Transfusion Medicine最新文献

Background: Despite efforts to standardise practice using evidence-based guidelines, fresh frozen plasma (FFP) remains the blood component most frequently prescribed inappropriately. This study assessed the appropriateness of FFP transfusion in two tertiary teaching hospitals and analysed the characteristics of appropriate and inappropriate transfusions.

Methods: Patients who had undergone FFP transfusion between October and December 2022 at two tertiary teaching hospitals were retrospectively analysed. Only the initial FFP transfusion data were analysed for each patient. Patient characteristics; laboratory test results, including prothrombin time, international normalised ratio, and activated partial thromboplastin time; and the association of FFP transfusion with various factors were examined. Sub-therapeutic dosing was defined as the transfusion of ≤2 units of FFP. FFP transfusions were classified into eight groups based on a classification algorithm to determine their appropriateness.

Results: In total, 584 FFP transfusions (2301 units) were analysed, with 42.1% involving subtherapeutic dosing. FFP transfusions were performed in the intensive care unit (ICU; 30.5%), general ward (24.8%), operating room (21.1%), and emergency room (22.9%). Overall, 51.5% of FFP transfusions were deemed appropriate, with significant variations being observed between the hospitals (Hospital B vs. Hospital A: 73.2% vs. 35.3%). Inappropriate FFP transfusions were associated with a higher INR, with 73.4% of them being associated with severe bleeding and/or surgery.

Conclusions: In conclusion, 40.6% of FFP transfusions were deemed inappropriate in the present study owing to failure to meet laboratory criteria. The present study provides valuable insights into the optimisation of plasma transfusion practices and emphasises the requirement for institution-specific management.

Background: Cytomegalovirus (CMV) infection remains a major cause of morbidity and mortality after allogeneic stem cell transplantation (aSCT). In 2012, the UK Advisory Committee for the Safety of Tissues and Organs (SaBTO) recommended that CMV-unselected (CMV-U) blood components could be safely transfused to this population without increasing the risk of transfusion-transmitted CMV (TTI-CMV). A 2015 survey of UK transplant centres found that 22.7% of aSCT centres did not follow this recommendation. In response, a subsequent good practice paper addressed concerns regarding the determination of pre-transplant CMV serostatus. Annual Serious Hazards of Transfusion (SHOT) reports continue to reassure, with no emerging safety concerns linked to the increased use of CMV-U blood components in this setting.

Objectives: To clarify changes in English practice regarding the provision of CMV-U blood components for potential allogeneic stem cell recipients and to identify factors contributing to the continued use of CMV-seronegative (CMV-N) blood components outside SaBTO recommendations.

Methods: We surveyed English aSCT centres to establish current practices and perceptions.

Results: Of the 32 English transplant centres, 28 responded (88%), 19 adult and nine paediatric centres; 10.7% continue to provide CMV-N components to all CMV-N potential aSCT recipients. Cited reasons include concerns for patients with primary immunodeficiency syndromes and a misperception that TTI-CMV is a 'never event'. Furthermore, 17.9% of centres continue to provide CMV-N components contrary to SaBTO recommendations, citing risks of CMV disease in primary immunodeficiency syndromes, resolution of ambiguous CMV serostatus, and HIV infection.

Conclusion: Adherence to SaBTO guidance on transfusion of CMV-U blood components to aSCT recipients continues to improve, but further changes are likely to be challenging, based on the survey responses received and may require international collaboration.

Background: Blood transfusion services are vital to healthcare; however, blood component wastage remains a persistent challenge for transfusion facilities, impacting resource efficiency and patient care. In this four-year retrospective before-and-after study, we investigated blood component wastage at a tertiary hospital in Saudi Arabia to identify key causes of wastage and evaluate the impact of targeted interventions introduced in 2024.

Methods: Statistical analyses included z-tests for rate comparisons, effect size estimation using Cohen's h, and 95% confidence intervals (CIs) to assess the impact of the interventions.

