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Blood transfusion needs in COVID‐19 patients: An observational prospective unicentric study COVID - 19患者的输血需求:一项观察性前瞻性单中心研究
Pub Date : 2022-06-13 DOI: 10.1111/tme.12886
U. La Rocca, G. Giovannetti, F. Maldarelli, Mirella Farinelli, M. Piazzolla, A. Angeloni, F. Pugliese, S. Coluzzi
Dear Editor, In 2019 a severe acute respiratory syndrome (SARS-CoV-2), caused by a novel coronavirus (2019-nCoV), was described in Wuhan City, Hubei Province, China, which then rapidly spread and evolved into a pandemic. As of 5 July 2021, 183,298,109 confirmed cases of coronavirus disease (COVID-19) and 3,971,687 deaths all over the world have been reported. Italy is one of the most involved countries, reaching 4,259,909 confirmed cases (as of 2 July 2021) and 127,566 deaths. Clinical presentations of SARS-CoV-2 are various. Most infected patients are asymptomatic, others develop mild symptoms like dry cough, sore throat, and fever, with a spontaneous resolution. Some cases evolve into pulmonary oedema, severe pneumonia, acute respiratory distress syndrome (ARDS), and septic shock resulting in organ failure. Most-used treatments are chloroquine and hydroxychloroquine, claimed to block viral entry into cells and have immunomodulatory effects, lopinavir/ritonavir and other antivirals, corticosteroids, anti-cytokines or immunomodulatory agents (tocilizumab, a monoclonal antibody IL-6 receptor antagonist), low-molecular-weight heparin (LMWH) to limit the risk of an associated coagulopathy and disseminated intravascular coagulation (DIC). The WHO has published guidelines to manage the blood supply in response to the COVID-19 pandemic. The guidance underlines the role of blood services in assessing, planning, and responding to the outbreak. In fact, lockdown and social distancing may lead to limited blood resources. Moreover, while blood transfusion requirement may decrease as the health care system is focused on treating COVID-19 patients, thus deferring other clinical interventions, transfusions will still be necessary for emergency situations and to support COVID-19 patients with severe sepsis. Critical patients may develop anaemia as a consequence of multifactorial and complex pathogenesis. Phlebotomies and other surgical procedures, coagulopathies, pathogen-associated haemolysis, hypoadrenalism, and nutritional deficiencies, as well as the concomitant administration of different drugs, may cause Haemoglobin (Hb) to drop. Decreased erythropoietin production and/or activity could be the consequence of inflammatory cytokines such as IL-1 and TNF-α. The risk in COVID-19 patients is even higher due to the well-known pro-haemolytic effect of hydroxychloroquine, especially in G6PDHdeficient individuals, even if there are few findings supporting the necessity for G6PDH deficiency screening before starting this drug. Here we report the results of a retrospective evaluation of blood transfusion supply in patients (pts) affected by COVID-19, admitted to Policlinico Umberto I, Sapienza University of Rome, during the epidemic outbreak, taking into account treatments, comorbidities, clinical and laboratory parameters, especially those related to RBC transfusion. From the 1 March 2020 to 27 April 2020, 71 patients with COVID-19 infection were admitted to Policl
