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Background Methods Results Conclusion The subject of pre‐job training for transfusion service laboratory technicians is very important. The key is how to make a reasonable systematic training programme to improve the effectiveness of training.A prospective training programme was conducted and an assessment was performed at enrollment (baseline) and reassessment after 3‐months training, using the same tools with a validated questionnaire.Clinical competency‐oriented prospective pre‐job training significantly improves the clinical transfusion‐related comprehensive skills of new employees. The post‐training assessment score was significantly affected by undergraduate major.This study provided a clinical competency‐oriented training programme for new employees in the department of transfusion medicine that could effectively enhance their comprehensive abilities. [ABSTRACT FROM AUTHOR]

Summary Sickle cell disease (SCD) is one of the most common genetic disorders in the world predominantly affecting economically disadvantaged populations. There is a notable discrepancy between the growing adult SCD population and available diagnostic and therapeutic interventions for SCD. Sickle cell hepatopathy (SCH) is an all‐inclusive term to describe the acute and chronic liver manifestations of SCD. The pathophysiology of SCH follows no defined pattern or sequence that poses challenges to clinicians and researchers alike. Evidence is lacking for this underreported disease at various levels from diagnostic to therapeutic options. This paper reviews the basic pathophysiology, clinical features, biochemical and radiological findings of various SCH manifestations and outlines the management of each condition. Old and new therapy options in SCD including hydroxyurea, red blood cell exchange transfusion, ursodeoxycholic acid, voxelotor, l‐glutamine and crizanlizumab have been reviewed to investigate the role of these options in treating SCH. The role of liver transplant, haematopoietic stem cell transplant and gene therapy in SCH patients have been reviewed. [ABSTRACT FROM AUTHOR]

Granulocyte transfusions are indicated for patients with severe neutropenia and evidence of bacterial or fungal infection who are unresponsive to standard antimicrobial therapy. With a limited expiration time of 24 hours after collection, granulocytes are often transfused before results of infectious-disease screening tests are available, and before a transfusion service can perform a risk assessment if postdonation information is provided after the collection. The case we describe herein demonstrates a clinical scenario meeting indications for granulocyte transfusion, coupled with the clinical management undertaken after the granulocyte donor disclosed a positive result for a COVID-19 self-test taken 1 day after donation. In this case, the patient did not develop new COVID-19 symptoms and tested negative for COVID-19 after transfusion of the implicated unit. These findings add to the body of evidence in the literature that COVID-19 is not transmitted via blood transfusion. [ABSTRACT FROM AUTHOR]

The Heidenhain variant of Creutzfeld-Jakob disease (CJD) is a rare form that initially presents with visual disturbances. In early stages, the presentation can mimic neuromyelitis optica spectrum disorders (NMOSD) and lead to unnecessary treatment modalities. Herein, we describe a case of a 66-year-old man who presented with bilateral vision loss and retro-orbital discomfort. In addition to immunosuppressive therapy, he received 4 rounds of therapeutic plasma exchange after his preliminary diagnosis of NMOSD. We were surprised to note that his condition did not show improvement but deteriorated, with severe neurocognitive symptoms. Eventually, CJD was suspected, and real-time quaking-induced conversion (RT-QuIC) was performed. By the time the diagnosis of Heidenhain variant of CJD was confirmed, the patient was discharged to hospice care and died shortly after. [ABSTRACT FROM AUTHOR]

In this study, it was aimed to investigate bacterial contamination in apheresis platelet suspensions (APS) by automated blood culture system and flow cytometry method (FCM). 33 spiked APS each using 11 bacterial strains (5 standard strains, 6 clinical isolates), were prepared in three different dilutions (1–10, 10–50, 50-100 cfu/mL), incubated in two different temperatures (35–37 °C and 22–24 °C) and different incubation times (18–96 h) evaluated by FCM. This three different dilutions were also inoculated into special platelet culture bottles (BacT/ALERT® BPA) and loaded into the blood culture system. Additionally 80 APSs routinely prepared in the Transfusion Center were evaluated by both FCM and the blood culture system. Platelets were lysed by freeze-thaw method. All spiked samples were positive with BacT/ALERT® BPA in 12–18 h. In 96 h incubation at 22–24 °C, the presence of bacteria was detected by FCM in all other samples (31/33) except low dilutions (1–10 and 10–100 CFU/ml) of K.pneumoniae standard strain. In the 35–37 °C, the presence of bacteria was detected by FCM in all samples (33/33) after 48 h of incubation. In routine APS one sample detected as positive (Bacillus simplex) with BacT/ALERT® BPA and no positivity was detected by FCM. The freeze-thaw method, which we have optimized for the lysis of platelets, is very practical and can be easily applied. The BacT/ALERT® system has been found to be very sensitive in detecting bacterial contamination in PSs. Flow cytometry method has been found to be successful, fast, easy to use and low cost in detecting bacterial contamination in PSs. [ABSTRACT FROM AUTHOR]

Objective: Prolong platelet survival and functionality up to 28 days. Methods: A sample of apheresis platelets was evaluated, distributed in 3 groups according to the cryopreservative solution used: DMSO5%+2%albumin; DMSO5%+NaCl0,9% and DMSO5%+Dextrose2%. They were then frozen at -80 °C and thawed at 7, 14 and 28 days. The in vitro survival and viability were assessed by the post-thaw platelet count and the CD41, CD61 and CD42a staining percentages by flow cytometry. The functionality was determined with the percentage of post-stimulation aggregation with 1Nm-thrombin using the Chromo-Log490 aggregometer. The control group (CG) consisted of fresh platelets under constant agitation at 22 °C. Results: A total of 72 platelet aliquots was analyzed. The CG presented a platelet-count of 1934 ± 0.5 × 109/L and a 100% viability. The percentages of CD41, CD61 and CD42a labeling were 99, 98.5 and 96.5%, respectively. The percentage of aggregation was 99%. On day 7 of the post-freezing, the platelet count for groups 1, 2 and 3 was 1,844 ± 102, 1,856 ± 76 and 1,752 ± 226, with the viability of 98, 96 and 95%, respectively. On day 14, the counts were 1,722 ± 238, 1,649 ± 215 and 1,578 ± 223 with the viability of 96, 95 and 94% and, on day 28, they were 1,602 ± 374, 1,438.6 ± 429 and 1,406.6 ± 436, with the viability of 96, 94 and 93%, respectively. Group1 presented a higher expression of membrane antigens. Aggregation percentages were 90, 98 and 89% at day 7, 88%, 98 and 87% at day 14 and 84%, 95 and 82% at day of the 28 post-freezing, respectively, with group2 presenting the best results. Conclusion: The results support cryopreservation as a reasonable method to prolong platelet survival up to 28 days, maintaining its functionality and viability greater than 50%.

