Rachel E. Colbran, Melinda M. Dean, R. Harley, Robert L. Flower, Glen Shuttleworth, C. Styles, Helen M. Faddy
Background: Blood donor history questionnaires are used world-wide to detect blood supply and donor safety risks. Donors are less likely to return to donate blood following deferral, therefore removing questions with limited impact on safety would likely improve donor satisfaction and donation rates. Early human immunodeficiency virus (HIV) infection can manifest as acute retroviral syndrome (ARS). This study aimed to evaluate the impact of questioning and deferring blood donors for self-reported symptoms of ARS on Australian blood transfusion safety. Methods: A retrospective analysis of Australian Red Cross Lifeblood databases for the 17-year period, 2000–2016, was undertaken. Voluntary Australian blood donors who reported rash and lymphadenopathy on the donor questionnaire (DQ) were determined at risk of ARS and thus HIV. The proportion of donors deferred for possible ARS, the proportion who later returned, and donor return time for ARS and other 12-month deferrals was assessed. HIV status on subsequent donation in ARS declaring donors and proportion of HIV-positive donors with ARS-like symptoms was also reviewed. Results: Of donors who declared possible ARS, 65.56% [95% confidence interval (CI): 55.74–75.37%] were deferred and only 22.34% (95% CI: 17.40–27.29%) of deferred donors later returned. Compared to other 12-month deferral categories, donors deferred for possible ARS were less likely to return. No donor who declared possible ARS and subsequently donated tested HIV-positive. Moreover, no donors who tested HIV-positive reported both rash and lymphadenopathy in combination. Conclusions: The ARS question does not effectively differentiate HIV-positive from HIV-negative donors. The continued questioning of donors about ARS, through a self-reported combination of rash and lymphadenopathy, resulted in loss of donors who were unlikely to pose a threat to transfusion safety.
背景：全世界都在使用献血者历史问卷调查来检测血液供应和献血者安全风险。献血者在推迟献血后再次献血的可能性较小，因此，删除对安全影响有限的问题可能会提高献血者的满意度和献血率。早期人类免疫缺陷病毒（HIV）感染可表现为急性逆转录病毒综合征（ARS）。本研究旨在评估因献血者自述的 ARS 症状而对其进行询问和推迟献血对澳大利亚输血安全的影响。方法：对澳大利亚红十字会生命之血数据库 2000-2016 年 17 年间的数据进行了回顾性分析。在献血者调查问卷（DQ）中报告有皮疹和淋巴结病症状的澳大利亚自愿献血者被确定为有ARS风险，因此也有感染艾滋病毒的风险。评估了因可能的 ARS 而推迟献血的献血者比例、后来返回的献血者比例、ARS 和其他 12 个月推迟献血的献血者返回时间。此外，还审查了申报 ARS 的捐献者在后续捐献中的 HIV 感染情况，以及 HIV 阳性捐献者中出现类似 ARS 症状的比例。结果：在申报可能存在 ARS 的捐献者中，65.56% [95% 置信区间 (CI)：55.74-75.37%]被推迟捐献，只有 22.34% (95% CI：17.40-27.29%) 被推迟的捐献者后来返回了捐献。与其他延期 12 个月的类别相比，因可能存在 ARS 而延期的捐献者返回的可能性较低。宣布可能存在 ARS 的捐献者中，没有人在随后的捐献中检测出 HIV 阳性。此外，没有 HIV 检测呈阳性的捐献者同时报告了皮疹和淋巴结病。结论：ARS 问题不能有效区分 HIV 阳性和 HIV 阴性捐献者。继续通过自我报告的皮疹和淋巴结病来询问捐献者有关 ARS 的情况，会导致不太可能对输血安全构成威胁的捐献者流失。
{"title":"Making every question count: the impact of temporary donor deferral for suspected acute retroviral syndrome","authors":"Rachel E. Colbran, Melinda M. Dean, R. Harley, Robert L. Flower, Glen Shuttleworth, C. Styles, Helen M. Faddy","doi":"10.21037/aob-23-16","DOIUrl":"https://doi.org/10.21037/aob-23-16","url":null,"abstract":"Background: Blood donor history questionnaires are used world-wide to detect blood supply and donor safety risks. Donors are less likely to return to donate blood following deferral, therefore removing questions with limited impact on safety would likely improve donor satisfaction and donation rates. Early human immunodeficiency virus (HIV) infection can manifest as acute retroviral syndrome (ARS). This study aimed to evaluate the impact of questioning and deferring blood donors for self-reported symptoms of ARS on Australian blood transfusion safety. Methods: A retrospective analysis of Australian Red Cross Lifeblood databases for the 17-year period, 2000–2016, was undertaken. Voluntary Australian blood donors who reported rash and lymphadenopathy on the donor questionnaire (DQ) were determined at risk of ARS and thus HIV. The proportion of donors deferred for possible ARS, the proportion who later returned, and donor return time for ARS and other 12-month deferrals was assessed. HIV status on subsequent donation in ARS declaring donors and proportion of HIV-positive donors with ARS-like symptoms was also reviewed. Results: Of donors who declared possible ARS, 65.56% [95% confidence interval (CI): 55.74–75.37%] were deferred and only 22.34% (95% CI: 17.40–27.29%) of deferred donors later returned. Compared to other 12-month deferral categories, donors deferred for possible ARS were less likely to return. No donor who declared possible ARS and subsequently donated tested HIV-positive. Moreover, no donors who tested HIV-positive reported both rash and lymphadenopathy in combination. Conclusions: The ARS question does not effectively differentiate HIV-positive from HIV-negative donors. The continued questioning of donors about ARS, through a self-reported combination of rash and lymphadenopathy, resulted in loss of donors who were unlikely to pose a threat to transfusion safety.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140085376","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}
