Vox Sanguinis最新文献

Background and objectives: The presence of warm autoantibodies (WAAs) complicates pre-transfusion and compatibility testing. Despite attempts to provide antigen-matched red blood cells (RBCs), the risk of alloimmunization remains. Rates of alloimmunization and indications for transfusion were reviewed to streamline testing and RBC provision algorithms at a large tertiary care centre serving patients with lymphoid cancers and complex surgical needs.

Materials and methods: This retrospective observational study investigated the development of new RBC alloantibodies in patients with WAAs. This included 295,109 antibody screenings and 3129 antibody investigations (AIs) performed on 2493 patients between 1 September 2019 and 30 June 2024. AI results for patients with a history of WAAs were reviewed, along with diagnoses, transfusion data, and where applicable, phenotyping and genotyping results.

Results: Ninety-four patients had WAAs. Twenty-three of them (24%) had lymphoproliferative disorders (LPDs) and 21 (22%) required urgent antibody tests for surgical procedures. Fifty-one patients (54%) received RBC transfusions, and 30 of them (59%) had anaemia with haemoglobin below 70 g/dL. Thirteen patients (14%) required RBC genotyping because of recent transfusions or indeterminate results. The alloimmunization rate was 10%, including anti-Jk^a, anti-Kp^a, anti-Jk^b, anti-C^w, anti-Js^a and anti-Le^a, after RHDCE/K or more extended-matched RBC transfusions.

Conclusion: RBC alloantibodies develop in patients with WAAs, as the urgency of transfusions often limits the complete identification of antibodies and extended phenotype matching. With prompt investigation and RBC preparation, the risk of alloimmunization to major antibodies can be minimized.

Background and objectives: Natural disasters pose significant challenges to maintaining a continuous and safe blood supply. This study aimed to analyse the emergency response of the Turkish Red Crescent (TRC) blood services during the 2023 Turkey earthquake, focusing on blood supply continuity, donor mobilization and lessons learnt for future preparedness.

Materials and methods: A retrospective analysis was conducted using operational data from the TRC General Directorate of Blood Services. Information on blood component requests, supplies, donor mobilization, infrastructure status and personnel deployment was collected from the period immediately following the earthquake through the subsequent recovery phase.

Results: The earthquake severely disrupted blood service infrastructure in the affected provinces, resulting in the destruction of two blood collection units and damage to several facilities. Despite these challenges, the TRC successfully met demands from the transfusion centres through rapid activation of its Emergency Crisis Board, inter-regional redistribution of packed red blood cells and strategic donor management. Within 15 days, 250,708 blood units were collected nationwide-a 129% increase compared to pre-disaster levels. Controlled donation scheduling, proactive communication and inter-regional staff deployment ensured sustained operations and prevented overcollection. However, gaps in data interoperability between hospitals and TRC systems limited real-time monitoring of clinical blood usage.

Conclusion: The TRC's response demonstrated the effectiveness of a centralized and integrated blood service model in managing large-scale emergencies. Key lessons include the importance of donor flow regulation, transparent communication and improved hospital data integration to enhance future disaster preparedness and resilience.

Background and objectives: This study presents the results and experiences of bacterial testing of blood components (BCs) at the Croatian Institute of Transfusion Medicine during the period 2011-2024.

Materials and methods: During the 14-year period, 74,283 BCs were tested. Among these, 20,231 components (8345 red blood cell concentrates, 5729 platelet concentrates [PCs] and 6157 plasma units) were tested as part of statistical quality control (QC). In addition, 100% bacterial screening was implemented for aphaeresis platelets in November 2019 and for pooled platelets in October 2022 with 17,187 aphaeresis platelets and 36,865 pooled platelets tested by the end of 2024. All pooled platelets were tested using the large-volume delayed sampling (LVDS) method, whereas 9596 aphaeresis platelets were tested using the two-step method (from November 2019 to November 2022) and 7591 using LVDS (from November 2022 to December 2024). BCs were sampled and inoculated into both aerobic and anaerobic culture bottles and incubated at 36 ± 1°C for 7 days.

Results: As part of the statistical QC, 20,231 BCs (5729 PCs) were tested, resulting in a confirmed contamination rate of 0.09% (0.14% for PCs). Since the implementation of universal screening, 54,052 PCs have been examined, with a confirmed positivity rate of 0.18%. The most frequently detected organism was Cutibacterium acnes.

Conclusion: The confirmed positive rate of bacterial testing in our study and the isolates from positive cultures are comparable to similar studies. Active bacterial screening of BCs, among other measures, remains a critical step for preventing transfusion-associated bacterial infections.

