Search

Background Study Design and Methods Results Conclusion Adverse transfusion reactions (ATRs) represent undesired responses in patients. Different reports indicate that rates of ATRs are 1.3–2.6 times higher in pediatric populations compared with adults. The aim of this study was to investigate whether similar trends are observed within the pediatric population in Colombia.This retrospective study, conducted from January 1, 2018, to December 31, 2022, investigated transfusion occurrences and ATRs. Data were collected from the National Hemovigilance Information System. ATRs were reported by medical personnel using standardized forms following guidelines set by the International Society of Blood Transfusion.The study included 2,097,179 patients receiving 6,637,363 transfusions, with 6830 ATRs. In comparison with adult transfusions, pediatric transfusions exhibit a male bias, a higher rate of ATRs per 10,000 transfused patients (79.4 vs. 27.7), a greater prevalence of allergic reactions and a lower incidence of febrile nonhemolytic transfusion reactions (FNHTRs). The rate of ATRs varied across age groups: 17.1 for those aged 0–1 year, 120.5 for individuals aged 2–14 years, 42.5 for people aged 15–65 years, and 24.4 for those over 65 years. Among pediatric patients, 688 of 1126 allergic reactions were linked to platelet transfusions. Platelets obtained via apheresis had a higher ATR rate compared with those from the buffy coat method (OR: 1.44), while in adults, 960 of 3002 allergic reactions were attributed to platelet transfusions, with higher ATR rates for apheresis platelets compared with buffy coat platelets (OR: 1.41).ATRs in the Colombian pediatric population were three times higher than adults. [ABSTRACT FROM AUTHOR]

Objective The aim of this work was to resolve the uncertainty of whether transfusion of fresher red blood cells (RBCs) is better or not with regard to the safety and efficacy. Methods This systematic review was performed in accordance with our protocol registered on PROSPERO (https://www.crd.york.ac.uk/prospero/display%5frecord.php?ID=CRD42022379183). Results After a literature search, 13,247 records were identified, and 26 randomized controlled trials (RCTs) involving 53,859 participants were eligible and included in this review. The results in our review suggested that there was no significant effect of fresher vs older RBCs on mortality (relative risk [RR] = 1.04; 95% CI, 0.99-1.09; P =.39; I 2 = 0%), transfusion reactions (RR = 0.87; 95% CI, 0.57-1.33; P =.64; I 2 = 0%). However, the transfusion of fresher RBCs might increase the risk of nosocomial infection (RR = 1.11; 95% CI, 1.02-1.20; P =.02; I 2 = 0%), whereas there was no significant difference in the fresh vs old subgroup (RR = 0.87; 95% CI, 0.68 to 1.12; P =.28; I 2 = 0%). Conclusion Our study updated and reinforced the evidence of previously published systematic reviews that support the safety and efficiency of current practice of issuing the oldest available RBCs in the blood bank inventory. [ABSTRACT FROM AUTHOR]

To describe the use of plasma transfusion in anaesthetized dogs, specifically the triggers for use, the population administered plasma, reported adverse events and human errors associated with transfusion. Retrospective observational study. A total of 85 client-owned dogs. A search of electronic transfusion and anaesthetic records at a university teaching hospital was performed to identify dogs administered plasma during the study period (January 2017 to June 2021). Data collected included signalment, surgical procedure, intraoperative triggers for transfusion, the type of plasma, rate of transfusion and the presence of transfusion reactions, human errors or deviation from transfusion guidelines. During this period, 85 dogs were administered plasma. Sepsis was diagnosed in 49/85 (58%) dogs, with 42/85 (49%) animals undergoing surgery for septic peritonitis. Perianaesthetic hypotension contributed to the decision to administer plasma in 67/85 (79%) dogs. In 33/85 (39%) dogs, hypotension was the only reason for transfusion, while 31/85 (36%) had other influencing factors, most commonly hypoproteinaemia. Fresh frozen plasma was administered in 95% of cases. Only 31% of transfusions were started at a slower 'test dose' rate and 79% of dogs administered boluses of plasma. No definite, probable or possible transfusion reactions were identified using current veterinary guidelines. Plasma transfusions were commonly administered to dogs presenting with sepsis for haemodynamic optimization. Clinicians often chose to bolus plasma instead of initiating transfusions at the recommended initial slow starting rate. No transfusion reactions were identified; however, some reactions may have been masked by the effects of general anaesthesia and/or have been difficult to recognize in this critically ill canine population. [ABSTRACT FROM AUTHOR]

Objective To explore a new approach to assess the risk of RhCE alloantibodies after transfusion and to establish a strategy for selecting RhCE compatible donors. Methods The Landsteiner’s law and the principle of population genetics were used to determine the combinations of RhCE antigen mismatch between donor and recipient in random blood transfusion, and the big data of Rh blood group distribution in the Chinese population were used to calculate mismatch probability and the chance of finding compatible donors. Results An analysis was performed for the data of RhD, C, c, E, and e antigen typing for 458 542 Chinese individuals reported in the literature, and the results showed that in the strategy of only using RhD matched donors, RhCE antigen mismatches accounted for 25.16% of all blood transfusions, among which the mismatch of Rh phenotypes DCCee, DccEE, DCcee, and DccEe accounted for 14.97%, 5.01%, 2.21%, and 2.26%, respectively, and the mismatch of the phenotypes Dccee, DCCEE, DCCEe, and DCcEE accounted for 0.71% in total. The individuals with DCcEe phenotype could accept the blood from a donor with any Rh phenotype. Conclusion The Rh blood group in the Chinese population is characterized by a high frequency of DCe haplotype, and individuals with Rh phenotype DCCee are the high-risk population for producing RhCE alloantibodies after blood transfusion. RhC, c, E, and e antigen typing is of great significance in searching for Rh antigen matched donors. Blood transfusion from donors compatible with common RhCE phenotypes can prevent the appearance of RhCE alloantibodies in approximately 90% of recipients.