Background and Objective: Patient blood management (PBM) programs have recently been defined as ‘a patient-centered, systemic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood, while promoting patient safety and empowerment’. Many benefits are associated with developing a PBM program. These include reducing donor exposure, ensuring a safe blood supply, and potential cost savings from utilizing alternative therapies. Once blood is collected, it must be processed and tested for immunohematologic and transfusion-transmitted disease markers. The collection, testing, processing, and manufacturing of blood components contribute to their increasing cost. In the United States (U.S.), the cost associated with manufacturing blood components is then transferred to the transfusion services that acquire the components. The transfusion service then performs additional testing on the blood/blood component. The component is then priced for the recipient,
{"title":"Economics of patient blood management in the United States: a narrative review","authors":"Shaughn Nalezinski, Mary Berg, Crystal Labrecque","doi":"10.21037/aob-22-35","DOIUrl":"https://doi.org/10.21037/aob-22-35","url":null,"abstract":"Background and Objective: Patient blood management (PBM) programs have recently been defined as ‘a patient-centered, systemic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood, while promoting patient safety and empowerment’. Many benefits are associated with developing a PBM program. These include reducing donor exposure, ensuring a safe blood supply, and potential cost savings from utilizing alternative therapies. Once blood is collected, it must be processed and tested for immunohematologic and transfusion-transmitted disease markers. The collection, testing, processing, and manufacturing of blood components contribute to their increasing cost. In the United States (U.S.), the cost associated with manufacturing blood components is then transferred to the transfusion services that acquire the components. The transfusion service then performs additional testing on the blood/blood component. The component is then priced for the recipient,","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140084611","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}
{"title":"An overview of serology and molecular biology of the Rh blood group system","authors":"Lilian Castilho","doi":"10.21037/aob-2023-03","DOIUrl":"https://doi.org/10.21037/aob-2023-03","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091598","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}
Hussam Elmelliti, Muhammad Abd Ur Rehman, Ahmed Al-Sukal, H. Akram, A. A. Hssain
Background and Objective: Blood Product transfusion is often required during extracorporeal membrane oxygenation (ECMO) support for several reasons. Most of the available data and literature have assessed packed red blood cells (PRBCs) transfusion during extracorporeal support, however it is key to define the threshold for the variability of other blood products available for transfusion. This review aims to highlight published data supporting blood product transfusion, other than PRBCs, in patients on ECMO support, including guidelines, local protocols, and patient outcomes. Methods: PubMed and Google Scholar were primarily used to access the targeted literature published until December 2022. We have also used authoritative text, published guidelines, and expert consensus. The literature on platelets, fresh frozen plasma (FFP), cryoprecipitate, albumin, and activated recombinant factor VII (rFVIIa) was summarized separately. Key Content and Findings: Platelets, FFP, and cryoprecipitate, were discussed in detail with their guidelines and recommended dosage, while albumin and rFVIIa are discussed briefly, primarily due to lack of literature. The relevance of viscoelastic clotting tests to blood product transfusion were also reviewed. In emergency setting, ECMO circuits can be primed with crystalloid while cross-matching blood is being prepared. Albumin can be used as an additive to the primes as it increases the circuit life and prevents protein loss by adding oncotic pressure to the prime. The average platelet units transfused directly correlated with the type of ECMO. Platelet transfusion increases the platelet count by 30,000–100,000/μL. If the