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Shi J, Wang W, Xu J, Yin W. Regulation of lipid metabolism: a new strategy for platelet storage. Platelets 2025; 36:2465321. [PMID: 39950500 DOI: 10.1080/09537104.2025.2465321] [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: 10/28/2024] [Revised: 01/30/2025] [Accepted: 02/03/2025] [Indexed: 05/09/2025]
Abstract
Transfusions of platelets are often used as prophylaxis in patients with hematologic malignancies and as treatment for active bleeding. However, platelets are in short supply due to the fact that they could only be kept for 5-7 days in vitro and they lose some of their functionality as a result of platelet storage lesions. To address this issue, refrigeration, cryopreservation and platelet additive solutions have been researched to determine their abilities to extend platelet storage duration. However, refrigerated platelets are quickly cleared after transfusion, while platelets in platelet additive solutions still present issues such as platelets quality and the risk of allergic reactions. Recent studies showed that changes in lipid metabolites during platelet storage and inadequate of fatty acid metabolism may also limit platelet shelf life and function. In this review, we address the principles of lipid metabolism during platelet storage and discuss the strategies for effective platelet storage systems. The findings of this review highlight the role of lipid metabolism during platelet storage, providing insights into future research focused on extending the preservation period and function of platelet.
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Affiliation(s)
- Jieyun Shi
- College of Life Sciences, Northwest University, Xi'an, China
- Department of Transfusion Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Wenting Wang
- Department of Transfusion Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Jinmei Xu
- Department of Transfusion Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Wen Yin
- Department of Transfusion Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
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2
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Jacobs JW, Booth GS, Lewis-Newby M, Saifee NH, Ferguson E, Cohn CS, Delaney M, Morley S, Thomas S, Thorpe R, Raza S, Weaver MS, Woo JS, Sharma D, So-Osman C, Yurtsever N, Tormey CA, Waters A, Goldman M, Yan MTS, Fasano RM, Stephens LD, Allen ES, Erikstrup C, Infanti L, Schlafer TD, Warner MA, Winters JL, Tobian AAR, Bloch EM. Medical, Societal, and Ethical Considerations for Directed Blood Donation in 2025. Ann Intern Med 2025. [PMID: 40354666 DOI: 10.7326/annals-25-00815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Abstract
In the United States and other high-income countries, blood donation primarily relies on anonymous, voluntary donors. However, directed blood donation-where people donate for a specific recipient-has resurged, particularly due to misinformation surrounding COVID-19 vaccination. Requests for "nonvaccinated" blood, driven by misconceptions about vaccine safety, have led to legislative attempts to mandate compliance. Historically, directed donation was used to mitigate the risk for transfusion-related infections before modern screening techniques rendered it largely unnecessary. Today, it presents important patient safety risks, including increased infectious disease transmission, immunologic complications, and logistic burdens. Directed donations also introduce inefficiencies, diverting resources from the community blood supply and exacerbating shortages. Moreover, directed donation for nonmedical indications lacks scientific justification. Blood safety is ensured through rigorous donor screening, pathogen testing, and processing measures. There is no evidence that blood from vaccinated donors poses risk. Requests for nonvaccinated blood, as well as other directed donation preferences based on personal beliefs, introduce biases that are not grounded in medical necessity. Accommodating such requests undermines public trust in blood safety protocols and legitimizes unfounded fears. Ethical concerns arise as non-medically justified requests reinforce discriminatory practices, such as selecting donors based on race or gender. Allowing such preferences risks politicizing blood donation, spreading misinformation, and straining health care systems. Although autonomy is a core ethical principle in medicine, it does not justify non-evidence-based interventions. Given the potential harm and societal impact, directed blood donations should be limited to rare, medically necessary cases. Ongoing legislative efforts to mandate these requests require unified opposition from the medical and scientific community to uphold ethical, evidence-based, blood allocation practices.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (J.W.J., G.S.B.)
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (J.W.J., G.S.B.)
| | - Mithya Lewis-Newby
- Divisions of Pediatric Cardiac Critical Care and Pediatric Bioethics and Palliative Care, Departments of Pediatrics and Bioethics and Humanities, University of Washington School of Medicine, Seattle Children's Hospital, Seattle; and Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington (M.L.-N.)
| | - Nabiha H Saifee
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle; and Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, Washington (N.H.S.)
| | - Eamonn Ferguson
- School of Psychology, The University of Nottingham, Nottinghamshire, United Kingdom; and National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (E.F.)
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; and Association for the Advancement of Blood and Biotherapies (AABB), Bethesda, Maryland (C.S.C.)
| | - Meghan Delaney
- Division of Pathology & Laboratory Medicine, Children's National Hospital, Washington, DC (M.D.)
| | - Sarah Morley
- New Zealand Blood Service, Auckland, New Zealand (S.M.)
| | - Stephen Thomas
- Joint Professional Advisory Committee, London; and NHS Blood and Transplant, London, United Kingdom (S.T.)
| | - Rachel Thorpe
- Research and Development, Australian Red Cross Lifeblood, West Melbourne, Victoria, Australia; and Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (R.T.)
| | - Sheharyar Raza
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (S.R.)
| | - Meaghann S Weaver
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska (M.S.W.)
