Vox Sanguinis最新文献

Background and objectives: Transfusion-associated circulatory overload (TACO) is the leading cause of transfusion-related morbidity and mortality. We evaluated the incidence of TACO and its association with new fever (HOT-TACO) at a comprehensive cancer centre.

Materials and methods: Retrospective review of haemovigilance data (July 2019-October 2020) identified 100 possible to definite TACO cases. TACO cases were classified as HOT-TACO or regular TACO, differentiated by an association with new-onset fever. Both groups were assessed by type, age of blood products involved, reaction severity, cancer diagnosis and white blood cells (WBC) counts.

Results: Among 1382 transfusion reactions in a 15-month period, 111 cases of TACO (8%) were diagnosed. A total of 100 adult TACO cases were included in this study; 16% of them were HOT-TACO cases. The median WBC counts pre- and post-transfusion in the HOT-TACO versus regular-TACO group were not statistically different (pre- 5.400 vs. 2.050, p = 0.19; post 4.100 vs. 1.900, p = 0.45). However, the HOT-TACO group had a 2.7-fold higher pre-WBC and a 2.2-fold higher post-WBC when compared with the regular TACO group. There were no significant differences in age of the blood products involved, red blood cell (RBC) age (median 12 days, p = 0.34), platelet age (single donor platelet [SDP]/random donor platelet [RDP] unit) (median 5/5 days, p = 0.32/p = 0.72) or reaction severity between groups.

Conclusion: We found an association of TACO and new fever in 16% of cases compared with 32% reported in a non-exclusive oncological setting. Findings are likely related to impaired immune response present in cancer patients associated with immunosuppression. Our findings support that fever should not be used to distinguish transfusion-related acute lung injury (TRALI) from TACO.

Background and objectives: The main use of plasma has evolved into market-driven plasma-derived medicinal products (PDMPs), but it still requires donors. Availability of PDMPs in access to care is often considered restrictively, in terms of volumes of plasma required for production and whether or not to remunerate donors. Unfortunately, this leads to an inability to meet today's challenges, both in terms of patient access to treatment and donor protection.

Materials and methods: Here we review how the current challenges can be held under two major human fundamental rights and their associated ethical principles: the right to health protection and the right to human dignity.

Results: Our research shows how advantageous it could be to reposition the fundamental right to health protection as an input parameter for decisions on the transfusion and plasma supply chain, as this would enable reconciliation of both patient access to these therapies and the protection of donors. This objective means that actions must be prioritized on parameters that do not impact human rights so that the plasma donated is fully exploited and the donors adequately protected.

Conclusion: Decisions could be made within the remit of human rights, and finally go over the opposition between access to care and donor health protection. As PDMPs have created a kind of international human interdependence, it is our responsibility to place both patients and donors under the umbrella of fundamental human rights, to act not as if a choice has to be made between the two, but in ways that protect them both.

Recent events have highlighted the urgent need for comprehensive blood preparedness plans at local, regional, national and cross-border levels within the Nordic countries. This article outlines the perspectives and strategies related to blood preparedness in Norway, Sweden and Finland, in the context of emergencies, disasters and armed conflicts. Norway, Sweden and Finland share long borders and similar geography, including vast rural areas with limited health care resources. Finland operates a centralized blood service, whereas Norway and Sweden maintain decentralized systems, with regional authorities responsible for their own blood supply. All three countries adhere to a total defence concept, wherein military forces depend on civilian transfusion services. In mass casualty events, the demand for transfusion services to provide urgent blood and blood components is expected to be high. Haemorrhage remains the leading cause of preventable prehospital death in trauma cases, and the availability of blood products in prehospital settings is critical in both civilian and military environments. Key priorities identified include: establishing stockpiles of shelf-stable blood products, developing surge capacity plans for rapid upscaling of blood collection and whole blood and component production, conducting joint training and exercises involving blood establishments, transfusion services, hospitals and military units, and collaboration in a pilot cross-border initiative-the Nordic Blood Preparedness Project-in northern Norway, Sweden and Finland, aimed at harmonizing regulations and procedures during emergencies. To effectively save lives during disasters and armed conflicts, it is essential to have well-documented and operational blood preparedness plans in place.

Background and objectives: Provision of red cells for intrauterine transfusion (IUT) can be challenging when the mother has an antibody to a high frequency antigen, as compatible allogeneic red cells may be scarce. The aim was to validate a novel component: split, frozen, thawed, washed and irradiated red cells for IUT, which could be used if foetal transfusion with maternal blood is necessary.

Materials and methods: Six standard red cell concentrates were glycerolized on Day 5 and split into three smaller packs before freezing. A split from each donation was thawed and deglycerolized using the ACP215 and resuspended in saline-adenine-glucose-mannitol. The haematocrit was adjusted to IUT (70%-85%). The components, each approximately 80 mL, were immediately irradiated and tested for full blood count, haemolysis and supernatant potassium 8 and 24 h later.

