Vox Sanguinis最新文献

Background and objectives: The safety of varying plasma donation frequencies remains unclear. This non-inferiority randomized controlled trial investigated the effect of plasma donation frequency on total serum protein (TSP), immunoglobulin G (IgG) concentrations, additional biomarkers, adverse events (AEs) and psychological distress.

Materials and methods: In this trial, 120 male donors were randomized into three groups: high-frequency plasma donors (HFPDs, three times every 2 weeks), regular-frequency plasma donors (RFPDs, once every 2 weeks) and a control group (whole blood donation every 3 months). Blood samples were collected biweekly from baseline until the last donation in Week 16 and 4 weeks after the last donation.

Results: HFPDs completed median (range) 21.5 (1-24), RFPDs 8 (1-8) and controls 2 (1-2) donations. HFPDs had lower concentrations of TSP and IgG compared to controls, with a mean difference (95% confidence interval [CI]) of -5.5 g/L (-7.4, -3.6) and -2.8 g/L (-3.8, -1.8), respectively. Within-group analysis revealed significant reductions, which increased with the frequency of donations, in TSP, IgG, IgG subclasses, immunoglobulin M (IgM), immunoglobulin A (IgA), ferritin and haemoglobin. Many of the biomarkers required more than 4 weeks to return to baseline levels. Only mild AEs were reported, and plasma donation frequency had no effect on psychological distress.

Conclusion: High- and regular-frequency plasmapheresis substantially reduces concentrations of TSP, IgG and other biomarkers, with greater reductions at higher donation frequencies. Further research is needed to assess the long-term health implications of frequent plasma donation.

Background and objectives: Hepatitis delta virus (HDV) superinfection with hepatitis B virus (HBV) infection can cause a severe form of viral hepatitis. A nation-wide general population study in Cameroon in 2018 showed a high seroprevalence of 46.7% (901/1928) of HDV among hepatitis B surface antigen (HBsAg) carriers. However, there is a lack of published data on the seroprevalence of HDV among the HBV-positive blood donor population in Cameroon. The aim of this study was to determine the seroprevalence of HDV among blood donors positive for HBV at the Yaounde Central Hospital.

Materials and methods: First-time blood donors were screened for HBsAg between June and November 2022 using a rapid test (DIASPOT), followed by an enzyme-linked immunosorbent assay (ELISA) (Fortress diagnostics) if the rapid test was negative. HBsAg-positive samples were further screened for anti-HDV by ELISA (HDVAb, DIAPRO, DAB.CE).

Results: Of the 195 blood donors who tested positive for HBsAg, 91 (46.7%) were positive by the rapid test, whereas 104 (53.3%) were negative by the rapid test but positive by ELISA. Anti-HDV was detected in 39 (20%) of samples. Anti-HDV reactivity was associated with the HBsAg screening method (p < 0.05).

Conclusion: The burden of HDV/HBV infection among asymptomatic blood donors in the Yaounde region of Cameroon is of concern.

Background and objectives: Obtaining consent for blood transfusion is a critical component of patient safety and promotes active patient engagement. This study aimed to assess how this practice is currently implemented in Brazil.

Materials and methods: A cross-sectional study was conducted from September 2024 to January 2025. Healthcare professionals involved in transfusion procedures across Brazil were invited to complete an electronic questionnaire based on international recommendations. Data were analysed using descriptive statistics.

Results: Of 109 responses, 9 were excluded due to duplication. In the final sample, 63% were professionals affiliated with teaching hospitals and 61% worked in services performing over 200 transfusions per month. Overall, 21% reported not using a consent form prior to transfusion. Among the remaining respondents, 15% stated that consent could be obtained at admission, regardless of transfusion indication. The validity period of consent and procedures for legally incapacitated patients varied widely. Additionally, 33% of forms did not mention benefits, 82% of them did not include a description of the transfusion process, only 20% addressed alternatives to transfusion, and 33% included an option for revocation.

Conclusion: The transfusion consent process in Brazil requires significant improvement. Strengthening this practice is essential to uphold patient autonomy and enhance engagement of patients and families in healthcare decisions.

Background and objectives: Many family investigations of the HLA region are performed in order to identify HLA identical related stem cell donors. In rare cases, deviations from the expected inheritance can be observed. Such a case is shown in this presentation.

