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.

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.

Background: Haemoglobin plays a crucial role in oxygen transport, and any acute deviation will trigger compensatory hemodynamic functions. While the consequences of anaemia are well documented, the effects of haemoglobin reduction in individuals without anaemia remain less explored. Patients with polycythaemia vera and healthy blood donors, who both undergo regular phlebotomies, offer a valuable model for studying these effects.

Methods: This observational case-crossover study assessed short-term physiological and quality-of-life changes following phlebotomy in five patients with polycythaemia vera and six healthy blood donors. Participants were remotely monitored using a smartwatch and completed daily quality-of-life assessments. The primary outcome was heart rate, while secondary outcomes included step count and quality-of-life measures.

Results: Patients with polycythaemia vera exhibited stable heart rates, with only minor variations in physical activity and quality of life after phlebotomy. In contrast, healthy blood donors experienced a significant increase in heart rate, which returned to baseline within a week. Physical activity remained clinically unchanged in both groups, and quality-of-life scores were stable.

Conclusions: This pilot study demonstrates that any acute haemoglobin reduction, even within the normal range, induces measurable heart rate changes that are directly related to probably the most optimal oxygen delivery state. Moreover, our studies show that wearable technology is sensitive enough to detect these effects. Hence, this nowadays readily available telemetry allows monitoring of subtle physiological changes in a research setting, but it also offers a path towards optimising QoL for patients with anaemia, polyglobulia and for blood donors.

Background: The H antigen, precursor of the A and B blood groups, is a high-prevalence antigen. Very few H antigen-negative (H-) blood donors are available in the United Kingdom.

Case presentation: We present the case of a second pregnancy in a 28-year-old woman with the very rare AB_h phenotype, and the presence of anti-H, anti-A and anti-B. Only H- (O_h) and AB_h phenotype red cells were compatible. Given the rarity of individuals with these phenotypes, there were insufficient compatible red cell units for management of a major antepartum or postpartum haemorrhage. For this high-risk pregnancy, meticulous multidisciplinary team (MDT) planning took place between haematologists, obstetricians, anaesthetists, hospital laboratory staff and multiple teams within National Health Service Blood and Transplant including the National Frozen Blood Bank, Rare Donor Team and Red Cell Immunohaematology Laboratories. The MDT produced a birth management plan for various eventualities where blood transfusion may have been required. This process included the creation of our hospital's first vaginal cell salvage policy. A successful routine vaginal delivery was managed without transfusion.

Conclusion: This case highlights the optimal care of a woman with an extremely rare blood group in pregnancy. The principles of management described here are also more widely applicable to women in whom transfusion is contraindicated, undeliverable or declined for other reasons.

Background: An NGS-based assay was developed to determine the presence or absence of paternally inherited genetic variants in cfDNA derived from the fetus in the plasma of pregnant women. This assay can be used in connection with NGS-based prenatal prediction of fetal blood groups in immunised pregnant women. The purpose of the assay is to minimise the risk of a false-negative outcome in the situation with a prediction of the absence of a blood group allele from the fetus.

Methods: The underlying principle was to examine genetic markers, with each single marker giving a small contribution to the probability of differentiating between individuals (woman and fetus) and combining several markers into one multiplex PCR assay with enough discerning power to determine whether cfDNA from a fetus was present in maternal plasma. If only maternal cfDNA was detected, a prediction of the absence of a fetal blood group might be due to a false-negative result based on insufficient amounts of fetal cfDNA.

Results: The assay did not require knowledge of maternal or paternal genotypes. The genetic markers were deletion or insertion variants and were selected using an SQL algorithm searching all autosomes from gnomAD v 3 on the Google Cloud Platform and included alleles with a frequency close to 0.5 in four different ethnic populations, including several other criteria. The final assay consisted of a multiplex PCR amplification of 22 different biallelic delin markers, each located on a separate chromosome. The assay is informative in >99% of cases with at least one primer set. After experimental testing, an algorithm for scoring test results was defined, and the cut-off was set at <0.15%.

Conclusion: Per sample, the control assay required one extra dedicated multiplex PCR, which was eventually spiked into the sequencing reaction. The assay estimated the presence of non-self-genetic variation and may have applications beyond control for the presence of fetal cfDNA.

Background: Hospital de Clínicas, in conjunction with the Universidad de la República UDELAR in Uruguay, evaluated the quality of blood components after separation with a top-and-bottom (TB) system, comparing it with the top-and-top (TT) system and verifying compliance with local and international standards.