Abstract Background Transfusion-related acute lung injury (TRALI) is a rare life-threatening complication of blood product transfusion. Intravenous immunoglobulin (IVIG)-related TRALI is scarcely reported. Case presentation A 63-year-old male patient suffering from multiple sclerosis treated with half-yearly rituximab infusions, was hospitalized due to dry cough, daily fever and shivering for seven days despite antibiotic therapy. Because of the history of COVID-19 one month prior without the symptoms having improved since, persistent bilateral multifocal areas of ground glass opacities in chest computed tomography and positive SARS-CoV-2 PCR from bronchoalveolar lavage with a cycling time of 30.1 COVID-19 due to long-shedding SARS-CoV-2 under immunosuppression with rituximab was diagnosed. He received treatment with nirmatrelvir und ritonavir and because of diagnosed IgG deficiency additionally a single dose of 20 g IVIG. During the IVIG infusion, the patient acutely developed tachycardia, hypotension, fever, chills, and hypoxemic respiratory failure due to pulmonary edema. TRALI was promptly diagnosed, and the patient was transferred to the intensive care unit for non-invasive ventilation for less than 24 h. The patient was discharged home from regular ward 72 h later in a good general condition and no remaining symptoms of TRALI. Conclusion IVIG-related TRALI is a rare but life-threating condition and prompt recognition is lifesaving. Due to an increased use of IVIG not only in long-shedding SARS-CoV-2, an increase of TRALI incidence is expected.

Background: To determine the awareness and knowledge of blood donation and transfusion reactions among various departments in our tertiary care centre. Material and methods: The cross-sectional study, conducted at ACS Medical College and Hospital in Chennai from March to May 2024, focused on 20 departments. Researchers distributed a pre-tested, self-structured e-questionnaire to the participants, who submitted their responses via email to a designated account. Results: Out of the 20 departments surveyed, 64% were Faculty, 19% Postgraduate, and 17% were Interns. A significant majority, comprising 64% faculty, reported being aware of voluntary blood donation and transfusion reactions. However, despite the awareness and access to information, only a small fraction of the participants, knew about the right period of blood donation and transfusion reactions. Conclusion: This study infers that knowledge and awareness of blood donation and transfusion reactions were relatively higher among faculty in department of surgery, obstetrics and pathology and least among psychiatry, anatomy and forensic medicine. Based on these findings, the study recommends organising regular talks and interactive sessions as essential measures to bridge the gap in knowledge, identify and dispel misconceptions, and motivate individuals for regular discussions based on blood donation and transfusion reactions. These initiatives aim to enhance awareness, clarify any misunderstandings, and foster a proper knowledge about blood donation and transfusion reactions among the patients in time of need like mass destruction like accidents and natural calamities.

Background: Transfusion-related acute lung injury (TRALI) is a rare life-threatening complication of blood product transfusion. Intravenous immunoglobulin (IVIG)-related TRALI is scarcely reported. Case presentation: A 63-year-old male patient suffering from multiple sclerosis treated with half-yearly rituximab infusions, was hospitalized due to dry cough, daily fever and shivering for seven days despite antibiotic therapy. Because of the history of COVID-19 one month prior without the symptoms having improved since, persistent bilateral multifocal areas of ground glass opacities in chest computed tomography and positive SARS-CoV-2 PCR from bronchoalveolar lavage with a cycling time of 30.1 COVID-19 due to long-shedding SARS-CoV-2 under immunosuppression with rituximab was diagnosed. He received treatment with nirmatrelvir und ritonavir and because of diagnosed IgG deficiency additionally a single dose of 20 g IVIG. During the IVIG infusion, the patient acutely developed tachycardia, hypotension, fever, chills, and hypoxemic respiratory failure due to pulmonary edema. TRALI was promptly diagnosed, and the patient was transferred to the intensive care unit for non-invasive ventilation for less than 24 h. The patient was discharged home from regular ward 72 h later in a good general condition and no remaining symptoms of TRALI. Conclusion: IVIG-related TRALI is a rare but life-threating condition and prompt recognition is lifesaving. Due to an increased use of IVIG not only in long-shedding SARS-CoV-2, an increase of TRALI incidence is expected. [ABSTRACT FROM AUTHOR]

Introduction: Major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HCT) is a common practice and represents a challenging transfusion scenario. Prolonged thrombocytopenia with increased platelet transfusion needs is one of its reported adverse effects, and this has been linked to the persistence of recipient anti-donor isoagglutinins. Case Presentation: A 55-year-old male patient, O Rh(D)-positive, with chronic myelomonocytic leukemia underwent major incompatible allo-HCT from a A Rh(D)-negative donor. He presented with prolonged thrombocytopenia and multiple transfusion reactions after A Rh(D)-negative platelet transfusions. Considering the outcomes of numerous examinations, we tested the anti-A1 titers, finding a significant persistence of anti-donor isoagglutinins. We limited platelet transfusions to blood group O Rh(D)-negative donors, which significantly decreased the requirement for platelet transfusions. In addition, the transfusion reactions ceased. Conclusion: In case of transfusion reactions against platelet products in major ABO-incompatible allo-HCT patients, isoagglutinin monitoring should be considered and a change in the platelet transfusion protocol may be beneficial in patients presenting high isotiters against recipient's blood type. [ABSTRACT FROM AUTHOR]

