Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine最新文献

Efficient quality improvement in Blood Establishments (BE) relies on monitoring Key Performance Indicators (KPIs) within the Quality Management Review (QMR). KPIs serve as objective measures to identify system weaknesses and promote continuous quality improvement. The QMR integrates KPI data with inputs from various sources like non-conformities and audit reports, facilitating informed decision-making for improvement initiatives. This study was conducted at the Transfusion Medicine Department of a General Oncology Hospital with the aim of evaluating the quality improvement. Over a period of 6 years (2018-2023) some interventions were implemented to enhance blood sufficiency and blood stock management. The aim of the present study was to assess the impact of these interventions on the values of KPIs and, consequently, on the effectiveness of the system regarding the examined issues. The values of the KPIs before and after the interventions were compared to identify statistically significant differences. The years following the interventions the WAPI% index for expired red blood cell units was reduced, the acceptance limits of units collected per blood drive were met, the blood units collected in the BE increased and the deficit in red blood unit was reduced. The selected KPIs were significantly improved with minor exceptions. In conclusion, the systematic monitoring of KPIs and strategic interventions underscored in this study illustrate how targeted quality management practices can enhance operational efficiency and ensure sustainable improvements in BEs. Ongoing efforts to refine these approaches aim to achieve broader quality enhancement goals across blood management practices.

Extracorporeal photopheresis (ECP) is a vital therapeutic option for pediatric patients with immune-mediated conditions. However, the high extracorporeal volume (ECV) involved in ECP poses a risk of hypovolemia, often necessitating red blood cell (RBC) priming to maintain hemodynamic stability. This study evaluates a conservative approach to ECP without RBC priming in pediatric patients, aiming to reduce allogenic blood exposure. A retrospective review of 16 ECP procedures across 3 pediatric patients with ECV exceeding 15% of total blood volume (TBV) found no significant adverse events or hemodynamic instability. The absence of RBC priming did not result in any documented complications. These findings suggest that conservative blood priming can safely reduce allogenic blood exposure in pediatric ECP, potentially minimizing transfusion-related risks. Further research is needed to establish guidelines for patient selection and monitoring during non-prime ECP in pediatric populations.

Background and objectives: Transfusion reaction is often masked in critically ill patients because of underlying disease or certain pre-medications. The study was planned to know the incidence and determine risk factors associated with these acute transfusion reactions (ATRs) in intensive care (ICU) patients by actively monitoring the transfusion events.

Material and methods: In this prospective observational study, critically ill patients admitted to ICU and having an ICU stay of 24 hours prior to transfusion were enrolled. Each enrolled patient was actively monitored after each transfusion of blood component at 15 minutes, 1 hour, 6 hours and 24 hours. Transfusion reactions reported from ICU during the study period were considered as passively reported ATRs.

Results: Transfusion of 850 components translating to 430 transfusion episodes was actively monitored. Thirty-three ATRs were observed in 27 patients. Incidence of ATR on active monitoring (0.039) was higher than on passive reporting (0.006). On active monitoring, 06 cases of TACO, 2 cases of TAD, 1 case each of TRALI and TTBI, 3 cases of FNHTR were recorded. A significant association between positive fluid balance (p=0.01) and generalised oedema (p=0.01) was observed with TACO. Twelve cases were labelled as unclassifiable complication of transfusion. Rise in BP was the only symptom observed in all these cases. The mean post-transfusion systolic blood pressure and diastolic blood pressure at 1 hour, 6 hours and 24 hours were significantly higher (p < 0.05) than pre-transfusion values.

Conclusion: Active monitoring provides us with a true insight into the incidence of various ATRs.

Background and objectives: Prevention of vasovagal events has been a major concern for blood centres to reduce the negative impact of decreased donor return for whole blood donation. This study aims to find out the effectiveness of applied muscle tension in reducing vasovagal events in first-time blood donors.

Materials and methods: This cohort study involves the active application of applied muscle tension given by the donor with an inbuilt mechanism through an adjustable spring-fitted footrest in the blood donor couch (Remi India Pvt. Ltd). The outcome measure was encountering vasovagal events from the beginning of whole blood donation till at least 15 minutes of the observation period after blood donation in the blood donation complex. Vasovagal events were monitored objectively by measuring heart rate and blood pressure before, during whole blood donation, and after recovery from vasovagal events. Various signs of VVRs, such as dizziness, facial pallor, and sweating, were taken into consideration.

Results: This study includes the observation of adverse donor events among first-time blood donors in a total of 2192 whole blood donations. The vaso-vagal events were associated significantly with the muscle tension applied, education, and anxiety level of the blood donors. The regression analysis showed the muscle tension applied, education level, anxiety scale, hemoglobin percentage, volume of blood collected and BMI as an independent predictor of adverse vaso-vagal events in whole blood donation.

