Transfusion Medicine最新文献

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.

Objectives: Rapid and accurate identification of blood groups is the foundation of emergency blood support. We performed a complete assessment of a new solid-phase kit for ABO forward grouping and RhD grouping (ABD Kit, InTec Products, Xiamen, China) on the analytical performance, which was compared with those of traditional methods.

Methods: We analysed 1260 clinical samples using the ABD Kit, including weakly agglutinated samples of A, B and D antigen, and compared the test results with those via Gel card, test tube and slide methods. We also validated the results of typing blood samples containing weak antigens using first-generation gene sequencing.

Results: The ABO forward group and RhD group of 1260 samples was determined using ABD Kit, revealing that the inter-batch repeatability rate of the kit was 100%. The results of the kit were compared with those of the gel card method, revealing that the detection accuracy of the kit was also 100%, which was confirmed by comparing the detection of weak antigen samples with the results of first-generation gene sequencing. The accuracy of the test tube agglutination method was 100%. In contrast, the accuracy of the slide agglutination method was low, especially in the detection of weak A blood antigens (agglutination strength 1+), weak B blood antigens (agglutination strength 1+) and weak D blood antigens (agglutination strength 1+ or 2+).

Conclusions: The ABD Kit (InTec Products, Xiamen, China) showed high sensitivity, reproducibility and specificity, indicative of excellent analytical performance. It is a reliable, practical and promising solution for rapid and accurate identification of blood types.

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.

Background: Blood centres, as part of their routine operations, generate various forms of waste during the collection-to-transfusion continuum. However, not all discarded blood components equate to 'wastage'.

Methods: A critical technical appraisal distinguishing blood discard (necessary and regulatory-compliant) from blood wastage (preventable and avoidable) was done.

Results: We propose clear operational definitions and introduce refined metrics such as blood discard rate (BDR), blood wastage rate (BWR) and total discard rate (TDR) to ensure accurate reporting. The concept of 'all-cause blood discard' encompassing both justified discards and true wastage is emphasised.

Conclusion: Misinterpretation of data on discarding as wastage by technical personnel, policymakers, media and the public at large can lead to a trust deficit in transfusion services. Adoption of these distinctions and metrics will improve transparency, resource management and public confidence in blood services.

Background and objectives: Hyperhaemolysis syndrome is a life-threatening complication of transfusion, potentially triggered by macrophage activation, with limited treatment options. Tocilizumab, an anti-IL6 monoclonal antibody, has mechanistic rationale for use and has been shown to be effective in a small number of cases. In this paper, we review four cases of hyperhaemolysis treated with tocilizumab in the context of the existing literature.

Materials and methods: Cases of use of tocilizumab in hyperhaemolysis were identified from two large specialist haemoglobinopathy centres between the period January 2021 and March 2025. Clinical and laboratory data were collected.

Results: Four cases of hyperhaemolysis treated with IVIG, steroids and tocilizumab were reported. In all cases, haemolysis responded rapidly to tocilizumab therapy. Two patients subsequently received RBC transfusions without haemolysis; two patients died from causes unrelated to haemolysis.

Conclusions: This case series supports the use of tocilizumab as a therapeutic option for rapid resolution of haemolysis. It is generally widely available and should be considered a suitable and cost-effective alternative to currently available options.

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.

Objective: To evaluate the benefits of implementing Bedside Electronic Transfusion Checks (BETC) to patients and value for money at four hospitals at Barts Health NHS Trust.

Background: BETC aims to enhance transfusion safety by reducing errors associated with positive patient identification checks for compatibility, blood sample labelling, and blood component administration. There is limited evidence on the potential benefits to patients and healthcare professionals as well as value for money for implementing BETC.

Methods: The BETC implementation at four hospitals adopted a non-randomised, staggered, multi-phase strategy. Alongside the implementation, an evaluation study was conducted. The intervention consists of a portable handheld scanning device and a mobile printer used for printing labels that are attached to the compatibility blood bottles and for verifying the patient's details against blood units prior to blood administration. Eligible patients are those who received blood transfusions or had compatibility tests performed during the evaluation period. The outcomes for evaluation include transfusion-related errors and cost savings from an NHS perspective. Regression-based time-series intervention analyses will be applied to evaluate the impacts of BETC implementation.

