Transfusion Medicine最新文献

Background and objectives: High-quality ABO antibody titre testing is required for ABO-incompatible haematopoietic stem cell transplantation and kidney transplantation. To assess the feasibility of automated ABO titration as an alternative to manual and semi-automatic titration during the peri-transplant period, a comparative study was conducted internally in a transfusion medicine laboratory.

Materials and methods: This study was performed in two stages. Firstly, the differences in anti-A/B detecting using conventional tube test (CTT) and manual column agglutination technology (CAT) were compared in group O pregnant women. Then, manual and automated CAT were applied to simultaneously detect ABO antibody levels in non-AB-group adult haematological oncology patients.

Results: In the first stage, four groups of 192 comparable results were generated from 48 subjects, which showed a high correlation between CTT and manual CAT (p < 0.001). However, the detection sensitivity of the latter was at least 1 fold higher dilution than that of the former. Fifty-six patients were tested in the second stage by simultaneous manual and automated CAT, and the paired titers differed within an acceptable range (±1 fold dilution). However, the concordance was slightly higher in group IgM (85.4%) than in group IgG (80.5%). Blood group specificity of ABO titers was also observed in this population, and no association between titers and other factors was found.

Conclusion: Automated CAT standardises ABO titre testing and saves labor costs, although manual review of weak positive reactions is still necessary. Due to the blood group specificity of ABO antibodies, special attention should be paid to the quality control and clinical relevance of titre testing for group O recipients in ABO-mismatched transplantation.

Objectives: Trauma-induced coagulopathy (TIC) can be fatal but preventable if recognised early. With emerging uses of rotational thromboelastometry (ROTEM) to guide transfusions in trauma, patient outcomes with TIC-defined by initial ROTEM and conventional coagulation tests (CCTs) during massive haemorrhage protocol (MHP) activations were evaluated at a primary trauma centre in British Columbia.

Methods: This retrospective observational study included adult trauma patients requiring MHP from June 1, 2020, to May 31, 2022. TIC, defined by initial results including (1) ROTEM-based EXTEM A10 <40 mm, EXTEM CT >100 s, EXTEM ML30 >10%, FIBTEM A10 <10 mm; and (2) CCT-based INR ≥1.8, PTT ≥1.5 times of upper normal limit, platelets <50 x 10⁹/L, and Clauss Fibrinogen <1.5 g/L, was assessed for its correlation with mortality. Modified Poisson regression was used to model 28-day mortality.

Results: Twenty-two of sixty-eight patients (32%) had abnormal ROTEM but normal CCTs. TIC defined by CCTs was associated with increased mortality [24 h: 5/13 (38%) vs. 5/55 (9%), p = 0.025; 28d: 8/13 (62%) vs. 11/55 (20%), p = 0.002]; compared to ROTEM, which was not [24 h: 7/35 (20%) vs. 3/33 (9%), p = 0.307; 28d: 11/35 (31%) vs. 9/33 (27%), p = 0.594], despite requiring significantly higher blood component transfusion within the first 4 and 24 h of MHP (p-values<0.05).

Conclusions: ROTEM is more sensitive in identifying TIC. Patients with abnormal CCTs had a higher death rate, and those with abnormal ROTEM had no significantly increased mortality. A prospective study is required to assess the effects of ROTEM further.

Introduction: Due to the non-availability of formal training during residency for clinicians in transfusion medicine, there is a prevalent knowledge gap for transfusion practices, which leads to increased patient risks and elevated healthcare costs. There is no indigenous questionnaire available, which could be used for knowledge assessment. This study aims to develop and validate an Indigenous questionnaire to assess clinicians' knowledge of transfusion medicine and bedside transfusion practices.

Materials and methods: The questionnaire was designed using a nominal group technique involving subject experts, considering the type of information required, themes, appropriate wording, layout, and presentation. The questionnaire consisted of 25 knowledge-based questions and 4 general questions. Piloting of the questionnaire was done to check for feasibility, validation, and reliability. Content validity was assessed by six experts using the Content Validity Index (CVI). Reliability was assessed using test-retest and split-half methods, with a sample of 56 participants. Cronbach's alpha and Kappa statistics were used to measure internal consistency and agreement, respectively.

Results: The questionnaire displayed acceptable feasibility with a mean difficulty score of 6.93 on a scale of 1-10, with test-retest responses showing near-perfect agreement (kappa value 0.8-0.99). All experts gave more than 70% agreement on the relevance of content, with a mean CVI of 85%. Test-retest reliability showed near-perfect agreement (Kappa 0.8-0.99, p = 0.008) and good internal consistency (Cronbach's α = 0.806). The split-half method yielded a Cronbach's α of 0.89 and an intraclass correlation coefficient of 0.88 (95% CI 0.57, 0.97, p = 0.001) Construct validity was confirmed through factor analysis.

