1
|
Cheng Z, Kong Y, Lin Y, Mi Z, Xiao L, Liu Z, Tian L. Transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion: A systematic review and meta-analysis. Transfus Apher Sci 2024; 63:103943. [PMID: 38820943 DOI: 10.1016/j.transci.2024.103943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND ABO-nonidentical platelets transfusion has been frequently employed to address clinical platelets insufficiencies. The significance of ABO compatibility for platelets transfusion is not clearly defined. This study is aimed to explore the transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion. STUDY DESIGN AND METHODS A systematic articles search was performed for eligible studies published up to November 30, 2023 through the PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure database, Wanfang database and SinMed. Meta-analysis Of Observational Studies in Epidemiology study guidelines for observational studies and Newcastle Ottawa bias scale were implemented to assess studies. Meta-analysis was performed using Manager 5.3. This study is registered with PROSPERO, number CRD42023417824. RESULTS A total of 11 retrospective cohort studies and 7 prospective cohort studies with a sample size of 104,359 platelets transfusions were included. There was significant difference in transfusion effectiveness between the ABO-identical and ABO-nonidentical platelets transfusions (RR 1.20, 95 % CI 1.11-1.38, P < 0.00001, I2 = 21 %), also the ABO-identical platelets transfusions showed more platelets increment than ABO-nonidentical ones, but it was not statistically significant (MD 0.34, 95 % CI - 0.01 to 0.70, P = 0.06, I2 = 0 %). Allergy and fever occurred more in ABO-nonidentical platelets transfusions in terms of adverse reactions (RR 0.63, 95 % CI 0.41-0.96, P = 0.03, I2 = 0 %; RR 0.59, 95 % CI 0.37-0.94, P = 0.03, I2 = 31 %). When it comes to the mortality, the ABO-identical platelets transfusions did not statistically improve survival in patients who received multiple platelets transfusions (RR 0.77, 95 % CI 0.72-0.83, P = 0.17, I2 = 38 %) and who only received less than 3 transfusions (RR 0.74, 95 % CI 0.52-1.06, P = 0.10, I2 = 47 %) compared with the ABO-nonidentical platelets transfusions. CONCLUSION In comparison to ABO-identical platelets transfusions, nonidentical platelets transfusions exhibited lower transfusion efficacy. However, the clinical safety between these two groups was similar, which indicated that ABO-nonidentical transfusions are acceptable, albeit inferior to ABO-identical ones.
Collapse
Affiliation(s)
- Zhanrui Cheng
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China
| | - Yujie Kong
- Department of Laboratory, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610599, China; School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan 610500, China
| | - Yuwei Lin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China; School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Ziyue Mi
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China
| | - Ling Xiao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China; School of Public Health, Anhui Medical University, Hefei 230032, China.
| | - Li Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China.
| |
Collapse
|
2
|
White SK, Walker BS, Schmidt RL, Metcalf RA. The incidence of transfusion-related acute lung injury using active surveillance: A systematic review and meta-analysis. Transfusion 2024; 64:289-300. [PMID: 38116828 DOI: 10.1111/trf.17688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-related mortality. A concern with passive surveillance to detect transfusion reactions is underreporting. Our aim was to obtain evidence-based estimates of TRALI incidence using meta-analysis of active surveillance studies and to compare these estimates with passive surveillance. STUDY DESIGN AND METHODS We performed a systematic review and meta-analysis of studies reporting TRALI rates. A search of Medline and Embase by a research librarian identified studies published between January 1, 1991 and January 20, 2023. Prospective and retrospective observational studies reporting TRALI by blood component (red blood cells [RBCs], platelets, or plasma) were identified and all inpatient and outpatient settings were eligible. Adult and pediatric, as well as general and specific clinical populations, were included. Platelets and plasma must have used at least one modern TRALI donor risk mitigation strategy. A random effects model estimated TRALI incidence by blood component for active and passive surveillance studies and heterogeneity was examined using meta-regression. RESULTS Eighty studies were included with approximately 176-million blood components transfused. RBCs had the highest number of studies (n = 66) included, followed by platelets (n = 35) and plasma (n = 34). Pooled TRALI estimates for active surveillance studies were 0.17/10,000 (95% confidence intervals [CI]: 0.03-0.43; I2 = 79%) for RBCs, 0.31/10,000 (95% CI: 0.22-0.42; I2 = <1%) for platelets, and 3.19/10,000 (95% CI: 0.09-10.66; I2 = 86%) for plasma. Studies using passive surveillance ranged from 0.02 to 0.10/10,000 among the various blood components. DISCUSSION In summary, these estimates may improve a quantitative understanding of TRALI risk, which is important for clinical decision-making weighing the risks and benefits of transfusion.