Introduction: In veterinary medicine there are few readily available products for platelet transfusion to patients with thrombocytopenia. Commercial tabletop platelet concentrating systems have recently become available to veterinarians, primarily directed towards uses associated with regenerative medicine. These systems could potentially be used to produce fresh concentrated platelets for use in transfusion medicine. This study evaluated the concentration, activation, and sterility of a double centrifugation platelet concentrate (PC) produced by a commercial benchtop system. Methods: Ten healthy dogs were studied. Whole blood was collected and mixed with ACD-A in a 1:7.6 ratio of ACD-A to whole blood. 12 mL of this mixture was processed into PC via single centrifugation, while 60 mL of the anticoagulated whole blood was processed via a commercial double centrifugation system. Both types of PC were evaluated for platelet concentration, CD62P expression with and without thrombin stimulation, and for sterility. Results: Mean platelet count in the double centrifuged PC was 863 ± 352 × 10³/µL, with very low white blood cell contamination (median of 0.47 × 10³ leukocyte/µL (range 0.15-2.18 × 10³/µL)). The double-centrifuged PC had similar baseline activation characteristics (as determined by P-selectin expression) as the single centrifuge PC (0.76% vs. 0.72% unstimulated, 30.5% vs. 34.9% stimulated, p = 0.432). Discussion: The benchtop PC system studied here did not cause activation of platelets during production and produced a sterile product that can be further investigated as a source of fresh platelet concentrates for transfusion purposes. [ABSTRACT FROM AUTHOR]

Background and Objectives Patient blood management reduces unnecessary transfusions to improve patients' health. Familiarity of physicians with this program is necessary to improve the outcomes of patients health. This study was conducted to evaluate the effect of education on the level of knowledge of residents in medical centers in Yazd, 2022-2023. Materials and Methods The study was a before and after quasi-experimental intervention. 57 medical residents participated. A 20 question questionnaire measured the residents' knowledge level in patient blood management before and after the education. The validity of the questionnaire was measured by a survey of experienced physicians in the management of patient's blood. Reliability with Cronbach's alpha test was 0.8. The data were analyzed using t and Paired-t tests in SPSS 20 software. Results 35 participants (61.4%) were women and 22 (38.6%) were men. Their mean age was 30.58 ± 5.45 years.The average knowledge scores were 9.38 ± 3.77 and 14.01 ± 3.50 before and after education, respectively (p < 0.001). The lowest response rate before instructions pertained to evaluation of patients' anemia before surgery and knowledge of autologous blood usage. The knowledge score had no significant relationship with age, sex, blood prescription history, and medical practice duration. Conclusions Education effectively increased the knowledge of residents. It is suggested to include hold targeted educational programs with emphasis on the areas of anemia management and the use of autologous blood, publish educational guides, and include transfusion medicine and the patient's blood management program in medical education curricula. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day‐to‐day clinical care. These gaps are prevalent in resource‐limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context‐appropriate up‐to‐date education, (2) teaching participants how to independently deliver a case‐based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. Materials and Methods: In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train‐the‐trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in‐person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. Results: Fifty‐one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self‐rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. Conclusion: Transfusion medicine education in Rwanda using a train‐the‐trainer approach was well‐received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project. [ABSTRACT FROM AUTHOR]

OBJECTIVE Determine the hemolytic effect of an 18-µm microaggregate blood filter during in vitro sea turtle whole blood transfusions as well as describe the average diameter of leatherback (Dermochelys coriacea) and Kemp’s ridley sea turtle (Lepidochelys kempii) RBCs. ANIMALS 5 green (Chelonia mydas), 5 loggerhead (Caretta caretta), and 5 Kemp’s ridley sea turtles (total n = 15). METHODS Heparinized sea turtle blood was infused at 60 mL/h through a microbore extension set without and then with a postsyringe, inline 18-µm microaggregate blood filter. Pre- and postfiltration PCV, Hct, total solids, sodium, chloride, potassium, glucose, and free plasma hemoglobin concentrations were measured. With the use of light microscopy and archived blood smears, the maximum and minimum diameter of 20 RBCs from each of the 5 leatherback and 5 Kemp’s ridley sea turtles were measured with a calibrated ocular micrometer using 400X magnification. RESULTS There were no significant differences between pre- and postfiltration samples for Hct, total solids, sodium, chloride, potassium, glucose, and free plasma hemoglobin concentrations; however, there was a significant median postfiltration decrease in PCV of approximately 4%, representing a 13% decrease of the total RBCs transfused. Average maximum diameters for leatherback and Kemp’s ridley sea turtle RBCs were 19.7 and 16.1 µm, respectively. CLINICAL RELEVANCE Although the 18-µm microaggregate blood filter does not hemolyze transfused sea turtle RBCs and is likely safe for in vivo blood transfusions, the filter’s pores may retain a small proportion of infused RBCs given their diameter. [ABSTRACT FROM AUTHOR]

