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

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.

Objectives: Neonatal hyperbilirubinemia, or newborn jaundice, is a common condition caused by high bilirubin levels. Blood group incompatibility between mother and baby is a major cause. This study examined the link between different blood group incompatibilities and their management in newborns with jaundice.

Material & methods: This prospective observational study included 190 neonates with hyperbilirubinemia requiring phototherapy. They were divided into two groups: control (blood group compatible) and case (blood group incompatible). Data on demographics, investigations, and management were collected.

Results: Blood group incompatibility was present in 36.3% of cases, primarily ABO (28.9%). Rh incompatibility and ABO + Rh incompatibility accounted for 5.3% and 1.6%, respectively. DAT was positive in 32.7% of ABO incompatible cases, with anti-B more prevalent. Neonates with ABO incompatibility had the highest mean total serum bilirubin (TSB) level (13.04 mg/dL) and the largest overall decrease in TSB (-33.77%).The mean phototherapy duration was significantly longer in cases (44.1 h) compared to controls (35.5 h). ABO incompatible neonates had a longer average phototherapy duration (42.32 h) compared to controls. However, ABO+Rh and pure Rh incompatible cases had highest phototherapy duration among cases. Moreover, within ABO cases, the mean phototherapy duration was higher in DAT-positive cases (46 h) compared to DAT-negative cases (40.2 h). Delivery mode, parity, and gender did not significantly influence phototherapy duration, but gestational age might play a role.

Conclusion: Various blood group incompatibilities, beyond RhD, are significantly associated with hyperbilirubinemia requiring phototherapy. ABO incompatibility was the most common cause. Neonatal jaundice is linked to blood group mismatch, with ABO+Rh and pure Rh incompatibility requiring longer phototherapy. However, ABO incompatible cases had longer phototherapy in comparison to controls. Gestational age might influence phototherapy duration.

Introduction: T lymphocyte collection is essential for CAR T-cell engineering in refractory hematologic malignancies but needs to be optimised. No guidelines have been established for predicting the amount of T lymphocytes to be collected. The quantity of lymphocytes and especially T cells collected depends on the pre-cytapheresis lymphocyte blood level (pcLBL) and the number of blood volumes (BVs) processed. Our aim was to define and standardise a simple method for predicting the number of T lymphocytes collected, taking into account the number of BVs processed and the pcLBL regardless of the procedures defined by different companies.

Methods: We used data from our large retrospective series, which included 407 collection sessions using the same cytapheresis method in 400 patients mainly being followed up for non-Hodgkin's lymphoma (NHL) or multiple myeloma (MM). We initially analysed the performance of lymphocyte collections using collection efficiencies (CE1 and CE2), which are indices that determine the ability to collect as many cells as possible, and also assessed the percentage of neutrophils collected. Finally, we evaluated whether the number of T cells collected could be easily predicted by multiplying the pcLBL and number of BVs by an average factor.

Results: In our series, CE1 and CE2 for total lymphocytes and T cells were between 76 +/- 15% and 69 +/- 15%, thus confirming adequate cell collection. A low percentage of neutrophils was collected (9 +/- 12%). Confirmation of adequate cell collection led us to consider the relationship between pcLBL and T-cell collection. We then demonstrated that the amount of T cells collected correlated with pcLBL, and could be predicted by multiplying pcLBL by 2.5 for each BV processed.

Conclusion: Easy prediction of T-cell collection is an important tool that can help apheresis and haematology teams monitor collection sessions, regardless of the companies involved and CAR T-cell technology.

Objectives: This study aimed to measure the psychometrics qualities of an extended model of the Theory of Planned Behavior (TPB) applied to plasma donation, and its relevance in the evaluation of interventions aiming at converting whole-blood donors (WBD) to plasma donation.

Methods: Two studies were conducted. The first (N = 433) compared the efficacy of two communication strategies (standard strategy centered on motivations to donate vs. experimental strategy centered on barriers to donate) for influencing specific determinants of the extended model of the TPB and for engaging WBD in plasma donation. The second study (N = 309) evaluated the gain of adding to the experimental strategy an implementation intentions protocol to facilitate the behavior.

Results: Study 1 showed the relevance of the extended model as a measurement tool of intention's determinants, and the efficacy of the experimental strategy compared to the standard approach to bolster intention, F(2,430) = 7.03, p < 0.001, partial η² = 0.032, and to increase the likelihood of commitments χ2(2, N = 433) = 11.904, p = 0.003, Cramer's V = 0.17. Study 2 replicated these results but did not demonstrate any effect of the implementation intentions protocol to strengthen the intervention, χ²(1, N = 188) = 1.341, p = 0.25.

Conclusions: These studies showed that addressing barriers to donation is an efficient communication and recruitment strategy. We encourage blood collection agencies to develop communication campaigns in this direction rather than focusing on donors motivations.

Background/objectives: Pediatric patients with sepsis are frequently subjected to red blood cell (RBC) transfusions but yet its association with mortality is still controversial.