Collapse
Affiliation(s)
- Sandra K White
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | | | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- ARUP Laboratories, Salt Lake City, Utah, USA
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- ARUP Laboratories, Salt Lake City, Utah, USA
| |
Collapse
|
3
|
Murugesan M, Augustine M, Velayudhan SC, Darussalam T, Nayanar SK. Hemolysin test as a tool to screen high-titer Group O platelet apheresis donors: A prospective study. Asian J Transfus Sci 2023; 17:189-194. [PMID: 38274950 PMCID: PMC10807529 DOI: 10.4103/ajts.ajts_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/23/2022] [Accepted: 05/22/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Minor ABO-incompatible apheresis platelet transfusion poses a risk of hemolytic transfusion reactions in non-Group O recipients when donor's plasma possesses unusual high titers for anti-A and anti-B. The aim was to determine whether the hemolysin test can be used as a screening tool to predict high-titer Group O platelet apheresis donors. METHODS A prospective study, with Group O platelet donor's samples, was tested for hemolysin test and antibody titration test in parallel. Antibody titration was also performed on products suspended in platelet additive solution (PAS). Hemolysin test was assessed for diagnostic accuracy against antibody titration. Chi-square test and Mann-Whitney U-test were used to determine the relationship between the hemolysin test and antibody titration. RESULTS Among 107 Group O platelet donations, median anti-A and anti-B titers in donors were 32 (8-128) and 32 (4-256), respectively. High titer (≥128) for ABO antibodies was seen in 18% of donations, whereas hemolysin test was positive in 69% of donations. Hemolysin test results differ significantly with antibody titration results (P = 0.03). Hemolysin test had higher sensitivity (89%) with a strong negative predictive value (94%). None of the products suspended in PAS had high-titer antibodies. CONCLUSION Adopting hemolysin test as a screening tool may label a large number of units (69%) unsuitable for ABO-incompatible platelet transfusion. Alternatively identifying donors with high antibody titer or positive hemolysin test and selectively suspending their product in PAS may be a cost-effective approach and certainly prevent high-titer antibodies in the product.
Collapse
Affiliation(s)
- Mohandoss Murugesan
- Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Merline Augustine
- Department of Transfusion Medicine, Goa Medical College, Bambolim, Goa, India
| | | | - Thahira Darussalam
- Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala, India
| | | |
Collapse
|
4
|
Thevenin M, Putot S, Manckoundia P, Putot A. Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account? Am J Med 2022; 135:1008-1015.e1. [PMID: 35469733 DOI: 10.1016/j.amjmed.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration. METHODS During this 2-year retrospective study in an acute geriatric unit, 514 patients with hemoglobin <10 g/dL and troponin sampling were included. Thirty-day and 1-year mortality were compared according to transfusion status and troponin and hemoglobin levels. RESULTS Of the 514 anemic patients included (median age 88 years), 157 (31%) had elevated troponin concentrations. These patients were more likely to die at 30 days (49% vs 27%, P < .001) and 1 year (65% vs 51%, P = .004) than patients with normal values. Among patients with elevated troponin concentrations, 30-day mortality tended to be lower in transfused than in not-transfused patients (hazard ratio 0.48; 95% confidence interval, 0.21-1.08; P = .07). This association was not found in patients without troponin elevation (hazard ratio 1.09; 95% CI, 0.61-1.93; P = .8). Transfusion was associated with 30-day survival in patients with hemoglobin ≤8 g/dL. It was also associated with excess 1-year mortality in patients with hemoglobin >8 g/dL. CONCLUSIONS This pilot study suggests that transfusion could be associated with better 30-day outcomes in older anemic patients with anemia-related myocardial injury. Thus, troponin levels could be involved in decision-making relative to transfusion in anemic older patients. Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins.