• Transfusion therapy is an indispensable form of treatment, and important element of the public health system. • Epidemiology is crucial for ensuring the safety of transfusion treatment, by continuous surveillance and timely identification mitigation of risks. • Surveillance systems provide tools for risk assessment and management, in order to estimate the magnitude of any health effect that derives from decisions of policy makers. • Surveillance of adverse reactions and adverse events associated with blood transfusion, has demonstrated the importance of multidisciplinary cooperation between blood and public health services. Transfusion therapy is an indispensable form of treatment, and an important element of the public health system. Due to its origin, blood's clinical use is associated with various risks that may cause adverse reactions and events. Progress in quality and safety of blood components has eliminated numerous risks, especially those of infectious origin. However, some risks cannot be predicted, while others cannot always be prevented. Globalisation and climate change constantly favour the spread of infectious agents. Against this, epidemiology plays a central role in ensuring the safety of transfusion treatment, by continuous surveillance and timely identification of risks, and in the development of routine and additional tests as measures for risk mitigation. As a quantitative discipline based on research methods, epidemiology is a method of reasoning; it relies on the generation and testing of hypotheses; it utilises other scientific resources, particularly in the field of blood donation and blood transfusion, thus having many applications. The main focus falls on transfusion-transmissible infections, and on environmental or occupational diseases, injuries, disabilities and death causes at large. The practice of epidemiology relies on a systematic approach and measurement of disease frequencies. Surveillance is a key element, involving continuously gathering, analysing, and evaluating data regarding diseases, morbidity and mortality, and disseminating the conclusions of the analyses to relevant competent authorities; in this way, action is taken for disease prevention and control. Surveillance systems also provide an important tool for risk assessment, a method to assess and characterise the critical parameters in the functionality of equipment, systems or processes of using scientific data in order to estimate the magnitude of any health effect that derives from decisions of policy makers. Epidemiological surveillance, particularly for the incidence of adverse reactions and adverse events associated with blood transfusion at the national and international levels, has demonstrated the importance of multidisciplinary cooperation between blood and public health services. [ABSTRACT FROM AUTHOR]

Background: Blood donors are screened for medication use to determine their health status and to ensure that the collection will be safe and efficacious for transfusion. Although stringent medication deferral guidelines exist for human blood donors, no consensus exists as to which medications should be permitted among canine donors. Methods: A brief survey regarding canine donor screening methods was distributed to an online hematology and transfusion medicine group and included questions pertaining to commonly prescribed medications and consumption of a raw food diet. Key Findings: The survey results demonstrate that more than half of the respondents accept canine donors given thyroid supplements, whereas respondents were split as to whether they accept canine donors given antihistamines chronically. Most survey respondents exclude canine donors taking anti‐inflammatory or anti‐itch medications unless in acute circumstances and only after a washout period. More than half of the survey respondents exclude dogs fed a raw food diet. Significance: The survey results demonstrate that there is no obvious agreement regarding which medications to permit in canine donors. Evidence‐based guidelines are needed to inform best practices and the subsequent decisions made by donor programs. [ABSTRACT FROM AUTHOR]

Comparing the effect of serious game and problem-based learning on nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing. In this quasi-experimental study, 76 undergraduate nursing students were enrolled through a convenience sampling method, and were allocated to one of the three groups of serious game, problem-based learning, and control through the block randomization method. Data were collected using a valid and reliable 3-part researcher-made tool, completed before and two weeks after the intervention. Statistical analysis was performed using paired t -test, analysis of covariance, and Bonferroni post hoc test. A significance level of <0.05 was considered. After the intervention, mean scores of both knowledge and clinical decision-making skill increased significantly in both intervention groups (p < 0.05). Mean post-test scores of both knowledge and clinical decision-making skill in the serious game group, and only clinical decision-making skill in the problem-based learning group were significantly higher than the control group (p < 0.05). However, no significant difference was observed regarding mean post-test scores of both knowledge and clinical decision-making skill between the intervention groups (p > 0.05). Both serious game and problem-based learning are proven to be effective in improving nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing. Since learning now occurs beyond classrooms and the new generation of students spend most of their time in virtual places, utilizing technology-based teaching methods like serious games can benefit both educators and students by providing continuous education, saving their time and expenses, etc. • Combining serious games and problem-based learning methods are effective in improving nursing students' knowledge and clinical decision-making skills when it comes to applying transfusion medicine in pediatric nursing. • Quiz-based serious games enhance knowledge acquisition. • Problem-based learning enhances clinical decision-making skills. [ABSTRACT FROM AUTHOR]

Background: Granulocyte concentrates (GCs) are usually prepared by single-donor apheresis after G-CSF pretreatment and have to be transfused within 24 h after cell collection because of the rapid decrease in pH and cell survival due to high lactate production by red blood cell contamination. GCs pooled from buffy coats of whole blood donations could improve the availability of these products. Methods to reduce red blood cell and platelet contamination may improve storability. We developed a manufacturing process for pooled GCs and investigated cell viability and functionality over time. Methods: Six ABO blood group-identical buffy coats were pooled. Subsequently, the red blood cells spontaneously sedimented after the addition of hydroxyethyl starch. The resulting leukocyte-enriched supernatant was washed twice with saline to reduce platelets and was resuspended in ABO-identical donor plasma. The leukocyte concentrate was transferred to a platelet storage bag and stored up to 72 h at 20–24°C w/o agitation. Cell count and viability, pH, blood gases, phagocytosis, and oxidative burst activity were monitored. Results: The number of red blood cells and platelets was reduced to 0.4% and 6.1% of the baseline levels. About 50% of the original present leukocytes could be extracted (n = 76). In the course of 72 h of storage, there were no significant changes in white blood cell counts (p = 0.12). The viability exceeded 98% during the entire period. The rate of granulocytes performing phagocytosis and oxidative burst remained above 95% anytime. Conclusion: GCs prepared from pooled buffy coats provide a precious alternative to granulocytes obtained from apheresis. Reduction of red blood cells and platelets by more than 90% extends the maximum shelf life of GCs from 24 h to 72 h. For a therapeutic dose of at least 1 × 1010 granulocytes, 15–20 buffy coats are required. [ABSTRACT FROM AUTHOR]

Background: In the pediatric care field, ensuring safe and effective blood transfusions, promptly identifying adverse reactions, and implementing appropriate interventions are crucial. Therefore, undergraduate nursing curricula need to be structured to meet these professional standards and prepare nursing students, as future team members, to respond to relevant clinical situations. The objective of this study was to investigate how problem- and task-based learning affects knowledge and clinical decision-making of undergraduate nursing students concerning the use of transfusion medicine in pediatric nursing. Material and methods: This quasi-experimental study involved 82 nursing students recruited from two nursing schools in Iran using convenience sampling. Participants received educational content through either problem- (n = 40) or task-based learning (n = 42) methods. A researcher-made tool, comprising three parts and proven to be valid and reliable, was utilized for data collection. The tool was administered both before and immediately after the intervention. Data were analyzed using Wilcoxon rank-sum, Mann-Whitney U, Spearman's correlation and multivariate analysis of covariance tests via SPSS v16.0. A p-value of

