Transfusion Medicine最新文献

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.

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: 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.

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.

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.