Collapse
Affiliation(s)
- Manon Thevenin
- Acute Geriatric Unit, Dijon University Hospital, Dijon, France
| | - Sophie Putot
- Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France
| | | | - Alain Putot
- Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France; Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), University of Burgundy, Dijon, France.
| |
Collapse
|
5
|
Jhaveri P, Bozkurt S, Moyal A, Belov A, Anderson S, Shan H, Whitaker B, Hernandez-Boussard T. Analyzing real world data of blood transfusion adverse events: Opportunities and challenges. Transfusion 2022; 62:1019-1026. [PMID: 35437749 DOI: 10.1111/trf.16880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Blood transfusions are a vital component of modern healthcare, yet adverse reactions to blood product transfusions can cause morbidity, and rarely result in mortality. Therefore, accurate reporting of transfusion related adverse events (TRAEs) is paramount to improved transfusion practice. This study aims to investigate real-world data (RWD) on TRAEs by evaluating differences between ICD 9/10-based electronic health records (EHR) and blood bank-specific reporting. STUDY DESIGN AND METHODS TRAE data were retrospectively collected from a blood bank-specific database between Jan 2015 and June 2019 as the reference data source and compared it to ICD 9/10 diagnostic codes corresponding to various TRAEs. Seven reactions that have corresponding ICD 9/10 diagnostic codes were evaluated: Transfusion related circulatory overload (TACO), transfusion related acute lung injury (TRALI), febrile non-hemolytic reaction (FNHTR), transfusion-related anaphylactic reaction (TRA), acute hemolytic transfusion reaction (AHTR), delayed hemolytic transfusion reaction (DHTR), and delayed serologic reaction (DSTR). These accounted for 33% of the TRAEs at an academic institution during the study period. RESULTS Among 18637 adult blood transfusion recipients, there were 229 unique patients with 263 TRAE related ICD codes in the EHR, while there were 191 unique patients with 287 TRAEs identified in the blood bank database. None of the categories of reaction we investigated had perfect alignment between ICD 9/10 codes and blood bank specific diagnoses. DISCUSSION Multiple systemic challenges were identified that hinder effective reporting of TRAEs. Identifying factors causing inconsistent reporting between blood banks and EHRs is paramount to developing effective workability between these electronic systems, as well as across clinical and laboratory teams.
Collapse
Affiliation(s)
- Perrin Jhaveri
- School of Medicine, Stanford University, Stanford, California, USA.,Stanford Blood Center, Stanford, California, USA
| | - Selen Bozkurt
- Department of Medicine (Biomedical Informatics), Stanford University School of Medicine, Stanford, California, USA
| | - Axel Moyal
- Department of Medicine (Biomedical Informatics), Stanford University School of Medicine, Stanford, California, USA
| | - Artur Belov
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, US FDA, Silver Spring, Maryland, USA
| | - Steven Anderson
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, US FDA, Silver Spring, Maryland, USA
| | - Hua Shan
- School of Medicine, Stanford University, Stanford, California, USA.,Stanford Blood Center, Stanford, California, USA
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, US FDA, Silver Spring, Maryland, USA
| | - Tina Hernandez-Boussard
- School of Medicine, Stanford University, Stanford, California, USA.,Department of Medicine (Biomedical Informatics), Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
6
|
Shallis RM, Zeidan AM. Management of the Older Patient with Myelodysplastic Syndrome. Drugs Aging 2021; 38:751-767. [PMID: 34342860 DOI: 10.1007/s40266-021-00881-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/19/2023]
Abstract
No two diagnoses of myelodysplastic syndrome are genuinely alike, owing to differing and dynamic mutational topography and epigenetic aberrancy. Consequently, no two patients with myelodysplastic syndrome are identical and disease-specific and patient-specific factors are considered in formulating the optimal treatment, which includes few that are disease modifying. Age itself should not be an absolute contraindication to therapy, including intensive therapy such as allogeneic hematopoietic stem cell transplantation, which is the only curative therapy. However, age associates with an increased prevalence of frailty and comorbidities that must be considered and may preclude a path to cure. Palliative therapies are the mainstay for many patients with myelodysplastic syndrome, which is a disease of older adults with the majority of patients diagnosed at age ≥ 75 years. The older patient requires heightened attention to end organ function/reserve and drug-drug interactions as well as insurance, income, cost, and socioeconomic and psychosocial issues that influence management. Many prior studies have included relatively younger populations or have not specifically performed high-quality subgroup analyses of older patients. In this review, we discuss the available standard-of-care therapies for myelodysplastic syndrome as they specifically relate to the older population and assess the emerging therapeutics that may further the pursuit for personalized treatment and improve both the outcomes and quality of life of the older patient with myelodysplastic syndrome.