Study design and methods: Whole blood (WB) was collected using TB (n = 150) and TT (n = 130). TB units were processed with MacoPress Smart, obtaining red cell concentrate (RCC), plasma (PL), and buffy coat (BC). After 2 h, BC had a soft spin centrifugation for a single unit of platelet concentrate (SUPC). TT bags were managed on day 0 (up to 8 h of collection) with manual press obtaining RCC and platelet-rich plasma units (PRP). PRP had hard spin centrifugation and was separated again with the manual press to collect PL and SUPC.

Results: TB system produced RCC with higher haemoglobin concentration and Haematocrit but with lower volume and Hb/unit (p < 0.001). The TB system produced RCC with lower leukocytes and residual platelet levels (p < 0.001). SUPC showed fewer residual leukocytes and red cell levels with TB (p < 0.001), but TT produced a higher mean platelet count than the TB system (p < 0.001). During this evaluation, there was no significant difference in the mean plasma volume (p = 0.178).

Conclusion: The analysis favors the implementation of TB in the HC Blood Bank, improving the quality and safety of the transfusion service.

Objectives: The study aimed to analyse transfusion practices in sensitised autoimmune haemolytic anaemia (AIHA) patients and transfusion outcomes following transfusion of antigen-matched best-matched (AMBM) red cells.

Background: Transfusion practices in AIHA patients across resource-poor settings remain a challenge. The outcome of transfusions following the practice of transfusing best-matched (BM) units remains unknown. The data on alloimmunisation rates in sensitised AIHA patients, the utility of adsorption, and transfusion of AMBM red cells from resource-poor settings will enhance the adoption of optimal practices.

Methods and materials: Retrospective data on AIHA patients' work-up were collected and analysed for a 5-year interval. Patients were grouped based on the presence or absence of alloimmunisation and whether they received transfusion of AMBM versus BM units based on serological testing. Inter-transfusion interval (ITI) and post-transfusion haemoglobin increment (PTHI) were calculated and compared.

Results: Of 368 AIHA patients during the study period, adsorption was performed in 138 patients with a history of a sensitising event. Red cell alloantibodies were identified in 74 patients (53.6%). Shorter ITI was observed in alloimmunised patients when transfused BM red cells versus AMBM red cells [2 (1-3) days vs. 4 (3-5) days; p < 0.001]. Lower PTHI was observed in alloimmunised patients when transfused BM red cells versus AMBM red cells [0.65 (0.45-0.8) g/dl vs. 0.9 (0.7-1.2) g/dL; p < 0.001].

Conclusion: High alloimmunisation rates were observed in sensitised AIHA patients. Significantly higher PTHI and longer ITI were observed with transfusion of AMBM units. These findings highlight the benefits of identifying and matching against alloantibodies for better transfusion outcomes.

Background and objectives: There is limited knowledge regarding cefamandole-related drug-induced immune haemolytic anaemia (DIIHA). We conducted a comprehensive serological and clinical follow-up study of a case of cefamandole-induced DIIHA to improve understanding of this condition.

Materials and methods: A patient with advanced hepatocellular carcinoma developed severe haemolytic anaemia along with significant worsening of hepatic and renal function after intravenous cefamandole was administered for a urinary tract infection. Serological testing included the direct antiglobulin tests (DATs), irregular red blood cell (RBC) antibody screening and detection of cefamandole-dependent antibodies using two standard methods for drug-dependent antibodies: 'testing in the presence of soluble drug' and 'testing drug-treated RBCs', which were performed after cefamandole discontinuation. Clinical follow-up was conducted for 41 days after drug cessation.

Results: The results of DAT for anti-IgG and anti-C3d were strongly positive, while irregular RBC antibody screening was negative. Plasma samples collected at different points from 13 to 38 days after cefamandole discontinuation were incubated with cefamandole-coated RBCs at 37°C, revealing both IgM and IgG cefamandole-dependent antibodies, with a maximum titre of 16. Following treatment with blood transfusion, intravenous immunoglobulin (IVIG), and methylprednisolone, anaemia and organ dysfunction showed marked improvement. Therefore, the patient was diagnosed with cefamandole-induced DIIHA.

Conclusions: This study may be the second serological analysis and the first comprehensive clinical follow-up of cefamandole-induced DIIHA. It demonstrates that cefamandole-dependent antibodies can activate complement, leading to severe haemolytic anaemia and hepatic and renal impairment. The 'testing drug-treated RBCs' method is suitable for detecting cefamandole-dependent antibodies.