Results: At 8 and 24 h post manufacture, haemolysis was 0.20% (0.16%-0.25%) and 0.24% (0.18%-0.29%), respectively, and supernatant potassium was 20.3 mmol/L (15.1-27.1 mmol/L) and 43.1 mmol/L (33.5-58.4 mmol/L), respectively (mean [range]). Both haemolysis and potassium were within levels for standard irradiated IUT units.

Conclusion: Red cells split, frozen, thawed, washed and manufactured into IUT units and immediately irradiated are expected to be a beneficial component for very rare clinical cases.

Background and objectives: In March 2024, the Colombian National Food and Drug Surveillance Institute declared a shortage of anti-RhD immunoglobulin, a critical product for preventing haemolytic disease of the foetus and newborn (HDFN) in RhD-negative women carrying RhD-positive foetuses. The aim of this work was to analyse the impact of this shortage on obstetric institutions, transfusion services and prophylactic management of the RhD-negative pregnant population.

Materials and methods: A descriptive, cross-sectional study was conducted using an online survey distributed between December 2024 and February 2025. Data were analysed according to region and experience with shortages.

Results: Twenty-seven institutions (17.9%) providing obstetric and transfusion services completed the survey. Most respondents (88.9%) represented obstetric services, followed by transfusion medicine (7.4%) and clinical pharmacy (3.7%). In 92.6% of institutions, physicians prescribed anti-RhD immunoglobulin. Shortages were reported by 22.2% (n = 6) of institutions. Prophylaxis was administered during weeks 28-40 in 51.9% (n = 14) and during weeks 14-27 in 22.2% (n = 6), while one reported both periods. Anti-D administration was reported postpartum in 44.4% of cases, following abortion in 29.6%, after foetal haemorrhage in 7.4%, after trauma in 3.7% and once at the physician's discretion.

Conclusion: Although some institutions reported shortages of anti-RhD immunoglobulin (particularly in the Andine region), these did not lead to changes in clinical indications, and prophylactic use during late pregnancy and the postpartum period remains the predominant practice nationwide.

Background and objectives: Red blood cell (RBC) transfusions have been associated with retinopathy of prematurity (ROP) and adverse long-term neurodevelopmental outcomes in very preterm infants. Although lower transfusion thresholds reduce the incidence of ROP, they have not improved neurological outcome. Periventricular leukomalacia (PVL) is a major cause of long-term neurodevelopmental impairment in very preterm infants. The objective of this study was to determine whether exposure to RBC transfusions is an independent, dose-dependent risk factor for PVL.

Materials and methods: A retrospective cohort study was conducted. Infants born at 32 weeks of gestation or less or with a birth weight <1500 g were eligible. Infants transferred from other hospitals, managed with palliative care or who died before cranial imaging were excluded. Exposure was defined as the cumulative number of RBC transfusions during neonatal intensive care. Outcomes were PVL and severe ROP. Multivariable logistic regression analyses were performed and stratified by birth weight <750 g and ≥750 g.

Results: RBC transfusions were independently associated with PVL and ROP. The adjusted odds ratio was 1.10 and 1.09, respectively, in infants weighing <750 g, and 1.26 and 1.15 in infants weighing 750 g or more, respectively, with statistically significant confidence intervals.

Conclusion: RBC transfusions were independently associated with PVL in preterm infants. As lowering transfusion thresholds has not been associated with improved neurological outcomes, consideration of cord blood products may be warranted.

Background and objectives: Previous studies have shown clinicians' knowledge and practice are suboptimal across all major steps in the clinical transfusion process. Like other settings, limited information is available in Ethiopia. Therefore, we conducted a study to assess clinicians' transfusion medicine knowledge and clinical practice.

Materials and methods: A cross-sectional study was conducted at two academic hospitals to examine the correlation between transfusion medicine knowledge and clinical use of blood. Clinicians (n = 232), selected using a random sampling technique, completed a self-administered, structured knowledge assessment. A sampled (n = 152) subset of these clinicians was assessed for appropriate clinical use of blood using a predefined checklist. Student's t-test, one-way analysis of variance (ANOVA) and chi-square test were used. Statistical significance was assessed by 95% confidence intervals (CIs) and p values <0.05.

Results: Clinicians' mean knowledge score increased significantly by level of specialization. Out of a maximum score of 80, the mean ± standard deviation (SD) score for general practitioners was 38.1 (SD: ±6.2) while the score for specialists was 45.1 (SD: ±5.8), p = 0.001. Clinicians trained on transfusion guidelines had higher scores (46.6, SD: ±7.2) compared to untrained clinicians (40.3, SD: ±7.0), p = 0.001. Clinical use of blood was deemed appropriate in 41.4% [95% CI: 33.6%-49.2%] of cases. Appropriate clinical use of blood was associated with a higher mean knowledge (43.7, SD: ±7.1) than observed in inappropriate clinical use (40.7, SD: ±8.3) in 58.6%, p = 0.02.