Collapse
Affiliation(s)
- Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, Yale University, 333 Cedar Street, PO Box 208028, New Haven, CT, 06520-8028, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, Yale University, 333 Cedar Street, PO Box 208028, New Haven, CT, 06520-8028, USA.
| |
Collapse
|
7
|
Dimova RB, Egelebo CC, Izurieta HS. Systematic Review of Published Meta-Analyses of Vaccine Safety. Stat Biopharm Res 2020. [DOI: 10.1080/19466315.2020.1763833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
8
|
Prodger CF, Rampotas A, Estcourt LJ, Stanworth SJ, Murphy MF. Platelet transfusion: Alloimmunization and refractoriness. Semin Hematol 2019; 57:92-99. [PMID: 32892848 DOI: 10.1053/j.seminhematol.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022]
Abstract
The transfusion of platelets for both prophylaxis and treatment of bleeding is relevant to all areas of medicine and surgery. Historically, guidance regarding platelet transfusion has been limited by a lack of good quality clinical trials and so has been based largely on expert opinion. In recent years however there has been renewed interest in methods to prevent and treat hemorrhage, and the field has benefited from a number of large clinical trials. Some studies, such as platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH) and platelets for neonatal transfusion Study 2 (PLANET-2), have reported an increased risk of harm with platelet transfusion in specific patient groups. These studies suggest a wider role of platelets beyond hemostasis, and highlight the need for further clinical trials to better understand the risks and benefits of platelet transfusions. This review evaluates the indications for platelet transfusion, both prophylactic and therapeutic, in the light of recent studies and clinical trials. It highlights new developments in the fields of platelet storage and platelet substitutes, and novel ways to avoid complications associated with platelet transfusions. Lastly, it reviews initiatives designed to reduce inappropriate use of platelet transfusions and to preserve this valuable resource for situations where there is evidence for their beneficial effect.
Collapse
Affiliation(s)
- Catherine F Prodger
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK
| | - Alexandros Rampotas
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK
| | - Lise J Estcourt
- NHS Blood and Transplant, Oxford; UK; National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford; UK
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK; NHS Blood and Transplant, Oxford; UK; National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford; UK
| | - Michael F Murphy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK; NHS Blood and Transplant, Oxford; UK; National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford; UK.
| |
Collapse
|
9
|
Boureau AS, de Decker L. Blood transfusion in older patients. Transfus Clin Biol 2019; 26:160-163. [DOI: 10.1016/j.tracli.2019.06.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
|
10
|
Roubinian N, Kleinman S, Murphy EL, Glynn SA, Edgren G. Methodological considerations for linked blood donor-component-recipient analyses in transfusion medicine research. ACTA ACUST UNITED AC 2019; 15:185-193. [PMID: 32368251 DOI: 10.1111/voxs.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years, there has been a concerted effort to improve our understanding of the quality and effectiveness of transfused blood components. The expanding use of large datasets built from electronic health records allows the investigation of potential benefits or adverse outcomes associated with transfusion therapy. Together with data collected on blood donors and components, these datasets permit an evaluation of associations between donor or blood component factors and transfusion recipient outcomes. Large linked donor-component recipient datasets provide the power to study exposures relevant to transfusion efficacy and safety, many of which would not otherwise be amenable to study for practical or sample size reasons. Analyses of these large blood banking-transfusion medicine datasets allow for characterization of the populations under study and provide an evidence base for future clinical studies. Knowledge generated from linked analyses have the potential to change the way donors are selected and how components are processed, stored and allocated. However, unrecognized confounding and biased statistical methods continue to be limitations in the study of transfusion exposures and patient outcomes. Results of observational studies of blood donor demographics, storage age, and transfusion practice have been conflicting. This review will summarize statistical and methodological challenges in the analysis of linked blood donor, component, and transfusion recipient outcomes.