Conclusion: Applied muscle tension is an effective tool to reduce the incidence of VVRs in first-time blood donors. Pre-donation counseling of first-time donors may reduce the anxiety level and, in turn, the VVRs.

Daratumumab-containing quadruplet induction regimens have recently become the standard of care for patients with newly diagnosed multiple myeloma who are candidates for autologous hematopoietic stem cell transplantation. Daratumumab is a known immunosuppressant, and previous studies have shown that it may impair stem cell mobilization yields. We report a retrospective study of 104 newly diagnosed multiple myeloma patients comparing mobilization yields between those who received quadruplet daratumumab-containing induction and those who received traditional three-drug induction. Our results demonstrated that there were no statistically significant differences in achieving the patient-specific minimally required CD34+ cell yield after the first mobilization attempt between patients in the daratumumab-containing arm and those in the non-daratumumab-containing arm (P = 0.28).However, patients who received the quadruplet induction regimen with daratumumab experienced a statistically significant longer duration of apheresis collection (median of 2 days in the daratumumab-containing arm vs. 1 day in the non-daratumumab-containing arm, P = 0.011) than those who received traditional three-drug induction.Our findings reinforce the importance of incorporating both granulocyte-colony stimulating factors and plerixafor upfront into mobilization practices. Furthermore, the findings of this study may have implications for the judicious use of apheresis machines and further inform the optimal delivery of daratumumab-containing induction therapies for newly diagnosed multiple myeloma.

Aim: To study cardiac serious adverse reactions in blood donors (CSARD) reported in the context of whole blood donation (WBD) or apheresis donation (AD) in France. Although potentially serious, they have been poorly studied so far.

Methods: Retrospective descriptive study of the 125 CSARD (myocardial infarction-MI, acute coronary syndrome-ACS, angina pectoris-AP, rhythm disorder-RD) reported between 2010 and 2021. The studied parameters were age, gender, type of donation, diagnosis, time to onset, imputability, severity (grade), cardiovascular risk factors (CVRF). They were reviewed within the reports by 5 experts, who independently recorded their opinions on each parameter (except age, gender, type of donation). The collegial analysis of the opinions then resulted in a consensus for all cases. The time between the occurrence of CSARD and donation has been extended and limited to 48 h. An additional criterion of imputability was added for the CSARD attributed to causes other than the donation (e.g., coronary atheroma) but Aggravated or Triggered by the donation: AT1 possibly (>24-48 h post-donation), AT2 probably (>12-24 h post-donation) or AT3 certainly (within 12 h or pre-donation start).

Results: Out of 125 reports, 50 were excluded: cardiac qualification of SARD invalidated (8), lack of data (2), absence donation (1), occurrence more than 48 h after the donation (39). The 75 included CSARD (including 5 deaths) comprised 58 coronary events (38 MI, 13 ACS, 7 AP) and 17 RD, and their complementary imputability criterion (AT) was classified respectively as follows 1 (20%), 2 (24%), 3 (56%). The estimated cumulative incidence of CSARD/106 donations is 2.1, significantly higher for AD (5.3) than for WBD (1.6; p < 0.001). The male (M) and female (F) percentages are 81% vs 19%, significantly different from the ones of the standard donor population over 2010-21: 48% M vs 52% F. The median ages, 55 years (30-70) in men, and 47 years (23-68) in women, were significantly higher than the ones of standard donor population 2010-21, respectively 46 (p < 0,001) and 41 (p = 0,04). In the 58 coronary accidents, at least 3 CVRF were noted in 38 cases (66%) and at least 4 CVRF in 20 cases (34%), including 5 with 5 CVRF. In 6/75 cases (8%) pre-existing signs not detected during the pre-donation interview (PDI) would have permanently contraindicated donation.

Conclusions: A complementary study should assess whether a more formalised consideration of CVRF in the PDI could reduce the frequency of CSARD of coronary type.

Background and objectives: Red cell transfusion is the mainstay of therapy for anemia and it is important to transfuse adequate dosage of red cells to maintain tissue oxygen demands. Additionally, it is also important to avoid overload of red cells to prevent adverse effects. Therefore, we compared the rise in hemoglobin and hematocrit for random-Based transfusion (RBT) and formula-based blood transfusion (FBBT) among patients to get a better understanding of differences in clinical outcome between the two methods.

