Vox Sanguinis最新文献

Background and objectives: Serum immunoglobulin G (IgG) and total protein are used to monitor plasmapheresis donor safety. However, there is a lack of information from large donor cohorts to determine the best use of these measurements.

Materials and methods: We identified 230,144 plasmapheresis donors making their first donation between 1 July 2020 and 31 March 2024. IgG and total protein were measured prior to the first donation and then annually, following our donor safety monitoring protocol. We considered individuals who had not donated for 12 months to estimate intra-individual biological variability of IgG. We compared four models to predict which donors would develop IgG < 6 g/L.

Results: The IgG reference interval for the cohort was 7.67-15.6 g/L. IgG declines 5%-11% after the age of 45 years. The intra-individual biological variability of IgG (5.2%) is small, indicating that there is homeostatic set point for individual IgG. IgG is reduced by plasmapheresis but recovers to recruitment level after 12 weeks. When plasma is donated every 2-3 weeks, mean IgG plateaus 1 g/L below recruitment concentration. IgG at recruitment is the best predictor of which donors will have IgG < 6 g/L after a year of donations. Total protein is a low-value test in this context.

Conclusion: Plasmapheresis is safe and sustainable for almost every donor, at the 2-weekly frequency allowed in Australia. The donors most likely to experience unacceptably low IgG are those with very low recruitment IgG levels. These donors could be recommended 12-week intervals between donations or other donation types.

Background and objectives: Access to blood components in pre-hospital bleeding resuscitation is challenging. Dried plasma is a logistically superior alternative, and new products are emerging. Therefore, we aimed to evaluate laboratory and practical differences in three differently produced dried plasma products.

Materials and methods: Single-donor lyophilized LyoPlas®, pooled-donor, lyophilized and pathogen-reduced OctaplasLG Powder®, and single-donor sprayed-dried FrontlineODP™ along with fresh plasma (in-house, pre-FrontlineODP and OctaplasLG) as controls were analysed (n = 8). Laboratory tests included measurements of various coagulation factors and thromboelastography. The practical evaluation of the dried plasma products included preparation time, time to dissolve the dried plasma and total time, together with subjective opinions from eight clinical users.

Results: The coagulation factor content was within human reference ranges for all dried plasma, with approximately 10%-20% loss compared with fresh plasma. More variations were observed in the single-donor products compared with the pooled products. Clot formation analysed by thromboelastography showed normal graphs. Reconstitution time was similar, ranging from on average 7-9 min. In the user evaluation, the reconstitution time and the possibility of using a plastic bag for the transfusion were emphasized as important, the latter fulfilled by two of the products.

Conclusion: The study supports that dried plasma may be produced with lyophilization or spray-drying technique, as well as with the addition of pathogen reduction, with preserved coagulation capability. The products were reconstituted in acceptable time and deemed feasible for pre-hospital use by eighth test users.

Background and objectives: Artificial intelligence (AI) has been gaining increasing interest in healthcare. During the 2024 International Society of Blood Transfusion (ISBT) Congress, the Clinical Transfusion Working Party (CTWP) conducted a session to explore the exciting intersection of AI in transfusion medicine (TM) practice, education and research. We report here the potential applications and the session outcome.

Materials and methods: A pre-workshop survey explored the participants' demographics and areas of use of AI and whether they have had any AI-specific training or education. The workshop included presentations on the regulatory aspects of AI use and its application in TM practice, education and research. These were followed by round-table discussions to explore participants' experience and concerns.

Results: The workshop had 72 attendees, with 38% falling in the 36-45-year age group. A total of 70% indicated the use of AI, but only 12% reported having specific training or education. Participants expressed interest in different potential applications but also shared concerns on over-reliance, potential loss of skills, the accuracy of provided information and content plagiarism.

Conclusion: The findings of the workshop highlight the need for training, educational resources, standards and regulatory frameworks to guide the use of AI tools in the field of TM.

Background and objectives: Great variations may be observed in the haemoglobin (Hb) content of packed red blood cell (PRBC) units prepared by different methods. This study aimed to assess the Hb increment in thalassaemia major patients transfused with leucoreduced PRBCs (LPRBCs) prepared by two different methods: (i) standard leucoreduced PRBCs (SLPRBCs) and (ii) leucoreduced PRBCs prepared by a new method where leucoreduction of whole blood is done first (NLPRBCs).

Materials and methods: This prospective, randomized, controlled trial included 80 adult thalassaemia major patients who were randomized into two groups of 40 each. Group I patients received SLPRBC and those of Group II received NLPRBC transfusions for 3 months.

Results: SLPRBCs had a mean (±SD) volume of 275.50 ± 17.07 mL, while it was 316.46 ± 1.42 mL for NLPRBCs (p < 0.001). The mean Hb content of SLPRBCs was 50.60 ± 5.12 g, while that of NLPRBCs was 56.98 ± 5.92 g (p < 0.001). The mean Hb increment in Group I patients was 2.11 ± 0.89 g/dL, while that of Group II patients was 2.48 ± 0.88 g/dL (p < 0.001). The mean transfusion interval for Group I patients was 20.30 ± 3.75 days, while it was 21.34 ± 5.13 days for Group II patients (p < 0.045). A significant positive correlation was observed between the Hb dose transfused and the Hb increment with both SLPRBC (ρ = 0.4, p < 0.001) and NLPRBC (ρ = 0.19, p = 0.011) transfusions.

