Vox Sanguinis最新文献

Background and objectives: Randomized controlled trials have demonstrated morbidity and mortality in critically ill patients are unaffected by transfusing fresh (<7 days old) packed red blood cells (pRBCs); however, there is limited evidence regarding transfusion with pRBCs nearing expiry (35-42 days). The aim of this study was to investigate the effects of transfusing pRBCs close to the end of shelf life (≥35 days) on clinical outcomes in critically ill patients.

Materials and methods: A retrospective observational analysis of data obtained from centralized electronic medical records (2007-2013), sourced from all public and licensed private hospitals in Queensland, Australia, with intensive care units. Multivariate logistic and linear regressions were used to analyse association between transfusion with pRBCs nearing expiry, and in-hospital mortality, hospital length of stay (HLOS) and rate of discharge home. Comparisons are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: The study included 10,350 critically ill adult patients transfused ≥1 unit of non-irradiated pRBCs (64,594 pRBCs units transfused). Receiving at least 1-unit pRBCs ≥ 35 days old was associated with increased mortality (OR 1.21 [95% CI 1.06-1.38]; p = 0.005), decreased discharge to usual residence (OR 0.81 [95% CI 0.73-0.89]; p < 0.0001) and increased hospital LOS (estimate 2.55 [95% CI 1.60-3.49]; p < 0.0001). There was also association with increased sepsis (OR 1.27 [95% CI 1.13-1.42]; p < 0.0001) and delirium (OR 1.25 [95% CI 1.06-1.49]; p = 0.01).

Conclusion: Transfusion of ≥1-unit pRBCs ≥ 35 days old was associated with higher morbidity and mortality in critically ill patients.

Background and objectives: Seasonal vaccinations reduce donor illness and appointment cancellations and ensure plasma products have antibodies to vaccine-directed strains. We aimed to describe donor influenza and COVID-19 vaccination history and compare this with the general population.

Materials and methods: Two online donor surveys were carried out in 2021 and 2024. Donors were asked about demographics, influenza (2019/2020, 2020/2021 and 2023/2024 seasons) and COVID-19 (ever and 2023/2024 season) vaccination and reasons for vaccination choices. General population vaccination statistics were extracted from public reports. Percentages of donors receiving vaccination were calculated with 95% confidence intervals. Multiple logistic regression models were fitted with demographics as independent variables.

Results: In survey 1, 4582 (30.4% response rate) donors completed a questionnaire; in survey 2, 6376 (21% response rate). More donors under age 65 received the influenza vaccine compared with the general population under age 65 (58% vs. 30% in 2019/2020, 63% vs. 28% in 2023/2024, p < 0.0001) and aged 65+ (81% vs. 70% in 2019/2020, 90% vs. 73% in 2023/2024, p < 0.0001). Fewer donors and the general population received the COVID-19 vaccine in 2023/2024 (under 65 45% vs. 39%; 65+ 76% vs. 67%, p < 0.0001). Most said they were vaccinated to prevent infection and protect others.

Conclusion: Seasonal vaccination rates are higher in older donors, consistent with public health recommendations. Blood donors are more likely to be vaccinated against seasonal influenza than the general population, but post-pandemic uptake of the COVID-19 booster vaccine was low, more similar to the general population.

Background and objectives: Syphilis cases surged in Japan, exceeding 10,000 in 2022, primarily through heterosexual transmission. The Japanese Red Cross Blood Services (JRCBS) screens donated blood for syphilis, disqualifying positive donors. This study explores syphilis infection among blood donors to understand its impact on blood collection and supply.

Materials and methods: Data from blood donors (2015-2022) at JRCBS were analysed. Treponema pallidum (TP) antibody was tested by chemiluminescent enzyme immunoassay or chemiluminescent immunoassay. A total of 39,199,047 donations were scrutinized. Reactive samples were further tested by rapid plasma reagin (RPR).

Results: The number of TP and RPR positives (referred as syphilis positives) in 2022 compared with 2015 increased by 1.7 times in blood donors and 4.9 times in the general population. High syphilis-positive rate in 2022 was mainly observed among male first-time/reactivated donors and females in their 20s and 30s. Although syphilis cases in general population declined during the Corona pandemic, no significant decrease occurred in syphilis-positive donors.