Background: Non-hemolytic acute transfusion reactions (ATRs) are generally not fatal, but they can cause serious increases in workload and costs as a result of blood product wastage. Methods: A retrospective analysis was made of the data of the 7-year period between January 2016 and December 2022 to identify the possible associations between patient and product characteristics and the development of ATRs. Results: A total of 113,666 blood products were transfused during the study period. There were 146 ATRs with an estimated rate of 1.28 per 1000 blood products administered. The most common ATR was mild allergic reactions (n = 84, 57.6%). No statistically significant relationship was found in blood group distribution between patients who had and did not develop ATR (p = 0.797). Febrile Non-hemolytic Transfusion Reaction (FNHTR) was more common in patients receiving erythrocyte suspension (ES) transfusion, and Fresh Frozen Plasma (FFP) was mostly used in those with mild allergic reactions (p < 0.001). Patient age was determined as > 60 years in those who developed FNHTR or 'others,' and < 60 years in patients with mild allergic reactions (p = 0.046). Conclusion: The results of the current study demonstrated that regardless of blood group, the probability of developing FNHTR is high when ES is transfused in elderly patients, and the probability of developing mild allergic reaction is high when FFP is used. While recognizing that ATRs are difficult to prevent, it can be emphasized that prediction and management may become easier if clinicians keep these possibilities in mind when making transfusion decisions. [ABSTRACT FROM AUTHOR]

Background: Premedication administration to patients who are to receive blood transfusions continues despite evidence of a lack of benefit when given to prevent febrile nonhemolytic or mild allergic transfusion reactions. Reviews of ordering practices and staff surveys on an adult inpatient hematology–oncology unit in our multisite oncology medical center indicated a lack of standardization and overuse of premedication in blood transfusions and a lack of knowledge of when it was appropriate to use premedication. Methods: A literature search was performed, and the evidence led to a proposal for a quality improvement (QI) project focused on development of an evidence-based algorithm to guide clinicians in when to administer which premedication, development of clear documentation for premedication plans, integration of the documented premedication plans into electronic orders for blood products, and staff education. Interventions included a hospital-wide algorithm and an electronic order to be integrated with a premedication plan for each patient on the adult hematology–oncology unit. Results: Seven months after implementation of the intervention, premedication use among patients decreased by 57.6%, and the transfusion reaction rate decreased from 1% to 0.8%. Staff knowledge as measured by responses to pre- and postintervention surveys on the appropriate use of premedication also improved. Conclusion: Evidence-based interventions can reduce the incidence of premedication use in patients receiving blood transfusions. To address premedication overuse in blood transfusions at their institution, the authors developed and implemented an evidence-based algorithm to guide clinicians in when to administer premedication and an electronic order to be integrated with a premedication plan for each patient on an adult hematology–oncology unit. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion (BT) may be associated with an increased risk of thromboembolism. The associations between transfusion reactions (TRs) during BTs and potential risk factors for the development of thromboembolism in patients underwent blood transfusion have not been analyzed. Therefore, this study aimed to compare risk factors associated with the development of venous thromboembolism (VTE) or pulmonary embolism (PE) between patients underwent blood transfusion with and without TRs. Study Designs and Methods: The retrospective study was conducted between April 1, 2017, and March 31, 2020, at a medical center in Taiwan. Blood‐transfused patients were grouped into two cohorts as follows: those who experienced TRs and those who did not experience TRs. Both cohorts were subjected to follow‐up until March 31, 2021. The endpoints for both groups were the occurrence of VTE or PE or the date of March 31, 2021. To investigate between‐cohort risk differences, a Kaplan–Meier survival analysis and multiple Cox proportional hazard model was used. Results: A total of 10,759 patients underwent 59,385 transfusion procedures, with 703 patients in the TR group, and 10,056 patients in the non‐TR group. The risk of VTE or PE was twice as high in the TR group than in the non‐TR group (adjusted hazard ratio 2.53, 95% confidence interval 1.49–4.29, p =.001). Meanwhile, age, female sex, transfusion frequency increment, and being nondiabetic was associated with an increased risk of developing thromboembolism. Conclusion: TRs are associated with increased long‐term thromboembolism risk in patients underwent blood transfusion. It is imperative for clinicians to acknowledge this and maintain rigorous follow‐up. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Post-transfusion purpura (PTP) is a rare delayed adverse event characterized by severe thrombocytopenia associated with mucosal bleeding and purpura. PTP is associated with the development of alloantibodies to human platelet antigens (HPAs) and should be distinguished from other thrombocytopenic syndromes. This report is of a 69-year-old man with refractory cardiogenic shock and thrombocytopenia 4 days following blood transfusion, diagnosed with post-transfusion purpura. Case Report: A 69-year-old man was admitted to a tertiary medical center with refractory cardiogenic shock. Four days after he received 1 unit of packed red blood cells, his platelet count plummeted from 147 K/uL to <2 K/uL within hours, associated with delayed presentation of notable hematuria and femoral catheter oozing. An extensive thrombocytopenia work-up, including an initial platelet antibody screen, was unrevealing. The patient was treated with supportive transfusions, dexamethasone, and intravenous immunoglobulin, with rapid platelet recovery. Post-transfusion purpura panel testing later identified anti-human platelet antigen-5b antibodies, confirming the diagnosis. Conclusions: This report presents an unusual course and presentation of post-transfusion purpura in an elderly man. Unusual features of this case include male sex, hyper-acuity of thrombocytopenia, lack of prior transfusions, exam findings, identification of a less common alloantibody, and negative initial platelet antigen screening. This report highlights the importance of monitoring patients for post-transfusion adverse events. Although PTP is rare, rapid diagnosis and management are required to control this potentially life-threatening condition. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion is a life-saving procedure, but there are always potential risks, such as blood transfusion reactions. Objectives: Considering the importance of the subject and the lack of a similar study in Guilan province, this research was conducted to analyze blood transfusion reactions. Methods: This retrospective descriptive study was conducted at Al-Zahra Hospital in Guilan, Iran, between 2020 and 2022. The files of all patients who received blood products at this center and experienced a reaction were reviewed. A checklist was completed, which included details such as the hospital ward, age, blood group, underlying disease, type of surgery, type of injected product, history of transfusion, history of reaction and allergy, type of reaction, and treatment intervention. Results: During the study period, 4,887 cases received transfusions. Among them, 18 cases (0.36%) showed reactions during transfusion, of which 14 cases (0.35% of total packed cell injections) were related to packed cell injection. Shivering was the most common reaction, occurring in 8 cases (15.38%). The main interventions included the administration of steroids in 10 cases (25%), antihistamines in 7 cases (17.5%), and oxygen therapy in 7 cases (17.5%). Three cases (7.5%) were transferred to the ICU, and in three cases (7.5%), the blood transfusion was stopped. One mortality was reported, and no cases of incompatible blood transfusion were documented. Conclusions: The incidence of reactions to blood product injections at this center appears to be acceptable. However, it was found that the information recording systems were very inefficient, and forms were incompletely filled, which should be addressed and corrected. [ABSTRACT FROM AUTHOR]