2019年,在中国湖北省武汉市发现了一种由新型冠状病毒(2019- ncov)引起的严重急性呼吸综合征(SARS-CoV-2),随后迅速传播并演变成一场大流行。截至2021年7月5日,全世界共报告了183,298,109例冠状病毒病(COVID-19)确诊病例和3,971,687例死亡病例。意大利是疫情最严重的国家之一,确诊病例达4 259 909例(截至2021年7月2日),死亡人数达127 566人。SARS-CoV-2的临床表现多种多样。大多数感染患者无症状,其他患者出现干咳、喉咙痛和发烧等轻微症状,可自行消退。有些病例发展为肺水肿、严重肺炎、急性呼吸窘迫综合征(ARDS)和感染性休克导致器官衰竭。最常用的治疗方法是氯喹和羟氯喹,声称可以阻止病毒进入细胞并具有免疫调节作用,洛匹那韦/利托那韦和其他抗病毒药物,皮质类固醇,抗细胞因子或免疫调节剂(托珠单抗,单克隆抗体IL-6受体拮抗剂),低分子肝素(LMWH),以限制相关凝血病和弥散性血管内凝血(DIC)的风险。世卫组织发布了应对COVID-19大流行的血液供应管理指南。该指南强调了血液服务机构在评估、规划和应对疫情方面的作用。事实上,封锁和保持社交距离可能会导致血液资源有限。此外,虽然输血需求可能会减少,因为卫生保健系统的重点是治疗COVID-19患者,从而推迟了其他临床干预措施,但在紧急情况下和支持COVID-19严重败血症患者时,输血仍然是必要的。由于多因素和复杂的发病机制,危重患者可能发生贫血。静脉切开术和其他外科手术、凝血功能障碍、病原体相关溶血、肾上腺素减退和营养缺乏,以及同时服用不同药物,都可能导致血红蛋白(Hb)下降。促红细胞生成素产生和/或活性降低可能是炎性细胞因子如IL-1和TNF-α的结果。由于羟基氯喹具有众所周知的促溶血作用,COVID-19患者的风险甚至更高,特别是在G6PDH缺乏的个体中,尽管很少有研究结果支持在开始使用这种药物之前进行G6PDH缺乏筛查的必要性。在此,我们报告了一项回顾性评估结果,该结果是在疫情爆发期间,考虑到治疗、合并症、临床和实验室参数,特别是与红细胞输血有关的参数,在罗马萨皮恩扎大学(Sapienza University of Rome) Umberto I医院收治的COVID-19患者(pts)的输血供应。从2020年3月1日至2020年4月27日,共有71名COVID-19感染患者入住翁贝托第一医院、传染病科或重症监护病房。其中47人需要输血支持;男性30例,女性17例;中位年龄为72岁(38-95岁)。47例患者中有16例(34%)为a型血。45例患者需要红细胞,平均每次输血3次(1-20次);9例患者接受血浆支持,平均输血4次(3-24次)。45名患者中有5名需要红细胞,也需要血浆供应;两名患者仅接受血浆治疗。2例患者接受血小板、红细胞和血浆(见图1D)。47例患者中有32例(68%)出现合并症,如高血压和心血管疾病(18例)、糖尿病(9例)、肿瘤/血液疾病(6例)、自身免疫性疾病(3例)。在47例需要输血的患者中,有22例因严重的临床疾病而入住ICU。所有患者均给予相同的治疗,包括抗病毒药物、低分子肝素和羟氯喹(400mg/天);1例患者因G6PDH缺乏而未接受羟氯喹治疗。考虑到羟氯喹的促溶血作用,我们监测了接受红细胞输注的患者的溶血标志物,观察到以下中位值:入院时Hb为12.3 g/dl (7.4-16.6);首次输血时Hb为7.5 g/dl(6.7-11),乳酸脱氢酶(LDH)为383 UI/L (271-781, n.v 125-225)。所有患者的直接和间接抗球蛋白试验均为阴性,因此排除了免疫介导的溶血性贫血。从COVID-19诊断到输血需求的中位时间为13天(0 ~ 33天);所有患者的LDH值均在确诊后第一次羟氯喹给药后5天(1 ~ 11天)开始升高,峰值中位数为706 IU/L(301 ~ 2805)。 更详细地说,在图1中,我们报告了22名患者的Hb和LDH值的趋势(图1A),以及两名代表性患者的每日LDH和Hb概况和输血需求。第一位患者(图1B)是一名42岁女性,患有高血压和自身免疫性肝炎,接受类固醇治疗。6天后,Hb和LDH值分别达到9.8 g/dl和1000 IU/L(入院时Hb为13 g/dl, LDH为282 UI/L)。14天后,LDH达到2285 UI/L。收稿时间:2020年6月9日修稿时间:2022年2月5日收稿时间:2022年4月24日
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引用次数: 0
A critical contribution in a time of crisis: Examining motivations and deterrents to COVID‐19 convalescent plasma donation and future donation intentions among prospective Canadian donors 危机时期的关键贡献:研究加拿大潜在捐赠者对COVID - 19恢复期血浆捐赠的动机和威慑因素以及未来捐赠意愿
Pub Date : 2022-05-17 DOI: 10.1111/tme.12875
K. Holloway, Chantal Campbell, Ridwaanah Ali, Larkin Davenport Huyer, D. Hart, J. Haw, S. Brennenstuhl, Q. Grundy
To understand motivations and deterrents to donate COVID‐19 convalescent plasma for a clinical trial and determine whether they predict intention to donate source plasma.