Conclusion: The developed indigenous questionnaire is a reliable and valid tool for assessing the knowledge of clinicians towards transfusion medicine and bedside transfusion practices. The detailed, methodical strategy used to prepare and validate the questionnaire ensures its applicability and relevance in various clinical settings and can be easily adopted by others intending to prepare similar questionnaires. The questionnaire is available with the author and, on demand, may be provided for knowledge assessment.

Aim: This cross-sectional study aimed to determine the impact of a severe earthquake on blood donation as per blood safety and donation behaviour.

Materials and methods: This retrospective cross-sectional study included a total of 263 779 whole-blood donors at the Turkish Red Crescent during two periods: before (25 January 2023 - 5 February 2023) and after (6 February 2023 - 17 February 2023) the earthquake that occurred on 6 February 2023. Demographic data describing the donors, donor types, the number of blood donations by province, blood donations by blood groups, hospital demand, and transfusion transmissible infection (TTI) rates according to donor type were evaluated.

Results: There was a 129% increase in blood donations after the earthquake. his increase was significant among female donors, younger age groups, and first-time donors. However, a significant increase in TTI rates was not detected in either first time donors or repeat donors.

Conclusion: Our study focuses on blood banking activities of the Turkish Red Crescent during the 2023 Türkiye earthquake. While previous disasters have shown excess blood collection, we emphasise the need for a balanced approach to avoid wastage and shortages. Our study emphasises the importance of efficient blood utilisation and the necessity of regular, voluntary blood donations to ensure a stable supply, especially for high-demand blood groups like O Rh (-).

Introduction: Therapeutic thrombocytapheresis (TTA) is used to promptly reduce platelet count to prevent thrombohemorrhagic complications that may develop in extreme thrombocytosis. In this study, the efficacy and safety of TTA were investigated in our patients who underwent TTA for extreme thrombocytosis for more than 20 years.

Materials and methods: Forty-four patients who underwent TTA due to extreme thrombocytosis between January 2000 and December 2021 in Erciyes University, Faculty of Medicine Therapeutic Apheresis Unit were analysed retrospectively. Extreme thrombocytosis was defined as a platelet count >1000 × 10⁹/L.

Results: The median percentage of platelet reduction was 62.2% (28.6%-90.1%). TTA was administered with Spectra Optia in 45.5% (n = 20) and Fresenius in 54.5% (n = 24) of the patients. No statistically significant difference was observed between age, gender, diagnoses, and devices used regarding TTA efficiency. The percentage of platelet reduction was higher in those who had a platelet precount above 1500 × 10⁹/L than those who did not (64.5% ± 9.9% vs. 57.3% ± 12.9%, p = 0.045). No major complications were observed. Mild side effects were observed in five (11.4%) patients.

Conclusion: TTA provided prompt, effective, and safe reduction of platelet count in the treatment of extreme thrombocytosis.

Background and objectives: Mononuclear cell (MNC) collection is critical for paediatric patients undergoing cellular therapies such as chimeric antigen receptor T-cell and haematopoietic stem cell transplantation. In children, extracorporeal volume (ECV) often exceeds 15% of total blood volume (TBV), traditionally necessitating red blood cell (RBC) priming to reduce the risk of haemodynamic instability. However, RBC priming introduces allogenic blood exposure and related complications. This study evaluated the safety and feasibility of unprimed MNC collection in paediatric patients with ECV/TBV ratios greater than 15%.

Materials and methods: We retrospectively reviewed two paediatric patients with B-cell acute lymphoblastic leukaemia (B-ALL) who underwent MNC collection using the Spectra Optia system in continuous mononuclear cell collection mode. Both patients had ECV/TBV ratios of 16% and 17%, respectively. Vital signs and laboratory parameters were monitored throughout and after the procedures to assess for adverse events, haemodynamic instability, and need for transfusion.

Results: Both patients completed MNC collection without adverse reactions, interruptions, or clinically significant changes in vital signs. Post-procedural haemoglobin and platelet counts showed no major declines, and neither patient required transfusion. Collection efficiency met institutional standards, and no symptoms of hypovolemia or citrate toxicity were observed.

Conclusion: Unprimed MNC collection can be safely performed in paediatric patients even when the ECV/TBV ratio exceeds 15%. With careful monitoring and procedural planning, this conservative strategy may reduce allogenic blood exposure without compromising safety or collection efficiency.

Background: A large, retrospective study was designed to interrogate current NHS Blood and Transplant (NHSBT) HLA matching strategies for the provision of HLA selected platelets (HLA SP) and to determine whether additional factors such as ABO blood group matching, patient diagnosis, patient and/or donor age, sex, ethnicity, age of platelet unit at transfusion and possibly seasonal variation also play a role in transfusion efficacy.