Materials and methods: Alleles of the HLA complex have been defined in the members of an Austrian family with atypical segregation of HLA alleles by using the following methods: HLA DNA typing by low-, medium- and high-resolution techniques; genotyping of short tandem repeat (STR) markers in the HLA region; and array-based genome-wide single-nucleotide polymorphism (SNP) analyses.

Results: A duplication of the HLA region encompassing HLA-B, HLA-C and the STR loci D6S2678 and STR-MICA is detected.

Conclusion: A duplication in the HLA-B/-C region of the HLA system is observed, which results from an unequal crossing-over encompassing a chromosomal region of around 377 kb.

Background and objectives: India, home to the largest population of patients with thalassaemia major (TM), has made notable progress in the care through the National Health Mission, National Rare Disease Registry and Thalassaemia Bal Sewa Yojana. This study aimed to assess the infrastructure, support systems and human resources across thalassaemia treatment centres in India to map current service availability and guide policy enhancements for its prevention and comprehensive management.

Materials and methods: A nationwide survey was conducted between January 2023 and March 2024 among centres managing TM. The survey was disseminated through professional groups, civil societies and non-governmental organizations.

Results: Sixty-eight centres participated (government 26, private 28, charitable 14). About 85% of patients were from low-income families, highlighting the dependence on government support. Transfusion services with leukodepleted red cells were available in 97% of centres, with most maintaining adequate pre-transfusion haemoglobin. Chelation service was accessible in the majority of centres, and 87% provided prenatal diagnostics. Bone marrow transplantation was offered in 60 centres and comprehensive care services in 58 centres. Despite free transfusions and chelation, monthly out-of-pocket costs ranged from Indian rupees (INR) ₹500 to ₹16,000 (US$ 5.92-189.49).

Conclusion: Government initiatives have expanded thalassaemia services and reduced financial barriers. Continued efforts to strengthen the national registry and unify policy frameworks will help ensure equitable access across all regions.

Disaster preparedness on a national scale for the provision of blood products during an emergency requires a multifaceted approach. In Israel, the national blood collector, Magen David Adom (MDA), is responsible for collecting, testing and distributing blood products to hospitals and the Israeli Defense Force (IDF). Through close collaboration between MDA and the IDF, blood products have been a mainstay in the prehospital resuscitation of injured soldiers and civilians for several years. Injured soldiers and civilians are taken to the same hospitals; there is not a differentiation between military and civilian hospitals in Israel, which poses its own challenges when stocking blood during peace times and when scaling up operations during times of emergency. This review will examine the approaches to collecting, distributing and administering blood during disasters in Israel from these three perspectives-the national blood supplier, the IDF and a trauma hospital-and highlight some of the unique challenges faced during these circumstances.

Background and objectives: Paediatric transfusion therapy is critical for managing haematological and genetic disorders. However, parental knowledge about transfusion risks, including transfusion-transmitted infections (TTIs) and adverse reactions, remains largely unexplored. This study assessed parental knowledge, attitudes and practices (KAP) regarding paediatric blood transfusions.

Materials and methods: A prospective cross-sectional study was conducted at a tertiary care children's hospital in India over 6 months. A structured questionnaire evaluated parental knowledge.

Results: Among 230 parents (51.7% mothers), 51.3% knew their child's ABO blood group and 76.1% correctly identified the required blood component. Awareness of TTIs screened in donated blood (25.9%) and leukoreduction (2%) was low. Parents of children on chronic transfusion therapy demonstrated significantly better knowledge (p = 0.001 for blood group, p < 0.001 for blood component). Education level strongly predicted transfusion-related knowledge: parents with high school education were 16.8 times more likely to know the blood group (odds ratio [OR] = 16.84, p < 0.001) and 10.4 times more likely to identify the correct blood component (OR = 10.44, p = 0.026).

Conclusion: Significant gaps exist in parental knowledge, particularly regarding TTIs and leukoreduction. Higher education and chronic transfusion exposure improve awareness. Graduate education was linked to a better understanding of TTIs (OR = 2.95, p = 0.038). Targeted education can enhance transfusion safety and the consent process.