Results: From 2021 to 2024, 83,185 components were prepared and 13,954 units were discarded. Between 2021 and 2023, the average waste rate was 19.44%. Leading causes included expiration (28.40%), TTI screening reactivity (20.11%), and low platelet yield (18.39%). Following the 2024 implementation of targeted measures-including improved inventory policies, donor screening, and transfusion practices-total waste declined by 35.71% (p < 0.001, 95% CI: 0.016 to 0.024), with a moderate effect size (Cohen's h = 0.20). Total monthly waste rates were also significantly reduced (mean difference of 7.73 percentage points; p < 0.001, 95% CI: 4.87% to 10.59%, Cohen's d = 2.29). The WAPI scores improved across all components, and associated costs were reduced by 15.9%, saving approximately SAR 171366 (US$45856).

Conclusion: These findings demonstrate the effectiveness of interventions for reducing blood component wastage and enhancing transfusion service efficiency. Ongoing monitoring and continuous quality improvement are essential to sustain these outcomes and further optimize transfusion practices.

Background and aims: D antigen is a crucial factor in both blood transfusions and haemolytic disease of foetus/newborn (HDFN). Some variants of the D antigen can produce anti-D and should be considered Rh-negative, while others are Rh-positive and can receive Rh-positive blood. Efficient and cost-effective genotype tests in the management of Rh-negative blood usage and preventive management of HDFN require knowledge of the distribution of RHD variant alleles among different populations. The aim of this study was to determine the frequency of weak D/partial D variants in blood donors of Yazd Blood Center.

Materials and methods: Between October 2022 and October 2023, 43 blood samples with weak D antigen expression from blood donors at Yazd Blood Center were analysed. The samples' phenotypes were identified using serological methods to detect the e, c, E, C, and D antigens. The D variant-associated alleles were evaluated using polymerase chain reaction-SSP, restriction fragment length polymorphism, and DNA sequencing techniques.

Results: The result showed four different weak D and one Partial D allele. The highest prevalence was related to RHD* weak partial 15 (48.8%), followed by RHD*01W.80 (18.6%), RHD*01W.1 (4.6%), and RHD*01W.4 (2.3%). There were seven cases (16.2%) of RHD*Partial DLO. This study showed the association between weak D type 15 and antigens E.

Conclusion: The results of this study highlight the specific pattern of RHD variants in the Yazd population. Weak D type 15 showed the highest prevalence, while weak D type 80 was particular to the Yazd region.

Background: This protocol describes a study to test a commercial blood warming device in warming blood transfusions to prevent hypothermia associated with packed red blood cell (PRBC) transfusions in very preterm infants.

Objectives: Very preterm infants receiving blood transfusions warmed by a commercial blood warmer will have less central body hypothermia post transfusion (abdominal temperatures <36.5°C) and/or a higher mean abdominal temperature for the hour after the transfusion is complete compared to those receiving blood transfusions by standard of care. This trial has been registered with Clinicaltrials.gov (trial number NCT05170633).

Methods: In this trial, which is funded by The Gerber Foundation and adhered to the SPIRIT2013 checklist, 140 very preterm infants with an order to receive PRBCs will be randomised into a standard of care group to receive one PRBC transfusion over 3 h with blood in a syringe at room temperature or into the intervention group to receive one PRBC transfusion over 3 h using a Hotline® Blood and Fluid Warmer. Abdominal skin temperatures will be measured every minute through a blood transfusion using a skin thermistor and datalogger.

Data analysis: Descriptive statistics will be computed for each group to compare demographics and all infant pre-, during, and post-transfusion body temperatures. A student t-test will be used to compare the groups on mean post-transfusion temperatures as a primary outcome variable. To examine thermal change over time between the two groups, linear mixed models with a random intercept will be utilised.

Results: This trial began in January 2022, in a South Carolina neonatal intensive care unit and is ongoing.

Discussion: This RCT will determine if warming PRBC transfusions will prevent hypothermia in preterm infants during and after blood transfusions. Results from this trial will be used to design national standards for blood transfusions in preterm infants to decrease morbidity and mortality.

Objectives: The aim of this paper is to report results of racialised young adults' awareness of the stem cell registry. Further, we examine recruitment materials and outreach strategies to increase stem cell awareness and registration among young, racialised Canadians.