Objective: To determine the number of homologous blood transfusions received by canine surgical patients after introducing a cell salvage device (CSD), trends in surgeries requiring blood transfusion, and the incidence of transfusion reactions. Study Design: Retrospective study. Setting: Single referral hospital. Animals: All dogs having surgery at a single center (November 2015 to February 2021). Interventions: Medical records of dogs having surgical treatment, including those that received either an autologous or homologous blood transfusion, were reviewed. The surgical patients were the baseline population, and the 2 transfusion groups were compared within this population to analyze the trends. Main Results: A total of 37 and 86 dogs received autologous and homologous blood transfusions, respectively. There was an upward trend in the number of total monthly blood transfusions. No significant increase in the monthly number of homologous transfusions was observed before or after acquisition of the CSD. There was also an upward trend in total monthly surgeries, including those with higher risks of hemorrhage. Dogs receiving homologous blood transfusions had a higher incidence of clinical signs consistent with transfusion reactions (6.98%). Conclusions: An upward trend in autologous blood transfusions was seen with the introduction of a CSD. Hospitals with large surgical caseloads at high risk of hemorrhage may see a decreased need for outsourced blood products with the use of the CSD. The device can lead to a more responsible use of an increasingly scarce resource and decrease the risk of a blood transfusion reaction in dogs. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion is an effective therapeutic practice. However, even adopting all procedures for transfusion safety, there are risks, one of which is immediate adverse reactions. The aim of this study was, by active search, to evaluate the occurrence of immediate adverse reactions estimating the occurrence rate within the first 24 h. Methods: An exploratory, descriptive, prospective study with quantitative analysis was carried out of patients undergoing surgery who received blood component transfusions during hospitalization from October 2018 to August 2019. Data on blood component request forms were collected from the transfusion agency by reviewing medical records and interviewing the patient or family members. Descriptive statistics and the chi-square test were used to analyze the association of demographic variables with the presence or absence of transfusion reactions. Results: A total of 1042 blood component units were transfused in 393 transfusions performed on 184 patients. The main transfused blood component was packed red blood cells. Seventeen reactions were identified in the medical records, using the active search method, none of which had been reported. The transfusion reaction rate was 16.3 occurrences per 1000 transfused units, while the notification rate for the 9389 blood component units transfused by the transfusion agency in the study period was 3.83/1000. There was no statistically significant association between the occurrences or not of transfusion reactions and demographic variables. Conclusion: Through the active search method, it was possible to observe the underreporting of adverse reactions, showing inadequate compliance with current legislation, which is essential to minimize errors and increase transfusion safety.

