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

Background: Post-transfusion platelet refractoriness (PTR) is a major complication in transfusion medicine. While non-immune factors are the most common cause, immune-mediated PTR, often caused by alloimmunization against human leukocyte antigens (HLA), leads to ineffective platelet transfusions, increased bleeding risks, and poorer outcomes in patients with hematologic malignancies or undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Objective: To assess the effectiveness of platelet antibody screening, particularly anti-HLA antibody detection using mean fluorescence intensity (MFI) thresholds, in reducing the incidence of immune-mediated PTR and improving transfusion-related outcomes.

Methods: This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines, involved a comprehensive search of databases including PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The outcomes include post-transfusion PTR incidence, survival rates, and transfusion-related complications. To assess the effectiveness of platelet antibody screening, relative risks (RRs) and odds ratios (ORs) were calculated, with further subgroup analyses performed based on mean fluorescence intensity (MFI) thresholds, patient populations, and screening methodologies.

Results: The final analysis included seven retrospective cohort and case-control studies, encompassing a total of 2865 patients. Patients who underwent antibody screening had a significantly lower PTR incidence (15.4 %, 95 % CI: 12.1-18.7 %) compared to unscreened patients (28.6 %, 95 % CI: 23.7-33.5 %), reflecting a 46 % reduced risk (RR: 0.54, 95 % CI: 0.41-0.71). High MFI thresholds (>10,000) showed stronger specificity for predicting PTR, while lower thresholds (>5000) demonstrated greater sensitivity. Secondary outcomes included reduced mortality, improved engraftment, and fewer transfusion-related complications in patients identified via screening who subsequently received compatible transfusions.

Conclusions: Platelet antibody screening is an effective strategy for identifying patients at risk for immune-mediated PTR. This screening enables the implementation of targeted transfusion protocols (e.g., HLA-matched platelets), which mitigate PTR and improve clinical outcomes, particularly in high-risk populations. Standardizing MFI thresholds and protocols is essential for broader clinical application. Further prospective research is needed to validate these findings and assess cost-effectiveness.

Background: Blood donation is essential for maintaining an adequate blood supply, but repeated donation can lead to iron depletion and anemia. Evidence from nationally representative populations is limited.

Methods: We conducted a cross-sectional analysis of adults (≥18 years) from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Blood donation within the past 12 months was self-reported. Outcomes included anemia (hemoglobin <13.0 g/dL in men, <12.0 g/dL in women), iron deficiency (serum ferritin <70 µg/L), and iron deficiency anemia (IDA, both conditions). Secondary outcomes included serum ferritin, serum iron, total iron-binding capacity (TIBC), and transferrin saturation. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95 % confidence intervals (CIs), adjusting for sociodemographic, lifestyle, and clinical factors.

Results: Among 16,619 adults, 738 (4.4 %) reported blood donation in the past year. Donors were younger, more often male, physically active, and had lower prevalence of hypertension and diabetes. Compared with non-donors, donors had significantly lower serum ferritin (98.8 vs. 160.2 µg/L), serum iron (78.3 vs. 84.5 µg/dL), and transferrin saturation (22.3 vs. 25.1), but higher total iron-binding capacity (360.4 vs. 345.2 µg/dL). Iron deficiency anemia was more common among donors (5.7 % vs. 1.3 %, p < 0.001). Donation was strongly associated with IDA (adjusted OR 3.72, 95 % CI 2.33-5.95, p < 0.001), but not with overall anemia.

Conclusions: Blood donation is independently associated with iron deficiency anemia but not with overall anemia in U.S. adults. Enhanced donor monitoring and preventive strategies may help safeguard donor health while maintaining blood supply.

Background: The stability of red cell concentrates (RCCs) during storage is routinely assessed by measuring haemolysis, which must remain below 0.8 % in Europe and 1.0 % in the USA. Haemolysis during storage is influenced by both technical factors (e.g., additive solutions, leukoreduction) and donor-related characteristics, such as age and gender.

Objective: To investigate the influence of donor age, gender, donation frequency and collection time on haemolysis in RCCs during storage.

Materials and methods: A retrospective study was conducted on 768 RCCs prepared at the Croatian Institute of Transfusion Medicine over a 13-year period (2011-2023). Haemolysis was assessed on day 35 of storage. Haematological parameters were measured using an Abbott Cell-Dyn Ruby analyser, and free haemoglobin levels using a Plasma/Low Hb photometer, with subsequent calculation of haemolysis percentage. Donor demographic data (age, gender, donation frequency) were retrieved from the blood bank software e-Delphyn. Statistical analyses, including independent-samples t-tests, ANOVA, and correlation analysis, were performed using IBM SPSS Statistics software.

Results: A total of 768 RCC units were analysed. Male donors exhibited significantly higher haemolysis levels compared to female donors (P < 0.001), particularly among younger age groups. In female donors older than 50 years, the median of haemolysis was significantly higher than in those under 50 years (P = 0.022). A weak but statistically significant correlation was observed between haemolysis and donation frequency (rho = 0.163; P < 0.001). However, donation frequency and collection time were not major contributors to haemolysis in regression analysis.

Conclusion: Donor gender and age significantly influence the level of haemolysis in stored RCCs, with higher haemolysis observed in male and older donors. Donation frequency and collection time were not identified as major contributors to haemolysis in regression analysis. These findings support previous research and highlight the importance of considering donor-related factors when aiming to optimize RCC quality and storage outcomes.