Tranexamic acid (TXA) is an essential life-saving medicine that prevents clot breakdown in patients who are haemorrhaging from trauma, childbirth, surgery and other causes. While TXA is inexpensive, it is not widely used, especially in low- and middle-income countries, which also experience challenges in the domains of blood collection, testing, storage and transfusion. TXA has been extensively studied for the treatment of traumatic, obstetric and surgical bleeding, and landmark trials have repeatedly demonstrated its safety, efficacy and life-saving potential, especially when given early (within 3 h of the inciting event). Among trauma patients with blunt and penetrating injuries as well as head trauma, TXA decreases the risk of mortality and is also cost effective. Among women with postpartum haemorrhage, TXA decreases the risk of death due to bleeding, and has been successfully implemented as part of a bundled response. Among surgical patients across sub-specialties, TXA decreases the risk of mortality and even decreases the need for blood product transfusion. Furthermore, these trials have shown that TXA does not increase the risk of adverse events such as thrombosis or seizure. We encourage the global community to shift its focus from further trials to the development of standardized implementation protocols, which have been shown to increase TXA use in both high- and low-resource settings. Expansion of TXA availability and use in global blood deserts will help bridge the gap for haemorrhaging patients who are at risk of death and disability from injury, childbirth or surgical bleeding.

Background and objectives: Artificial intelligence (AI) and big data are technologies with the potential to transform transfusion medicine (TM). This survey explored the scope of AI and big data use in TM across the Eastern Mediterranean and North Africa region.

Materials and methods: A survey was distributed among transfusion professionals to explore current use, perceived benefits and barriers to adopting AI and big data.

Results: Fifty respondents participated; the majority worked in national/regional transfusion services, and 58% worked in academic institutions. Only 24% reported using AI in daily TM practice, primarily for administrative tasks, education and research. Clinical applications were mainly in blood donor recruitment and management. Most used generative AI tools (92%) and were self-taught. Big data were employed in 36% of respondents' institutions, most often for inventory forecasting and optimizing blood product utilization. Most institutions used data based on laboratory information systems (89%), donor databases (72%) and electronic healthcare/patient records (67%). The main challenges and concerns regarding AI adoption were the lack of regulatory guidance, limited expertise, insufficient clinical validation of AI tools, implementation cost and ethical and privacy concerns. In terms of big data, the key barriers were insufficient expertise in data management and a lack of infrastructure for data storage.

Conclusion: AI and big data adoption in TM within the region remains limited. Major barriers include regulatory gaps, lack of expertise, cost constraints and infrastructure limitations. Strategic investment in regulatory frameworks, targeted training and technical resources is essential to facilitate safe and effective integration into transfusion practice.

Background and objectives: Granulocyte transfusions may benefit patients with neutropaenia and life-threatening infections unresponsive to antimicrobial therapies. Current aphaeresis-based granulocyte concentrate (GC) production requires donor stimulation and hydroxyethyl starch (HES), which raises safety and supply concerns. This study assessed the feasibility and quality of GCs derived from pooling 10 residual leukocyte units (RLUs) processed via the Reveos automated blood processing system.

Materials and methods: Whole blood (WB) from 10 ABO-compatible donors was processed using the Reveos system to obtain 10 mL RLUs. A modified platelet pooling device enabled sterile pooling of RLUs with added plasma. The final product was irradiated and analysed on days 0, 1 and 2 post-irradiation. Parameters assessed included cell counts, sterility, biochemical properties, viability, surface markers (CD15, CD10, CD62L and CD11b) and neutrophil functions: chemotaxis, phagocytosis, oxidative burst and H₂O₂ release.

Results: All GCs (n = 10) met sterility criteria and contained a mean granulocyte dose of 0.95 ± 0.17 × 10¹⁰. Neutrophils were mature (CD15⁺CD10⁺) and remained viable on day 2. Functional assays demonstrated sustained phagocytic and respiratory activity up to 48 h post-processing, although chemotactic response and reactive oxygen species (ROS) production declined significantly from 24 h after processing (p < 0.05).

Conclusion: Pooling of Reveos-derived RLUs is a feasible, HES-free strategy to produce viable and functional GCs over 24 h from processing and irradiation. This approach provides a readily available alternative to aphaeresis products that could potentially enhance transfusion coordination.