了解为临床试验捐献COVID - 19恢复期血浆的动机和阻碍因素,并确定它们是否预测捐献源血浆的意愿。
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引用次数: 0
Utility of pre‐operative haemoglobin concentration to guide peri‐operative blood tests for hip and knee arthroplasty: A decision curve analysis 利用术前血红蛋白浓度指导髋关节和膝关节置换术围手术期血液检查:决策曲线分析
Pub Date : 2022-05-11 DOI: 10.1111/tme.12873
P. Dhiman, V. Gibbs, G. Collins, B. Van calster, Gardash Bakhishli, G. Grammatopoulos, A. Price, Adrian Taylor, Melissa S. Murphy, B. Kendrick, A. Palmer
Assess the prognostic value of pre‐operative haemoglobin concentration (Hb) for identifying patients who develop severe post‐operative anaemia or require blood transfusion following primary total hip or knee, or unicompartmental knee arthroplasty (THA, TKA, UKA).
评估术前血红蛋白浓度(Hb)对识别原发性全髋关节或膝关节置换术(THA, TKA, UKA)后发生严重术后贫血或需要输血的患者的预后价值。
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引用次数: 3
Trust and distrust: Identifying recruitment targets for ethnic minority blood donors 信任与不信任:确定少数民族献血者招募对象
Pub Date : 2022-05-02 DOI: 10.1111/tme.12867
E. Ferguson, E. Dawe-Lane, Zaynah Khan, C. Reynolds, K. Davison, D. Edge, S. Brailsford
We explore the role of trust, distrust, and the prevailing socio‐political context to better understand why people from ethnic minority communities are less likely to be blood donors compared to people from White communities. Recruiting more ethnic minority donors will enhance representativeness, reduce inequality, and help meet the clinical need to increase the proportion of blood with Ro Kell antigen to treat Sickle Cell Disease (SCD).
我们探讨了信任、不信任和主流社会政治背景的作用,以更好地理解为什么少数民族社区的人比白人社区的人更不可能献血。招募更多的少数民族献血者将提高代表性,减少不平等,并有助于满足临床需要,增加含有Ro Kell抗原的血液比例,以治疗镰状细胞病(SCD)。
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引用次数: 7
Diagnostic accuracy of Abbott Architect Assay as a screening tool for human T‐cell leukaemia virus type‐1 and type‐2 infection in a London teaching hospital with a large solid organ transplant centre 雅培建筑师测定法在伦敦一家拥有大型实体器官移植中心的教学医院中作为人类T细胞白血病病毒1型和2型感染筛查工具的诊断准确性
Pub Date : 2022-04-26 DOI: 10.1111/tme.12866
N. Lee, Jamie Murphy, Rasheed Al-Khudairi, A. Sturdy, T. Mahungu, T. Haque, P. Griffiths, J. Tosswill, D. Irish
In the United Kingdom, organ donors/recipients are screened for evidence of human T‐cell leukaemia virus type‐1 and type‐2 (HTLV‐1/2) infections. Since the United Kingdom is a low prevalence country for HTLV infections, a screening assay with high sensitivity and specificity is required. Samples with repeat reactivity on antibody testing are sent to a reference lab for confirmatory serological and molecular testing. In the case of donor screen, this leads to delays in the release of organs and can result in wastage. We aim to assess whether a signal/cut‐off (S/CO) ratio higher than the manufacturer's recommendation of 1.0 in the Abbott Architect antibody assay is a reliable measure of HTLV‐1/2 infection.
