Transfusion Medicine最新文献

Background: Blood transfusion's life-saving potential is often marred by the risks of transfusion-transmissible infections (TTIs) from blood donors, for which sub-Saharan African countries record some of the highest burdens.

Aims: We aimed to assess the seroprevalence of HBV, HCV, HIV, and Treponema pallidum among blood donors in Nigeria, and determine the association of seropositivity with particular blood donor characteristics.

Methods: A retrospective cross-sectional study was conducted to determine the seroprevalence of HBV, HCV, HIV, and Treponema pallidum among blood donors in 13 blood establishments in Nigeria's six geopolitical zones from January 2018 to December 2019 following screening with highly sensitive Enzyme-Linked Immunosorbent Assays. Data was collected from the country's web-based software District Health Information System, Version 2 and analysed using R Studio.

Results: The overall TTI seroprevalence was 10.1%, and declined from 10.9% in 2018 to 9.4% in 2019. Male donors (AOR = 0.1; 95% CI: 0.1-0.2, p < 0.001), those aged 46-55 years (AOR = 0.8, 95% CI: 0.7-0.9, p < 0.001), and first-time donors (AOR = 0.1, 95% CI: 0.10-0.12, p < 0.001) were less likely to be seropositive; whereas paid donors (AOR = 2.3, 95% CI: 2.1-2.6, p < 0.001) and mobile blood drive donors (AOR = 1.4; 95% CI: 1.3-1.5, p < 0.001) were more likely to be seropositive.

Conclusion: The seroprevalence of TTIs in Nigerian blood donors is high, especially among females, paid donors, and those at mobile donation sites, emphasising the importance of targeted continuous population health education and quality donor selection towards enhancing blood safety.

Objective: This study aims to explore the impact of pressurisation and simultaneous warming at a combination of 50 kPa and 46°C on the quality of suspended red blood cells in an ex vivo environment.

Background: During massive rapid blood transfusion, pressure and temperature-controlled blood warming devices are often used to prevent hypothermia caused by the infusion of large amounts of cold blood. If the pressure and temperature are not properly applied during this process, it can endanger the patient's life safety.

Methods/materials: 400 mL of human suspended red blood cells stored at 2-6°C were subjected to pressure and simultaneous warming at a combination of 50 kPa and 46°C. Changes in blood temperature and blood quality-related indicators before and after warming under pressure were detected, with the procedure repeated six times.

Results: In the ex vivo simulated test environment, there were no statistically significant differences in routine blood indicators, biochemical indicators, and hemolysis rates of suspended red blood cells before and after pressure and warming transfusion at 50 kPa pressure and 46°C temperature (P>0.05). There were no significant changes in osmotic fragility after pressure and warming transfusion, and no obvious hemolysis was observed in the morphology of suspended red blood cells under an electron microscope.

Conclusion: In the ex vivo simulated test environment, pressure and warming transfusion at 50 kPa pressure and 46°C temperature had no significant impact on blood quality, and the blood quality met the standards for the use of blood products.

Objectives: To understand the current status of transfusion training for haematology specialty registrars in the UK and identify potential solutions for improvement.

Background: Transfusion knowledge and experience are essential for all haematologists. There are concerns regarding inconsistencies with the delivery of transfusion training.

Methods: A 30-question online survey was distributed using the SurveyMonkey platform to UK haematology specialty trainees in June-July 2023.

Results: A total of 150 responses (response rate 24%) were received from trainees at different stages of training in 17 training regions. Forty-four percent (66/150) trainees had undertaken or were expected to undertake a dedicated transfusion post during their training; these were deemed to be educationally useful. Ninety-nine percent (149/150) trainees had managed transfusion queries at work. Most trainees (69%, 103/150) had received teaching in hospitals outside of a dedicated transfusion post. A high proportion (87%, 131/150) had attended a transfusion course provided by a national blood service. Levels of overall satisfaction with the transfusion training provided varied: very satisfied/satisfied (30%), neutral (31%), dissatisfied/very dissatisfied (39%). The most common barriers to training selected were lack of exposure to the transfusion laboratory (75%), clashing clinical commitments taking priority (74%), and lack of provision of dedicated transfusion training (70%).

Conclusion: There is mixed satisfaction with the transfusion training received by UK haematology registrars, evident from this survey. Protected time for transfusion training in dedicated transfusion posts and in other hospital posts, including laboratory time, is needed for all haematology trainees.

Objectives: Evaluating blood transfusion practices and their impact on morbidity and mortality across extracorporeal membrane oxygenation (ECMO) configurations.

Background: As ECMO becomes increasingly utilised in critical care, the ideal Hgb level remains uncertain. While guidelines recommend higher levels, emerging evidence suggests potential harm. Our study addresses this gap by investigating the optimal Hgb level for ECMO.

Methods: A retrospective cohort study included all adult patients receiving ECMO between January 2016 and December 2018. The primary outcome assessed the optimal Hgb level associated with reduced ECMO duration and in-hospital mortality. Multivariable and Cox-proportional regression analyses were performed.

Results: A total of 306 patients underwent ECMO, with 31 patients having mean Hgb levels 7-7.9 g/dL, 176 patients 8-8.9 g/dL, 72 patients 9-9.9 g/dL, and 27 patients ≥10 g/dL. The mean (SD) age was 56 years (15), with 60.8% male (186/306). ECMO configurations were primarily Venoarterial (VA) (59.8%), followed by Venovenous (VV) (36.9%) and Hybrid (3.3%). The 7-7.9 g/dL Hgb group was associated with longer ECMO duration (mean 17.5 days, coefficient 2.2, 95% CI 0.02-4.4, p = 0.048) compared to the ≥10 g/dL group, with no significant mortality differences across Hgb levels. VA ECMO patients had a significantly higher mortality risk than VV ECMO patients (aHR 2.33, 95% CI 1.50-3.60, p < 0.001). Blood product use, including RBC and Cryo, was associated with longer ECMO duration, while FFP reduced both duration (coefficient - 0.84, 95% CI -1.11--0.57, p < 0.001) and mortality risk (aHR 0.895, 95% CI 0.818-0.973, p = 0.012).