Background and Objectives: Platelet storage lesion (PSL) adversely affects the quality of platelet concentrates (PCs). Platelets are prone to activation during storage. Moreover, elevated free mitochondrial DNA (mtDNA) levels in PCs are associated with a higher risk of adverse transfusion reactions. Therefore, we aimed to evaluate the correlation between platelet activation markers and mtDNA release during PC storage. Materials and Methods: Six PCs prepared by the platelet‐rich plasma method were assessed for free mtDNA copy number using quantitative real‐time PCR and CD62P (P‐selectin) expression by flow cytometry on days 0 (PC collection day), 3, 5 and 7 of storage. Lactate dehydrogenase (LDH) activity, pH, platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were measured as well. The correlation between free mtDNA and other PSL parameters, and the correlation between all parameters, was determined. Results: Significant increases in free mtDNA, MPV and PDW, and a significant decrease in platelet count and pH were observed. CD62P expression and LDH activity elevated significantly, particularly on storage days 5–7 and 0–3, respectively. Moreover, a moderate positive correlation (r = 0.61) was observed between free mtDNA and CD62P expression. The r values between free mtDNA and LDH, pH, platelet count, MPV and PDW were 0.81, −0.72, −0.49, 0.81 and 0.77, respectively. Conclusion: The interplay between platelet activation and mtDNA release in promoting PSL in PCs may serve as a promising target for future research on applying additive solutions and evaluating the quality of PCs to improve transfusion and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Due to chemotherapy-induced neutropenia or hematologic malignancies, immunocompromised cancer patients may have higher incidence of febrile nonhemolytic transfusion reactions compared with the general population and frequently require platelet transfusions. This quality improvement project compared the safety of transfusion using prestorage leukocyte-reduced and pooled whole blood–derived platelets (Acrodose/WBD) with conventionally produced poststorage WBD platelets (RDP) using an active hemovigilance system. Methods Every patient receiving a blood product at the hospital was virtually monitored in real time by trained nurses from a remote hemovigilance unit. These nurses monitor a digital dashboard, which populates a watch list of patients from the time blood product administration is initiated until 12 hours posttransfusion. Over the course of 6 months, 371 patients receiving 792 RDP transfusions and 423 patients receiving 780 Acrodose/WBD platelets transfusions were monitored for transfusion reactions. Results We identified 26 transfusion reactions in RDP but only 12 transfusion reactions in the Acrodose/WBD platelet group. Conclusion Acrodose platelet transfusion was associated with fewer transfusion reactions, which resulted in significant cost savings. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine preoperative T&S and determine transfusion and transfusion reaction rates that make universal preoperative T&S cost effective. Methods: A decision tree model from the health care sector perspective compared costs (2020 US dollars) and effectiveness (quality-adjusted life-years, QALYs) of universal preoperative T&S (cross-matched blood) vs no T&S (O negative blood). Our primary outcome was the incremental cost-effectiveness ratio (ICER). Input parameters included transfusion rates, transfusion reaction incidence, transfusion reaction severity rates, and costs of management. The base case included a transfusion probability of 1.26%; a transfusion reaction probability of 0.0013% with or 0.4% without T&S; and with a transfusion reaction, a 50% probability of inpatient management and 0.0042 annual disutility. Costs were estimated from Medicare national reimbursement schedules. The time horizon was surgery/admission. We assumed a willingness-to-pay threshold of $150,000/QALY. One- and two-way sensitivity analyses were performed. Results: The base case and one-way sensitivity analyses demonstrated that routine preoperative T&S is not cost effective, with an ICER of $63,721,632/QALY. The optimal strategy did not change when base case cost, transfusion probability, or transfusion reaction disutility were varied. Threshold analysis revealed that if transfusion reaction probability without T&S is >12%, routine T&S becomes cost effective. Scenarios identified as cost effective in the threshold and sensitivity analyses fell outside reported rates for urogynecological surgery. Conclusions: Within broad ranges, preoperative T&S is not cost effective, which supports re-evaluating routine T&S prior to urogynecological surgery. [ABSTRACT FROM AUTHOR]

Transfusion reactions induced by platelet transfusions may be reduced and alleviated by leukocyte reduction of platelets. Although leukoreduction of apheresis platelets can be performed either pre-storage or post-storage, seldom studies directly compare the incidence of transfusion reaction in these two different blood products. We conducted a retrospective study to compare the transfusion reactions between pre-storage and post-storage leukoreduced apheresis platelets. We reviewed the general characteristics and the transfusion reactions, symptoms, and categories for inpatients who received pre-storage or post-storage leukoreduced apheresis platelets. Propensity-score matching was performed to adjust for baseline differences between groups. A total of 40,837 leukoreduction apheresis platelet orders were reviewed. 116 (0.53%) transfusion reactions were reported in 21,884 transfusions with pre-storage leukoreduction, and 174 (0.91%) reactions were reported in 18,953 transfusions with post-storage leukoreduction. Before propensity-score matching, the odds ratio for transfusion reactions in the pre-storage group relative to the post-storage group was 0.57 (95% confidence interval [CI] 0.45–0.72, P < 0.01); the odds ratio after matching was 0.63 (95% CI 0.49–0.80, P < 0.01). A two-proportion z-test revealed pre-storage leukoreduction significantly decreases the symptoms of chills, fever, itching, urticaria, dyspnea, and hypertension as compared with those in post-storage leukoreduction. Pre-storage leukoreduced apheresis platelet significantly decreased febrile non-hemolytic transfusion reaction as compared with post-storage groups. This study suggests pre-storage leukoreduction apheresis platelet significantly decreases the transfusion reaction as compared with those in post-storage leukoreduction. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to investigate the influence of the leukoreduction moment (preor post-storage) of blood components on the clinical outcomes of patients transfused in the emergency department. Methods: retrospective cohort study of patients aged 18 years or older who received preor post-storage leukoreduced red blood cell or platelet concentrate in the emergency department and remained in the institution for more than 24 hours. A generalized mixed-effects model was applied in the analyses. Results: in a sample of 373 patients (63.27% male, mean age 54.83) and 643 transfusions (69.98% red blood cell), it was identified that the leukoreduction moment influenced the length of hospital stay (p0.050) on transfusion reactions, healthcare-associated infections, or mortality. Conclusions: patients who received pre-storage leukoreduced blood components in the emergency department had a shorter length of hospital stay.

