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

Background and objectives: Blood donor cohorts are an underappreciated resource for surveillance and public health programming for infectious diseases. The incidence of hepatitis C virus (HCV) infection was evaluated in repeat blood donors in Georgia.

Materials and methods: Using data from the national hepatitis C screening registry, we calculated overall hepatitis C incidence for 2017-2023 and annual incidence during 2017-2022 among adults who donated blood at least twice and had a nonreactive HCV antibody (anti-HCV) test result upon first screening and a subsequent anti-HCV test conducted in any location. Rates of anti-HCV seroconversion and current infection were calculated by year, sex, age group, and location of last HCV screening and expressed per 100,000 person-years (PY).

Results: Of 101,443 blood donors with ≥2 anti-HCV results,775 (0.8%) seroconverted to anti-HCV reactive, of whom 403 (52.0%) had current infection. Incidence of anti-HCV seroconversion decreased from 408 per 100,000 PY in 2017 to 218 per 100,000 PY in 2022 and incidence of infection decreased from 172 per 100,000 PY in 2017 to 118 per 100,000 PY in 2022. Males, persons aged 18-39 years, and people last tested for HCV in prisons had the highest incidence rates for anti-HCV seroconversion and HCV infection, while persons last screened in blood banks and during antenatal care had the lowest.

Conclusion: Despite the observed decline, incidence of HCV infection among repeat blood donors remains high in specific subgroups. Hepatitis C prevention, screening and treatment interventions need to particularly focus on incarcerated populations and young adults in Georgia.

Background and objectives: Platelet storage duration may influence transfusion effectiveness and patient outcomes.The present study aimed to evaluate the effect of platelet storage duration on platelet increment and clinical outcomes in patients admitted to the intensive care unit (ICU).

Material and methods: This prospective, open-label, randomized controlled trial, conducted at a single centre, enrolled ICU patients requiring platelet transfusion. Patients were randomly assigned to receive platelet concentrates aged ≤3 days (Group 1) or 4-5 days (Group 2). Platelet increments were assessed by Absolute Platelet Count Increment (ACI), Corrected Count Increment (CCI), and Percentage Platelet Recovery (PPR). Clinical outcomes including bleeding, infection rates, ICU stay, red cell transfusion requirements, and mortality were also monitored.

Results: Patients transfused fresher platelets (Group 1) had higher median ACI, CCI and PPR at 1 hour compared to those transfused older platelets (Group 2) though the difference was not statistically significant.At 24 hours, Group 1 patients had a median ACI of 28,000/µl compared to 14,000/µl in Group 2(p = 0.001). The median CCI was 16,800 in Group 1 versus 8,200in Group 2(p = 0.001). Group 1 also had a higher median PPR of 45.7% compared to 23.6% in Group 2(p = 0.011).There was no significant difference in clinical outcomes such as bleeding, infection rates, ICU stay, or mortality between the groups. Multivariate analysis indicated that co-morbidities and higher APACHE-III score were associated with increased mortality.

Conclusion: Transfusion of fresher platelets resulted in higher increments and transfusion effectiveness but did not affect clinical outcomes or mortality. Trial registration details: Clinical Trials Registry of India (CTRI/2023/03/050676).

Objectives: Plateletpheresis (PP) has become increasingly prevalent due to its cost-effectiveness and fewer immunological and infectious complications for recipients. This study compares hematological indices of platelet donors and instrument-related parameters in high-yield PP donors using Haemonetics MCS+ and Trima Accel.

Methods: Eligible and healthy PP donors meeting the platelet donation criteria were randomly selected.19 single-dose platelet (SDP), and 26 double-dose platelet (DDP) donors underwent PP using the Haemonetics MCS+, while 21 SDP and 21 DDP donors were processed using the Trima Accel system. Complete Blood Count (CBC) and hematological indices of donors between groups with both devices were measured with the cell counter. Platelet yield, collection efficiency (CE), and collection rate (CR) were evaluated for both devices. Results were reported using R-4.3.2 software and a p-value<0.05 was considered statistically significant RESULTS: The Trima Accel processed significantly more blood volume and had shorter procedure times than MCS+. Platelet yield in the SDP group with Trima Accel was significantly higher than the Haemonetics MCS+. The Trima Accel demonstrated a significantly higher CR and CE than the MCS+ in both SDP and DDP groups. Post-PP lymphocyte counts significantly decreased with the Trima compared to the MCS+ in the SDP group. However, post-PP hematocrit (HCT), mean corpuscular volume (MCV), and mean platelet volume (MPV) in the DDP group with the MCS+ were significantly lower than Trima.

Conclusion: Double-dose plateletpheresis (DDP) offers advantages in cost-effectiveness and platelet production, and although it reduces some hematological indices, these remain within normal limits. The Trima Accel may offer superior efficiency and processing times compared to the MCS+. However, careful monitoring of DDP donors following AABB standards remains essential.

Objectives: During the SARS-CoV-2 pandemic, there has been significant increased use of vvECMO as rescue therapy. Patients with COVID-19 as anticoagulation is needed for vvECMO support, may develop bleeding complications requiring an increased number of RBC transfusions. We would like to report the RBC transfusion needs following the implementation of an ECMO program. Data on blood usage in this population is important in view of the decline in donations due to the pandemic.

Study design and methods: We analyzed data on RBC transfusions in patients who required vvECMO for COVID-19 related ARDS in a Belgian ICU from March 2020 to March 2022. The primary end point was RBC transfusion requirements. and the relationship to outcome. We also analyzed the evolution of this requirement during the four waves.