Conclusion: Targeting Hgb level >8 g/dL in ECMO patients may help reduce ECMO duration.

Background: During the COVID-19 pandemic, blood banks faced the risk of shortages of blood components and adopted measures to mitigate this threat. The present study aims to describe the influence of the pandemic on a large hemotherapy centre, including data from 21 regional blood centres (Hemominas-Minas Gerais/Brazil).

Methods: Time series for the blood donor attendance were constructed covering 8 years (2016-2023). Blood centre performance indicators from the pandemic period (2020-2023) were compared with the pre-pandemic period (2016-2019).

Results: During the pandemic, a 11.6% decline in the production of blood components was observed (Semiannual average of 355 511 vs. 402 528 units). The first half of 2022 was the period with the highest number of COVID-19 cases (third wave) and the lowest production. The drop in the number of candidates for blood donation was more pronounced in the most populated cities. An increase in returning donors was observed, as well as a decrease in the deferral rate. The time series analysis indicated a strong downward trend in blood donors during the pandemic period but with a tendency to recover from the second half of 2023.

Conclusion: The COVID-19 pandemic significantly affected the hemotherapy system in Minas Gerais, resulting in a drop in the production of blood components. The operation of Hemominas as a network of blood centers contributed to mitigating the effects of the pandemic, alleviating the scarcity of blood components, especially in the most populated cities, where blood donation was very affected and where the largest and most complex hospitals are located.

Pure red cell aplasia (PRCA) is a known complication of major/bi-directional ABO incompatible allogeneic stem cell transplantation (ABOi allo-SCT). Persistence of recipient's antibodies against the donor's red blood cells (RBCs) leads to delay in recovery of RBCs which can last up to several months. This complication can result in patients becoming transfusion dependent. There is no standard treatment but a combination of different treatment strategies which includes tapering immunosuppression/discontinuation, steroid, erythropoietin, anti-CD-20 monoclonal antibody, daratumumab and therapeutic plasma exchange (TPE). Here we report a case of PRCA after ABOi allogeneic peripheral blood SCT treated successfully with TPE.

Background: Mixed agglutination is a serological pattern in some ambiguous ABO blood type identification. This study focused on the serological and molecular genetic characteristics of a B3 phenotype induced by a c.259G > T mutation in the ABO gene.

Study design and methods: Serological methods such as gel cards and tubes were used to identify the ABO blood type of the patient, with fluorescent PCR for ABO genotyping and Sanger sequencing for analysing the ABO exons. Protein 3D Structure was simulated and further analysed using SWISS-MODLE and PyMOL. Both the wild-type (VAL-87, ABO*B.01) and the mutant (p.Val87Leu) plasmids were transfected into Hela cells to assess the agglutination intensity of the transfected cells with anti-B antibodies.

Results: Serological testing showed weak expression of the B antigen and mixed agglutination with anti-B antibodies. ABO genotyping indicated the presence of a B allele, but exon sequencing revealed an additional c.259G > T mutation in exon 6 based on the ABO*B.01 allele. The simulated three-dimensional structures of the proteins showed increased steric hindrance with mutations, leading to a relatively loose structure. The transfected Hela cells with the mutant (p.Val87Leu) plasmid exhibited a significantly reduced agglutination intensity with anti-B antibodies.

Conclusion: Based on comprehensive serological, genetic, and simulation analyses, it is concluded that the c.259G > T mutation in exon 6 of the ABO*B.01 allele results in an amino acid change within the enzymatic active site. This alteration likely impacts protein stability and reduces B antigen expression, leading to the B3 subtype phenotype.

Background and objectives: Blood safety is the top priority in transfusion medicine. However, patients in Vietnam are only transfused with ABO and RhD compatible blood products, which could pose a threat to induce alloimmunization. This study was performed to provide information about the frequencies of antigens and phenotypes of clinically significant blood groups in Vietnamese donors.

Materials and methods: Blood samples were taken from donors to identify red cell antigens by column agglutination tests. Antigen and phenotype frequencies were calculated and expressed as percentages. Gene frequencies were calculated under the standard assumption of Hardy-Weinberg equilibrium.

Results: Among the Rh antigens, e was the most common (96.96%) followed by D (96.72%), C (92.86%), c (43.10%), and E (32.59%) with D+C+E-c-e+(54.02%) being the most common phenotype. In the Lewis and Duffy blood group system, the major phenotypes found were Le (a-b+) (60.43%) and Fy (a+b-) (85.39%), respectively. In the Kell and Lutheran blood group system, k and Lu^b were present in 100% of the donors, respectively. The most common phenotypes in the Kidd and MNS blood group system were Jk (a+b+) (47.62%) and M + N+(46.63%), S-s+ (94.42%), respectively. Mi^a was seen in 9.20% of the donors. The frequency of P1 was 22.25%.

Conclusion: This study shows the frequencies of 21 blood group antigens in Northern Vietnam donors. Knowledge of red cell antigen phenotype frequencies can help prepare indigenous cell panels, provide antigen-negative blood to patients with multiple alloantibodies, and prevent alloimmunisation.