecular characterisation of RHD and RHCE alleles in Saudi Arabia, revealing marked allelic and genotypic diversity, with important implications for transfusion safety in the Jazan region, where hemoglobinopathies are prevalent.

Background: The Donor Health Assessment Questionnaire (DHQ) is fundamental to blood safety. We describe attitudes towards truthfulness among first-time donors who tested positive for transfusion transmissible infections and those who did not.

Methods and materials: From 2005 to 2022 donors positive for infectious markers (cases) and demographically matched controls rated their agreement with statements about truthfulness, privacy and the value of the DHQ.

Results: There were 798 (32% participation) cases and 3192 (39% participation) controls. Most said they read questions carefully (93% cases, 96% controls, p < 0.01) and answered truthfully (95% cases, 99% controls p < 0.01). Fewer thought the questions make the blood safer (79% cases, 80% controls, p = 0.39) and some agreed it is OK not to answer questions truthfully if you know your blood is safe (21% cases, 16% controls, p < 0.01). Privacy to answer personal questions was generally adequate (88% cases, 91% controls, p < 0.01). Attitudes were similar regardless of paper or electronic DHQ format.

Conclusion: Most first time donors believe they answer screening questions truthfully, but some question the safety benefit to recipients and judge whether they need to be truthful. This was true for donors with positive infectious markers as well as their matched infection-negative controls.