Methods: We consecutively selected 125 patients with sepsis, severe sepsis, and septic shock admitted to intensive care unit (ICU) in our center from January 2022 to January 2023, and finally 100 patients were included in this retrospective cohort study. The patients were divided into two groups: group I who received RBC transfusion and group II who did not receive RBC transfusion. Logistic regression analysis was used to determine the demographic and clinical factors related to receiving RBC transfusion. The association of RBC transfusion with mortality was determined by the Cox regression model, and the mechanical ventilation rate and length of stay by the logistic regression model.

Results: Among the 100 patients, 67 and 33 cases belonged to the RBC-transfused and not-transfused groups, respectively. Lower hemoglobin level (OR = 0.918, 95%CI: 0.881-0.957, p < 0.001), increased c-reactive protein level (OR = 1.022, 95%CI: 1.002-1.043, p = 0.034), and lower platelets count (OR = 0.994, 95%CI: 0.988-0.999, p = 0.023) were associated with RBC transfusions. While the associations of RBC transfusion with mortality and mechanical ventilation were not shown to be statistically significant (HR = 3.926, 95%CI: 0.952-16.186, p = 0.058 and OR = 2.588, 95%CI: 0.832-8.046, p = 0.1), RBC transfusion might be associated with increased ICU length of stay (OR = 16.477, 95%CI: 3.86-70.342, p < 0.001). In the overall survival analysis, younger age (HR = 0.093, 95%CI: 0.027-0.320, p < 0.001), the use of mechanical ventilation (HR = 8.893, 95%CI: 1.483-53.336, p = 0.017), and more severe disease (severe sepsis vs. sepsis, HR = 24.531, 95%CI: 1.923-321.914, p = 0.014; septic shock vs. sepsis, HR = 32.187, 95%CI: 2.977-347.949, p = 0.004) were related to increased mortality.

Conclusions: RBC transfusions are significantly associated with increased ICU length of stay and not associated with 28-day mortality and mechanical ventilation rate. Other factors affecting mortality in pediatric patients with sepsis, severe sepsis, and septic shock are younger age, use of mechanical ventilation, and more severe disease.

In the third week of November 2024, a critical incident involving the refusal of a blood transfusion was reported at our hospital. The case involved a 65-year-old Indian patient who had been admitted for a proposed stoma closure surgery. Although the healthcare team deemed an urgent blood transfusion necessary as part of the patient's treatment plan, the transfusion was refused due to misinformation from the patient's attendants regarding the patient's original blood type. Their refusal was also driven by a fear of the potential consequences of an erroneous mismatched blood transfusion. The blood transfusion centre (BTC) laboratory confirmed the patient's blood type as B Rh (D) positive. However, the attendants raised concerns about the accuracy of this blood grouping, citing previous misunderstandings and misinformation that led them to believe the patient was AB Rh (D) positive until that point. Despite receiving multiple assurances and thorough explanations from the attending physician and nursing staff, the attendants remained distrustful of the BTC laboratory results and requested a re-evaluation of the patient's blood type. As a result, a fresh blood sample was collected for repeat typing. After a one-on-one discussion with our transfusion medicine specialist, the attendants were ultimately convinced of the confirmed blood type. Subsequently, three compatible packs of packed red blood cells (PRBC) of B Rh (D) positive were issued to the patient over the next three consecutive days from our blood centre. This situation underscores the importance of effective communication and education regarding the patient's actual blood type. Our report further details the incident, its consequences, the associated ethical dilemmas, and recommendations to prevent similar occurrences in the future.

Background: Plasma-derived medicines (PDMs) are essential for treating various disorders and require large volumes of human plasma. The debate on voluntary and compensated plasma donation continues, while WHO advocating for voluntary donations. This study examines factors influencing plasma donation, focusing on the effectiveness of voluntary donation and identifying key motivators and barriers.

Methods and materials: This study was conducted in four blood centers. Two questionnaires were developed. The motivation questionnaire was administered to donors who had contributed plasma four times or more. The barrier questionnaire was distributed to donors who had donated only once. Chi-Square was used to compare variables and t-tests for means.

Results: Of participants, 245 frequent plasma donors completed the motivation questionnaire, and 664 one-time donors filled out the barrier survey. Altruism motivated frequent donors, while barriers included time constraints, preference for blood donation, and lack of awareness. Among frequent donors, 84.00% [CI 95%: 0.79-0.89] were willing to donate plasma or had no preference between donating plasma or blood, compared to 39.90% [CI 95%: 0.36-0.43] of one-time donors. Tendency to donate among one-time donors increased to 68.70% [CI 95%: 0.65-0.71], 93.40% [CI 95%: 0.91-0.95], and 43.50% [CI 95%: 0.40-0.47], when requested, friends needed PDMs, or compensation was offered.

Conclusions: Increased tendencies for plasma donation were reported when donors were directly approached by blood centers and friends required PDMs. Results challenge significance of monetary incentives in motivation of plasma donors, suggesting that fostering an understanding of crucial role of plasma donation proves more influential in driving contributions.