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California (J.S.W.)
| | - Deva Sharma
- Division of Transfusion Medicine, Department of Pathology, Microbiology & Immunology, and Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (D.S.)
| | - Cynthia So-Osman
- Department of Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands; and Department of Haematology, Erasmus Medical Center, Rotterdam, the Netherlands (C.S.-O.)
| | - Nalan Yurtsever
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (N.Y., C.A.T.)
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (N.Y., C.A.T.)
| | - Allison Waters
- Irish Blood Transfusion Service, National Blood Centre, Dublin; and UCD School of Public Health, Physiotherapy and Social Science, University College Dublin, Dublin, Ireland (A.W.)
| | - Mindy Goldman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa; and Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada (M.G.)
| | - Matthew T S Yan
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada (M.T.S.Y.)
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta; and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia (R.M.F.)
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California (L.D.S., E.S.A.)
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California (L.D.S., E.S.A.)
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (C.E.)
| | - Laura Infanti
- Regional Transfusion Centre Swiss Red Cross Basel, Basel; and Division of Hematology, University Hospital of Basel, Basel, Switzerland (L.I.)
| | - Timothy D Schlafer
- Lincoln Memorial University Duncan School of Law, Knoxville, Tennessee (T.D.S.)
| | - Matthew A Warner
- Department of Anesthesiology and Perioperative Medicine, and Patient Blood Management Program, Mayo Clinic, Rochester, Minnesota (M.A.W.)
| | - Jeffrey L Winters
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (J.L.W.)
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.A.R.T., E.M.B.)
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.A.R.T., E.M.B.)
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Rajesh A, Schaefer RM, Krohmer JR, Bank EA, Holcomb JB, Jenkins DH. From shortages to solutions: Liquid plasma as a practical alternative to whole blood for prehospital trauma resuscitation. Transfusion 2025; 65 Suppl 1:S288-S296. [PMID: 40181605 DOI: 10.1111/trf.18183] [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: 12/16/2024] [Revised: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 04/05/2025]
Abstract
Trauma-induced hemorrhagic shock remains a leading cause of preventable mortality, necessitating timely and effective resuscitation strategies. While low-titer O whole blood (LTOWB) is the preferred choice for prehospital resuscitation due to its balanced composition and ease of use, overall widespread implementation is hindered by persistent supply chain issues and daily logistical challenges of access and deployment. Platelets, containing plasma as a component, are considered the next best alternative to LTOWB but are constrained by their short shelf life and ongoing scarcity, and ongoing storage compliance, rendering their use impractical. This review evaluates plasma-based alternatives, particularly liquid plasma (LP), as a viable and cost-effective substitute therapeutic modality. LP offers a 26-day refrigerated shelf life compared to the 5-day limit of thawed fresh frozen plasma (FFP) and eliminates the challenges associated with freezing and thawing while maintaining clinical efficacy. Preliminary economic analyses further underscore the advantages of LP, demonstrating reduced wastage and lower costs compared to LTOWB, especially when partnering with a hospital system. Acknowledging the barriers in implementing prehospital blood transfusion programs due to blood supply and costs, we advocate for emergency medical service (EMS) adoption of LP, highlighting its availability, comparable efficacy to LTOWB, and cost-effectiveness. Until LTOWB becomes more accessible, LP should be prioritized in prehospital care to optimize outcomes for trauma patients in hemorrhagic shock.