Conclusion: Although the increase in syphilis positives among blood donors may be a reflection of the increase in the general population, the rate of increase was less pronounced among blood donors. Although the increase in the syphilis-positive rate may not affect blood product safety, it would have a significant impact on the number of potential blood donors in the future because the increase was more frequently observed in young donors and new donors, and currently, syphilis-positive individuals are permanently deferred from blood donation. The implementation of effective measures to prevent transmission in the general population is required.

Background and objectives: Understanding the experiences and perceptions of new plasma donors is important for developing strategies to retain them.

Materials and methods: This qualitative study focuses on new donors' experiences with plasma donation, the factors that influence their interest in donating again and their thoughts about establishing a regular plasma donation routine. We conducted 48 one-on-one semi-structured interviews and used reflexive thematic analysis with a relational approach to donation to analyse these data.

Results: For new plasma donors in this study, interest in returning to donate again was facilitated by relational care, where donors were cared for by attentive staff, and felt they could care for others by donating. Their interest in helping others through ongoing donation was influenced by their relationships with people who have benefited from blood products or experienced illnesses they associated with plasma-derived medicines, as well as their sense of social responsibility and community belonging. The most prevalent deterrent to donating again was the experience of feeling unwell during or after donation. The practice of relational care from staff members can mitigate the fallout of the negative experience. Retention of new donors requires flexibility to ensure that donation is easy, convenient and does not negatively impact their health and ability to care for others in their social network.

Conclusion: Investigating retention decisions for new plasma donors through the lens of relational care provides insight that can help blood collection agencies develop more effective strategies for retention in non-remunerated settings.

Background and objectives: Implementing and complying with a maximum surgical blood ordering schedule (MSBOS) is challenging but essential to avoid waste and reduce costs. MSBOS helps manage blood product scarcity and healthcare expenditure by avoiding unnecessary pre-transfusion testing and preparation, reducing product waste and improving clinical and operational efficiencies while maintaining patient safety.

Materials and methods: A multi-hospital health system in Ohio and Florida performing more than 200,000 surgeries annually implemented MSBOS through a risk-stratified protocol and electronic medical record automation.

Results: The first-year analysis included 107,149 cases in 23 surgical specialties and 18 hospitals. Compliance with MSBOS improved over time, reducing type and screen tests by 4166 and saving $223,839 in costs. No patient safety issues were identified.

Conclusion: This project demonstrates that adopting MSBOS in a large health system adds value by reducing unnecessary testing and costs while maintaining patient safety.

Background and objectives: Trans and gender-diverse people who wish to donate blood face significant barriers with policies and procedures differing across countries. It remains critical to explore the experiences and perspectives of trans and gender-diverse people in different locations to understand challenges in local systems. We undertook a qualitative study focussed on procedures and processes affecting trans and gender-diverse people in Australia, and their views about needed change.

Materials and methods: Stakeholders collaborated with the researchers to refine the focus of and design the research. Semi-structured interviews were conducted with 14 trans and gender-diverse people who were current, past or potential donors. The interviews comprised open-ended questions about donation experiences, knowledge of current policies and procedures and preferences for change. Interviews were analysed using thematic analysis.

Results: Participants reported varied and inconsistent donation experiences. When compared with current practice, participants preferred a two-step approach to donor registration that asks for sex reported at birth followed by gender identity. However, they also expressed concern that the two-step approach could deter new donors and stressed the importance of only collecting information relevant to eligibility assessment. Participants were supportive of a gender-neutral approach to assess eligibility to donate.

Conclusion: Our study highlights significant barriers and procedural inconsistencies for trans and gender-diverse individuals when (considering) donating blood. We recommend more inclusive practices including clear communication about data use, rigorous staff training on gender diversity, registration processes that respect all gender identities and adopting a gender-neutral approach to donor screening.

Background and objectives: Individuals with the rare p phenotype have red cells lacking P, P1 and P^k antigens and make clinically significant anti-PP1P^k. The phenotype arises from inactivating mutations in A4GALT, which encodes the enzyme responsible for production of P1 and P^k. We present results from serological and molecular investigations of a case of anti-PP1P^k with a novel molecular background of the p phenotype.

Materials and methods: Samples from a 32-year-old Indian blood donor were investigated due to the presence of a pan-reactive alloantibody, together with samples from his sister and mother. Standard serological investigations and A4GALT sequencing were performed.