international normalized ratio (INR) is greater than 1.5–2.0 or if there is significant bleeding, FFP can be given in aliquots of 10 mL/kg. Cryoprecipitate is given at a dose of 5 mL/kg of body weight if the fibrinogen level is less than 100–150 mg/dL and will increase the fibrinogen concentration by 50 mg/dL/10 kg of body weight. Thromboelastography (TEG), and thromboelastometry (TEM) reduce the requirement for blood product transfusion in bleeding patients. Conclusions: This review has highlighted the lack of data available regarding non-PRBC blood product transfusions and the appropriate therapy practices and preventive measures in ECMO patients. Further research is warranted to define and guide blood product transfusion thresholds, management practices, and limitations in ECMO patients.
{"title":"Blood products other than packed red blood cells in extracorporeal membrane oxygenation: guidelines, local protocols, and outcomes—a narrative review","authors":"Hussam Elmelliti, Muhammad Abd Ur Rehman, Ahmed Al-Sukal, H. Akram, A. A. Hssain","doi":"10.21037/aob-21-82","DOIUrl":"https://doi.org/10.21037/aob-21-82","url":null,"abstract":"Background and Objective: Blood Product transfusion is often required during extracorporeal membrane oxygenation (ECMO) support for several reasons. Most of the available data and literature have assessed packed red blood cells (PRBCs) transfusion during extracorporeal support, however it is key to define the threshold for the variability of other blood products available for transfusion. This review aims to highlight published data supporting blood product transfusion, other than PRBCs, in patients on ECMO support, including guidelines, local protocols, and patient outcomes. Methods: PubMed and Google Scholar were primarily used to access the targeted literature published until December 2022. We have also used authoritative text, published guidelines, and expert consensus. The literature on platelets, fresh frozen plasma (FFP), cryoprecipitate, albumin, and activated recombinant factor VII (rFVIIa) was summarized separately. Key Content and Findings: Platelets, FFP, and cryoprecipitate, were discussed in detail with their guidelines and recommended dosage, while albumin and rFVIIa are discussed briefly, primarily due to lack of literature. The relevance of viscoelastic clotting tests to blood product transfusion were also reviewed. In emergency setting, ECMO circuits can be primed with crystalloid while cross-matching blood is being prepared. Albumin can be used as an additive to the primes as it increases the circuit life and prevents protein loss by adding oncotic pressure to the prime. The average platelet units transfused directly correlated with the type of ECMO. Platelet transfusion increases the platelet count by 30,000–100,000/μL. If the international normalized ratio (INR) is greater than 1.5–2.0 or if there is significant bleeding, FFP can be given in aliquots of 10 mL/kg. Cryoprecipitate is given at a dose of 5 mL/kg of body weight if the fibrinogen level is less than 100–150 mg/dL and will increase the fibrinogen concentration by 50 mg/dL/10 kg of body weight. Thromboelastography (TEG), and thromboelastometry (TEM) reduce the requirement for blood product transfusion in bleeding patients. Conclusions: This review has highlighted the lack of data available regarding non-PRBC blood product transfusions and the appropriate therapy practices and preventive measures in ECMO patients. Further research is warranted to define and guide blood product transfusion thresholds, management practices, and limitations in ECMO patients.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140082928","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}
{"title":"Implication of novel RH alleles in blood transfusion therapy","authors":"Lilian Castilho","doi":"10.21037/aob-23-26","DOIUrl":"https://doi.org/10.21037/aob-23-26","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138627450","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}
Tracey E. Madgett, Wajnat A. Tounsi, A. J. Halawani, N. Avent