Collapse
Affiliation(s)
- Nareg Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California.,Vitalant Research Institute, San Francisco, California.,University of California, San Francisco, San Francisco, California
| | | | - Edward L Murphy
- University of California, San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gustaf Edgren
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
11
|
St Lezin E, Karafin MS, Bruhn R, Chowdhury D, Qu L, Bialkowski W, Merenda S, D'Andrea P, McCalla AL, Anderson L, Keating SM, Stone M, Snyder EL, Brambilla D, Murphy EL, Norris PJ, Hilton JF, Spencer BR, Kleinman S, Carson JL. Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study. Transfusion 2019; 59:1934-1943. [PMID: 30882919 DOI: 10.1111/trf.15249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with cancer or other diagnoses associated with chronic anemia often receive red blood cell (RBC) transfusion as outpatients, but the effect of transfusion on functional status is not well demonstrated. STUDY DESIGN AND METHODS To estimate the effect of transfusion on functional status and quality of life, we measured 6-minute walk test distance and fatigue- and dyspnea-related quality-of-life scores before and 1 week after RBC transfusion in 208 outpatients age ≥50 with at least one benign or malignant hematology/oncology diagnosis. To account for potential confounding effects of cancer treatment, patients were classified into two groups based on cancer treatment within 4 weeks of the study transfusion. Minimum clinically important improvements over baseline were 20 meters in walk test distance, 3 points in fatigue score, and 2 points in dyspnea score. RESULTS The median improvement in unadjusted walk test distance was 20 meters overall and 30 meters in patients not receiving recent cancer treatment. Fatigue scores improved overall by a median of 3 points and by 4 points in patients without cancer treatment. There was no clinically important change in dyspnea scores. In multiple linear regression analysis, patients who maintained hemoglobin (Hb) levels of 8 g/dL or greater at 1 week posttransfusion, who had not received recent cancer treatment, and who did not require hospitalization during the study showed clinically important increases in mean walk test distance. CONCLUSIONS Red blood cell transfusion is associated with a modest, but clinically important improvement in walk test distance and fatigue score outcomes in adult hematology/oncology outpatients.
Collapse
Affiliation(s)
- Elizabeth St Lezin
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Department of Laboratory Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Matthew S Karafin
- Medical Sciences Institute (MSI), BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Roberta Bruhn
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | | | - Lirong Qu
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Walter Bialkowski
- Medical Sciences Institute (MSI), BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Lisa Anderson
- Medical Sciences Institute (MSI), BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, California
| | | | | | - Edward L Murphy
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Philip J Norris
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Joan F Hilton
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | | | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Jeffrey L Carson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | |
Collapse
|
12
|
Acute Hemolytic Transfusion Reaction in Group B Recipient Associated with Group A Apheresis Platelet Donor: Case Report and Literature Review. Case Rep Med 2018; 2018:8259531. [PMID: 30034477 PMCID: PMC6035818 DOI: 10.1155/2018/8259531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022] Open
Abstract
Acute hemolytic transfusion reaction is a known but rare potential adverse event related to platelet transfusion. Most reported cases of platelet-related hemolytic transfusion reaction have resulted from transfusion of platelets from group O donor to group A recipient. We identified only one prior case report in the literature of hemolytic transfusion reactions resulting from transfusion of apheresis platelets from group A donor to group B recipient. In that case report, two platelet units were obtained from a single donation and transfused into two separate patients. Both patients exhibited acute hemolytic reactions. The donor is reported to have high anti-B titers, as well as report of probiotic use. We report a case of acute hemolytic reaction in group B recipient following transfusion of apheresis platelets from group A donor with high-titer anti-B but unknown status of probiotic use. This case demonstrates that while low, there still exists potential risk for hemolysis from out-of-group A plasma transfusion.
Collapse
|
13
|
Potential impact of complement regulator deficiencies on hemolytic reactions due to minor ABO-mismatched transfusions. Blood Adv 2017; 1:1977-1982. [PMID: 29296844 DOI: 10.1182/bloodadvances.2017008805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022] Open
Abstract
Minor ABO-mismatched transfusions are a common occurrence, although infrequent transfusion reactions occur. We sought to investigate the regulation of complement C3 activation induced by anti-A. In vitro complement C3 activation was observed with 10 of 30 group O samples and correlated with immunoglobulin M (IgM) anti-A titers. We developed an in vitro paroxysmal nocturnal hemoglobinuria (PNH) model of hemolysis in which group A1 red blood cells (RBCs) were chemically treated with 2-aminoethylisothiouronium (AET) to alter regulators of complement C3 activation. Intravascular hemolysis was simulated by incubating an IgG nonhemolytic group O plasma (titer = 32) with A1 RBCs. IgG was detected on the RBCs, but hemolysis was observed with AET-treated RBCs only. When treated and untreated RBCs were tested together (1:4), we determined that the failure to observe C3b/d deposition on RBCs was due to the complete hemolysis of the AET-treated minor RBC population. A group O patient with a 9% CD59-deficient PNH clone was sensitized with an IgM anti-I. Hemolysis, with a weak positive direct antiglobulin test (DAT) resulting from C3b/d, was observed after incubation with fresh AB serum. Flow cytometry showed an 86% reduction of the PNH clone. Our work indicates that the transfusion of minor ABO-mismatched plasma could cause hemolysis with a negative DAT C3b/d. We propose that the presence of a PNH clone is 1 possible cause of unexplained anemia for recipients of ABO-mismatched product. This work suggests that other acquired or inherited defects of decay-accelerating factor and membrane inhibitor of reactive lysis could be responsible for infrequent but clinically important hemolysis after ABO-mismatched transfusions.