Background and Objectives Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare and fatal complication caused by blood transfusion. In this condition, donated lymphocyte cells attack host tissues. In this review article, the history, prevalence, pathogenesis, clinical symptoms, risk factors, diagnostic methods, strategies to reduce its occurrence, prognosis, disease management, and laboratory characteristics of this condition are discussed. Materials and Methods For this purpose, a search was made using published reliable research in Google Scholar, PubMed, and MEDLINE databases and the findings of more than 70 articles were cited. Results The following study showed that live T lymphocytes from donated blood products and the resulting cytokine storm play a role in the occurrence of this complication. The symptoms of this disease appear in the form of skin rash, pancytopenia, and fever, and its diagnosis is based on clinical symptoms and laboratory findings of skin biopsy, increased liver enzymes, confirmation of lymphocyte chimerism using STR-PCR, and determination of the HLA phenotype of lymphocytes and FISH method. This complication has a higher prevalence in populations with high genetic similarity or people with immune deficiencies, however, it also occurs in other people who do not have these conditions or who have partial donor-recipient HLA matching (one-way HLA matching). Conclusions This complication is one of the fatal complications caused by blood transfusion that occurs within 2 to 30 days after blood products transfusion; the typical cases are associated with more than 90% mortality and mild or atypical cases have longer survival and are associated with a better prognosis that may go undetected or be treated spontaneously. [ABSTRACT FROM AUTHOR]

Health-care-associated infections (HAIs) can occur if a contaminated product bypasses current tests and prophylactic measures. These contaminations may be missed due to low bacterial loads or the presence of adhered biofilms. Antibacterial coatings applied inside blood storage bags or onto medical devices are promising to further reduce the residual risk of HAIs. The aim of this study was to optimize the antibacterial efficacy of a polymer — polydopamine — as a potential material for the prevention of transfusion-transmitted bacterial infections. When varying the concentration of dopamine monomers (1-3 mg/mL), the sample position (horizontal vs vertical), the stirring speed (0–90 RPM) and the reaction time (0.5 – 24 h), the morphology and wettability of the coatings were modified as determined by UV–visible (absorbance 0.013 – 0.562 at 320 nm), wettability (contact angle 35 – 61 °C) and atomic force microscopy measurements (total roughness 6 – 140 nm). The resulting cytotoxic (< 6%) and antibacterial behaviors (< 90 – 99% bacterial reduction) of the coatings were determined using ISO-10993–5 and ISO 22196 standardization. Coatings with good thickness and roughness had optimal antibacterial effects against Staphylococcus aureus (1.6 ± 0.4 log reduction), although minimal reduction was measured against Escherichia coli (0.05 log reduction). The antibacterial efficacy of polydopamine appears to be linked to its thickness and roughness, two parameters that may affect the surface wettability and, in turn, bacterial adhesion. Based on these results, polydopamine could be employed to help limit HAIs, although its antibacterial properties need to be further improved depending on the nature of bacteria and the requirements of the applications.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare and understudied transfusion reaction most commonly seen in adult females after correction of chronic, severe anemia. Transfusion-associated RCVS (TA-RCVS) typically presents with thunderclap headaches and one or more systemic (hypertension, nausea/vomiting) or neurologic (seizure, stroke, visual changes) symptoms within a week after red blood cell transfusion. Treatment of RCVS is based on blood pressure control; a recent study suggested that early use of nimodipine could shorten the disease course., (© 2024 AABB.)

Background: Children treated for cancer are at risk for adverse effects of iron due to transfusions administered during prolonged marrow suppression, which may increase exposure to toxic forms of iron, extrahepatic iron accumulation, and long-term organ damage., Objective: This study aimed to characterize the severity and organ distribution of clinically significant, multisystem iron overload (IO) in an at-risk cohort of pediatric cancer patients., Methods: This was a retrospective, cross-sectional study of childhood cancer patients who underwent a magnetic resonance imaging (MRI) due to clinical concern for IO. Data regarding cancer type and treatment, transfusion history, MRI and laboratory results, and treatment for IO were collected. Severity of IO was analyzed by non-parametric tests with respect to clinical characteristics., Results: Of the 103 patients, 98% of whom had a Cancer Intensity Treatment Rating (ITR-3) of 3 or higher, 53% (54/102) had moderate or greater hepatic siderosis, 80% (77/96) had pancreatic siderosis, 4% (3/80) had cardiac siderosis, and 45% (13/29) had pituitary siderosis and/or volume loss. Pancreatic iron was associated with both cardiac (p = .0043) and pituitary iron (p = .0101). In the 73 off-therapy patients, ferritin levels were lower (p = .0008) with higher correlation with liver iron concentration (LIC) (p = .0016) than on-therapy patients. Fifty-eight subjects were treated for IO., Conclusion: In this heavily treated cohort of pediatric cancer patients, more than 80% had extrahepatic iron loading, which occurs with significant exposure to toxic forms of iron related to decreased marrow activity in setting of transfusions. Further studies should examine the effects of exposure to reactive iron on long-term outcomes and potential strategies for management., (© 2024 Wiley Periodicals LLC.)

Abstract: Chronically transfused patients with sickle cell disease typically do not exhibit iron-mediated extrahepatic toxicity. However, we demonstrate that the pituitary gland is vulnerable to iron deposition, and it occurs regardless of other extrahepatic involvement. Severe pituitary siderosis is associated with early organ dysfunction., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Introduction: Alloimmunization and transfusion reactions underscore the crucial role of precise immunohematological techniques to enhance safety in transfusion. This study aims to determine the frequency of alloimmunization in patients treated at a Brazilian university hospital, investigate demographic, clinical, and epidemiological characteristics of patients with positive irregular antibody screening, as well as to assess the frequency of erythrocyte antigens and anti-erythrocyte antibodies in the population., Materials and Methods: This retrospective observational study included all irregular antibody-positive patients treated at the transfusion service of Hospital de Clínicas of the Federal University of Uberlandia between January 2019 and December 2020., Results: Of the 201 irregular antibody-positive patients, alloimmunization was more common in women (64.2%) than in men (35.8%). Blood groups A (39.8%) and O (38.8%), and Rh positive samples (69.1%) predominated, and about half (48.2%) of the patients were transfused for preoperative procedures. The most frequently found clinically significant alloantibodies were anti-D (27.2%), anti-E (15.0%), and anti-Kell (11.5%). Of the patients, 30.6% had multiple antibody associations, with anti-D and anti-C being the most common combination. Erythrocyte immunophenotyping was performed for 76 patients with the most frequent antigens detected being e (100%), c (86.8%), and C (40.8%). Among the 14 pregnant women evaluated, most were multiparous, 85.7% had anti-D as the most prevalent antibody, and had the A-negative blood type (33.3%)., Conclusion: Alloantibody screening and identification associated with erythrocyte immunophenotyping are necessary for a better understanding of the alloimmunized population, ensuring greater safety and efficacy of transfusion therapy in the hospital setting., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. All rights reserved.)