BACKGROUND: Except for public health case reports, the incidence of Zika virus (ZIKV), chikungunya virus (CHIKV), and dengue virus (DENV) infection are not available to assess the potential blood transfusion safety threat in Brazil. METHODS: Pools of 6 donation samples (MP6) left over from human immunodeficiency virus, hepatitis B virus, and hepatitis C virus nucleic acid testing were combined to create MP18 pools (3 MP6 pools). Samples were tested using the Grifols triplex ZIKV, CHIKV, and DENV real-time transcription mediated amplification assay to estimate prevalence of RNAemia and incidence, and to compare these results to case reports in São Paulo, Belo Horizonte, Recife, and Rio de Janeiro, from April 2016 through June 2019. RESULTS: ZIKV, CHIKV, and DENV RNAemia were found from donors who donated without overt symptoms of infection that would have led to deferral. The highest RNAemic donation prevalence was 1.2% (95% CI, .8%-1.9%) for DENV in Belo Horizonte in May 2019. Arbovirus infections varied by location and time of year, and were not always aligned with annual arbovirus outbreak seasons in different regions of the country. CONCLUSIONS: Testing donations for arboviruses in Brazil can contribute to public health. Transfusion recipients were likely exposed to ZIKV, CHIKV, and DENV viremic blood components during the study period.

Abstract Background Health research is often driven by the desire to improve the care and health of the community; however, the translation of research evidence into policy and practice is not guaranteed. Knowledge translation (KT) activities, such as dissemination and end-user engagement by researchers, are important to achieving this goal. This study examined researchers’ views on and practices of KT in the field of transfusion medicine. Methods An anonymous, cross-sectional survey was distributed to transfusion medicine researchers in May 2022 by emailing corresponding authors of papers in four major blood journals, emailing grant recipients, posting on social media, and through international blood operator networks. Comparative analyses were conducted for career stage, work setting, research type, and KT training. Results The final sample included 117 researchers from 33 countries. Most participants reported that research translation was important (86%) and felt it was their responsibility (69%). Fewer than half felt they had the skills to translate their research (45%) or knew which strategies to employ (45%). When examining how research findings are shared, most reported using diffusion activities (86%), including publishing in peer-reviewed journals (74%), or presenting at academic conferences (72%). Fewer used dissemination methods (60%), such as developing educational materials (29%) or writing plain language summaries (30%). Greater use of tailored dissemination strategies was seen among researchers with KT training, whilst traditional diffusion strategies were used more by those working in an academic setting. Most participants had engaged end-users in their research (72%), primarily to consult on a research component (47%) or to involve them in the research process (45%). End-user engagement was greater among researchers with established careers, working in both academic and applied settings, and with KT training. Conclusions Whilst participating researchers acknowledged the importance of KT, they typically focused on traditional diffusion strategies. This is despite well-established knowledge of the limited impact of these strategies in achieving KT. Those with KT training were more likely to use tailored dissemination strategies and engage end-users in their research. This demonstrates the value of sharing knowledge from the KT field with health researchers to facilitate KT.

Background: In Australia, a man cannot donate blood if he has had sex with another man within the past 3 months. However, this policy has been criticized as being discriminatory as it does not consider lower risk subgroups, and led to calls for modifications to the policy that more accurately distinguish risk among gay, bisexual, and other men who have sex with men (GBM). Study Design and Methods: We used data from a nationally representative survey to estimate the proportion of GBM aged 18–74 years old who would be eligible to donate under current criteria and other scenarios. Results: Among the 5178 survey participants, 155 (3.0%) were classified as GBM based on survey responses, Among the GBM, 40.2% (95% CI 28.0%–53.7%) were eligible to donate based on current criteria, and 21.0% (95% CI 14.5%–29.5%) were ineligible due to the 3 months deferral alone. Eligibility among GBM, all men, and the population increased as criteria were removed. Under the new Australian plasma donation criteria, 73.6% (95% CI 64.4%–81.1%) of GBM, 68.4% (95% CI 65.5%–71.2%) of all men, and 60.8% (95% CI 58.8%–62.8%) of the full population were estimated to be eligible. Only 16.1% (95% CI 8.6%–28.1%) of GBM knew that the male‐to‐male sex deferral period is 3 months. Discussion: Changing the deferral criteria and sexual risk evaluation would lead to a higher proportion of GBM being eligible to donate blood. Knowledge of the current GBM deferral period is very low. Improved education about the current criteria and any future changes are required to improve blood donation rates. [ABSTRACT FROM AUTHOR]

Background: Pathogen inactivation treatment (PIT) has been shown to alter platelet function, phenotype, morphology and to induce a faster aging of platelet concentrates (PCs). Key pieces of information are still missing to understand the impacts of PITs at the cellular level. Objectives: This study investigated the impact of amotosalen/UVA on PCs, from a post-translational modifications (PTM) point of view. Phosphoproteomic analyses were conducted on resting platelets, right after the amotosalen/UVA treatment and compared with untreated PCs. Method: A two-arm study setting was carried out to compare PIT (amotosalen/UVA) to untreated PCs, on day 1 post-donation. Based on a pool-and-split approach, 12 PCs were split into two groups (treated and untreated). Quantitative phosphoproteomics was performed using TMT technology to study the changes of phosphoproteins right after the PIT. Results: A total of 3,906 proteins and 7,334 phosphosites were identified, and 2,473 proteins and 2,214 phosphosites were observed in at least 5 to 6 replicates. Compared to untreated platelets, PIT platelets exhibited an upregulation of the phosphorylation effects, with 109 phosphosites identified with a higher than 2-fold change. Two pathways were clearly identified. The mitogen activated protein kinases (MAPKs) cascade, which triggers the granule secretion and the activation of the pS15 HSPB1. One of the shape change pathways was also observed with the inhibition of the Threonine 18 and Serine 19 phosphorylations on myosin light chain (MLC) protein after the amotosalen/UVA treatment. Conclusions: This work provides a deep insight into the impact of amotosalen/UVA treatment from a phosphoprotein viewpoint on resting platelets. Clear changes in phosphorylation of proteins belonging to different platelet pathways were quantified. This discovery corroborates previous findings and fills missing parts of the effect of photochemical treatments on platelets. [ABSTRACT FROM AUTHOR]