Collapse
|
14
|
Mahmoudi R, Novella JL, Jaïdi Y. [Transfusion in elderly: Take account frailty]. Transfus Clin Biol 2017; 24:200-208. [PMID: 28690038 DOI: 10.1016/j.tracli.2017.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population.
Collapse
Affiliation(s)
- R Mahmoudi
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France.
| | - J-L Novella
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France
| | - Y Jaïdi
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France
| |
Collapse
|
15
|
Parmar N, Pendergrast J, Lieberman L, Lin Y, Callum J, Cserti-Gazdewich C. The association of fever with transfusion-associated circulatory overload. Vox Sang 2016; 112:70-78. [DOI: 10.1111/vox.12473] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- N. Parmar
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
| | - J. Pendergrast
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Medical Oncology & Hematology (DMOH); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Medicine - Division of Hematology; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
| | - L. Lieberman
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
| | - Y. Lin
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
- Department of Clinical Pathology; Blood & Tissue Bank Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - J. Callum
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
- Department of Clinical Pathology; Blood & Tissue Bank Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - C. Cserti-Gazdewich
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Medical Oncology & Hematology (DMOH); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Medicine - Division of Hematology; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
| |
Collapse
|
16
|
Xia W, Ye X, Xu X, Chen D, Deng J, Chen Y, Ding H, Shao Y, Wang J, Liu J, Li H, Huang YF, Fu Y, Santoso S. The prevalence of leucocyte alloantibodies in blood donors from South China. Transfus Med 2016; 25:385-92. [PMID: 26876912 DOI: 10.1111/tme.12276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/29/2015] [Accepted: 01/02/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Several studies had demonstrated that leucocyte antibodies including anti-human leucocyte antigen (anti-HLA) antibodies (class I and class II) and anti-human neutrophil antigen (anti-HNA) antibodies (HNA-1, -2 and -3) present in the blood products are responsible for transfusion-related acute lung injury (TRALI). Therefore, selection of blood products exclusive of anti-HLA and anti-HNA antibodies may lower the risk of TRALI reaction. However, the prevalence of leucocyte antibodies among blood donors in China is currently not known. STUDY DESIGN AND METHODS Blood samples were collected from 454 male and 560 female donors (143 nulliparous and 417 multiparous female). HLA class I and II antibodies were analyzed by bead assays. Anti-HNA-1 and -2 antibodies were screened by the LABScreen assay (One Lambda Inc.), and HNA-3 were detected by antigen capture assay, and confirmed by the granulocyte agglutination test (GAT). RESULTS Screening of the total cohort showed higher prevalence of HLA antibodies in female compared with male donors (19.64 vs. 4.63%). We found antibodies against HLA class I (13.21%) and HLA class II (11.43%) in 560 female donors. The most frequent antibodies against HLA class I and II in parous females (n = 69) reacted with were A*11 (28.81%), B*07 (42.37%), Cw*07 (20.34%) and DRB1*04 (40.43%) molecules. Among 778 donors (randomly selected from 1014 donors), we found three donors with neutrophil reactive antibodies, two against HNA-2 and one without known specificity. Anti-HNA-3 antibodies were not found so far. CONCLUSION In this study, we found alloimmunization against HLA class I, II and HNA in 4.63, 24.70 and 0.39%, respectively, in our female blood donors, indicating that the use of plasma containing blood products from parous female blood donors without HLA antibodies pre-testing may increase the risk of TRALI reaction. Although immunization against HNA seems to be a rare event in China, further observation is necessary to decide the necessity of HNA antibodies screening in our blood donors.