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Affiliation(s)
- Aashish Rajesh
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Jon R Krohmer
- Department of Emergency Medicine, Western Michigan University, Kalamazoo, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
- EMSMD PLLC, Grandville, Michigan, USA
| | - Eric A Bank
- Harris County Emergency Services District 48, Katy, Texas, USA
| | - John B Holcomb
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Bhatt HV, Hu Y, Lin HM, Egorova N, Ouyang Y, Levin MA. Comparison of Perioperative Outcomes for Transfusion of Hemoconcentrated Bypass Versus Cell Saver Blood in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2025; 39:1173-1179. [PMID: 39984367 DOI: 10.1053/j.jvca.2025.01.035] [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: 09/25/2024] [Revised: 01/22/2025] [Accepted: 01/27/2025] [Indexed: 02/23/2025]
Abstract
OBJECTIVE Hemoconcentration and cell saver use are blood conservation techniques that are often used in cardiac surgery to salvage the patient's own blood to reduce autologous transfusion. The purpose of this study was to examine the perioperative outcomes including transfusion rates in cardiac surgical patients receiving hemoconcentrated blood versus cell saver blood via retrospective chart review. We hypothesized that hemoconcentration would have better patient outcomes, including reduced transfusion rates, compared to only cell salvage technique. DESIGN Single-center, retrospective chart review case-control study SETTING: Cardiac operating room of a tertiary care center PARTICIPANTS: Patients over 18 years old who underwent elective open-heart surgery with cardiopulmonary bypass between January 2015 to January 2018. Patients for emergencies, off-pump cases, transplants, and reoperations and with a need for second bypass were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The specific outcomes assessed include perioperative transfusion of packed red blood cells and blood products, intensive care unit (ICU) length of stay, hospital length of stay, and surgical site infections. Patient characteristics such as ejection fraction and comorbidities, pulmonary hypertension, atrial fibrillation history, and coagulation dysfunction were also analyzed. Propensity score matching was done to balance the covariates between the groups. The differences for each outcome outlined above were calculated. Of the 744 observations, 735 were used for analysis after propensity matching. Postoperative ICU red blood cell transfusions recorded a mean difference of -0.37 (95% CI: -0.78, 0.04). Postoperative ICU platelets and fresh frozen plasma recorded mean differences of -0.01 (95% CI: -0.11, 0.09) and -0.08 (95% CI: -0.19, 0.03), respectively. There were no significant differences in outcomes in bivariate- and covariate-adjusted models. CONCLUSIONS There is no significant difference in postoperative blood transfusion rates in hemoconcentrated versus cell saver blood usage in cardiac surgery patients. Further studies are needed to analyze specific quantities and ratios of hemoconcentrated and cell saver blood used in these patients for a more clinically relevant analysis. This would allow incorporation of hemoconcentration and cell saver techniques into better blood conservation processes and guide overall transfusion strategies to reduce transfusion rates of blood and blood products in cardiac surgical patients.
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Affiliation(s)
- Himani V Bhatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Young Hu
- Department of Family Medicine, Stamford Hospital/Columbia University, Stamford, CT
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuxia Ouyang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthew A Levin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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5
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Hyde MK, Masser BM, Thorpe R, Philip AA, Salmon A, Scott TL, Davison TE. Rethinking the role of older donors in a sustainable blood supply. Transfusion 2025; 65:758-766. [PMID: 40047217 PMCID: PMC12005585 DOI: 10.1111/trf.18190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/16/2025] [Accepted: 02/18/2025] [Indexed: 04/19/2025]
Affiliation(s)
- Melissa K. Hyde
- School of PsychologyThe University of QueenslandBrisbaneAustralia
- Research and DevelopmentAustralian Red Cross LifebloodMelbourneAustralia
| | - Barbara M. Masser
- School of PsychologyThe University of QueenslandBrisbaneAustralia
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Rachel Thorpe
- Research and DevelopmentAustralian Red Cross LifebloodMelbourneAustralia
- School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Aaron Akpu Philip
- Research and DevelopmentAustralian Red Cross LifebloodMelbourneAustralia
| | - Amanda Salmon
- School of PsychologyThe University of QueenslandBrisbaneAustralia
| | - Theresa L. Scott
- School of PsychologyThe University of QueenslandBrisbaneAustralia
| | - Tanya E. Davison
- Research and InnovationSilverchainMelbourneAustralia
- Monash Art, Design and ArchitectureMonash UniversityMelbourneAustralia
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6
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Du Y, Xia Y, You C, Wang Y, Duan D, Xu W, Xu Q, Zhang H, Han C. Impact of red blood cell transfusion in massive burn: a multicenter cohort study. Sci Rep 2025; 15:6196. [PMID: 39979424 PMCID: PMC11842838 DOI: 10.1038/s41598-025-91052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/18/2025] [Indexed: 02/22/2025] Open
Abstract
Blood transfusions were frequently in massive burn patients, current studies focus on the trigger threshold of red blood cell transfusion, and few studies focus on the impact of red blood cell transfusion volume on patient outcomes. We initiated a multicenter cohort study to explore the impact of red blood cell transfusions volume on patient mortality. 379 patients in three centers were enrolled to the cohort. The extroperative and overall RBC transfusion in the death group were significantly higher than those in the survival group (p < 0.001), and this difference became insignificant within the operation (p = 0.312). RBC transfusion volume and mortality risk of patients was obviously not linear (p < 0.0001) and would be L-shaped, and the threshold would be 6U. 1:1propensity matching was used to adjust the burn area, full thickness burned area and inhalation injury. There was no significant difference in the outcome and bloodstream infection between the two groups, but the length of stay, length of stay in burn ICU and mechanical ventilation time of the low red blood cell group were significantly lower than those of the high red blood cell group. Our findings therefore support the approach of a restrictive transfusion strategy in severely burned patients. This also confirms the scientificity of restrictive transfusion strategy and suggests that unnecessary red blood cell transfusion should be avoided in clinic.
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Affiliation(s)
- Yong Du
- Department of nursing , Second Affiliated Hospital Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, China.
- Department of burn and wound care center, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
| | - Yilan Xia
- Department of nursing , Second Affiliated Hospital Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, China.