在英国,对器官供体/受者进行筛查,以寻找人类T细胞白血病病毒1型和2型(HTLV‐1/2)感染的证据。由于英国是HTLV感染的低流行率国家,因此需要一种具有高灵敏度和特异性的筛选试验。抗体检测中具有重复反应性的样品被送到参考实验室进行确认性血清学和分子检测。在供体筛选的情况下,这会导致器官释放的延迟,并可能导致浪费。我们的目的是评估信号/切断(S/CO)比在雅培建筑师抗体测定中高于制造商推荐的1.0是否为HTLV‐1/2感染的可靠测量。
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引用次数: 1
Designing and testing an ethnic‐ancestry question for Australian blood donors: Acceptability, feasibility, and understanding 设计和测试澳大利亚献血者的种族血统问题:可接受性、可行性和理解
Pub Date : 2022-04-21 DOI: 10.1111/tme.12865
L. Gahan, Carley N. Gemelli, Sarah P Kruse, Tanya E. Davison
We aimed to evaluate the acceptability, feasibility, and understanding of a donor ethnic‐ancestry question with Australian blood donors.
我们的目的是评估澳大利亚献血者对献血者种族血统问题的可接受性、可行性和理解。
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引用次数: 0
Convalescent plasma for COVID‐19: Donor demographic factors associated high neutralising antibody titres COVID - 19恢复期血浆:供体人口统计学因素相关的高中和抗体滴度
Pub Date : 2022-04-17 DOI: 10.1111/tme.12868
J. Mehew, Rachel J. Johnson, David J Roberts, A. Griffiths, H. Harvala
Convalescent plasma containing high levels of SARS‐CoV‐2 antibodies has been studied as a possible treatment for COVID‐19. Better understanding of predictors of high antibody levels is needed for improving supply of high‐quality therapeutic plasma.
已经研究了含有高水平SARS - CoV - 2抗体的恢复期血浆作为治疗COVID - 19的可能方法。需要更好地了解高抗体水平的预测因子,以改善高质量治疗血浆的供应。
{"title":"Convalescent plasma for COVID‐19: Donor demographic factors associated high neutralising antibody titres","authors":"J. Mehew, Rachel J. Johnson, David J Roberts, A. Griffiths, H. Harvala","doi":"10.1111/tme.12868","DOIUrl":"https://doi.org/10.1111/tme.12868","url":null,"abstract":"Convalescent plasma containing high levels of SARS‐CoV‐2 antibodies has been studied as a possible treatment for COVID‐19. Better understanding of predictors of high antibody levels is needed for improving supply of high‐quality therapeutic plasma.","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121514604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
The British Standard for (European Conformity[CE] Marked) Anti‐D: Its rarely discussed but important role in quantitating anti‐D in patient plasma 英国标准(欧洲合格[CE]标志)抗- D:它很少被讨论,但在定量患者血浆中抗- D的重要作用
Pub Date : 2019-11-26 DOI: 10.1111/tme.12649
B. Fox, J. Hockley, L. Studholme
Dear Sir, The National Institute for Biological Standards and Control (NIBSC) has been issuing the British Standard for Anti-D, used to calibrate the AutoAnalyser for quantitation of anti-D in patient plasma, for some 40 years. Recently, whilst establishing the current 3rd British Standard (CE Marked) for anti-D in plasma, we realised that, although there are passing references in the literature, the origins and establishment of this standard have never been published. First, we would like to