Conclusion: Better knowledge of transfusion medicine is associated with better transfusion medicine practice. This underscores the importance of implementing transfusion medicine training in Ethiopia.

Background and objectives: Globally, there is high variability in paediatric transfusion practices. As per the World Health Organization (WHO), the majority of transfusions in low-income countries are administered to children under 5 years. This study aimed to characterize the epidemiology and indications for blood component transfusions among neonatal and paediatric patients across India.

Materials and methods: A prospective longitudinal multicentre study was conducted over 6 months (April-September 2022). Standardized data sheets captured age, gender, diagnosis, transfusion indication, component type and first versus repeat transfusion status for all paediatric requests.

Results: Twenty-three medical institutions (combined 32,759 beds) participated in the study. Among 396,092 total blood component requests, 52,658 (13.2%) were for paediatric patients. Most were male (60.1%), aged 5-12 years (26.4%), and 42.7% required >1 transfusion. Red cell components were the most frequently requested (68%), followed by platelets (17.5%) and plasma (12.3%). Medical indications accounted for 67.6% requests, followed by 30.3% surgical indications. Haematology (48%), oncology (17.1%) and infections (10.5%) were the most common medical indications; however, cardiac surgeries (44.2%) and gastrointestinal surgeries (30%) were the most common surgical indications. Haemoglobinopathies (21.4%) were overall the most common indication for the transfusions reported.

Conclusion: Paediatric patients accounted for over 13% of all transfusion requests, predominantly for red cells and medical indications (mainly haemoglobinopathy). This represents the first large-scale epidemiological assessment of paediatric transfusion indications in India and establishes foundational evidence to guide understanding of blood utilization trends in children as well as indicate priority research areas for the future.

Background and objectives: The coronavirus disease 2019 pandemic in 2020 caused severe disruptions to blood supplies in China. In response, a collaborative strategy known as the 'Baby Dad Blood Donation Project' (BDBDP) was implemented by the Guangzhou Blood Center and associated hospitals. The current research aims to evaluate the effects of this project.

Materials and methods: A match-pair study design was adopted, involving three male participant groups: BDBDP participants (Father donors [F-donors]); spontaneous donors at mobile blood drives or apheresis donation stations (Spontaneous donors [S-donors]); and Non-donors (N-donors) who had never donated blood. F- and S-donors were matched by age, donation frequency and volume. N-donors, sourced from an online marketplace, were age-matched with F-donors. Following a 1:1:1 pairing, 535 males were selected per group. Participants completed a questionnaire and were followed for 2 years.

Results: In total, 104 (19.4%) F-donors and 198 (37.0%) S-donors re-donated blood within 2 years (p < 0.001). Among first-time donors, 36 (10.6%) F-donors re-donated compared to 91 (26.7%) donors. N-donors exhibited a significantly lower first-time donation rate (26 (4.8%), ps < 0.001). Saving lives (p = 0.875) was the primary motive of present blood donation among all donors, but F-donors were more likely to donate blood because of preferential blood use (p < 0.001). Lack of motivation emerged as the primary reason why first-time F-donors had not donated previously.

Conclusion: The BDBDP effectively encouraged first-time donations among the fathers-to-be and raised awareness about blood donation. However, re-donation rates were modest, indicating the need for ongoing engagement strategies to sustain donor participation.

Background and objectives: To meet the long-term demand for blood products while preserving donor health in the long run, blood establishments must recruit a sufficient number of new donors annually. To determine what will suffice, it is essential to be able to forecast future blood donation volumes as a function of new donors using estimates based on historical donation activity.

Materials and methods: Donor (n = 11,629,873) and donation data (n = 64,510,294) extracted from operational information systems of seven blood establishments were transformed into anonymous donation activity data (grouped by blood establishment, sex and blood group) in the form of time series of mean number of donations per donor, indexed by years since first donation. Linear models were fitted to the time series using ordinary least squares.

Results: Out of the various estimated models, the best fit (mean R² over blood establishments 99.95%) for past mean donation activity was achieved when regressing the logarithm of cumulative donation activity on the logarithm of years since first donation and an indicator variable for the year of first donation. In addition to the predictions, comparison of the estimated parameters revealed that there are significant differences between blood establishments, translating to differences in the expected number of donations accumulated over the lifetime of a donor.

Conclusion: Average donation activity can be modelled using a few variables and simple models, with high precision. The estimates can be used to create forecasts of future donation volumes, which in turn can be useful in long-term blood donation management.