- Department of burn and wound care center, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
| | - Chuanggang You
- Department of burn and wound care center, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yiran Wang
- Department of burn and wound care center, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Deqing Duan
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wanting Xu
- Department of Burn Injury, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qinglian Xu
- Department of Burn Injury, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongyan Zhang
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chunmao Han
- Department of burn and wound care center, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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Kelly K, Finlon J, Fulciniti S, Lee D, Jones M, Marschner S. Effect of the added plasma rinseback on residual cell types in plateletpheresis leukoreduction systems. Transfusion 2025; 65:202-210. [PMID: 39635935 DOI: 10.1111/trf.18086] [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: 09/11/2024] [Revised: 11/18/2024] [Accepted: 11/18/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Platelets collected by the Trima Accel apheresis device (Terumo BCT) are automatically leukoreduced through a leukoreduction system (LRS) where WBCs are trapped in a conical-shaped LRS chamber. The content has been used as a valuable source of mononuclear cells for research purposes. In frequent, long-term platelet apheresis donors, lymphopenia has been associated with the use of LRS chambers, and implementation of plasma rinseback at the end of the procedure has been shown to mitigate the depletion of lymphocytes. In this report, the cellular content of the LRS chamber and remaining disposable was characterized with and without plasma rinseback. STUDY DESIGN AND METHODS Trima disposable sets were obtained from apheresis platelet collections in 100% plasma or 35% plasma/65% PAS with or without plasma rinseback at the end of the collections. Cellular content was drained from the LRS chamber and the disposable and was characterized using a hematology analyzer and flow cytometer to establish total cell counts and proportions of RBC, platelet, and WBC subpopulations. RESULTS LRS chambers contained approximately 109 WBCs, with the majority being lymphocytes and monocytes. The addition of plasma rinseback significantly decreased the number of WBCs remaining in the disposable, thereby increasing the number of WBCs returned to the donor. However, rinseback did not impact the WBC content of the LRS chamber itself. CONCLUSIONS Blood Centers using the Trima Accel instrument may reduce lymphopenia in regular platelet donors by implementing plasma rinseback, while ensuring the cellular content of the LRS chamber intended for research purposes remains unaffected.
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Affiliation(s)
| | - Jeff Finlon
- Vitalant Research Institute, Denver, Colorado, USA
| | | | - Deborah Lee
- Vitalant Research Institute, Denver, Colorado, USA
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Pedraza M, Mejia J, Pitman JP, Arriaga G. Introduction of 7-day amotosalen/ultraviolet A light pathogen-reduced platelets in Honduras: Impact on platelet availability in a lower middle-income country. Vox Sang 2024; 119:1268-1277. [PMID: 39374943 PMCID: PMC11634442 DOI: 10.1111/vox.13740] [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: 07/16/2024] [Revised: 08/30/2024] [Accepted: 09/09/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Honduras became the first lower middle-income country (LMIC) to adopt amotosalen/UVA pathogen-reduced (PR) platelet concentrates (PCs) as a national platelet safety measure in 2018. The Honduran Red Cross (HRC) produces ~70% of the national platelet supply using the platelet-rich plasma (PRP) method. Between 2015 and 2018, PCs were screened with bacterial culture and issued as individual, non-pooled PRP units with weight-based dosing and 5-day shelf-life. PR PCs were produced in six-PRP pools with a standardized dose (≥3.0 × 1011), no bacterial screening and 7-day shelf-life. Gamma irradiation and leukoreduction were not used. MATERIALS AND METHODS PC production and distribution data were retrospectively analysed in two periods. Period 1 (P1) included 3 years of PRP PCs and a transition year (2015-18). Period 2 (P2) included 5 years of PR PCs (2019-23). PC doses were standardized to an equivalent adult dose for both periods. Descriptive statistics were calculated. RESULTS HRC produced 10% more PC doses per year on average in P2 compared to P1. Mean annual waste at HRC declined from 23.9% in P1 to 1.1% in P2. Two urban regions consumed 96% of PC doses in P1 and 88.3% in P2. PC distributions increased in 14/18 regions. CONCLUSION Standardized dosage, PR and 7-day shelf-life increased PC availability, reduced waste, eliminated bacterial screening and avoided additional costs for arboviral testing, leukoreduction and irradiation. Access to PC transfusion remains limited in Honduras; however, the conversion to pooled PR PCs illustrates the potential to sustainably expand PC distribution in an LMIC.
