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]

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]

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: COVID-19 convalescent plasma (CCP) is an important therapeutic option for outpatients at high risk of hospitalization from SARS-CoV-2 infection. We assessed the safety of outpatient CCP transfusions administered during clinical trials. STUDY DESIGN AND METHODS: We analyzed data pertaining to transfusion-related reactions from two randomized controlled trials in the U.S. that evaluated the efficacy of CCP versus control plasma in various ambulatory settings. Multivariable logistic regression was used to assess whether CCP was associated with transfusion reactions, after adjusting for potential confounders. RESULTS: The combined study reported 79/1351 (5.9%) adverse events during the transfusion visit, with the majority 62/1351 (4.6%) characterized by mild, allergic-type findings of urticaria, and/or pruritus consistent with minor allergic transfusion reactions; the other reported events were attributed to the patients underlying disease, COVID-19, or vasovagal in nature. We found no difference in the likelihood of allergic transfusion reactions between those receiving CCP versus control plasma (adjusted odds ratio [AOR], 0.75; 95% CI, 0.43-1.31). Risk of urticaria and/or pruritus increased with a pre-existing diagnosis of asthma (AOR, 2.33; 95% CI, 1.16-4.67). We did not observe any CCP-attributed antibody disease enhancement in participants with COVID-19 or increased risk of infection. There were no life-threatening severe transfusion reactions and no patients required hospitalization related to transfusion-associated complications. DISCUSSION: Outpatient plasma administration was safely performed for nearly 1400 participants. CCP is a safe therapeutic option for outpatients at risk of hospitalization from COVID-19.

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.

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: 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: Due to platelet availability limitations, platelet units ABO mismatched to recipients are often transfused. However, since platelets express ABO antigens and are collected in plasma which may contain ABO isohemagglutinins, it remains controversial as to whether ABO non-identical platelet transfusions could potentially pose harm and/or have reduced efficacy. STUDY DESIGN AND METHODS: The large 4-year publicly available Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) database was used to investigate patient outcomes associated with ABO non-identical platelet transfusions. Outcomes included mortality, sepsis, and subsequent platelet transfusion requirements. RESULTS: Following adjustment for possible confounding factors, no statistically significant association between ABO non-identical platelet transfusion and increased risk of mortality was observed in the overall cohort of 21,176 recipients. However, when analyzed by diagnostic category and recipient ABO group, associations with increased mortality for major mismatched transfusions were noted in two of eight subpopulations. Hematology/Oncology blood group A and B recipients (but not group O) showed a Hazard Ratio (HR) of 1.29 (95%CI: 1.03-1.62) and intracerebral hemorrhage group O recipients (but not groups A and B) showed a HR of 1.75 (95%CI: 1.10-2.80). Major mismatched transfusions were associated with increased odds of receiving additional platelet transfusion each post-transfusion day (through day 5) regardless of the recipient blood group. DISCUSSION: We suggest that prospective studies are needed to determine if specific patient populations would benefit from receiving ABO identical platelet units. Our findings indicate that ABO-identical platelet products minimize patient exposure to additional platelet doses.

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]

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]

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.

BackgroundPlatelet transfusion carries risk of transfusion-transmitted infection (TTI). Pathogen reduction of platelet components (PRPC) is designed to reduce TTI. Pulmonary adverse events (AEs), including transfusion-related acute lung injury and acute respiratory distress syndrome (ARDS) occur with platelet transfusion.Study designAn open label, sequential cohort study of transfusion-dependent hematology-oncology patients was conducted to compare pulmonary safety of PRPC with conventional PC (CPC). The primary outcome was the incidence of treatment-emergent assisted mechanical ventilation (TEAMV) by non-inferiority. Secondary outcomes included: time to TEAMV, ARDS, pulmonary AEs, peri-transfusion AE, hemorrhagic AE, transfusion reactions (TRs), PC and red blood cell (RBC) use, and mortality.ResultsBy modified intent-to-treat (mITT), 1068 patients received 5277 PRPC and 1223 patients received 5487 CPC. The cohorts had similar demographics, primary disease, and primary therapy. PRPC were non-inferior to CPC for TEAMV (treatment difference -1.7%, 95% CI: (-3.3% to -0.1%); odds ratio = 0.53, 95% CI: (0.30, 0.94). The cumulative incidence of TEAMV for PRPC (2.9%) was significantly less than CPC (4.6%, p = .039). The incidence of ARDS was less, but not significantly different, for PRPC (1.0% vs. 1.8%, p = .151; odds ratio = 0.57, 95% CI: (0.27, 1.18). AE, pulmonary AE, and mortality were not different between cohorts. TRs were similar for PRPC and CPC (8.3% vs. 9.7%, p = .256); and allergic TR were significantly less with PRPC (p = .006). PC and RBC use were not increased with PRPC.DiscussionPRPC demonstrated reduced TEAMV with no excess treatment-related pulmonary morbidity.

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.

The term transfusion-related acute lung injury (TRALI) was coined in 1985 to describe acute respiratory distress syndrome (ARDS) after transfusion, when another ARDS risk factor was absent; TRALI cases were mostly associated with donor leukocyte antibody. In 2001, plasma from multiparous donors was implicated in TRALI in a randomized controlled trial in Sweden. In 2003 and in many years thereafter, the U.S. Food and Drug Administration reported that TRALI was the leading cause of death from transfusion in the United States. In 2003, the United Kingdom was the first among many countries to successfully reduce TRALI using male-predominant plasma. These successes are to be celebrated. Nevertheless, questions remain about the mechanisms of non-antibody TRALI, the role of blood products in the development of ARDS in patients receiving massive transfusion, the causes of unusual TRALI cases, and how to reduce inaccurate diagnoses of TRALI in clinical practice. Regarding the latter, a study in 2013-2015 at 169 U.S. hospitals found that many TRALI diagnoses did not meet clinical definitions. In 2019, a consensus panel established a more precise terminology for clinical diagnosis: TRALI type I and TRALI type II are cases where transfusion is the likely cause, and ARDS are cases where transfusion is not the likely cause. For accurate diagnosis using these clinical definitions, critical care or pulmonary expertise is needed to distinguish between permeability versus hydrostatic pulmonary edema, to determine whether an ARDS risk factor is present, and, if so, to determine whether respiratory function was stable within the 12 hours before transfusion.