Introduction: The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. The 2011 Patient blood management guidelines: module 1 — critical bleeding/massive transfusion were updated and published. Systematic reviews were conducted for pre‐specified research questions, and recommendations were based on meta‐analyses of included studies. Main recommendations: The critical bleeding/massive transfusion guideline includes seven recommendations and 11 good practice statements addressing: major haemorrhage protocols (MHPs) facilitating a multidisciplinary approach to haemorrhage control, correction of coagulopathy and normalisation of physiological derangement;measurement of physiological, biochemical and metabolic parameters in critical bleeding/massive transfusion;the optimal ratio of red blood cells to other blood components;the use of tranexamic acid;viscoelastic haemostatic assays; andcell salvage. Changes in management as a result of the guideline: The new guideline recommends MHPs be established as standard of care in all institutions managing patients with critical bleeding. In addition to routine physiological markers, the new guideline recommends temperature, biochemistry and coagulation profiles be measured early and frequently, providing parameters that define critical derangements. Ratio‐based MHPs should include no fewer than four units of fresh frozen plasma and one adult unit of platelets for every eight units of red blood cells. In the setting of trauma and obstetric haemorrhage, administration of tranexamic acid within three hours of bleeding onset is recommended. The use of recombinant activated factor VII (rFVIIa) is not recommended. There was insufficient evidence to make recommendations on the use of viscoelastic haemostatic assays or cell salvage as part of MHPs. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of COVID-19 is slightly lower, and its mortality is higher in beta-thalassemia patients than in the general population. We evaluated the impact of COVID-19 in terms of incidence, clinical course, management, and specific antibody response to vaccination, in a cohort of patients with beta-thalassemia major. Methods: We retrospectively enrolled all transfusion-dependent beta-thalassemia major patients attending the Thalassemia Day Care Center of the University Hospital of Sassari, Italy, from March 1, 2020, to May 31, 2021. For each patient, demographic, clinical, laboratory, instrumental, and therapy data were collected. Patients aged ≥16 years received two doses of mRNA COVID-19 vaccine. Anti-SARS-CoV-2 serum antibodies were tested before and after the first vaccine dose. Results: A total of 68 patients (median age: 36.5 years; IQR: 13–42 years) were included. Nasopharyngeal swab (NPS) for SARS-CoV-2 detection by RT-PCR was positive in 5 (7.35%) of 68 patients (4 symptomatic). No COVID-19-related complications, hospitalizations, or deaths were observed. The transfusion regimen and iron chelation therapy were not significantly changed. Prior to COVID-19 vaccination, anti-SARS-CoV-2 antibodies were tested in 61 patients, 51 negative and 10 positive; five of the latter were also positive for SARS-CoV-2 on NPS. The 46 vaccinated subjects had an antibody response, with higher levels in subjects previously infected with SARS-CoV-2. Conclusion: Our findings suggest that patients with beta-thalassemia major are not at a higher risk of contracting SARS-CoV-2 infection and developing a severe form of COVID-19 despite being considered more vulnerable than the general population. [ABSTRACT FROM AUTHOR]

Blood transfusion remains an indispensable component of health care, contributing to saving millions of lives each year. Donating blood is an exceptionally special way to help another human being and save their life. Blood is an invaluable medicine that humans produce themselves, being the only source of this medicine. Blood transfusion is categorized as a form of transplantation, offering vital assistance to individuals in need while ensuring that it does not harm them in any way. Blood products must meet numerous national requirements to ensure their safety for use. Transfusion of incompatible blood or blood infected with bloodborne diseases can worsen the patient's condition, and in some cases, even lead to death. Ensuring a safe transfusion requires careful donor selection, comprehensive blood screening, and rigorous testing of blood products. Due to the emergence of new pathogens posing public health concerns, over time, mandatory testing of blood donors has included tests to detect these pathogens, aiming to reduce the risk of bloodbourne diseases. The detection and appropriate handling of reactive blood donations directly mitigate the risk of harm and the development of infections or diseases that the pathogen might induce in the recipient of the blood transfusion. Testing blood donors for HIV, hepatitis B and C, and Syphilis has become a foundation that persists to this day, significantly improving the safety of blood products. However, there was a challenge with the speed of infection detection, as many infected individuals could still be donors before the virus became detectable in the blood. The main goal was to produce higher quality and more reliable tests. After the successful implementation of serological testing for all voluntary blood donors worldwide, the safety of blood products has finally reached a high level. To provide an additional layer of blood safety, in the late 90s and early 2000s, the world gradually began to introduce molecular screening techniques for donors, known as Nucleic Acid Testing (NAT). The implementation of NAT testing has been a significant step in ensuring the safety of blood products. One of great advantages of NAT is its ability to detect and amplify very small amounts of viruses that are not detectable by serological test (18) In order to ensure the highest quality and safety of blood products, it is not sufficient to solely rely on laboratory tests and interpret their results. It is necessary to have a comprehensive strategy, standards, systems, and infrastructure prescribed by national health authorities and transfusion centers, and implemented into the laws and regulations of each individual country. Ongoing advancements in serological testing technologies contribute to improved sensitivity and specificity. The implementation of a comprehensive quality system in transfusion medicine and laboratory testing is of utmost importance, and continuous improvement should be the goal. It is crucial to continue monitoring all emerging threats to the safety of blood products and provide an adequate response. [ABSTRACT FROM AUTHOR]