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Affiliation(s)
- Marcelo Pedraza
- Programa Nacional de SangreCruz Roja Hondureña (Honduran Red Cross [HRC])TegucigalpaHonduras
| | - Julio Mejia
- Programa Nacional de SangreCruz Roja Hondureña (Honduran Red Cross [HRC])TegucigalpaHonduras
| | - John P. Pitman
- Scientific and Medical AffairsCerus CorporationConcordCaliforniaUSA
| | - Glenda Arriaga
- Programa Nacional de SangreCruz Roja Hondureña (Honduran Red Cross [HRC])TegucigalpaHonduras
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William N, Acker JP, Seghatchian J. Advancement of blood donor factors in RBC and blood component therapy using modern practices and methodologies: How to make multifactorial clinical decisions amid growing complexity. Transfus Apher Sci 2024; 63:104022. [PMID: 39520947 DOI: 10.1016/j.transci.2024.104022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Affiliation(s)
- Nishaka William
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Jerard Seghatchian
- International Consultancy in Modern Personalized Blood Component Therapies, London, UK.
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10
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D'Alessandro A. It's in your blood: The impact of age, sex, genetic factors and exposures on stored red blood cell metabolism. Transfus Apher Sci 2024; 63:104011. [PMID: 39423666 PMCID: PMC11606750 DOI: 10.1016/j.transci.2024.104011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2024]
Abstract
Transfusion of packed red blood cell (RBCs) saves millions of lives yearly worldwide, making packed RBCs the most commonly administered drug in hospitals after vaccines. However, not all blood units are created equal. By examining blood products as they age in blood banks, transfusion scientists are gaining insights into the intricacies of human chemical individuality as regulated by biological factors (such as sex, age, and body mass index), genetic and non-genetic factors like environmental, dietary, and other exposures. Here, we review recent literature on this topic, with an emphasis on studies linking genetic traits to the metabolic heterogeneity of blood products, the hemolytic propensity of stored RBCs, and transfusion outcomes in both healthy autologous and non-autologous patients requiring transfusion. Given the role of RBCs as a simplified model of eukaryotic cells, and RBC storage as a medically relevant application modeling erythrocyte responses to oxidant stress, these insights have the potential not only to guide the development of precision transfusion strategies, but also to identify novel mechanisms of RBC metabolic regulation relevant to responses to hypoxia and oxidant stress in human (patho)physiology.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA.
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11
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Marrero-Rivera G, García-Otálora MA, Gonzalez C, Pérez-Carrillo J, Rojas P, Castellanos P, Granados M, Herrera G, Montemayor C, Bakhtary S. Blood donor questionnaires and infectious disease screening in Latin American countries. Vox Sang 2024; 119:1201-1206. [PMID: 39198032 DOI: 10.1111/vox.13730] [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: 05/17/2024] [Revised: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Blood donor questionnaires are tools used to screen prospective blood donors to determine their eligibility. There are limited data regarding blood donor questionnaires and infectious disease screening of the blood supply in Latin American countries. This study aimed to survey donor centres in Latin American countries to learn more about blood donor screening and infection assessment. MATERIALS AND METHODS An international team of transfusion medicine professionals including medical directors and supervisors who work or collaborate with Latin American donor centres, called 'Comité de Investigación en Medicina Transfusional', designed a survey (16 questions) to characterize blood donor eligibility in Latin America. RESULTS Eighty-two institutions from 14 Latin American countries responded to the survey. Most donor centres (66%; 54 of 82) had a donor deferral percentage between 5% and 25%, and the most common causes of deferrals were low haemoglobin and high-risk behaviour. Most donors in blood centres were directed family donors compared with voluntary donors. Infection evaluation included mostly serologic assessment (81%; 30 of 37) for human immunodeficiency virus (HIV), Hepatitis B, Hepatitis C, Treponema pallidum and Trypanosoma cruzi rather than nucleic acid tests (5%; 2 of 37). CONCLUSION Heterogeneity exists in donor selection and infectious disease screening in Latin American countries. This survey provides valuable information to understand Latin American blood centre practices.
