Search

Background and Objectives: Strategies for overcoming alloimmune refractoriness to random donor platelets are based on the use of compatible platelets selected from large panels of HLA‐typed donors or cross‐matching (XM). The aim of this study was to review the effectiveness of a platelet XM programme for treating refractory haematological patients at Milan's Policlinico Hospital (PHM) 2002–2014 and Spedali Civili in Brescia (SCB) 2013–2016. Materials and Methods: A commercially available solid‐phase antibody detection system was used for platelet antibody detection and XM. Forty‐nine alloimmune refractory patients at PHM and 13 at SCB, respectively, received a median [IQR] of 12 [6–13] and 18 [13–15] XM compatible platelet transfusions after the detection of refractoriness. The absolute increases in post‐transfusion platelet counts obtained using random, and XM platelets were retrieved from the patients' hospital records. Results: The critical review at SCB showed that the median [IQR] 1 h post‐transfusion increase in platelet counts was 3 × 109/L [1–5] after 47/47 random platelet transfusions, and 10 × 109/L [2–25] after 325/326 XM compatible platelet transfusions. The documentation concerning the outcomes of XM platelet transfusions at PHM was incomplete, and so the findings of the review were inconclusive. Conclusion: This retrospective analysis confirmed the effectiveness of the XM programme at SCB, but revealed defective data collection and retrieval methods at PHM, thus underlining the importance of such methods. The literature review accompanying this retrospective analysis identified a recently described algorithm for ensuring platelet support in refractory patients that optimally integrates the combined use of XM and HLA typing. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to articles including "Quantification of D-Antigen Density of Weak D Red Blood Cell Phenotypes by Flow Cytometry: A Rapid Method to Estimate the Anti-D Immunization Risk," by A. Mendez, P. Jaquet, M. Furrer and B. M. Frey and "Section 1B: Rh Flow Cytometry: Coordinator's Report," by W. A. Flegel, V. Curin-Serbec and M. Delamaire.

In 1999, we implemented an automated platelet cross-matching (XM) programme to select compatible platelets from the local inventory for patients refractory to random donor platelets. In this study, we evaluated platelet count increments in 40 consecutive refractory patients (8·3% of 480 consecutive platelet recipients) given 569 cross-match-negative platelets between April 1999 and December 2001. XM was performed automatically with a commercially available immunoadherence assay. Pre-, 1- and 24-h post-transfusion platelet counts (mean ± SD) for the 569 XM-negative platelet transfusions containing 302 ± 71 × 109 platelets were 7·7 ± 5·5, 32·0 ± 21·0 and 16·8 ± 15·5 × 109/l respectively. Increments were significantly higher ( P < 0·05, t-test) than those observed in the same patients given 303 random platelet pools (dose = 318 ± 52 × 109 platelets) during the month before refractoriness was detected, when pre-, 1- and 24-h post-transfusion counts were 7·0 ± 8·6, 15·9 ± 16·1 and 9·6 ± 12·8 × 109/l respectively. The cost of the platelet XM disposable kit per transfusion to produce 1-h post-transfusion platelet count increments >10 × 109/l was euro 447. This programme enabled the rapid selection of effective platelets for refractory patients, from the local inventory. [ABSTRACT FROM AUTHOR]

Background: High-throughput genotyping platforms enable simultaneous analysis of multiple polymorphisms for blood group typing. BLOODchip® ID is a genotyping platform based on Luminex® xMAP technology for simultaneous determination of 37 red blood cell (RBC) antigens (ID CORE XT) and 18 human platelet antigens (HPA) (ID HPA XT) using the BIDS XT software., Materials and Methods: In this international multicentre study, the performance of ID CORE XT and ID HPA XT, using the centres' current genotyping methods as the reference for comparison, and the usability and practicality of these systems, were evaluated under working laboratory conditions. DNA was extracted from whole blood in EDTA with Qiagen methodologies. Ninety-six previously phenotyped/genotyped samples were processed per assay: 87 testing samples plus five positive controls and four negative controls., Results: Results were available for 519 samples: 258 with ID CORE XT and 261 with ID HPA XT. There were three "no calls" that were either caused by human error or resolved after repeating the test. Agreement between the tests and reference methods was 99.94% for ID CORE XT (9,540/9,546 antigens determined) and 100% for ID HPA XT (all 4,698 alleles determined). There were six discrepancies in antigen results in five RBC samples, four of which (in VS, N, S and Do(a)) could not be investigated due to lack of sufficient sample to perform additional tests and two of which (in S and C) were resolved in favour of ID CORE XT (100% accuracy). The total hands-on time was 28-41 minutes for a batch of 16 samples. Compared with the reference platforms, ID CORE XT and ID HPA XT were considered simpler to use and had shorter processing times., Discussion: ID CORE XT and ID HPA XT genotyping platforms for RBC and platelet systems were accurate and user-friendly in working laboratory settings.

