Vox Sanguinis最新文献

Background and objectives: Massive transfusion protocols (MTPs) are essential for timely resuscitation in trauma but carry the risks of blood product wastage and strain on transfusion services. Existing adult-based scoring systems are unreliable in paediatric populations. This study aimed to develop and validate a paediatric-specific scoring system to guide MTP activation.

Materials and methods: This is a retrospective cohort study using the 2018 National Trauma Data Bank. Paediatric trauma patients aged 1-15 years were included. The primary outcome was the need for massive transfusion, defined as >40 mL/kg of blood product within 4 h of admission. Multivariable logistic regression identified the predictors to develop the activation of massive transfusion in children (AMTC) score. The model was evaluated in an independent validation cohort.

Results: Among the 668 participants, the median age was 9 years, median weight was 34 kg and median Abbreviated Injury Scale score was 5. Within 4 h of admission, participants received a median of 27 mL/kg of blood products, and 222 patients (34%) received more than 40 mL/kg. Four factors independently predicted the need for massive transfusion, which were incorporated into the AMTC score: age, penetrating trauma, initial temperature and requiring surgery for haemorrhagic control. Using a cutoff of >2, the positive and negative predictive values were 46% and 83%, respectively.

Conclusion: The AMTC score provides a simple tool to identify paediatric trauma patients at risk of requiring massive transfusion. Its strong negative predictive value may help avoid unnecessary MTP activation, reduce blood product waste and alleviate blood banks' operational burden.

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: According to the World Health Organization, more than 1 billion people are at risk of leishmaniasis in over 89 countries. Environmental changes such as deforestation, urban expansion and climate change facilitate the spread of sand fly vectors and reservoirs, increasing disease transmission. The introduction of Leishmania into non-endemic regions may be further driven by globalization and ecotourism. Transfusion transmission, particularly of Leishmania infantum, remains a concern due to the parasite's ability to survive under blood storage conditions and its prolonged latent phase. We aimed to determine the prevalence of Leishmania spp. among blood donors in a non-endemic region.

Materials and methods: A prospective, cross-sectional study was conducted with 5145 blood donor samples collected from January to December 2023. Serological screening was performed using an in-house immunoglobulin G (IgG) ELISA based on Leishmania chagasi antigen. Samples with positive or inconclusive ELISA results were further tested by real-time PCR targeting internal transcribed spacer (ITS) and kinetoplast DNA (kDNA) regions, according to Pirmez et al. RESULTS: Among samples tested, 2.82% (141/5145) were ELISA-reactive. None of these were positive by PCR for ITS or kDNA.

Conclusion: The absence of Leishmania DNA in ELISA-reactive samples highlights the limitations of serological screening in low-endemicity areas. Inflammatory physiological conditions, such as pregnancy and abortion, may contribute to non-specific reactivity. The incorporation of molecular methods and the adoption of universal leukoreduction are recommended measures to ensure transfusion safety and avoid unnecessary donor deferrals.

Background and objectives: It remains unclear whether sleep deprivation and fasting increase the risk of vasovagal reactions (VVRs) in blood donors. This study explored this question.

Materials and methods: A large observational study was conducted in a regional blood centre handling 309,971 blood donations from 83,709 donors between 2017 and 2022. From these non-duplicated donors, 83,234 donors who donated 400 mL whole blood or apheresis blood were selected as subjects for analysis, of whom 2132 (2.6%) had VVRs. The associations of sleep duration the night before donation and the timing of the last meal before donation with VVRs were analysed together with general risk factors for VVRs, such as age, sex, body weight, donation experience and blood collection type.

Results: Younger age, female gender, lower body weight, first-time donation and apheresis donor were clear risk factors for VVRs in univariate analysis, although female gender and first-time donation were not identified as independent risk factors in multivariate analysis. There was no dose-dependent relationship between sleep duration or fasting time and VVR incidence, nor was any association identified in multivariate analysis.

Conclusion: Neither sleep duration nor donor-reported fasting time had any association with VVRs under the routine practice of providing snacks and drinks to donors just before blood donation. The present findings should help blood collection agencies to appropriately assess the risk of VVRs based on donor-reported sleep and fasting times.

Background and objectives: Unsuccessful red blood cell (RBC) transfusion, necessitating unscheduled repeat transfusion, is common and costly. Several technologies have been developed to assess stored blood quality, but the potential cost-effectiveness of pretransfusion testing versus no testing to prevent unscheduled re-transfusion is unknown.

Materials and methods: Projected benefits and costs of implementing a hypothetical pretransfusion assay were evaluated using Markov models with 10,000 Monte Carlo simulations. Chronic RBC transfusions were modelled at 1-month intervals over a 1-year time horizon, for 'simple' and 'complicated' (requiring antigen matching) cohorts. Model inputs included transfusion costs and quality-of-life weights. Cost-effectiveness was defined as incremental net monetary benefit (INMB) > 0, assuming willingness to pay <$50,000 per quality-adjusted life year (QALY).

Results: The Centers for Medicare and Medicaid Services reimbursement for a single-unit RBC transfusion was $970 ($853-$1313) and $2377 ($2057-$3317), respectively, for the simple and complicated cohorts. The hypothetical assay was priced at $100 ($38-$163) and was assumed to lower unscheduled re-transfusions by 30%, from 64% to 45% (40%-50%). Pretransfusion testing yielded 0.02 higher QALY (95% prediction interval [PI]: 0.01-0.02); annual per-patient cost savings of $269 (95% PI: $263-$276) and $3651 (95% PI: $3633-$3669), respectively, for the simple and complicated cohorts; and INMB of $1083 (95% PI: $985-$1180) and $4347 (95% PI: $4250-$4443).

Conclusion: Assessment of RBC quality by a hypothetical test prior to transfusion may reduce the incidence and associated costs of unscheduled re-transfusions and, with modelled assumptions, could be especially cost-effective for patients with complicated chronic transfusion requirements.

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.

Background and objectives: Cryopreservation allows for storage of red blood cells (RBCs) beyond the standard 35-day period. Current glycerol-based methods are labour-intensive and scale-limited in application. Tricine has been identified as a potential alternative cryoprotectant (CPA), demonstrating efficacy in sheep RBC. This study aims to evaluate the biocompatibility and efficacy of tricine in human RBC cryopreservation.

Materials and methods: Human and sheep RBCs were exposed to varying concentrations of tricine (2.0-20.0% w/v) or glycerol (20.0-40.0% w/v). Biocompatibility was assessed via 24-h incubation at 4°C, while cryoprotective efficacy was evaluated following freezing in liquid nitrogen, storage at -80°C and thawing at 37°C. RBC recovery was assessed via spectrophotometric estimation of haemolysis.

Results: Tricine was biocompatible, with <1% haemolysis in both species. When frozen, tricine provided significant protection against cryoinjury in sheep RBC, with maximal recovery at 8.0% w/v (42.17% ± 10.96% of RBC recovered). However, tricine lacked cryopreservative efficacy in human RBC, with post-thaw recovery rates on par with those seen following unprotected freezing. Even at the highest performing concentration (10.0% w/v), human RBC recovery remained low (16.08% ± 2.96%), highlighting the ineffectiveness of tricine in preserving human RBC integrity. Further analyses revealed greater hydrophilicity in sheep haemoglobin, which potentially influences freezing tolerance.

Conclusion: Despite promising results within the ovine model, tricine lacks CPA efficacy for human RBC. Species differences in RBC physiology likely contribute to these discrepancies. These findings emphasize the need for rigorous model selection in cryopreservation research and further investigation into CPA mechanisms.