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Affiliation(s)
| | | | - Carlos Gonzalez
- Fundación Hemocentro Buenos Aires, Argentina School of Medicine and Health Science, Buenos Aires, Argentina
| | - José Pérez-Carrillo
- Banco de Sangre Laboratorio Clínico, Clínica Colsanitas, Grupo Keralty, Bogotá, Colombia
| | - Paolo Rojas
- Centro de Sangre Valparaíso, Valparaíso, Chile
| | - Paula Castellanos
- Banco de Sangre del Hospital General de Accidentes del Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala
| | - Melissa Granados
- Centro Estatal de la Transfusión Sanguínea de Baja California Sur, Baja California Sur, Mexico
| | | | | | - Sara Bakhtary
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
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12
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Gammon RR, Almozain N, Hermelin D, Klein N, Mangwana S, Nair AR, O'Brien JJ, Shmookler AD, Stephens L, Bocquet C. RhD-Alloimmunization in Adult and Pediatric Trauma Patients. Transfus Med Rev 2024; 38:150842. [PMID: 39127022 DOI: 10.1016/j.tmrv.2024.150842] [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: 10/31/2023] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 08/12/2024]
Abstract
The actual risk of providing RhD-positive units to RhD-negative recipients remains debatable. There is no standard of care in the United States (US) to guide transfusion decisions regarding RhD type for patients with an unknown blood type, except for women of childbearing age and neonates. The risk of alloantibody formation by an RhD-negative patient exposed to RhD-positive blood is reported to be from 3% to 70%. Due to such wide variations, this review was undertaken to determine the prevalence of anti-D alloimmunization in trauma patients who are RhD-negative and were transfused RhD-positive blood products. This study used the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) approach to answer the question, "In trauma patients who were transfused blood, what is the prevalence of alloimmunization to the D-antigen?" The review included all published articles through April 3, 2022 in databases. Articles published after the search period found by the authors were added to the manuscript if they addressed the primary question and there was unanimous consensus. There were 1683 full-text articles that met the search criteria, with 19 studies meeting eligibility criteria. In addition, 57 references were added after the search period had closed. The incidence of anti-D alloimmunization in adult trauma patients receiving whole blood varied from 7.8% to 42.7%. In contrast, incidence varied in patients receiving red blood cells (RBCs), from 0 to 94%, depending on number of categories analyzed. Anti-D alloimmunization with platelet transfusions varied from 0% to 19%. The alloimmunization rate increased with age and was detected only in children older than 5 years. Recent guidelines recommend the administration of Rh immune globulin (RhIG) to all traumatically injured patients who are both RhD-negative and pregnant. However, there is no specific guidance focused on the RhD-negative patient, pregnant or nonpregnant, and who have received RhD-positive red blood cells (RBC) and platelets. While numerous studies have attempted to evaluate the frequency of RhD alloimmunization rate in trauma settings, emerging data suggests that many factors affect this phenomenon. Additionally, the role of RhIG administration in cases of RhD-incompatible transfusions within the trauma setting adds complexity. As our trajectory propels us towards precision medicine and tailored transfusion practices, gaining a big data approach becomes indispensable.
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Affiliation(s)
| | - Nour Almozain
- Department of Pathology and Transfusion Medicine, King Faisal Specialist Hospital and Research Centre-Riyadh, Riyadh, Saudi Arabia; Department of Pathology and Transfusion Medicine, King Saud University- Riyadh, Riyadh, Saudi Arabia
| | - Daniela Hermelin
- Impact life, St. Louis, Missouri, USA; Department of Pathology, Saint Louis University School of Medicine, Missouri, USA
| | - Norma Klein
- Department of Pathology, University of California Davis, Sacramento, CA, USA
| | | | - Amita Radhakrishnan Nair
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvantanthapuram, India
| | | | | | | | - Christopher Bocquet
- Standards Development and Quality Initiatives, Association for the Advancement of Blood and Biotherapies, Bethesda, MD, USA
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13
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Ali S, Botnarciuc M, Badea IA, Alexandru A, Tuta LA, Daba LC, Gurgas L, Chirila SI. Impact of the COVID-19 Pandemic on Blood Transfusion among Hospitalized Patients with Chronic Kidney Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1512. [PMID: 39336553 PMCID: PMC11434223 DOI: 10.3390/medicina60091512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/21/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients' access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019-2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190-2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020-2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics.
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Affiliation(s)
- Sevigean Ali
- Preclinical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania; (M.B.); (I.-A.B.); (L.C.D.); (L.G.); (S.I.C.)
| | - Mihaela Botnarciuc
- Preclinical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania; (M.B.); (I.-A.B.); (L.C.D.); (L.G.); (S.I.C.)
- Blood Transfusions Unit, Emergency Clinical County Hospital Constanta, Bdul Tomis nr. 145, 900591 Constanta, Romania
| | - Iulia-Andreea Badea
- Preclinical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania; (M.B.); (I.-A.B.); (L.C.D.); (L.G.); (S.I.C.)
| | - Andreea Alexandru
- Nephrology Department, Emergency Clinical County Hospital Constanta, Bdul Tomis nr. 145, 900591 Constanta, Romania;
| | - Liliana-Ana Tuta
- Nephrology Department, Emergency Clinical County Hospital Constanta, Bdul Tomis nr. 145, 900591 Constanta, Romania;
- Clinical Medical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania
| | - Lavinia Carmen Daba
- Preclinical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania; (M.B.); (I.-A.B.); (L.C.D.); (L.G.); (S.I.C.)
| | - Leonard Gurgas
- Preclinical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania; (M.B.); (I.-A.B.); (L.C.D.); (L.G.); (S.I.C.)
| | - Sergiu Ioachim Chirila
- Preclinical Disciplines Department, Faculty of Medicine, Ovidius University of Constanta, Campus B, Aleea Universitatii nr. 1, 900470 Constanta, Romania; (M.B.); (I.-A.B.); (L.C.D.); (L.G.); (S.I.C.)