Collapse
Affiliation(s)
- W Xia
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - X Ye
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - X Xu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - D Chen
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Deng
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Y Chen
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - H Ding
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Y Shao
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Wang
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Liu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - H Li
- Department of Biotechnology, Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Y F Huang
- Department of Surgery, Guangzhou First Municipal People's Hospital Affiliated to Guangzhou Medical College, Guangzhou, China
| | - Y Fu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - S Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, Giessen, Germany
| |
Collapse
|
17
|
Landim CS, Gomes FCA, Zeza BM, Mendrone-Júnior A, Dinardo CL. Prophylactic strategies for acute hemolysis secondary to plasma-incompatible platelet transfusions: correlation between qualitative hemolysin test and isohemagglutinin titration. Rev Bras Hematol Hemoter 2015; 37:217-22. [PMID: 26190423 PMCID: PMC4519819 DOI: 10.1016/j.bjhh.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/12/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Brazilian legislation has recently suggested the use of the qualitative hemolysin test instead of isohemagglutinin titers as prophylaxis for acute hemolysis related to plasma-incompatible platelet transfusions. The efficacy of this test in preventing hemolytic reactions has never been evaluated while isohemagglutinin titers have been extensively studied. The main objective of this study was to evaluate the correlation between the results of these two tests. The impact of each type of prophylaxis on the platelet inventory management and the ability of the qualitative hemolysin test to prevent red cell sensitization after the transfusion of incompatible units were also studied. METHODS A total of 246 donor blood samples were evaluated using both isohemagglutinin titers and the qualitative hemolysin test, and the results were statistically compared. Subsequently, 600 platelet units were tested using the hemolysin assay and the percentage of units unsuitable for transfusion was compared to historical data using isohemagglutinin titers (cut-off: 100). Moreover, ten patients who received units with minor ABO incompatibilities that were negative for hemolysis according to the qualitative hemolysin test were evaluated regarding the development of hemolysis and red cell sensitization (anti-A or anti-B). RESULTS Isohemagglutinin titration and the results of qualitative hemolysin test did not correlate. The routine implementation of the qualitative hemolysin test significantly increased the percentage of platelet units found unsuitable for transfusions (15-65%; p-value <0.001). Furthermore the qualitative hemolysin test did not prevent red blood cell sensitization in a small exploratory analysis. CONCLUSION Qualitative hemolysin test results do not correlate to those of isohemagglutinin titers and its implementation as the prophylaxis of choice for hemolysis associated with plasma-incompatible platelet transfusions lacks clinical support of safety and significantly affects platelet inventory management.
Collapse
|
18
|
Jackups R, Kymes S. Comparison of two platelet transfusion strategies to minimize ABO-nonidentical transfusion, outdating, and shortages using a computer-simulated "virtual blood bank". Transfusion 2015; 55:348-56. [PMID: 25178153 DOI: 10.1111/trf.12831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 07/06/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfusion of ABO-incompatible platelets (PLTs) is associated with reduced PLT recovery and a risk of transfusion reactions. However, a policy of transfusing only ABO-identical PLTs may increase wastage due to product outdating. A prospective study attempting to compare the effects of different ABO compatibility strategies could be costly and disruptive to a blood bank's operations. STUDY DESIGN AND METHODS We designed a "virtual blood bank," a stochastic computer program that models the stocking and release of products to meet demand for PLT transfusion in a simulated hospital population. ABO-nonidentical transfusions (ABOni), outdates, and inventory shortages were recorded and compared under two different transfusion strategies: ABO-First, a strategy that prioritizes transfusion of ABO-identical PLTs, and Age-First, a strategy that minimizes outdating by transfusing products closest to expiration. RESULTS The ABO-First strategy resulted in fewer ABOni but more outdates than the Age-First strategy. Under conditions that mimic a large hospital blood bank, the ABO-First strategy was more cost-effective overall than the Age-First strategy if avoiding an ABOni is valued at more than $19 to $26. For a small blood bank, the ABO-First strategy was more cost-effective if avoiding an ABOni is valued at more than $104 to $123. CONCLUSION Based on a virtual blood bank computer simulation, the cost of avoiding an ABOni using the ABO-First strategy varies greatly by size of institution. Individual blood banks must carefully consider these management strategies to determine the most cost-effective solution.