Expected results: The three-year evaluation includes a 12-month pre-implementation period (May 2022 to April 2023) and a 24-month implementation period (May 2023 to April 2025). All staff involved with bedside transfusion were trained on the new system. Data were collected from different transfusion datasets, process mapping dataset, and Health Economics Inventory dataset.

Discussion: Findings from this evaluation study will provide empirical evidence on the effectiveness and value for money of implementing BETC and will support decision-making for its wider roll-out in the UK.

Introduction: Hepatitis C is a silent disease characterised by a persistent inflammatory process in the liver. Since blood is the main route of transmission, the objective of this study was to estimate the positivity rate of hepatitis C virus (HCV) infection in blood donations from the Public Blood Network of the State of Santa Catarina and to analyse the temporal trend and spatial distribution of cases between 2010 and 2020.

Methods: This historical cohort study included blood donors who tested positive for HCV and donated blood at the service between January 1, 2010, and December 31, 2020.

Results: Out of a total of 1 316 605 blood donations, 782 new samples tested positive for HCV, corresponding to an overall positivity rate of 59.4 per 100 000 donations. The majority of HCV-positive donors were adults, male, of white skin colour, married, and had at least a secondary education. Most HCV-positive cases were found in the South and Coastal Regions of Santa Catarina, although municipalities with high positivity rates were observed across all macro-regions of the state.

Conclusions: The HCV positivity rate in blood donations from the Public Blood Network of the State of Santa Catarina demonstrated a downward trend over time, while maintaining sociodemographic characteristics similar to those reported in other regional studies. Furthermore, although HCV cases were reported in all macro-regions, the highest positivity rates occurred in the South, Alto Vale do Itajaí, Meio Oeste, Serra Catarinense, and Grande Oeste regions.

Background and objectives: Viscoelastic haemostatic assays (VHA) are part of patient blood management (PBM) for bleeding, associated with reduced transfusions. This study reviewed all major haemorrhage protocols (MHPs) using VHA in Queensland, Australia, and assessed variability.

Methods: VHA platforms in Queensland Health include rotational thromboelastometry (ROTEM® Sigma) and thromboelastography (TEG 6 s). PBM guidelines were searched for VHA-guided MHPs. Outcomes included viscoelastic thresholds and transfusion recommendations.

Results: Nineteen hospitals used VHA: sixteen with ROTEM and three with TEG. Among hospitals with ROTEM, fibrinolysis was assessed first in 13 algorithms, primarily using FIBTEM flat-line (n = 6) or ML >5% (n = 5). Fibrinogen thresholds were FIBTEM A5 <10 mm (n = 15) and <12 mm (n = 1). Platelet thresholds included EXTEM A5 <25 mm (n = 2) or EXTEM A5 <35 mm (n = 6) as isolated criteria, and EXTEM A5 <35 mm combined with FIBTEM A5 >10 mm (n = 9) as combined criterion. Coagulation factor thresholds were EXTEM CT >90 s (n = 13), EXTEM CT >80 s (n = 2) and INTEM CT ≥240 s (n = 1). TEG algorithms used CFF MA/A10 <15 mm (n = 3), <10 mm and <5 mm (n = 1). Platelet thresholds: CRT MA <50 mm (n = 3), and <25 mm (n = 1). Coagulation factor thresholds: CK R >9 min (n = 2) and CKH R >10 min (n = 1). Fibrinolysis: CRT LY30 >2.2% (n = 3). Doses varied across all algorithms: cryoprecipitate (10-30 U), FC (3-6 g), platelet (1-2 U), fresh frozen plasma (1-4 U), and prothrombin complex concentrate (PCC) (5-50 U/kg).

Conclusion: VHA-guided MHP showed marked variation with inconsistent transfusion thresholds. For similar clot kinetics, dosing of blood products and haemostatic agents differed, particularly PCC. Patients with the same coagulopathy may receive different treatment across hospitals. Centralised standardisation could improve PBM consistency.