Background and objectives: Cord blood contains an array of microRNAs (miRNAs) regulating gamma globulin expression. However, miRNAs in exosomes from cord blood have not been reported yet. This study aims to analyse the differential expression of miRNA regulating fetal haemoglobin expression in cord blood exosomes and exosomes of maternal sample as control.

Materials and methods: This study includes exploration of putative gene targets for upregulation of fetal haemoglobin by bioinformatic tools such as MicroRNA Base (miRBase), MicroRNA Regulatory Network Analysis (miRNet) and MicroRNA Prediction (miRmap). The exosomes were isolated from EDTA sample of cord blood using a commercially available kit (Qiagen, GmbH, Germany). Total RNA was isolated from the exosome pellet by miRNA easy Mini Kit and SYBR green miRNA quantitative reverse transcription polymerase chain reaction (qRT-PCR) kit was used to validate the expression of miRNAs. The miRNAs of exosomes were analysed to see their presence or absence and fold changes in their expression in cord blood compared to the maternal sample as control.

Results: The cord blood exosomes showed a significantly increased expression of miRNA 15a-5p, 381-3p, 210-3p, 326 and 103a-3p in cord blood exosomes compared to exosomes of maternal plasma sample. However, the differential expression was not significant for miRNA 486-3p, 23a-3p, 27a-5p, 96-5p, 34a-5p, 23b-3p and let-7a-5p. Bioinformatically, significantly increased miRNA expression responsible for increased fetal haemoglobin (HbF) level was associated with B-cell lymphoma/leukemia 11A (BCL11A), Myeloblastosis (MYB), Kruppel-like factor-1 (KLF-1), Testicular Rreceptor 4 (TR4), Specificity Protein 1 (SP1) and SRY-Box Transcriptor Factor 6 (SOX6) genes.

Conclusion: This study finds the presence of potential miRNAs in cord blood exosomes regulating HbF level in cord blood. The results of this study may serve as the basis for future clinical trials to reactivate the HbF expression in sickle cell disease (SCD).

Background and objectives: In July 2020, Brazil removed the long-standing restrictions on blood donation by men who have sex with men (MSM), shifting donor eligibility criteria towards individual behavioural risk assessment. We sought to establish the impact of this policy change on the safety of the blood supply.

Materials and methods: This retrospective cross-sectional study evaluated the prevalence and incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among blood donors at Fundação Pró-Sangue/Hemocentro de São Paulo. Data were analysed across two periods: before (P1: January 2019-June 2020) and after (P2: July 2020-December 2023) the MSM policy change. Prevalence was assessed in first-time donors, and incidence was calculated among repeat donors. The chi-square testing was used for statistical comparisons (p < 0.05).

Results: A total of 560,528 donations were included in the study. There were no significant differences in the prevalence per 100,000 donations of HIV (46.3 vs. 43.5; p = 0.77), HBV (33.3 vs. 27.7; p = 0.56) or HCV (94.1 vs. 72.6; p = 0.09) markers between P1 and P2. However, the prevalence of serological markers for syphilis increased significantly (745.7 vs. 1115.8; p < 0.0001) after the policy change. Donors with positive serological markers for syphilis in P2 were mostly younger and had higher education levels.

Conclusion: Lifting the MSM deferral policy in Brazil did not increase the prevalence or incidence of HIV, HBV or HCV markers among blood donors. The observed increase in the prevalence of serological markers for syphilis likely reflects broader population trends. These findings support risk-based donor screening as a safe and equitable approach to blood collection.

The application of technologies to inactivate pathogens in pooled plasma products is nowadays the standard. The number of blood centres applying these technologies to platelet concentrates is steadily increasing. However, pathogen inactivation (PI) of red cell concentrates and whole blood (WB) is challenging, as the haemoglobin-containing red cells quench light, and therefore require a different approach. Three technologies are currently under active development: S-303 (Intercept), UV-C (Theraflex) and riboflavin/UV (Mirasol). The S-303 technology is used for PI of red cell concentrates and has seen significant technical and clinical development in the last decade. Using this technology, red cell both ATP and haemolysis levels conform to objective requirements. For the UV-C technology, only one publication is available showing satisfactory quality of treated red cell concentrates in vitro. Lastly, the riboflavin and UV light technology is used on WB, and the in vitro data show room for improvement for red cell ATP and haemolysis levels. Part II of this review focuses on recovery studies and clinical trials that have been performed using pathogen-inactivated red cell concentrates.

Background and objectives: Early balanced transfusion is recommended for resuscitation of patients with severe bleeding. Whole blood (WB) is reintroduced as a feasible alternative to blood components, as it includes red blood cells, plasma and platelets in a physiological ratio.