Background: Health research is often driven by the desire to improve the care and health of the community; however, the translation of research evidence into policy and practice is not guaranteed. Knowledge translation (KT) activities, such as dissemination and end-user engagement by researchers, are important to achieving this goal. This study examined researchers' views on and practices of KT in the field of transfusion medicine. Methods: An anonymous, cross-sectional survey was distributed to transfusion medicine researchers in May 2022 by emailing corresponding authors of papers in four major blood journals, emailing grant recipients, posting on social media, and through international blood operator networks. Comparative analyses were conducted for career stage, work setting, research type, and KT training. Results: The final sample included 117 researchers from 33 countries. Most participants reported that research translation was important (86%) and felt it was their responsibility (69%). Fewer than half felt they had the skills to translate their research (45%) or knew which strategies to employ (45%). When examining how research findings are shared, most reported using diffusion activities (86%), including publishing in peer-reviewed journals (74%), or presenting at academic conferences (72%). Fewer used dissemination methods (60%), such as developing educational materials (29%) or writing plain language summaries (30%). Greater use of tailored dissemination strategies was seen among researchers with KT training, whilst traditional diffusion strategies were used more by those working in an academic setting. Most participants had engaged end-users in their research (72%), primarily to consult on a research component (47%) or to involve them in the research process (45%). End-user engagement was greater among researchers with established careers, working in both academic and applied settings, and with KT training. Conclusions: Whilst participating researchers acknowledged the importance of KT, they typically focused on traditional diffusion strategies. This is despite well-established knowledge of the limited impact of these strategies in achieving KT. Those with KT training were more likely to use tailored dissemination strategies and engage end-users in their research. This demonstrates the value of sharing knowledge from the KT field with health researchers to facilitate KT. [ABSTRACT FROM AUTHOR]

IntroductionIn veterinary medicine there are few readily available products for platelet transfusion to patients with thrombocytopenia. Commercial tabletop platelet concentrating systems have recently become available to veterinarians, primarily directed towards uses associated with regenerative medicine. These systems could potentially be used to produce fresh concentrated platelets for use in transfusion medicine. This study evaluated the concentration, activation, and sterility of a double centrifugation platelet concentrate (PC) produced by a commercial benchtop system.MethodsTen healthy dogs were studied. Whole blood was collected and mixed with ACD-A in a 1:7.6 ratio of ACD-A to whole blood. 12 mL of this mixture was processed into PC via single centrifugation, while 60 mL of the anticoagulated whole blood was processed via a commercial double centrifugation system. Both types of PC were evaluated for platelet concentration, CD62P expression with and without thrombin stimulation, and for sterility.ResultsMean platelet count in the double centrifuged PC was 863 ± 352 × 103/μL, with very low white blood cell contamination (median of 0.47 × 103 leukocyte/μL (range 0.15–2.18 × 103/μL)). The double-centrifuged PC had similar baseline activation characteristics (as determined by P-selectin expression) as the single centrifuge PC (0.76% vs. 0.72% unstimulated, 30.5% vs. 34.9% stimulated, p = 0.432).DiscussionThe benchtop PC system studied here did not cause activation of platelets during production and produced a sterile product that can be further investigated as a source of fresh platelet concentrates for transfusion purposes.

Rapid and reliable Rhesus D typing is crucial for blood donation centers. In instances of massive blood transfusion or reduced antigen expression, DNA-based phenotype prediction becomes mandatory. Our molecular RHD typing approach involves an initial real-time PCR for the most common aberrant RHD types in our region, RHD*01W.1 (weak D type 1), RHD*01W.2 (weak D type 2), RHD*01W.3 (weak D type 3), and RHD*07.01 (DVII). For comprehensive coverage, Sanger sequencing of RHD coding regions is performed in the case of PCR target-negative results. We evaluated the specificity and accuracy of these methods using the recently launched LightCycler® PRO real-time platform. All findings demonstrated remarkable accuracy. Notably, the LightCycler® PRO instrument offers a distinct advantage in data interpretation and integration via the HL7 interface. This study underlines the importance of including advanced molecular techniques in blood typing protocols, especially in scenarios where conventional serological methods may be insufficient.

Background and Objectives: Canadian out‐of‐hospital blood transfusion programmes (OHBTPs) are emerging, to improve outcomes of trauma patients by providing pre‐hospital transfusion from the scene of injury, given prolonged transport times. Literature is lacking to guide its implementation. Thus, we sought to gather technical transfusion medicine (TM)‐specific practices across Canadian OHBTPs. Materials and Methods: A survey was sent to TM representatives of Canadian OHBTPs from November 2021 to March 2022. Data regarding transport, packaging, blood components and inventory management were included and reported descriptively. Only practices involving Blood on Board programme components for emergency use were included. Results: OHBTPs focus on helicopter emergency medical service programmes, with some supplying fixed‐wing aircraft and ground ambulances. All provide 1–3 coolers with 2 units of O RhD/Kell‐negative red blood cells (RBCs) per cooler, with British Columbia trialling coolers with 2 units of pre‐thawed group A plasma. Inventory exchanges are scheduled and blood components are returned to TM inventory using visual inspection and internal temperature data logger readings. Coolers are validated to storage durations ranging from 72 to 124 h. All programmes audit to manage wastage, though there is no consensus on appropriate benchmarks. All programmes have a process for documenting units issued, reconciliation after transfusion and for transfusion reaction reporting; however, training programmes vary. Common considerations included storage during extreme temperature environments, O‐negative RBC stewardship, recipient notification, traceability, clinical practice guidelines co‐reviewed by TM and a common audit framework. Conclusion: OHBTPs have many similarities throughout Canada, where harmonization may assist in further developing standards, leveraging best practice and national coordination. [ABSTRACT FROM AUTHOR]

Background and Objectives: Septic transfusion reactions (STRs) occur as a result of bacterial contamination of blood or blood products, resulting in sepsis. This scoping review aimed to identify, explore and map the available literature on the STR criteria triggering the investigation of STR. Materials and Methods: Four electronic databases (MEDLINE, Web of Science, Science Direct, Embase) were searched to retrieve scientific literature reporting such criteria, published from 1 January 2000 to 5 May 2022. Grey literature was also searched from open web sources. Results: Of 1052 references identified, 43 (21 peer‐reviewed and 22 grey literature) met the eligibility criteria for inclusion and data extraction after full article screening. Of them, most (27/43, 62.79%) were found to report a single set of criteria, and only two reported four or more sets of criteria. The analysis of 66 sets of criteria collected from the selected references revealed 57 different sets. A few sets of criteria used only one sign and symptom (s/s) (12.12%, n = 8), whereas 16 sets used 7–15 s/s (n = 16/66; 24.24%). Of the total 319 occurrences of s/s associated with the 66 sets of criteria, post‐transfusion hyperthermia, body temperature increase and hypotension were the most common s/s categories. Of all the literature available, only one study tested the diagnostic accuracy of the STR criteria. Conclusion: This scoping review revealed a substantial variation in criteria used to identify suspected STR. Consequently, conducting further studies to enhance the diagnostic accuracy of these criteria, which trigger STR investigations, is imperative for advancing clinical practice. [ABSTRACT FROM AUTHOR]

