Transfusion Medicine最新文献

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.

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.

This systematic review and meta-analysis aim to evaluate the changes in coagulation factor and bacterial contamination by extending the preservation period of thawed cryoprecipitate for 5 days at refrigerated temperatures. Literature searches were conducted from three different databases, and the literature was screened according to the inclusion criteria. The quality of the literature was assessed using the Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I) tool, and a meta-analysis was conducted using RevMan5.3 software. Finally, five studies met the inclusion criteria. The meta-analysis results show that fibrinogen concentration remains stable after storing the thawed cryoprecipitate at refrigerated temperatures for 5 days Mean Difference (MD) = -0.0802, 95% Confidence Interval (CI) = -0.4220, 0.2616, p = 0.65. The systematic review showed that thawed cryoprecipitate stored at refrigerated temperatures for 120 h had a slight decrease in factor VIII activity but still met the current standard, von Willebrand factor content level remained relatively stable, factor XIII activity showed no significant decrease, and no bacterial contamination was detected. Overall, the available data suggest that fibrinogen concentration remained stable and no bacterial contamination was detected after storing the thawed cryoprecipitate at refrigerated temperatures for 5 days. The lack of assessment of aggregate formation is an important limitation of this review. In addition, the number of relevant studies is still relatively limited, and further extensive studies are necessary to confirm this conclusion.

Objectives: This study aimed to assess the concordance and comparative accuracy of commercially available immunohematology (IH) tests for pretransfusion testing.

Background: Pretransfusion tests are intended to ensure donor blood is matched with a compatible recipient. Automated testing has become the mainstay since the commercialisation of IH analysers, because of their reduced risk of human error and increased efficiency.

Methods/materials: A systematic literature review (SLR) was performed to identify studies evaluating the concordance and sensitivity/specificity of IH tests for ABO/RhD typing, antibody screening, or antibody identification. Pairwise meta-analysis of concordance and sensitivity/specificity of IH tests was conducted when feasible.

Results: The SLR identified 48 publications, of which 30 were included for meta-analysis. ID/IH gel (Bio-Rad), DG gel (Grifols), MTS/BioVue gel (Ortho Clinical Diagnostics), and Capture R (Immucor/Werfen) all had almost 100% pooled concordance with each other in ABO/RhD typing and antibody screening. Antibody identification results varied across studies, and pooled concordance rates were lower: 97.53% for DG gel versus ID/IH gel, 85.26% for ID/IH gel vs. MTS/BioVue gel, 85.54% for DG gel versus MTS/BioVue gel, and 71.19% for Capture R versus MTS/BioVue gel. For antibody screening, ID/IH gel, DG gel, and MTS/BioVue gel had pooled sensitivities of 94.23%, 96.31%, and 97.27%, respectively, with a pooled specificity of ~100% for all three tests.

Conclusion: All tests had good concordance in ABO/RhD typing and antibody screening, and lower pooled concordance rates for antibody identification. For antibody screening, 95% pooled sensitivity and ~100% specificity were estimated for DG gel, MTS/BioVue gel, and ID/IH gel.

Objective: To examine whether specific attitudes towards blood donation vary across MSM demographic groups; and preliminarily test whether these attitudes predict prior donation behaviour.

Background: Insights into blood donors' attitudes facilitate effective donor management, especially as policies for men who have sex with men (MSM) become more inclusive. While attitudes towards donating blood can predict donor decisions, it is unclear whether attitudinal factors specific to MSM groups will be important considerations for blood service providers engaging with this newly eligible donor group.

Methods: Data were drawn from a large (N = 3157) online cross-sectional survey of MSM in New Zealand. New items were developed to assess three attitudinal constructs: negative attitudes towards the MSM deferral policy, favourable attitudes towards blood services, and the tendency to view blood donation as a form of civic participation and belonging. Univariate analyses descriptively characterised demographic factors associated with those various attitudes, and multivariate logistic regressions were used to predict self-reported donation histories.

Results: Negative views of deferral policies and blood services varied across sample characteristics in univariate analyses, but did not systematically differ between donors and nondonors. However, a perception of blood donation as a means of civic belonging was consistently associated with greater donation, including 1.46 times the odds of having ever donated (p < 0.001) and 1.40 times the odds of having donated recently under the current 3-month deferral policy (p = 0.017).

Conclusion: These findings highlight the importance of recognising broader civic-related attitudes in MSM donor research and engagement strategies.

Background: The D antigen is the most clinically important antigen in the Rh system due to its high immunogenicity and being the main cause of hemolytic disease of the foetus and newborns (HDFN). High polymorphism of the RHD gene implicates that new RHD variant alleles may be regularly identified.

Study design and methods: D antigen status was examined using saline tubes with IgM anti-D (clone RUM-1). If a negative result was observed, indirect antiglobulin test (IAT) and adsorption-elution test were performed with four monoclonal anti-D reagents. A D-screen identification kit was used for partial D identification. All 10 exons of the RHD gene plus flanking intronic regions were amplified and sequenced.

Results: The serological investigation showed clearly negative results with all anti-D reagents used when testing against both probands RBCs. The sequencing results of probands revealed c.802-1G>C mutation in proband 1 and c.1154-2A>T mutation in proband 2. These mutations resulted in the change of 3' splice site in the intron-exon junction of intron 5 or intron 8 of the RHD gene from AG to AC or TG, abolishing the splicing effect.

Conclusions: We identified two novel splicing variants resulting from c.802-1G>C and c.1154-2A>T mutations in the RHD gene. Both mutations may abolish the splicing effect of the involved exons, leading to the D-negative phenotype.