provide a historical overview of how the first working standard was originally established and, second, how it has evolved, by reporting on the collaborative study to establish the current 3rd British Standard (CE Marked) for anti-D in plasma. In October 1971, the Directors of the UK National Transfusion Centres decided that a national working standard for anti-D, for use in automated assay techniques, was required for routine use in hospitals. The candidate standard was prepared from 23 L of pooled citrated plasma containing incomplete (IgG) anti-D from donors in early, mid and late stages of immunisation. Plasma was recalcified, the clot removed and excess calcium absorbed on an ion-exchange resin, followed by 0.45 μm filtration into three separate containers for sterile storage. Subsequently, the material from each of the three containers was distributed (0.5 mL) into glass ampoules and lyophilised to generate three batches (NIBSC filling codes: 72/229; 73/515; and 73/517) and stored at −20 C. Analyses showed that each ampoule contained 0.58% residual moisture and 0.14% oxygen. The three batches of lyophilised material, described above, were distributed in a collaborative study with the aim to establish a British Working Standard. These candidates were assayed against the International Standard (IS; 64/19) for Anti-D Incomplete Blood Typing Serum using groups O, R1R1 and R2r cells on the AutoAnalyser by five UK clinical laboratories. The results showed that there was no difference between the dose-response curves of the three candidate batches of lyophilised material. Consequently, data for all three batches were pooled for each laboratory, and anti-D potencies, relative to the IS, were determined by parallel-line analysis. There were signs of differences with the slope of pooled candidate data, which tended to be steeper than that of the IS, although non-parallelism (P <0 .01) was only found in 2 of 80 assays, no more than would be expected by chance. Deviations from linearity were observed in 8 of 80 assays with a very small error, which was overcome by reducing the weights of these assays in the potency calculations. The potency estimates varied between laboratories. Two laboratories obtained potencies of 14 IU/ampoule, and the other three laboratories estimated around 10 IU/ampoule. The overall mean potency from all laboratories was 11.54 IU/ampoule (95% confidence interval [CI]: 11.00-12.11). The discrepancy between laboratories was presumed to be a