Materials and methods: In this review, we aim to provide practical guidance and a framework for blood providers aiming to implement a WB programme. The review summarizes recommendations and practical implications identified from published literature, regulatory requirements and current programmes.

Results: WB donors are selected based on national donor selection criteria. When the patients' ABO-type is unknown, low titre anti-A and anti-B group-O WB (LTOWB) are recommended. ABO-group type-specific blood can be used in patients with known ABO type. Anticoagulants include CPD and CPDA-1. Leukoreduction can be performed with a platelet-sparing filter. WB is stored at +2 to -6°C for up to 35 days. Rotation of the stock and re-manufacturing to red cell concentrates minimizes outdating. The EDQM Guide to the preparation, use and quality assurance of blood components provides the minimum requirements. Post-implementation follow-up includes haemovigilance and quality surveillance. End users should be involved in the development of the programme and training of personnel. Emergency collection of WB can enable transfusion to patients in remote areas, during disasters and during war.

Conclusion: We conclude that implementation of a WB programme for routine and emergency management of patients with severe bleeding can be performed in a structured, safe and sustainable way.

Background and objectives: Severe transfusion reactions to group B-incompatible platelets and plasma possibly related to the α-gal syndrome (AGS) have been recently described. AGS is a potentially severe Immunoglobulin E mediated allergy to mammalian meat and meat-derived products associated with tick bites. The involved allergen, galactose-α-1,3-galactose (α-gal), is antigenically similar to the blood group B antigen. To further assess a potential association between AGS and allergic transfusion reactions (ATRs), we comparatively assessed the frequency of ATRs after plasma or platelet concentrate (PC) transfusion in relation to the degree of ABO compatibility between the recipient and the involved blood component in France.

Materials and methods: In France, all transfusions are centrally recorded, and ATR reporting is mandatory. Frequencies of severe ATRs involving PC or plasma in relation to ABO group distributions were analysed between 1 January 2022 and 31 December 2024.

Results: Among 981,955 PC and 580,230 plasma evaluable transfusions, severe ATRs were significantly higher in group O recipients transfused with group B or AB platelets (relative risk [RR]: 5.06, 95% confidence interval [CI]: 3.27-7.83, p < 0.001) and plasma (RR: 2.15, 95% CI: 1.37-3.36, p < 0.001) while not in group A recipients of group B or AB platelets (RR: 0.95, 95% CI: 0.30-2.96) or plasma (RR: 0.92, 95% CI: 0.45-1.88), when compared to ATR rates in all other recipients of PC or plasma, respectively.

Conclusion: In this national retrospective haemovigilance analysis, group B or AB PC or plasma transfused to group O recipients is associated with an increased risk of severe ATRs. Further studies will establish whether AGS is involved in this increased risk.

Background and objectives: Although COVID-19 convalescent plasma (CCP) has been successfully used to treat several viral infections, its effectiveness in neutralizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its broader immunological safety remain debated. Since viral infections can trigger autoimmunity, particularly through molecular mimicry and immune dysregulation, there is growing interest in understanding whether CCP contains autoantibodies that could affect recipient safety.

Materials and methods: In this study, we evaluated the presence of 20 different autoantibodies, along with anti-SARS-CoV-2 antibodies, in plasma samples from CCP donors. Samples were collected at three time intervals following COVID-19 symptom onset: 0-60, 60-120 and 120-180 days. Results were compared with those from healthy control plasma donors.

Results: Several autoantibodies- anti-Smith (anti-SM), anti-Sjögren syndrome antigen A, 60-kDa isoform (anti-SSA/Ro60), anti-proliferating cell nuclear antigen (anti-PCNA), anti-Ribosomal P and anti-ribonucleoprotein/Smith antigen complex (anti-RNP/SM)-showed modestly elevated levels in CCP samples collected within 0-60 days post symptom onset. In the 60-120-day period, autoantibody levels declined and approached levels observed in the control group. In the 120-180-day period, most autoantibody levels remained comparable to control levels. Our analysis showed no significant correlations between levels of neutralizing SARS-CoV-2 antibodies and autoantibody concentrations nor significant differences in autoantibody profiles between donors with high and low neutralizing antibody (NAb) titres.

Conclusion: Our findings suggest that SARS-CoV-2 infection may transiently elevate certain autoantibodies in CCP donors. However, most autoantibody levels decline over time and the overall profiles do not indicate sustained autoreactivity. These results support the immunological safety of CCP, particularly when collected between 60 and 120 days post infection, and highlight the importance of timing in optimizing both efficacy and safety in plasma donation strategies.