Background/objectives: Cancer-related anemia is associated with poorer quality of life and cancer progression. Red blood cell (RBC) transfusion might have an impact on perioperative outcomes after major oncologic surgery. We performed a systematic review and meta-analysis to evaluate whether RBC transfusion exposure (yes/no) and whether RBC transfusion strategies ('liberal' vs. 'restrictive') may impact on postoperative outcomes for patients admitted to an intensive care unit (ICU) following oncologic surgery.

Methods: We searched Pubmed, Embase and Cochrane Library to identify eligible articles published between 1st January 2000 to 31st December 2023. We included clinical trials and observational studies that evaluated RBC transfusion exposure and all studies that compared 'liberal' vs. 'restrictive' transfusion strategies, in adult critically ill patients admitted to ICU after oncologic surgery.

Results: Ten observational studies that compared transfused vs. non-transfused patients, and three comparative transfusion strategy studies (two randomized-controlled trials [RCTs] and one non-randomized) were included. In the observational studies, non-transfused patients had a better survival (OR 0.24 [0.06-0.92], p = 0.04; I² = 78 %), as well as reduced risks of sepsis (OR 0.37 [0.14-0.97], p = 0.04; I² = 91 %), acute kidney injury (OR 0.37 [0.21-0.65], p = 0.0005; I² = 83 %) and pneumonia (OR 0.32 [0.19-0.52], p < 0.00001; I² = 59 %). Hospital length-of-stay was also lower for non-transfused patients: mean difference -4.7 days [-7.13 to -2.26], p = 0.0002 (I² = 94 %). In the two RCTs, no difference was found between 'liberal' and 'restrictive' transfusion strategies on main outcomes. However, the strength of evidence was 'very low' to 'low' quality for the two RCTs.

Conclusions: After major oncologic surgery, perioperative anemia requiring transfusion therapy may impact adversely on postoperative outcomes. Our meta-analysis revealed high heterogeneity in observational studies and low strength of evidence in the transfusion strategy RCTs. Further high-quality comparative studies are needed to investigate RBC transfusion in this setting.

Background: Neonatal hyperbilirubinemia remains a common neonatal condition. While Rh immunoprophylaxis and phototherapy have dramatically reduced exchange transfusion (ET) use in high-income countries, ET remains essential in selected cases, particularly in transitioning healthcare systems. Comprehensive data from Southeast Europe are limited.

Aim: To evaluate 23-year trends in neonatal ET use, indications, and outcomes at a Serbian tertiary referral center.

Methods: This retrospective cohort study (2001-2023) included all neonates undergoing ET at the University Clinical Center of Serbia. Data were collected from medical, transfusion, and laboratory records. Primary outcome was ET rate trend; secondary outcomes included indications and complications.

Results: Among 145,702 deliveries, 243 ETs were performed in 206 neonates. ET rates declined significantly from 6.4 to 0 per 1000 deliveries (p < 0.001), mirroring trends observed in high-income countries. Hemolytic disease of the newborn accounted for 67 % of cases, primarily due to anti-D alloimmunization (65.9 %), a profile characteristic of settings with Rh prophylaxis gaps. Non-immune indications included anemia (36.7 %), infections (28.3 %), and other causes (35.0 %). Most procedures were double-volume ET (61.3 %). No ET-related mortality occurred; complications were transient. RhD-negative mothers showed high sensitization rates (82.1 %).

Conclusion: The significant decline in ET rates in Serbia reflects successful perinatal care improvements, yet the persistent burden of anti-D alloimmunization underscores challenges shared with many transitioning health systems. Strengthening Rh immunoprophylaxis programs and expanding access to bilirubin monitoring are essential public health strategies to further reduce ET need in similar healthcare settings worldwide.

Background and objectives: Reports on the changes in plasma fibrinogen levels in patients receiving cryoprecipitates synthesized using different methods are lacking. Therefore, we investigated these changes in patients who underwent cardiovascular surgery.

Materials and methods: We included 309 patients who underwent cardiovascular surgery and received 12 cryoprecipitate units between February 2020 and March 2024 and 204 patients were selected by propensity score matching. The cryoprecipitates were prepared using two methods. Fresh frozen plasma (FFP) was thawed at 2 to 6 °C for 24 h and centrifuged to remove the supernatant in the one-step method, whereas FFP was thawed, refrozen at -20 °C, and subsequently rethawed in the two-step method. We investigated the association between different cryoprecipitate preparation methods and ICU admission for ≥1 week, with in-hospital mortality considered as a competing risk in the analysis. In addition, we evaluated the changes in plasma fibrinogen levels before and after cryoprecipitate administration.

Results: Baseline plasma fibrinogen levels were significantly higher in the two-step method group than in the one-step method group. Differences in cryoprecipitate preparation methods were not significantly associated with ICU admission for ≥1 week, in the analysis that considered in-hospital mortality as a competing risk (P = 0.93). The increase in plasma fibrinogen levels after cryoprecipitate administration was significantly higher with the two-step method than with the one-step method (36 mg/dL vs. 51 mg/dL, P = 0.020).

Conclusion: The cryoprecipitates synthesized using the two-step method showed a higher increase in plasma fibrinogen levels than those prepared using the one-step method. These findings may help guide appropriate transfusion protocols by confirming intraoperative plasma fibrinogen levels.