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14
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Jacobs JW, Bates I, Cohn CS, Choudhury N, Owusu-Ofori S, Vrielink H, Patel EU, Wendel S, Tobian AAR, Bloch EM. The global blood donation index: an imperfect measure of transfusion need. Lancet 2024; 404:988-990. [PMID: 39244275 DOI: 10.1016/s0140-6736(24)01550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 09/09/2024]
Abstract
The optimum number of units of blood and the associated number of blood donors required to meet a given population's needs remain undetermined globally. Typically, a whole blood donation rate of ten donations per 1000 population, at a minimum, is necessary to meet a country's blood needs. This rate is attributed to a WHO recommendation that 1% of a given country's population should donate blood to ensure a blood supply that is sufficient to meet clinical needs. This often cited metric was first referenced in a 1971 WHO report, yet neither supporting data or references were provided, suggesting that it was flawed at its founding. Regardless, this metric does not provide an accurate or contemporary determination of blood needs, which has ramifications for health service provision and planning, particularly in low-income and lower-middle-income countries. Modelling studies that account for geographical variability in disease burden, health-care infrastructure, and transfusion practices are needed to accurately estimate blood needs. A paucity of data to inform modelling remains a major obstacle in this regard. We discuss the history of the global blood donation index and highlight some factors that should be considered to better understand contemporary blood needs.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA; Association for the Advancement of Blood and Biotherapies, Bethesda, MD, USA
| | | | | | - Hans Vrielink
- Unit of Transfusion Medicine of Sanquin Blood Supply, Sanquin Blood Supply Foundation, Amsterdam, Netherlands
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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15
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Chitrakar A, Bean SWM, Kanias T, Thomas KA. Stored platelet hemostatic phenotype and function is not altered when donors are on testosterone replacement therapy. Transfusion 2024; 64:1520-1532. [PMID: 38994922 PMCID: PMC11326535 DOI: 10.1111/trf.17926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/22/2024] [Accepted: 06/02/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Critical shortages in the national blood supply have led to a re-evaluation of previously overlooked donor sources for blood products. As a part of that effort, red blood cells collected from therapeutic phlebotomy of donors on testosterone replacement therapy (TRT) have been conditionally approved for transfusion. However, platelets from TRT donors are not currently approved for use due to limited data on effects of supraphysiologic testosterone on recipient safety and platelet function. The objective of this study was to provide a comprehensive profile of phenotype and function in platelets from TRT and control donors. STUDY DESIGN AND METHODS Platelets in plasma were collected from TRT and control donors (N = 10 per group; age- and sex-matched) and stored at room temperature for 7 days. On storage Day 1 (D1) and Day 7 (D7), platelet products were analyzed for platelet count, metabolic parameters (i.e., glucose, lactate, mitochondrial function), surface receptor expression, aggregation, thrombin generation, and thrombus formation under physiological flow conditions. RESULTS TRT donor platelets were not significantly different than control donor platelets in terms of count, surface phenotype, metabolic function, ability to aggregate, thrombin generation, or ability to form occlusive thrombus under arterial flow regimes. Both groups were similar to each other by D7, but had significantly lost hemostatic function compared to D1. DISCUSSION Platelets derived from donors undergoing TRT have similar phenotypic and functional profiles compared to those derived from control donors. This suggests that therapeutic phlebotomy of TRT donors may provide a useful source for platelet products.
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Affiliation(s)
| | | | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kimberly A Thomas
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Abou Daher L, Heppell O, Lopez-Plaza I, Guerra-Londono CE. Perioperative Blood Transfusions and Cancer Progression: A Narrative Review. Curr Oncol Rep 2024; 26:880-889. [PMID: 38847973 DOI: 10.1007/s11912-024-01552-3] [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] [Accepted: 05/18/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE OF REVIEW To examine the most recent evidence about known controversies on the effect of perioperative transfusion on cancer progression. RECENT FINDINGS Laboratory evidence suggests that transfusion-related immunomodulation can be modified by blood management and storage practices, but it is likely of less intensity than the effect of the surgical stress response. Clinical evidence has questioned the independent effect of blood transfusion on cancer progression for some cancers but supported it for others. Despite major changes in surgery and anesthesia, cancer surgery remains a major player in perioperative blood product utilization. Prospective data is still required to strengthen or refute existing associations. Transfusion-related immunomodulation in cancer surgery is well-documented, but the extent to which it affects cancer progression is unclear. Associations between transfusion and cancer progression are disease-specific. Increasing evidence shows autologous blood transfusion may be safe in cancer surgery.