Collapse
Affiliation(s)
- Ronald Jackups
- Department of Pathology & Immunology, Washington University School of Medicine, St Louis, Missouri
| | | |
Collapse
|
19
|
Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the U.S. elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012. Vox Sang 2014; 108:251-61. [DOI: 10.1111/vox.12215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Menis
- Food and Drug Administration; Silver Spring MD USA
| | | | | | | | | | | | | | - P. D. Mintz
- Food and Drug Administration; Silver Spring MD USA
| | - C. M. Worrall
- Centers for Medicare & Medicaid Services; Baltimore MD USA
| | - J. A. Kelman
- Centers for Medicare & Medicaid Services; Baltimore MD USA
| | | |
Collapse
|
20
|
Chen CH, Shu KH, Yang Y. Long-term effects of an oral iron chelator, deferasirox, in hemodialysis patients with iron overload. ACTA ACUST UNITED AC 2014; 20:304-10. [PMID: 25200910 DOI: 10.1179/1607845414y.0000000199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background/Purpose Retention of excess iron from transfused blood in organs in patients with renal anemia may lead to various systemic complications. Iron chelating agents such as deferasirox (DFX) decrease such iron overload. This study assessed the efficacy, safety, and tolerability of DFX in hemodialysis (HD) patients with iron overload. Methods We retrospectively (February 2008 to June 2012) reviewed data for eight HD patients with end-stage renal disease who were prescribed DFX (15 mg/kg/day) for transfusion-induced iron overload. Baseline and post-treatment levels of hematocrit, ferritin, erythropoietin (EPO), transferrin saturation (TSAT), total and unsaturated iron-binding capacity (TIBC and UIBC, respectively), and blood transfusion volumes were measured. Treatment efficacy was evaluated by observing changes in ferritin and TSAT during the study period; monthly EPO doses and blood transfusions were also recorded. Safety was evaluated in the form of adverse events. Results DFX administration caused statistically significant reductions in TSAT (68.2-49.2%; P = 0.036) and ferritin (3133.1-1215.6 ng/ml; P = 0.017). Significant post-treatment increases in UIBC (63.3-196.6 µg/dl; P = 0.018) and TIBC (210.0-422.4 µg/dl; P = 0.012) were also observed. While there were no significant differences in hematocrit values or EPO requirements after treatment, significant reductions in average monthly transfusion volumes (P = 0.026) were recorded. DFX was generally well tolerated; common adverse effects included nausea, vomiting, diarrhea, and abdominal pain. Conclusion DFX significantly improved iron metabolism in HD patients with iron overload and had an acceptable frequency of adverse effects.
Collapse
|
21
|
Blood transfusion reactions in elderly patients hospitalized in a multilevel geriatric hospital. J Aging Res 2014; 2014:178298. [PMID: 24804100 PMCID: PMC3997128 DOI: 10.1155/2014/178298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/22/2022] Open
Abstract
Background/Objectives. Blood transfusion is a critical issue for patients with chronic diseases such as heart failure, chronic kidney disease, and malignancy. However, side effects are not rare. The purpose of the study is to evaluate the frequency of adverse blood transfusion reactions in hospitalized elderly patients during a one-year period. Design/Setting/Participants. Blood transfusion reactions such as fever, chills, dyspnea, and others following blood transfusions in hospitalized geriatric patients during one-year period were examined. Results. 382 blood units (242 patients) were administered during the study period. In 40 (11%) cases, blood transfusion reactions occurred. Fever was the most common reaction in 29 cases (72%), four (10%) had shortness of breath, and 3 (8%) had vomiting and chills each. There were no lethal cases in the 24-hour period following blood transfusions. Conclusion. A relatively low rate of adverse blood transfusion reactions occurred in our geriatric patients. We may speculate that this is related to underreporting of minor symptoms due to the high percentage of demented patients in this population.
Collapse
|
22
|
Menis M, Anderson SA, Forshee RA, McKean S, Johnson C, Warnock R, Gondalia R, Mintz PD, Holness L, Worrall CM, Kelman JA, Izurieta HS. Transfusion-related acute lung injury and potential risk factors among the inpatient US elderly as recorded in Medicare claims data, during 2007 through 2011. Transfusion 2014; 54:2182-93. [PMID: 24673344 DOI: 10.1111/trf.12626] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011. STUDY DESIGN AND METHODS This retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9-CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors. RESULTS Of 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p < 0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years (OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males (OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite (OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis (OR, 1.89; 95% CI, 1.52-2.20), tobacco use (OR, 1.16; 95% CI, 1.00-1.26), and other diseases. CONCLUSION Our study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly.
Collapse
|
23
|
Karim F, Moiz B, Shamsuddin N, Naz S, Khurshid M. Root cause analysis of non-infectious transfusion complications and the lessons learnt. Transfus Apher Sci 2014; 50:111-7. [DOI: 10.1016/j.transci.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/27/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
|
24
|
Cid J, Harm SK, Yazer MH. Platelet transfusion - the art and science of compromise. Transfus Med Hemother 2013; 40:160-71. [PMID: 23922541 PMCID: PMC3725020 DOI: 10.1159/000351230] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
SUMMARY Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of 'high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed.
Collapse
Affiliation(s)
- Joan Cid
- Apheresis Unit, Department of Hemotherapy-Hemostasis, CDB, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sarah K. Harm
- Department of Pathology, University of Pittsburgh, PA, USA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
| |
Collapse
|