A 20-year-old pregnant woman at 12 week gestation with a history of thalassemia was admitted to the hospital with Hb 60g/L. She received two transfusions of 2 units of negative crossmatched washed red blood cells (RBCs) each, but shortly after she experienced a transfusion reaction. Symptoms included chest tightness, dyspnea, chills, and soy sauce colored urine. A post-transfusion specimen was sent to the blood type reference laboratory (BTRL) for investigation, which revealed the presence of anti-Le a and anti-Le b antibodies causing the immediate acute hemolytic transfusion reaction; interestingly, the patient's Le a antibody was found to be IgM, while the Le b antibody was both IgM and IgG. This combination of antibodies is rare and highlights the potential for clinically insignificant Lewis cold antibodies to cause serious reactions. It is important to not overlook these antibodies and to select antigen-negative units rather than relying solely on blood crossmatching. The use of polybrene in crossmatching blood tests may have limitations in the presence of Lewis antibodies, so alternative methods should be considered in difficult cases to ensure safe and effective transfusions. This case emphasizes the need for thorough testing and careful selection of blood products to reduce the risk of transfusion reactions and improve overall transfusion safety., (© 2024 by the Association of Clinical Scientists, Inc.)

Introduction: Blood transfusions are essential for managing blood loss in surgical patients but can lead to life-threatening reactions. This report presents a severe transfusion reaction in a postoperative total knee arthroplasty (TKA) patient, emphasizing the need for vigilant monitoring and timely intervention., Case Report: A 70-year-old male with a history of bilateral knee pain underwent right-sided TKA. Preoperative evaluations were normal. Post-surgery, significant blood loss led to a one-pint packed red blood cell transfusion. The patient developed fever, chills, palpitations, and rapid breathing, indicating a transfusion reaction. Despite immediate treatment, the patient's condition deteriorated, requiring ICU admission. Complications included acute kidney injury (AKI), metabolic acidosis, thrombocytopenia, pleural effusion, and aspiration pneumonitis. Multiple organ dysfunction syndrome (MODS) developed, necessitating hemodialysis. Despite comprehensive care, the patient passed away., Conclusion: This case highlights the critical need for rigorous pre-transfusion screening, vigilant monitoring, and immediate intervention in managing severe transfusion reactions in postoperative TKA patients. Comprehensive patient care strategies are essential to mitigate the multifocal complications associated with transfusion reactions. Additional research is needed to understand and prevent such life-threatening reactions., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

During 2018-2021, eight septic transfusion reactions occurred from transfusion of platelet units contaminated with Acinetobacter spp., Staphylococcus saprophyticus, Leclercia adecarboxylata, or a combination of those environmental organisms. Whether biofilm formation contributed to evasion of bacterial risk mitigations, including bacterial culture, point-of-care testing, or pathogen-reduction technology, is unclear. We designed a 12-well plate-based method to evaluate environmental determinants of single-species and multispecies biofilm formation in platelets. We evaluated bacteria isolated from septic transfusion reactions for biofilm formation by using crystal violet staining and enumeration of adherent bacteria. Most combinations of bacteria had enhanced biofilm production compared with single bacteria. Combinations involving L. adecarboxylata had increased crystal violet biofilm production and adherent bacteria. This study demonstrates that transfusion-relevant bacteria can produce biofilms well together. More work is needed to clarify the effect of biofilms on platelet bacterial risk control strategies, but US Food and Drug Administration-recommended strategies remain acceptable.

Purpose of Review: To examine the most recent evidence about known controversies on the effect of perioperative transfusion on cancer progression., Recent Findings: Laboratory evidence suggests that transfusion-related immunomodulation can be modified by blood management and storage practices, but it is likely of less intensity than the effect of the surgical stress response. Clinical evidence has questioned the independent effect of blood transfusion on cancer progression for some cancers but supported it for others. Despite major changes in surgery and anesthesia, cancer surgery remains a major player in perioperative blood product utilization. Prospective data is still required to strengthen or refute existing associations. Transfusion-related immunomodulation in cancer surgery is well-documented, but the extent to which it affects cancer progression is unclear. Associations between transfusion and cancer progression are disease-specific. Increasing evidence shows autologous blood transfusion may be safe in cancer surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Leukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion., Methods: We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence., Results: The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41-0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12-0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65-1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision., Conclusions: The results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed., Systematic Review Registration: PROSPERO CRD42020192202., (© 2024. The Author(s).)