Background: Major bleeding in patients undergoing therapeutic plasma exchange (TPE) has been studied in large databases; but without standardizing bleeding definitions. Therefore, we used standardized definitions to evaluate major bleeding in hospitalized patients undergoing TPE using public use data files from the Recipient Epidemiology and Donor Evaluation Study‐III (REDS‐III). Study Design and Methods: In a retrospective cross‐sectional analysis, we identified TPE‐treated adults in a first inpatient encounter. We evaluated major bleeding prevalence using (1) International Classification of Diseases (ICD) or Current Procedural Terminology (CPT) codes, (2) packed red blood cell (PRBC) transfusion, or (3) hemoglobin (Hgb) decline. Patients with major bleeding prior to their first TPE were excluded from the analysis. Results: Among 779 patients undergoing TPE, major bleeding by at least one of the three bleeding definitions occurred in 135 patients (17.3%). For each of the ICD/CPT, PRBC, and Hgb definitions, the prevalence of major bleeding was 2.8% (n = 31), 7.4% (n = 81), and 5.4% (n = 59), respectively. Only 3.7% of bleeds (5/135) were captured by all three definitions and 19.3% (26/135) exclusively by any two pairwise definitions. The addition of PRBC transfusion and Hgb decline to ICD/CPT code definitions increased bleeding prevalence threefold. Conclusion: Among hospitalized adults undergoing TPE in the REDS‐III study, the prevalence of major bleeding was 17.3%. The addition of PRBC and Hgb decline to ICD codes increased bleeding prevalence threefold. Future studies are needed to develop validated models that identify patients at risk for major bleeding during TPE. [ABSTRACT FROM AUTHOR]

Background: Safe blood transfusion is an increasing priority in global health equity. The Global Health 2030 commission lists access to a safe blood supply as essential for all surgical and nonoperative patients. The objective of this study was to determine if Transfusion Camp, when modified through a collaborative partnership between experts in Canada and Rwanda, results in improved knowledge and confidence among trainees in a resource‐limited setting in sub‐Saharan Africa. Methods: This prospective study took place at The University Teaching Hospital of Kigali in Rwanda. Participants were postgraduate medical trainees from departments where blood transfusion is frequent. Participants watched five prerecorded lectures and then attended a 5‐hour team‐based learning seminar to consolidate learning. Pre‐ and post‐data were analyzed on transfusion knowledge and trainee confidence. A Rasch analysis investigated the performance of individual questions in assessing respondent knowledge. Results: Of 31 trainees from surgery, anesthesia, internal medicine, and pediatrics invited to the course, 27 trainees attended the in‐person team‐based learning and 24 trainees completed the pre‐ and post‐course analysis. Trainee knowledge assessment improved from (mean ± SD) 7.7/20 ± 1.95 to 10.4/20 ± 2.4 (p <.0001) and this knowledge was maintained by 12 trainees on a 3‐month follow‐up with a mean score of 9.3/20 ± 2.3. Trainees reported increased confidence in managing transfusion medicine‐related patient issues. Conclusion: This pilot study demonstrated that Transfusion Camp education content modified to the local context can result in increased knowledge and confidence in managing transfusion‐related issues. These results will inform future planning of Transfusion Camp in resource‐limited settings. [ABSTRACT FROM AUTHOR]

Introduction: Plasmapheresis donation is considered safe and well tolerated, although long-term effects need to be clarified. The volumes of anticoagulant (ACD-A) used are variable and depend primarily on hematocrit (HCT), total blood processed, amount of plasma collected, and donor characteristics. To elucidate the effect of the plasma unit weight setting on plasmapheresis efficiency and ACD-A distribution, we enrolled male donors undergoing a controlled apheresis process donating 700 g and 720 g in two different sessions. In parallel, we investigated a possible effect of sex, recruiting women donating 700 g of plasma. Methods: The study was conducted on men donating 720 g and (12 months later) 700 g of plasma, and on women donating 700 g of plasma. The main outcomes were pre-/post-donation delta (Δ) citrate concentration in donor plasma and ACD-A reinfused to the donor. Information concerning the annual check-up and the procedure was also collected. Intergroup comparisons (men donating 720 g vs. men donating 700 g and men vs. women both donating 700 g) and intragroup associations with donor and procedural characteristics were reported. Results: With the procedure set at 720 g, the machine processed around 44 mL more whole blood to collect 20 g more plasma, and 720 g donors received around 12 mL more anticoagulant than 700 g donors. Accordingly, Δ citrate concentration was 1.5 times higher (12 μm), with a greater variability observed for 720 g donations. Citrate concentration in the plasma unit was lower in the 720 g group, although not significantly. Comparing outcomes between women and men donating 700 g, we observed higher (and highly variable) Δ citrate and reinfused ACD-A in women, accompanied by lower anticoagulant levels in the unit. Increased Δ citrate is inversely associated with HCT and age in men and with HCT and triglycerides in women. Reinfused ACD-A correlates with HCT in women but not in men. Conclusion: Unit weight setting and sex influence an ACD-A shift from the estimated values toward an increased reinfusion to donor. In parallel, we observed an impact of age and sex on post-donation citrate metabolism. Altogether, these elements should be taken into account for the development of tailored approaches aimed at maintaining similar safety profiles for all donors using different plasmapheresis settings. [ABSTRACT FROM AUTHOR]

Objective To compare the diagnostic performance of 10 mathematical formulae for identifying thalassemia trait in blood donors. Methods Compete blood counts were conducted on peripheral blood specimens using the UniCel DxH 800 hematology analyzer. Receiver operating characteristic curves were used to evaluate the diagnostic performance of each mathematical formula. Results In the 66 donors with thalassemia and 288 subjects with no thalassemia analyzed, donors with thalassemia trait had lower values for mean corpuscular volume and mean corpuscular hemoglobin than subjects without thalassemia donors (77 fL vs 86 fL [ P  < .001]; 25 pg vs 28 pg [ P  < .001]). The formula developed by Shine and Lal in 1977 showed the highest area under the curve value, namely, 0.9. At the cutoff value of <1812, this formula had maximum specificity of 82.35% and sensitivity of 89.58%. Conclusions Our data indicate that the Shine and Lal formula has remarkable diagnostic performance in identifying donors with underlying thalassemia trait. [ABSTRACT FROM AUTHOR]