尊敬的先生,国家生物标准与控制研究所(NIBSC)已经发布了英国抗- d标准,用于校准用于患者血浆中抗- d定量的自动分析仪,大约40年了。最近,在建立血浆中抗d的现行第三个英国标准(CE标志)时,我们意识到,尽管文献中有通过的参考文献,但该标准的起源和建立从未公布过。首先,我们想提供第一个工作标准最初是如何建立的历史概述,其次,它是如何演变的,通过报告合作研究建立目前的第三个英国血浆中抗d标准(CE标志)。1971年10月,联合王国国家输血中心主任决定,需要一项用于自动化验技术的抗- d国家工作标准,供医院常规使用。候选标准品由23 L混合柠檬酸血浆制备,这些血浆中含有免疫早期、中期和晚期供者的不完全IgG抗- d抗体。将血浆重新钙化,除去凝块,并用离子交换树脂吸收多余的钙,然后将0.45 μm过滤到三个单独的容器中进行无菌储存。随后,将三个容器中的材料(0.5 mL)分配到玻璃安瓿中并冻干,生成三批(NIBSC填充代码:72/229;73/515;和73/517),保存在- 20℃。分析表明,每个安瓿含有0.58%的残余水分和0.14%的氧气。上述三批冻干材料是在一项旨在建立英国工作标准的合作研究中分发的。将这些候选物与国际标准(IS;64/19)的抗- d不完全血型血清使用组O, R1R1和R2r细胞在autoanalyzer由五个英国临床实验室。结果表明,3个候选批次冻干物质的剂量响应曲线没有差异。因此,将所有三个批次的数据汇集到每个实验室,并通过平行线分析确定相对于IS的抗d效价。合并候选数据的斜率有差异的迹象,倾向于比IS的斜率更陡,尽管非平行性(P < 0.01)仅在80项分析中的2项中被发现,不超过偶然预期。80个测定中有8个测定存在线性偏差,误差很小,通过减少这些测定在效价计算中的权重来克服。不同实验室对其效力的估计各不相同。两个实验室获得的效力为14国际单位/安瓿,其他三个实验室估计约为10国际单位/安瓿。所有实验室的总体平均效价为11.54 IU/安瓿(95%可信区间[CI]: 11.00-12.11)。实验室之间的差异被认为是化验系统中某些变量的结果,这从参与者提供的信息中并不明显。当时,有一个直接的实际需要,即指定一个普遍可接受的值给一批拟议标准的有效含量,为此目的,所有实验室的总体平均效价被认为是足够的。在这项研究之后,第一个英国抗d (Rh0)抗体标准于1975年建立,用于AutoAnalyser测定血浆抗d水平,指定效价为11.5 IU/安瓿,编码为72/229。1988年,当72/229的库存不足时,有人建议用73/515代替72/229,因为它是从同一血浆池中制备的,并且被纳入了上述最初的合作研究。这一次,四家英国输血中心使用autoanalyzer对73/515和72/229进行了检测,研究结果显示73/515与72/229无法区分,效力在原始合作研究中获得的效力范围内。为了确保连续性,1992年,73/515被采用为抗d抗体的第二个英国标准,指定效价为11.5 IU/安瓿。2005年,通过合格评定途径,73/515根据体外诊断医疗设备指令98/79/EC获得了CE标志,并符合英国输血服务指南。最近,一项涉及三家英国输血中心的合作研究进行了autoanalyzer方法,以评估冻干制剂73/517中的抗d的稳定性及其替代ce标志标准(73/515)的适用性。每位参与者提供2安瓿73/515(冷冻后保存在- 20℃)和8安瓿73/517(检测前分别保存在- 70℃、- 20℃、+4℃和+20℃11年)。 他们被要求在试验当天重组一个。收稿日期:2019年8月14日修订日期:2019年9月26日接受日期:2019年11月1日DOI: 10.1111/ time .12649
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引用次数: 0
Amotosalen and ultraviolet A light efficiently inactivate MERS‐coronavirus in human platelet concentrates 阿莫托沙林和紫外线A光有效灭活人血小板浓缩物中的MERS -冠状病毒
Pub Date : 2019-11-06 DOI: 10.1111/tme.12638
A. Hashem, Ahmed M. Hassan, A. Tolah, M. Alsaadi, Q. Abunada, G. Damanhouri, S. El-Kafrawy, M. Picard-Maureau, E. Azhar, S. Hindawi
This study aimed to assess the efficacy of the INTERCEPT™ Blood System [amotosalen/ultraviolet A (UVA) light] to reduce the risk of Middle East respiratory syndrome‐Coronavirus (MERS‐CoV) transmission by human platelet concentrates.
本研究旨在评估INTERCEPT™血液系统[阿莫托萨伦/紫外线A (UVA)灯]降低人血小板浓缩物传播中东呼吸综合征-冠状病毒(MERS - CoV)风险的效果。
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引用次数: 41
Abstracts of selected papers presented at the 39th Annual Scientific Meeting of the Australian and New Zealand Society of Blood Transfusion, Sydney Convention and Exhibition Centre, Darling Harbour, Sydney, Australia, 16–19 October 2005 2005年10月16-19日,澳大利亚悉尼达令港,悉尼会议展览中心,第39届澳大利亚和新西兰输血学会年度科学会议论文摘要
Pub Date : 2006-06-01 DOI: 10.1111/j.1365-3148.2006.00660.x
s of selected papers presented at the 39 Annual Scientific Meeting of the Australian and New Zealand Society of Blood Transfusion, Sydney Convention and Exhibition Centre, Darling Harbour, Sydney, Australia,
在澳大利亚悉尼达令港悉尼会议展览中心举行的第39届澳大利亚和新西兰输血学会年度科学会议上发表的5篇论文。
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引用次数: 0
期刊
Transfusion Medicine (Oxford, England)
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