Background: Blood transfusion is the infusion of whole blood or its components into the veins of the patient to improve tissue oxygenation and maintain hemostasis. Besides its clinical use, it can pose a risk of transfusion complications with different factors., Purpose: The aim of this study was to assess blood transfusion complications, and associated factors among transfused adult patients at Tertiary care Hospital, Hyderabad, 2022., Materials and Methods: An institution-based cross-sectional study design was conducted on a total of 182 patients from March 20 to June 15, 2022. Patients were enrolled in the study using consecutive sampling method. The socio-demographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 3 ml of anti-coagulated blood and 30 ml of urine samples were collected to assess transfusion complications. CBC and Coombs test were performed from blood and urinalysis from urine, respectively. Chi-square, Fisher's exact test, and binary logistic regression were done using SPSS version 25. P-values less than 0.05 are declared as statistically significant., Results: An acute transfusion reaction (ATR) was encountered in 12 (6.6%) patients. It was 4.13, 7.78 and 3.96 times more likely to occur among patients with a previous history of transfusion, abortion, and transfused blood stored for more than 20 days compared to their counterparts, respectively. In addition, the odds of developing ATR increase by 2.07 as the number of transfused blood units increases by 1 unit., Conclusion: The incidence of acute transfusion reactions was high. During transfusion, clinicians should closely monitor patients who had history of transfusion, abortion, transfused old blood and more than 1 unit.

Transfusion-related adverse events involving packed red blood cells (PRBCs) and fresh frozen plasma (FFP) are not unusual. Reactions can happen at any time during the transfusion, as well as hours or days later. An acute pain transfusion reaction (APTR) is defined as sudden, intense joint pain, usually in the back and trunk, that appears right after transfusion after all other potential causes of transfusion reactions have been eliminated. The present article discusses two similar cases. A 38-year-old female presented with complaints of right-sided headache and photophobia for four days, associated with nausea, vomiting, and vertigo. She was evaluated for a migraine headache. Due to anemia, a one-unit PRBC was requested. After pre-transfusion testing, a one-unit non-leuko-reduced, coombs cross-match compatible B-positive packed red blood cell (PRBC) was issued and transfused. During the transfusion, the patient complained of chest pain. The transfusion was stopped. Her vitals did not vary much from the baseline. No other symptoms were present at that time. A 69-year-old female presented with complaints of vomiting, abdominal pain, and black tarry stool for a one-month duration. On evaluation, she was diagnosed with adenocarcinoma of the stomach. Given the increased prothrombin time/international normalized ratio (PT/INR) of 1.8, four-units of fresh frozen plasma (FFP) was requested, which was issued after performing minor cross-match compatibility. After five minutes of transfusion, she complained of severe pain at the transfusion site with chills and rigors. The transfusion was stopped. There was no change in the vitals of the patient from baseline. A complete workup was done to rule out other transfusion reactions in both cases. Thus, these patients experienced what is known as an acute pain transfusion reaction. APTR is typically self-limited and requires treatment of symptoms with pain control, supplemental oxygen, and emotional support. In both cases, supportive treatments were enough to control the pain symptoms of the patients., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Paudel et al.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Emergent Red Blood Cell (RBC) exchange is indicated in sickle cell disease (SCD) patients with severe acute chest syndrome. However, fully matched RBC units may not be available for patients with multiple RBC antibodies. Intravenous immunoglobulin (IVIG) and steroids were reported for preventing potential delayed hemolytic transfusion reaction (HTR) in simple transfusion of antigen-positive RBCs. We investigated the efficacy and safety of IVIG and steroids in two SCD patients presented with acute chest syndrome receiving RBC exchange with multiple incompatible units. The first patient had multiple historical alloantibodies, including anti-Jsb, although none of them were reactive. IVIG (1 g/kg) was given before and after RBC exchange with methylprednisolone (500 mg IV) one hour before exchange. Her sickle hemoglobin (HbS) was reduced from 89.4% to 17.4% after the exchange with five Jsb-positive units. The patient improved clinically without acute or delayed hemolysis. The second patient had reactive anti-Jsb on two different admissions 18 months apart. Only one of the sixteen units used in the exchanges was Jsb negative. He received the same IVIG regimen during both admissions but 100 mg IV hydrocortisone instead of methylprednisolone. His HbS was reduced from 63.4% to 22.4% after the first exchange. Significant clinical improvements were achieved after both exchanges. No delayed HTR was observed. Our experience of these two patients suggested that IVIG and steroids may be used in preventing potential delayed HTR in some SCD patients with rare antibodies receiving large amounts of antigen-positive RBC products. [ABSTRACT FROM AUTHOR]

Transfusion safety may be becoming dependent on the financial resources made available for transfusion structures and may vary between high-income countries (HIC) and low-to-middle-income countries (LMIC). To assess whether there is a difference in the reported TR between these two groups of countries, we examined TR reported in Tunis the capital of Tunisia, a LMIC, and compared their frequency with reported TR in HIC. Data of TR were collected from transfusion incident report (TIR) forms declared by healthcare facilities in Tunis between 2015 and 2019. They were analysed and compared to reported TR in France (ANSM) and UK (SHOT). The incidence of TR was 70.6/100 000 blood components (BP) issued. A third of TR (36.8%) occurred at night. Febrile non-hemolytic transfusion reactions (43.7%) and allergic reactions (35%) were the most reported TR respectively 22.4/100 000 BP and 17.9/100 000 BP. The rate of ABO incompatibilities was 1.96/100 000 red blood cell units (RBC): they were all caused by human error. The rates of TRALI, TACO and bacterial contaminations were respectively 1.26/100 000 BP, 1.4/100 000 RBC and 0.7/100 000 BP. While advanced technologies applied to transfusion have improved transfusion safety, this study shows that their impact has been relatively minor, as reported TR in LMIC are still comparable to those in HIC. ABO-incompatibilities are still higher in LMIC: this should be addressed by reinforcing the training of all healthcare personnel involved in transfusion medicine. [ABSTRACT FROM AUTHOR]