Background: Patients who are not White face disparities in securing unrelated donors because of the disproportionate representation of White registrants on stem cell registries, differences in genetic diversity across ethnicities, and attrition rates for donor registries.

Methods/materials: This qualitative study is informed by community-based participatory research. Focus groups were conducted with young adults ages 17-35 who self-identify as Black, Indigenous, and people of colour (BIPOC)/racialised, are comfortable speaking in English, and live in Canada.

Results: Five 2-h focus groups were conducted with 17 participants in total. Participants spoke to the interconnected themes of knowledge, trust, and engagement with their community. They were motivated by the idea of contributing to a more diverse registry. These perspectives informed their insight into what materials and events would resonate with their peers and their communities.

Conclusion: Our findings point to some concrete suggestions for materials that can resonate with young racialised Canadians. Further, stem cell registries should work collaboratively with young adults and young adult organisations to co-develop educational and recruitment materials and build relationships over time, developing their knowledge of stem cells and raising their confidence to host stem cell events within their communities.

Background: The COVID-19 pandemic posed a worldwide challenge for blood services. We aimed to evaluate the impact of the COVID-19 pandemic on blood donations and blood discards resulting from screening tests for transfused-transmitted infections (TTIs) in a Brazilian metropolitan.

Methods: Time-series cohort study including data of all blood donors from January 2018 to December 2021 at the Brasília Blood Center Foundation, Federal District, Brazil. The causal impact analysis was used to evaluate the impact of COVID-19 on blood donations, and a propensity score matching was used to evaluate the effect of the COVID-19 pandemic on the seroprevalence of TTIs.

Results: There were 205 965 blood donations during the study period. The blood donations significantly reduced soon after the onset of the COVID-19 pandemic in Brasilia, Brazil, in March 2020 until August 2020 (absolute effect per week: -2952; 95% CI: -4627 to -1355). However, from September 2020 to December 2021, blood donations had returned to the levels foreseen by the time-series model. Compared to the pre-COVID-19 period, the period between September 2020 and December 2021 was associated with a decrease of at least one reactive or indeterminate screening test for TTI (OR: 0.753, 95% CI: 0.665-0.854, p <0.001).

Conclusion: There was a substantial decrease in blood donations soon after COVID-19 onset in Brazil. However, within a few months, the donation levels had returned to those projected by the model, possibly due to measures implemented by the blood centre for blood donations. The seroprevalence of TTIs decreased during the COVID-19 pandemic.

Hemovigilance is essential for monitoring, analysing, and preventing adverse transfusion reactions. Hemovigilance Programme of India (HvPI), launched in 2012, aims to improve transfusion safety. However, challenges such as limited knowledge and underreporting persist, necessitating a critical appraisal of existing Knowledge, Attitude, and Practice (KAP) studies to guide future interventions. A systematic literature search was conducted using Google, PubMed, Scopus, Web of Science, and Google Scholar, focusing on KAP studies on hemovigilance in India published post-2012. Keywords included "hemovigilance," "blood transfusion safety," "adverse transfusion reactions," and "KAP studies," combined with "India" and "healthcare professionals." Filters for peer-reviewed, English-language studies were applied, and references were reviewed. Studies were appraised using the AXIS tool. Thirteen studies, with 1684 participants from teaching hospitals and tertiary care centres, were included. Most studies were conducted by pharmacology departments (84.6%), predominantly in western India (79.8%). While awareness of transfusion reactions was high, knowledge of reporting mechanisms and hemovigilance programmes was poor. Barriers included lack of training, time constraints, and fear of legal repercussions. Only one study met an acceptable quality score (≥16/20) on AXIS tool, while others demonstrated methodological weaknesses, inadequate sample size justification, lack of non-responder analysis, and insufficient statistical rigour. Despite highlighting the importance of KAP assessments in hemovigilance, the studies' geographical limitations and methodological constraints hinder generalisability. Future research should employ robust methodologies, expand geographical representation, and include diverse populations to enhance hemovigilance practices in India. Strengthening hemovigilance systems through coordinated efforts is essential for improving transfusion safety nationwide.