Results: The donor was found to have p phenotype, and his plasma contained anti-PP1P^k. Sequencing revealed a rare homozygous missense mutation in A4GALT (c.526G>A; p.Asp176Asn; rs371893172; frequency 0.00007), representing a novel null allele. The sister was heterozygous for this allele, while surprisingly the mother did not carry the allele. Enquiries revealed the mother was not the donor's biological mother, explaining the perceived discrepant sequencing results.

Conclusion: We have identified homozygosity for a novel A4GALT null allele (carrying c.526G>A, p.Asp176Asn), resulting in lack of functional 4-α-galactosyltransferase and a p phenotype, adding to the catalogue of known genetic backgrounds of this rare phenotype.

Background and objectives: The European Directorate for the Quality of Medicines & HealthCare has been co-ordinating an external quality assessment programme for blood establishment (BE) laboratories since 2010. To further expand the study portfolio, a new bacterial blood proficiency testing scheme (B-PTS) for platelet components (PCs) has been developed and validated in a pilot study.

Materials and methods: Sterile samples and those containing a low-count quantity of bacteria were prepared in spiking devices. Suitability of storage and shipping conditions for the samples was evaluated under different environmental conditions. Participants received the spiking devices, prepared the potentially contaminated PCs on site and tested them according to their routine screening procedures.

Results: Humidity compromised the quality of the samples. Optimized storage of the samples by adding a desiccant ensured satisfactory quality. In the pilot study, 9 of the 11 participants correctly identified the positive samples as being bacterially contaminated.

Conclusion: The newly developed bacterial B-PTS was successfully implemented in a pilot study. It enables an inter-laboratory comparison to determine the performance of BEs for the testing of bacterial contaminations in PCs.

Background and objectives: We should control free K⁺ during massive transfusion (>80 mL/kg) of red blood cells (RBCs) in small children. To manage this, several national and international guidelines recommend using RBCs stored only up to 7 days. We tested a washing step for RBCs in saline-adenine-glucose-mannitol (SAGM) with or without irradiation to reduce supernatant K⁺ levels, improve quality and potentially extend the shelf life of stored RBCs.

Materials and methods: RBCs of 240-330 mL were prepared from whole blood donations, then split into halves and stored in SAGM solution at 4 ± 2°C for 21 days. RBCs were split and washed on Days 1 and 8, and some were gamma-irradiated on Day 8. Glucose, lactate, lactate dehydrogenase (LDH), adenosine triphosphate (ATP), K⁺ and haemolysis were determined over 21 days.

Results: After washing on Day 1, only glucose and lactate improved, whereas after washing on Day 8, LDH and K⁺ also improved. Irradiation resulted in accelerated K⁺ accumulation and increased haemolysis. Mean extracellular K⁺ concentrations were 21.2 ± 1.03 mM after irradiation on Day 8 versus 1.12 ± 0.05 mM after irradiation plus wash on Day 8, and 38.80 ± 2.13 mM on Day 10 after irradiation on Day 8 and 16.6 ± 0.05 mM on Day 10 after irradiation plus wash on Day 8.

Conclusion: K⁺ concentrations remained <25 mM within 8 days of storage. We recommend irradiation by Day 8 at the latest for neonatal transfusion. The shelf life may be extended by another 48 h if the RBCs are also washed.

Background and objectives: Highly effective procedures for the preparation of allogeneic platelet gel (PG) use Ca-gluconate and batroxobin, an expensive commercial reagent. In this preliminary study, we explored the use of the plasmin-inhibitor, low-cost drug tranexamic acid (TXA) in place of batroxobin, based on the literature supporting TXA ability to prevent fibrinolysis and stabilize the gel formed by fibrin polymerization prompted by Ca-gluconate.

Materials and methods: Eight blood centres determined PG weight and volume of non-gelled, liquid portion in 116 PG prepared in 20-mL commercial BioNest D bags. Ten-millilitre platelet aliquots from platelets in 100% plasma or in 35% plasma/65% platelet additive solution (PAS) were aseptically transferred into the D bag, followed by the injection of 3.3 mL of 10% Ca-gluconate and 0.4 mL of TXA. After 30-min incubation, PG weight and non-gelled liquid volume were determined.

Results: PG weight and liquid volume at 30 min were 6.5 ± 3.4 g and 7.4 ± 3.5 mL with platelets in 100% plasma, and 3.7 ± 3.0 g and 10.2 ± 3.3 mL with PAS platelets, respectively.

Conclusion: This study provides preliminary evidence supporting the use of TXA as a low-cost reagent for PG manufacturing from platelets in 100% plasma.