Background: In 2005, the government of Lombardy, an Italian region with an ethnically varied population of approximately 9.8 million inhabitants including 250,000 blood donors, founded the Lombardy Rare Donor Programme, a regional network of 15 blood transfusion departments coordinated by the Immunohaematology Reference Laboratory of the Ca' Granda Ospedale Maggiore Policlinico in Milan. During 2005 to 2012, Lombardy funded LORD-P with 14.1 million euros., Materials and Methods: During 2005-2012 the Lombardy Rare Donor Programme members developed a registry of blood donors and a bank of red blood cell units with either rare blood group phenotypes or IgA deficiency. To do this, the Immunohaematology Reference Laboratory performed extensive serological and molecular red blood cell typing in 59,738 group O or A, Rh CCDee, ccdee, ccDEE, ccDee, K- or k- donors aged 18-55 with a record of two or more blood donations, including both Caucasians and ethnic minorities. In parallel, the Immunohaematology Reference Laboratory implemented a 24/7 service of consultation, testing and distribution of rare units for anticipated or emergent transfusion needs in patients developing complex red blood cell alloimmunisation and lacking local compatible red blood cell or showing IgA deficiency., Results: Red blood cell typing identified 8,747, 538 and 33 donors rare for a combination of common antigens, negative for high-frequency antigens and with a rare Rh phenotype, respectively. In June 2012, the Lombardy Rare Donor Programme frozen inventory included 1,157 red blood cell units. From March 2010 to June 2012 one IgA-deficient donor was detected among 1,941 screened donors and IgA deficiency was confirmed in four previously identified donors. From 2005 to June 2012, the Immunohaematology Reference Laboratory provided 281 complex red blood cell alloimmunisation consultations and distributed 8,008 Lombardy Rare Donor Programme red blood cell units within and outside the region, which were transfused to 2,365 patients with no untoward effects., Discussion: Lombardy Rare Donor Programme, which recently joined the ISBT Working Party on Rare Donors, contributed to increase blood transfusion safety and efficacy inside and outside Lombardy.

Introduction: Selecting units of rare blood for transfusion to patients with complex immunisation is one of the most critical processes of a Transfusion Centre. In January 2005 the 'Rare Blood Components Bank - Reference Centre of the Region of Lombardy' w as established with the following goals: 1) identifying regional rare blood donors; 2) creating a regional registry of rare donors; 3) organising a regional bank of liquid and frozen rare blood units; 4) setting up a regional Immunohaematology Reference Laboratory (IRL) to type donors and resolve complex cases., Methods: The key elements in establishing the Bank were periodic meetings organised by the directors and representatives of the regional Departments of Transfusion Medicine and Haematology (DTMH) and the institution of three working groups (informatics, regulations, finance)., Results: The regional IRL was set up, the relevant operating procedures were distributed region-wide, software features were defined and later validated upon activation, and the funds assigned were allocated to various cost items. The number and characteristics of the donors to be typed were identified and 14 regional DTMHs started to send samples. Overall, 20,714 donors were typed, for a total of 258,003 typings, and 2,880 rare donors were identified. Of these, 97% were rare donors because of combinations of antigens (2,139 negative for the S antigen and 659 negative for the s antigen) and 3% (n=82) because they were negative for high-frequency antigens. In the first 2 years of activity, the IRL carried out investigations of 140 complex cases referred from other Centres and distributed 2,024 units with rare phenotypes to 142 patients., Conclusions: The main goal achieved in the first 24 months from the start of the project was to set up a regional network able to meet the transfusion needs of patients with complex immunisation.