Materials and methods: In this study 752 patients were included who were admitted in the hospital and required transfusion of a single unit of PRBC. Patients included in the study were randomized in two categories, RBT and FBBT, using stratified random sampling without any bias. In RBT category, patients received blood transfusion according to standard practice i.e. patient received the full red cell unit without any modifications in volume. All odd number request in cross-match register during the study period who fulfilled the eligibility were included in this group. In FBBT group, even numbered requests in the crossmatch register were randomized to receive FBBT. In this category, patients received transfusion according to the following formula: Volume of PRBCs to be transfused= TBV × (Desired Hct - Current Hct of patient)/ Hct of donor unit (where the desired rise of Hct is 3%) RESULTS: In our study we found that the rise in hemoglobin and hematocrit levels were significantly higher for patients receiving FBBT as compared to the patients receiving RBT. Pre-transfusion hemoglobin and hematocrit did not have a significant difference whereas the post transfusion hemoglobin and hematocrit showed a higher rise in the FBBT group as compared to the RBT group. (Welch corrected t = 2.633, p value = 0.0086).

Conclusion: This study re-emphasizes the value of FBBT over the routinely used RBT. This study found that FBBT had an edge over RBT, providing significantly higher increase in post-transfusion Hb and Hct. The authors therefore are of the opinion that use of FBBT may be considered in routine clinical practice to optimize transfusions for the patients.

Objectives: Emergency collection may be the only way to access blood when an urgent need arises, such as in a military setting. However, it is important to preserve any excess whole blood donations for future transfusion needs. Cold or room temperature (RT) storage has been reported in the literature. This raises the question of which storage temperature best preserves haemostatic properties of whole blood (WB). Our study investigated this question for storage times up to 48 h.

Methods: This comparison study used 30 bags of WB collected from eligible military personnel. WB bags were randomly stored at either 22 °C or 4 °C. Samples from each bag were taken immediately after blood collection and analysed again after 48 h storage. Analyses included: metabolic and haematological parameters, coagulation factors, thrombin generation potential and platelet function (platelet activity, clotting capacity and aggregometry).

Results: The overall quality of both storage conditions at 48 h was adequate according to metabolic parameters. Aggregometry was significantly affected in both groups. Clot stiffness was better preserved in WB stored at RT, however coagulation time was extended compared to storage at 4 °C. The platelet count was reduced in 4 °C. The thrombin generation potential was maintained irrespective of storage conditions.

Conclusion: The storage at RT offers encouraging in vitro results to promote its use to recover haemostatic functions. As both conservation temperature is acceptable, this will offer greater flexibility to access blood in a resource-limited environment. The choice of either temperature should depend on the frequency of patient admissions.

Background and aim: Megaloblastic anemia (MA) is a rare pathology in childhood due, in the majority of cases, to a deficiency of folic acid and/or vitamin B12 (cobalamin). This study aims to determine the epidemiological, clinical, and paraclinical profiles of MA in children and to specify its etiologies, therapeutic modalities, and treatment responses.

Methods: This is a retrospective descriptive study of MA cases in children carried out in the General Pediatrics Department of the Hedi Chaker University Hospital of Sfax over a period of 42 years, from January 1979 to December 2021. We included all the patients under 16 years old with a myelogram showing megaloblastosis. The selected patients' demographic characteristics, physical signs, laboratory findings, and treatment responses were recorded.

Results: Twenty cases of MA were collected, including 11 boys and 9 girls. The incidence of MA in children was 0.014%. The median age at diagnosis was 3.37 years. The clinical presentation was anemic syndrome with pallor and asthenia in all the cases. Neurological manifestations were noted in 2 cases and digestive disorders in 10 cases. Seven infants had psychomotor delays. On admission, all our patients had anemia with an average value of 5.6 g/dl. It was macrocytic in 19 cases. The blood count also revealed leukopenia (7 cases), thrombocytopenia (10 cases), and pancytopenia (5 cases). The myelogram showed megaloblastosis in all the cases and sideroblasts in one. A brain MRI was performed on five patients, and it showed abnormalities in three cases. The etiological investigations revealed a vitamin B12 deficiency secondary to a maternal Biermer's disease (6 cases), malnutrition (3 cases), Imerslund's disease (3 cases), congenital deficiency in transcobalamin II (3 cases), Biermer's disease (1 case), giardiasis (1 case), folic acid deficiency secondary to a poor dietary intake (1 case), mitochondrial cytopathy with vitamin B12-Folic acid deficiency (1 case), and Pearson syndrome (1 case). Our treatment included symptomatic measures, replacement therapy, and etiological treatment. Favorable evolution was noted in 11 cases. Five patients had neurological sequelae, and one patient died.

Conclusion: Our study highlights the rarity and heterogeneity of the etiological contexts of MA in children. Early diagnosis and therapeutic support can improve the long-term neurological prognosis.