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

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.

Guillain-Barre syndrome (GBS) is a disease entity described in literature since 1859. It is associated with various etiological, clinical and immunological factors with prognostic predictive value. Both Intravenous immunoglobulin (IVIG) and Therapeutic Plasma Exchange (TPE) have been regarded as the first-line treatment for GBS. Certain diagnostic tools help us in early identification of GBS subtypes that may aid clinical management. Here, we have discussed six paediatric cases of GBS of Acute Motor Axonal Neuropathy (AMAN) subtype that were considered for TPE. 5 out of 6 patients were eventually weaned from mechanical ventilation and discharged from the hospital. This study emphasizes the role of TPE in management of severe IVIG refractory GBS with axonal involvement that can be beneficial to the patient. TPE may be considered early in GBS cases with axonal involvement.

Immunized platelet transfusion refractoriness (IPTR) has a high incidence of death and complications. HLA-matched platelet unit can effectively treat HLA-immunized PTR. A cohort study was undertaken on nine patients with IPTR hematological disorders who underwent HLA-matched PLT units due to HLA immunization at the First Affiliated Hospital of Soochow University between April 2022 and April 2023. We calculated the 14-hour corrected count increments (14 h-CCI) to evaluate the effect of PLT transfusions. A 14 h- CCI > 5000 was considered to be a successful transfusion. A total of 113 PLT units were transfused to the nine patients with HLA-immunized PTR. Of the 113 PLT units, 50 were random, 34 were cross-matched, and 29 were HLA-matched. The median 14 h-CCI values were 1683 for random PLT units, 5246 for cross-matched PLT units, and 5643 for HLA-matched PLT units (P = 0.02). Moreover, 10, 25, and 43.8% of transfusions were successful for random, cross-matched, and HLA-matched PLT units with non-immune factors (P = 0.013). Regarding non-immune factors, we confirmed that random PLT units, infection, splenomegaly, and bleeding affected platelet transfusion increments (P < 0.05).

In this study, we aimed to investigate the current genetic diversity and provide additional insights into the origins of the Algerian population by analyzing the frequencies of HLA -A,-B,-DRB1,-DQB1 alleles and associated haplotypes. We analyzed 1,082 unrelated healthy Algerian individuals, who were potential kidney donors, recruited and assessed in the Immunology Department of CHU Mustapha in Algiers over a 10-year period (2009-2019). HLA genotyping was performed by Polymerase Chain Reaction Sequence Specific Primers (PCR-SSP). The allelic typing estimate and haplotype frequencies were calculated using the R studio® software and Haplotype frequency estimation from the website https://hla-net.eu/. We identified a total of 20 HLA-A alleles, 31 HLA-B alleles, 13 HLA-DRB1 alleles and5 HLA-DQB1 alleles. Regarding the allele frequency, the haplotype frequency and the distribution with other population database, we were able to provide a description of Algerian genetic background and draw some anthropogenetic conclusions. This study of HLA polymorphism in the Algerian population shows a strong genetic similarity with the populations of southern Europe and North Africa (Morocco, Tunisia and Libya) with which it has shared a common history since antiquity. In addition to its contribution to anthropogenetics, our study, serve as a reference database for studies exploring associations between the HLA system and certain pathologies.

The electronic prescription of Labile Blood Products was recommended in a 1997 directive, to ensure transfusion safety in healthcare services. Following multiple institutional reminders by the Haemovigilance Unit of the Marseille Public Hospitals (APHM), the board of directors decided to set up a project for electronic transfusion records. Here we present the issues arising from this computerisation and the impact of this change of practice on the APHM and the Etablissement Français du Sang PACA-Corse (EFS PACA-Corsica; French Blood Institute Provence-Alpes-Côte d'Azur-Corsica). Concerning the APHM, we were overly optimistic when designing the prescription of Labile Blood Products (LBP), thinking that prescribers would choose the correct product qualifications. Unfortunately, the choice of LBP qualifications was excessive, resulting in product reception being blocked for the medical units. Furthermore, we were also faced with a resistance to change from the older doctors, while the younger doctors and junior doctors at ease with computers rapidly adhered to the tool. Concerning the EFS PACA-Corsica, this change in practice disconnected the link between the software in charge of red cell immunohaematology and LBP delivery, requiring the development of a new tool to re-establish a link. The EFS demanded a remote print-out, as a back-up for the electronic delivery of the prescription. The issue around identity discordance reinforced the ties between the APHM Haemovigilance and Identity Vigilance Units and the EFS. The partnership between our two structures was beneficial for the implementation of electronic transfusion records. The APHM gained in safety, obliging prescribers to note the duration of transfusion, and in healthcare traceability (reception, transfusion, adverse event reporting etc.). For the EFS PACA-Corsica, despite the difficulties encountered with software when the tool was first implemented, electronic nominative prescription made tasks simpler, gave better access to transfusion data, and reduced the number of phone calls from medical units inquiring about patient immunohaematology results. The comprehension and attentiveness between our two entities enabled us to complete this project and to resolve the problems as they appeared.

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 h compared to those transfused older platelets (Group 2) though the difference was not statistically significant. At 24 h, 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 8,200 in 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.