Conclusion: NLPRBCs had significantly higher Hb content than the SLPRBCs, leading to a better Hb increment post transfusion, which may potentially prolong the transfusion interval in thalassaemia major patients.

Background and objectives: Despite screening procedures, a few blood donors confirm positive for transfusion-transmissible infections and are deferred. Effective notification of laboratory results is essential to ensure that donors are advised of confirmed results and to seek medical care. Here we report results from post-notification interviews of Canadian Blood Services donors.

Materials and methods: Over 17 years, 2006-2022, all donors with confirmed positive results for hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell lymphotropic virus (HTLV) and syphilis were notified by registered mail of their result and advised to see a physician. In a separate communication, all donors were later invited to participate in a scripted interview asking whether they tested positive for an infection; if yes, which one, what their reaction was, whether they consulted a physician and whether public health contacted them. Frequencies of responses were calculated.

Results: Of 2654 donors with confirmed positive test results, 876 (33%) participated; 90% said they were informed of a positive test result. Of these, about a quarter did not know for which infection they were positive. Most were surprised, and some were sad or disappointed. Most saw a physician after notification (77%). About two-thirds with HBV or HCV said they were contacted by public health, slightly fewer (58%) with syphilis, 27% of those with HTLV.

Conclusion: Most donors recalled being notified and were aware of their positive test, but details of the infection were sometimes not understood or recalled, and not all donors consulted a physician about the infection.

Background and objectives: Professionals who work or study in transfusion medicine under 40 years of age are considered young professionals (YPs) by the International Society of Blood Transfusion (ISBT). While the ISBT provides opportunities for YPs, their needs have to be assessed to customize initiatives in a way that could potentially improve their engagement. This survey aimed to assess the needs of YPs in transfusion medicine and understand their perspectives on future ISBT initiatives.

Materials and methods: Between January and February 2023, a 28-question online survey was accessible through a generalized link across the ISBT network. Skip-logic responses from 352 YPs, including 151 ISBT members and 201 non-members, were analysed. Each question varied in the number of responders and, consequently, the number of responses.

Results: Firstly, the most important needs of YPs from the survey were educational opportunities and training programmes, with 70% of respondents indicating for educational content in specific fields of transfusion. Secondly, Transfusion Today published by the ISBT (46.9%) ranked the highest in engagement, while ISBT Academy and Academy funding ranked the lowest (12.8%). ISBT members reported attending ISBT activities or using ISBT resources more often than non-members, although this was not statistically significant. The primary barrier preventing both non-members and ISBT members from engaging in ISBT activities was a lack of awareness.

Conclusion: Raising awareness on a regular basis, a customized communication style (e.g., by a representative or different languages) and activities for non-members may be key to improving YP engagement and expanding the ISBT network.

Background and objectives: Although transfusion reactions occur in less than 2% of recipients, they are currently one of the most serious concerns in blood transfusion. Damage-associated molecular patterns (DAMPs) are released from injured, stressed or dead cells, leading to inflammation and immune system activation. One of the recognized DAMPs is mitochondrial DNA (mtDNA). It is found in various blood products, including fresh frozen plasma (FFP), red blood cell units (RBCUs) and platelet concentrates (PCs), and can induce adverse reactions in recipients by stimulating the innate immune system and inflammatory cellular pathways. The aim of this study was to investigate the factors influencing the release of mtDNA in various blood products and its subsequent impact on transfusion reactions.

Materials and methods: In this study, mtDNA, mitochondrial DNA, mtDNA DAMPs, extracellular mtDNA, blood products, blood components and transfusion reactions between 2009 and 2023 were searched in Google Scholar, PubMed and Scopus databases.

Results: This study has demonstrated the presence of mtDNA in the extracellular milieu of various blood products, including PCs, FFP and RBCUs. Understanding the determinants of mtDNA release and its implications for transfusion safety is critical. Strategies aimed at reducing mtDNA release, such as optimizing preparation techniques and donor selection criteria, hold promise for reducing transfusion-related complications.

Conclusion: By addressing these factors, healthcare providers can enhance the safety and efficacy of blood transfusion practices, ultimately improving patient outcomes.

Background and objectives: Identifying RhCE variants is essential to prevent alloimmunization and manage complex cases. Unfortunately, these variants are often only detected after antibody formation, as they may go unnoticed in serological tests. This study aimed to assess monoclonal antisera using various methodologies to define the reactivity patterns of some variants by variable expression of RhCE antigens.

Materials and methods: Samples were chosen based on atypical reactivity on routine RhCE typing of donors, screening of Afro-descendant donors using tube testing and patient samples with antibodies against their own antigens. All 53 samples were tested using tube, gel and microplate tests with five antisera. Antigen expression was assessed by flow cytometry, and RhCE variants were molecularly classified.

Results: Tube test screening of African descent donors proved more effective in identifying a broad range of weak or partial antigens, particularly when using anti-e composed of MS-21, MS-16, MS63 clones and anti-c from the MS8011531019 clone. Automated instrument phenotyping successfully identified samples with RHCE*ceJAL allele, while most other variants were detected as positive (4+), similar to gel test, which intensified most reactions. When comparing methods and antisera for detecting variant e antigens, tube test identified a higher percentage of weak samples (63%-77%) compared with microplate (35%) and gel tests (14%).

Conclusion: The results highlight the critical role of tube test in serological routines and the need to select clones capable of identifying RhCE variants. Detecting reduced RhCE antigen expression during routine serological testing can guide further molecular investigations and help prevent Rh alloimmunization.