Results: We admitted 538 patients for hypoxemic ARDS due to COVID-19. Sixty patients (11%) required vvECMO, of whom 27 (45%) died. Forty-seven (78 %) of the vvECMO patients were transfused a total of 403 packed RBC units.. Sites of hemorrhagic complications were ECMO cannulation sites and lungs. RBC transfusion per patient per day on vvECMO was 0.50 [0.30-0.67] units. There were no differences in hemorrhagic complications in vvECMO survivors and non-survivors. The percentage of vvECMO patients receiving a RBC transfusion increased slightly during the last COVID-19 wave, with 92 % of patients transfused.

Conclusions: vvECMO program is associated with a major need for RBC transfusions. These data are important when blood availability is decreased due to a pandemic and illustrates the need for studies on optimizing blood management including therapeutic anticoagulation target, threshold for RBC transfusion or alternatives to RBC transfusion.

Background: Packed red blood cell (PRBC) transfusion is critical in managing pediatric patients with conditions requiring frequent transfusions, such as leukemia, thalassemia, and bone marrow disorders. Alloimmunization, the formation of antibodies against foreign antigens present in the donor's blood, is a significant complication of repeated transfusions. Further, auto/alloimmunization is influenced by multiple factors, including antigenic differences between donor and recipient and the recipient's immune status.

Objectives: This study aimed to assess the prevalence and risk factors of auto/alloimmunization among pediatric patients undergoingmultiple PRBC transfusions in a tertiary care hospital in the sub-Himalayan region of Uttarakhand, India.

Methods: A cross-sectional study was conducted on 113 multi-transfused pediatric patients aged 4 months to 18 years who received more than one PRBC transfusion between September 2022 and August 2023. Antibody screening and identification were performed using column agglutination techniques. Statistical analysis was conducted to evaluate associations between demographic, clinical factors, and antibody detection.

Results: Alloimmunization was observed in 5.31% of patients, with the majority developing antibodies against the MNS blood group system. Autoantibodies were more common, detected in 17.7% of patients. Significant associations were found between the history of prior PRBC transfusions and the formation of alloantibodies (p = 0.005). Age, gender, and ethnicity did not show a statistically significant association with antibody detection.

Conclusions: The study reveals a relatively higher prevalence of autoimmunization among multi-transfused pediatric patients. The history of PRBC transfusions was a significant risk factor, indicating the need for extended RBC phenotyping and tailored transfusion strategies to reduce alloimmunization risks in these patients. Most patients and blood donors in this region belong to the local Garhwali community. This homogeneity may help explain the lower rate of alloimmunization observed, suggesting a degree of antigenic similarity among the blood donors and the recipients.

The main objective of these recommendations for good practices is to supplement the regulatory provisions of the decree of May 15, 2018 which sets the conditions for performing erythrocyte immunohematology tests in medical biology, in order to clarify their application for medical laboratories which conduct first-line immunohematology tests: erythrocyte phenotyping and detection of anti-erythrocyte antibodies. These recommendations cover all phases of a biological examination (pre-analytical, analytical, and post-analytical) as defined in the Public Health Code (Article L6211-2). Four levels of recommendations have been established: ● Recommended practices: complying with the requirements of the NF EN ISO 15189:2022 standard and ensuring optimal medical service delivery. ● Acceptable practices: situations which deviate from the best practices in immunohematology but still ensuring satisfactory patient management as well as transfusion and obstetrical safety. ● Non-recommended practices: not complying with the requirements of the NF EN ISO 15189:2022 standard and not allowing satisfactory patient management, but ensuring transfusion and obstetrical safety. ● Unacceptable practices: presenting a risk for transfusion or obstetrical complications. Compliance with these recommendations optimizes patient medical care, particularly in transfusion or obstetrical contexts.

Background: This study aimed to develop a machine learning classifier for predicting intraoperative blood transfusion in non-cardiac surgeries.

Methods: Preoperative data from 6255 patients were extracted from the VitalDB database, an open-source registry. The primary outcome was the area under the receiver operating characteristic (AUROC) curve of ML classifiers in predicting intraoperative blood transfusion, defined as the receipt of at least one unit of packed red blood cells. Five different machine learning algorithms including logistic regression, random forest, adaptive boosting, gradient boosting, and the extremely gradient boosting classifiers were used to construct a binary classifier for intraoperative blood transfusion, and their predictive abilities were compared.

Results: 337 (5%) patients received intraoperative blood transfusion. In the test-set, the logistic regression classifier demonstrated the highest AUROC (0.836, 95% CI, 0.795-0.876), followed by the gradient boosting classifier (0.810, 95% CI, 0.750-0.868), AdaBoost classifier (0.776, 95% CI, 0.722-0.829), random forest classifier (0.735, 95% CI, 0.698-0.771), and XGBoost classifier (0.721, 95% CI, 0.695-0.747). The logistic regression classifier showed a higher AUROC compared to that of a multivariable logistic regression model (0.836 vs. 0.623, P < 0.001). Among various parameters used to construct the logistic regression classifier, the top three most important features were operation time (0.999), preoperative serum hemoglobin level (0.785), and open surgery (0.530).

Conclusion: We successfully developed various ML classifiers using readily available preoperative data to predict intraoperative transfusion in patients undergoing non-cardiac surgeries. In particular, the logistic regression classifier demonstrated the best performance in predicting intraoperative transfusion.