: This review traces the evolution of RHD genotyping from the very early days of the discovery of Rh polypeptides in 1982, and the pioneering work of the late 1980s and early 1990s that made the whole approach of RH genotyping possible. This work is often overlooked in contemporary Rh literature with citations of reviews being used which often do not give the complete background story. We have attempted to rectify this here. This review focuses primarily on RHD genotyping, primarily because of space constraints not to include RHCE but also because RHD is of greater clinical significance. In Europe many countries offer routine non-invasive prenatal RHD screening to direct the use of prophylactic anti-D to mothers that require it-namely are carrying D-positive fetuses. The genotyping approach is empirical (and wisely so) and any potential variant identified in this process is treated as D-positive. In such cases although sometimes unnecessary administration of prophylactic anti-D may be given, it only reflects the situation that predated mass scale non-invasive testing, and many countries not offering RHD screening. The complexity of the RHD gene and the known plethora of D variants (partial, weak D-elute and multiple genetic mechanisms generating the D-negative phenotype) are explored but only inasmuch as the technology to detect them is discussed. By far the most powerful means of accurate RHD genotyping, so called gold standard testing is next-generation sequencing although our discussion is tempered by several caveats mainly involving the rapid bioinformatic determination of a D variant from its resultant sequence. We stress however that next generation sequencing (NGS) offers the substantial advantage over other conventional RHD genotyping strategies in that novel variants can be identified whereas other methods require that the variant has been previously described so as to direct sequence specific analysis.
{"title":"RHD molecular analysis—from discovery to next generation sequencing","authors":"Tracey E. Madgett, Wajnat A. Tounsi, A. J. Halawani, N. Avent","doi":"10.21037/aob-22-41","DOIUrl":"https://doi.org/10.21037/aob-22-41","url":null,"abstract":": This review traces the evolution of RHD genotyping from the very early days of the discovery of Rh polypeptides in 1982, and the pioneering work of the late 1980s and early 1990s that made the whole approach of RH genotyping possible. This work is often overlooked in contemporary Rh literature with citations of reviews being used which often do not give the complete background story. We have attempted to rectify this here. This review focuses primarily on RHD genotyping, primarily because of space constraints not to include RHCE but also because RHD is of greater clinical significance. In Europe many countries offer routine non-invasive prenatal RHD screening to direct the use of prophylactic anti-D to mothers that require it-namely are carrying D-positive fetuses. The genotyping approach is empirical (and wisely so) and any potential variant identified in this process is treated as D-positive. In such cases although sometimes unnecessary administration of prophylactic anti-D may be given, it only reflects the situation that predated mass scale non-invasive testing, and many countries not offering RHD screening. The complexity of the RHD gene and the known plethora of D variants (partial, weak D-elute and multiple genetic mechanisms generating the D-negative phenotype) are explored but only inasmuch as the technology to detect them is discussed. By far the most powerful means of accurate RHD genotyping, so called gold standard testing is next-generation sequencing although our discussion is tempered by several caveats mainly involving the rapid bioinformatic determination of a D variant from its resultant sequence. We stress however that next generation sequencing (NGS) offers the substantial advantage over other conventional RHD genotyping strategies in that novel variants can be identified whereas other methods require that the variant has been previously described so as to direct sequence specific analysis.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138608116","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}
{"title":"Serological analysis of Rh antigens: how far can we go?","authors":"Veera Sekaran Nadarajan","doi":"10.21037/aob-23-30","DOIUrl":"https://doi.org/10.21037/aob-23-30","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138616614","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}
Elba Nydia Reyes-Pérez, Lisette Maricruz Flores-Cuevas, Gustavo Martínez-Mier, Luis Eduardo Chávez-Güitrón, María Concepción Martínez-Jiménez, Martha Audelo-Guzmán, Jacqueline Calderón-García, J. M. Reyes-Ruiz
{"title":"Predictive value of the lactate dehydrogenase-to-albumin ratio (LAR) in classical Hodgkin’s lymphoma","authors":"Elba Nydia Reyes-Pérez, Lisette Maricruz Flores-Cuevas, Gustavo Martínez-Mier, Luis Eduardo Chávez-Güitrón, María Concepción Martínez-Jiménez, Martha Audelo-Guzmán, Jacqueline Calderón-García, J. M. Reyes-Ruiz","doi":"10.21037/aob-23-24","DOIUrl":"https://doi.org/10.21037/aob-23-24","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138621284","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}
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