Materials and methods: Data for 56 640 HLA SP transfusions over a 3-year period were collected. Transfusions with missing data for any factor under consideration were excluded, resulting in a cohort of 13 044 transfusions for analysis. Univariable and multivariable regression models were used to determine if any factors influenced an increase in platelet count of ≥10 × 10⁹/L. A stepwise logistic regression was applied, such that each influential factor was adjusted for effects on other factors included in the study.

Results: HLA match grade was confirmed as a significant factor in transfusion efficacy, with ABO mismatched units 20% less likely to give an adequate platelet increment (≥10 × 10⁹/L). Platelet donor age, gender and ethnicity were not significant. Conversely, patient diagnosis, ethnicity, gender and age showed significant associations with platelet increments. Some seasonal variation in efficacy of platelet transfusion was also demonstrated.

Conclusion: This study has demonstrated the efficacy of HLA SP transfusions in refractory patients with a wide range of diagnoses, the importance of HLA match grade, plus the marginal effect of ABO matching. A wide range of donor-related factors was excluded, while a number of patient-related factors were identified, requiring more extensive investigation in ongoing and independent studies, with implications for donor registry, clinical and laboratory practices.

Background: Red blood cell (RBC) alloimmunization is rarely reported in infants less than 4-6 months of age.

Methods/materials: Blood group and antibody screening used the gel card technique. All blood products were leukoreduced. All RBC doses transfused were group O, E-neg, K-neg but the pooled platelets transfused on day 45 and 61 included donors who were K-pos, and that transfused on day 61 also included an E-pos donor.

Results: We report a group O neonate with haemophagocytic lymphohistiocytosis (HLH) who developed alloantibodies to E and K antigens at 65 days (9 weeks) of age.

Conclusion: HLH is an inflammatory, 'hyperimmune' state, and alloimmunization is more likely when inflammation is present. If significant inflammation is present, transfusions should be avoided if possible.

Background: The Rh system is an extremely important blood group system with over 50 antigens, 5 of which (D, C, E, c and e) are considered most clinically significant. Rare Rh deficient phenotypes include D--, which is a blood group characterised by the lack of expression of C, c, E and e and exalted expression of the D antigen on the red cells due to mutations in both alleles of the RHCE gene. This is a multicentre approach to a case of the rare D-- phenotype.

Case report: A 56-year-old lady with bad obstetric history presenting with severe anaemia had to be evaluated for a panreactive antibody affecting cross-matching. On identifying a D-- phenotype by serology, a thorough family study was performed on 18 of her first and second-degree relatives. Three family members were also found to be of the rare phenotype, one of whom was pregnant. This relative was counselled appropriately and provided with an overview of her phenotype for her obstetric care team. Molecular analysis by QMPSF confirmed the serological findings. This case eventually became the motivation behind an institutional "rare donor" registry programme.

Results: Serology revealed a panreactive antibody affecting cross-matches. Her Rh phenotype was D+, C-, c-, E-, e-, K-, k+. Molecular analysis on her and three family members suggested homozygous CE-D hybrid alleles causing the D-- phenotype: RHCE-D(3-9)-CE.

Conclusion: D-- is an uncommon phenotype and was found to occur in a cluster in this family. Like most difficult immunohematological cases, it mandated a multicentric and a multi-technique approach to resolve.

Background: Blood transfusion is one of the priorities of a health system. However, this topic is poorly documented in under developing countries.

Objective: Describe the supply of blood transfusion in the West Region of Cameroon.

Methods/materials: This was a descriptive cross-sectional study conducted in health facilities that handles blood transfusion in the West Region of Cameroon from March to May 2022. Data were collected using an observational grid and a questionnaire administered face-to-face to the health personnel involved in blood transfusion to collect informations on blood transfusion practices. These data were analysed using SPSS 20 software for proportions and ArcGIS 10.3.1 for blood transfusion maps.

Results: 90/877 health facilities of the West Region supplied blood transfusion. Each of the 20 health districts had at least one health facility supplying blood transfusion service. Among the 90 health facilities supplying blood transfusion service, 86 (95.5%) consented to participate in the study. A mean of 4.5 health facilities carried out blood transfusion per health district with 3.8 health facilities per 100,000 occupants. Of the 90 health facilities, 14 (16.3%) had a blood bank, with 03 (21.4%) being non-functional, for a mean of 0.4 blood bank for 10,000 occupants. A total of 18 health facilities supplying blood transfusion were found around a radius of 5 km from a functional blood bank. Among the 86 health facilities, 12 (13.8%) had a blood conservation room; the main source of blood for transfusion was family donors 62 (72%); the type of blood product most frequently administered was whole blood 82 (96.5%); 3 (3.4%) had a plasma extractor/manual separator; 19 (22.1%) performed the ELISA chain, and the Cross match was performed in 57 (66.3%) health facilities.

Conclusion: The results of the study reveal limited geographic access of populations to health facilities supply blood transfusion and to blood banks in the West Region of Cameroon.