Background: Pathogen reduction of platelet concentrates (PCs) using amotosalen and broad‐spectrum UVA illumination contributes to the safety of platelet transfusion by reducing the risk of transfusion‐transmitted infections. We evaluated the in vitro quality of stored buffy‐coat (BC) PCs treated with amotosalen and a prototype light‐emitting diode (LED) illuminator. Methods: Double‐dose BC‐PCs collected into PAS‐III/plasma or SSP+/plasma (55/45%) were treated with amotosalen in combination with either conventional UVA lamps (INT100 Illuminator 320–400 nm) or LED illuminators at 350 nm. Platelet quality and function were evaluated over 7 days. Results: Platelet counts were conserved during storage in all groups, as was platelet swirling without appearance of macroscopic aggregates. Integrin αIIbβ3 and glycoprotein (GP) VI expression remained stable, whereas GPIbα and GPV declined similarly in all groups. UV lamp‐ and LED‐treated PCs displayed similar glucose consumption, lactate generation, and pH variation. Comparable spontaneous and residual P‐selectin and phosphatidylserine exposure, activated αIIbβ3 exposure, mitochondrial membrane potential, lactate dehydrogenase release, and adhesive properties under flow conditions were observed during storage. The use of SSP+/plasma compared with PAS‐III/plasma better preserved most of these parameters, especially during late storage, irrespective of the type of illuminator. Conclusion: Replacing the UVA lamp for photochemical treatment by LED illuminators had no impact on platelet metabolism, spontaneous activation, apoptosis or viability, or on the in vitro function of BC‐PCs stored for 7 days in SSP+ or PAS‐III/plasma. These findings support improved procedures for the pathogen reduction and storage of PCs, to ensure transfusion safety and retention of platelet functional properties. [ABSTRACT FROM AUTHOR]

Introduction: Dramatic improvements in blood transfusion have occurred during the last two decades. Transfusion medicine services and practices in Africa remain underexplored. Methods: A survey of blood bank/transfusion medicine (BBTM) practices, available blood products, blood product source(s), pre‐transfusion testing, and blood donor infectious disease testing methodologies across Africa was performed using the American Society for Clinical Pathology (ASCP) listserv. Survey recipients included hospital‐based laboratories/blood banks, national transfusion medicine services, and free‐standing laboratories (collectively referred to as institutions). Results: Responses from a total of 81 institutions across 22 countries were analyzed. All 81 institutions provide at least one type of blood product—whole blood, red blood cells (RBCs), platelets, plasma, and cryoprecipitate, with whole blood (90.1%, 73 of 81) and RBCs (79.0%, 64 of 81) most common, while cryoprecipitate is least common (12.4%, 10 of 81). Only five countries had a responding institution that provides all types of products. Among institutions that collect blood onsite, the most common sources of blood products are patients' family members (94.1%, 48 of 51) and pre‐screened on‐demand volunteer donors (82.4%, 42 of 51). The most commonly screened infectious agents are HIV and hepatitis B virus (both 81.5%), while 70.4% (57 of 81) test for hepatitis C virus (HCV) and Treponema pallidum. Discussion: This study highlights significant variability and restrictions in blood product availability, pre‐transfusion testing, and blood donor infectious disease testing across Africa. Further studies are needed to ascertain barriers to improving blood donor availability, blood product safety, and infectious disease testing. [ABSTRACT FROM AUTHOR]

Transfusion Medicine is facing mounting challenges, including but not limited to donor availability, blood supply shortages, and transfusion-associated complications, such as immunogenicity and transmission of viral infections. ‘Blood Pharming’, for in vitro Red Blood Cells (RBC) synthesis, offers a potentially effective approach to addressing the challenges and risks associated with the transfusion of blood and related products. This innovative approach employs cells from variable sources such as Hematopoietic stem cells (HSCs), induced pluripotent stem cells (iPSCs), or immortalized progenitor cell lines, directing their differentiation towards erythropoiesis in an in-vitro environment that mimics the normal bone marrow niche required for erythropoiesis. This review article provides a comprehensive analysis of the progress and hurdles in blood pharming, emphasizing in vitro RBC synthesis for clinical application. In-vitro large-scale production of RBCs offers cutting-edge advantages, such as consistent scalability, the capacity to acquire desired blood phenotypes, and a significant reduction in transfusion-related infections, however, substantial molecular and methodological challenges still need to be addressed before the transfer of this approach from bench to bedside. The review discusses the challenges in ensuring scalability that matches demand and supply, the structural and functional integrity of in-vitro synthesized RBCs compared to their in-vivo counterparts, and the cost-effective methods of RBC synthesis in vitro. It also highlights the importance of implementing thorough characterization and testing protocols to comply with regulatory standards. Additionally, it delves into the ethical concerns associated with commercializing such products. In summary, this review examines the progress and obstacles in the field of in-vitro blood pharming. Through a comprehensive analysis of the present state of the discipline, ongoing scholarly investigations, and prospective avenues of inquiry, our objective is to contribute to a more profound comprehension of the potential impact of synthetic RBCs on the transformation of transfusion medicine.

Background and objectivesManagement of severe allergic transfusion reactions (ATR) is challenging. In this study, we investigate the usefulness of skin tests and basophil activation tests (BAT) in chronically transfused patients for the prevention of future ATR.Materials and methodsBAT and skin tests were carried with the supernatant of red blood cell (RBC) units for a sickle-cell disease patient under chronic exchange transfusion who has presented a severe ATR, in order to prevent potential future ATR. If the results for both BAT and skin tests were negative, the RBC units could be transfused to the patient. If either one of the results was positive, the tested RBC unit was discarded for the patient.Results192 RBC units were tested with both tests. The level of results concordance between the two tests was 95%. Out of the 169 negative units with both tests, 118 units were transfused to the patient for which he presented no ATR.ConclusionIn our study, combining both BAT and skin tests was associated with a good negative predictive value since we were able to safely transfuse our patient. Further studies are still necessary to confirm this result but this pilot study indicates that skin tests and BAT might help prevent ATR. When BAT is not available, skin tests may also be useful in preventing ATR.