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Affiliation(s)
- Layal Abou Daher
- Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | | | - Ileana Lopez-Plaza
- Department of Pathology and Blood Bank, Henry Ford Health, Detroit, MI, USA
| | - Carlos E Guerra-Londono
- Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
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17
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Gordy D, Swayne T, Berry GJ, Thomas TA, Hudson KE, Stone EF. Characterization of a novel mouse platelet transfusion model. Vox Sang 2024; 119:702-711. [PMID: 38643983 DOI: 10.1111/vox.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Platelet transfusions are increasing with medical advances. Based on FDA criteria, platelet units are assessed by in vitro measures; however, it is not known how platelet processing and storage duration affect function in vivo. Our study's aim was to develop a novel platelet transfusion model stored in mouse plasma that meets FDA criteria adapted to mice, and transfused fresh and stored platelets are detectable in clots in vivo. STUDY DESIGN AND METHODS Platelet units stored in mouse plasma were prepared using a modified platelet-rich plasma (PRP) collection protocol. Characteristics of fresh and stored units, including pH, cell count, in vitro measures of activity, including activation and aggregation, and post-transfusion recovery (PTR), were determined. Lastly, a tail transection assay was conducted using mice transfused with fresh or stored units, and transfused platelets were identified by confocal imaging. RESULTS Platelet units had acceptable platelet and white cell counts and were negative for bacterial contamination. Fresh and 1-day stored units had acceptable pH; the platelets were activatable by thrombin and adenosine diphosphate, agreeable with thrombin, had acceptable PTR, and were present in vivo in clots of recipients after tail transection. In contrast, 2-day stored units had clinically unacceptable quality. CONCLUSION We developed mouse platelets for transfusion analogous to human platelet units using a modified PRP collection protocol with maximum storage of 1 day for an 'old' unit. This provides a powerful tool to test how process modifications and storage conditions affect transfused platelet function in vivo.
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Affiliation(s)
- Dominique Gordy
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Theresa Swayne
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Gregory J Berry
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Tiffany A Thomas
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Krystalyn E Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Elizabeth F Stone
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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18
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Ruiz JM, Hughes SD, Flores M, Custer B, Ingram M, Carvajal S, Rosales C, Kamel H, Vassallo R, France CR. Neighborhood ethnic density and disparities in proximal blood donation opportunities. Transfusion 2024; 64:1008-1015. [PMID: 38660952 DOI: 10.1111/trf.17847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Despite being the largest racial/ethnic minority group in the United States, Hispanic/Latinos (H/L) are significantly underrepresented among blood donors. A lack of proximal blood donation opportunities may be one factor contributing to these disparities. However, few studies have investigated this possibility. STUDY DESIGN AND METHODS Proprietary data on mobile blood collections in Maricopa County, Arizona, were gathered for the period of January 01, 2022 to April 30, 2022 and paired with census tract information using ArcGIS. Maricopa County encompasses the city of Phoenix with a total population of approximately 4.5 million people, including 1.5 million H/L residents. Blood drive count was regressed on H/L ethnic density and total population, and model estimates were exponentiated to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS During the specified period, approximately 27,000 red blood cell units were collected through mobile drives. Consistent with expectations, when controlling for total neighborhood population, each 10% increase in H/L ethnic density lowered the odds of having a blood drive in the corresponding neighborhood by 12% (OR = 0.88, 95% CI (0.83, 0.92), p < .001). DISCUSSION These findings provide initial evidence of fewer proximal donation opportunities in areas with greater H/L population density which may contribute to H/L underrepresentation in blood donation and the need for more inclusive collection efforts. Improved access to blood collection is modifiable and could help to increase the overall blood supply, enhance the ability to successfully match specific blood antigen needs of an increasingly diverse population, and bring about a more resilient blood system.
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Affiliation(s)
- John M Ruiz
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Shana D Hughes
- Vitalant Research Institute, San Francisco, California, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
| | - Maia Ingram
- School of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Scott Carvajal
- School of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Cecilia Rosales
- School of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Hany Kamel
- Vitalant, Medical Affairs, Scottsdale, Arizona, USA
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19
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Christensen RD, Bahr TM, Christensen TR, Ohls RK, Krong J, Carlton LC, Henry E, Sheffield MJ, Gerday E, Ilstrup SJ, Kelley WE. Banked term umbilical cord blood to meet the packed red blood cell transfusion needs of extremely-low-gestational-age neonates: a feasibility analysis. J Perinatol 2024; 44:873-879. [PMID: 38030793 DOI: 10.1038/s41372-023-01833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To assess the feasibility of drawing, processing, safety-testing, and banking term umbilical cord blood to meet the packed red blood cell transfusion (RBC Tx) needs of extremely-low-gestational-age neonates (ELGANs). DESIGN (1) Retrospectively analyze all ELGANs RBC Tx over the past three years, (2) Estimate local cord blood availability, (3) Assess interest in this project, and implementation barriers, through stakeholder surveys. RESULTS In three years we cared for 266 ELGANs; 165 (62%) received ≥1 RBC Tx. Annual RBC Tx averaged 197 (95% CI, 152-243). If 10% of our 10,353 annual term births had cord blood drawn and processed, and half of those tested were acceptable for Tx, collections would exceed the 95th % upper estimate for need by >four-fold. Interest exceeded 97%. Identified barriers included FDA approval, training to collect cord blood, and cost. CONCLUSION RBC Tx needs of ELGANS could be met by local cord blood collection.
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Affiliation(s)
- Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA.
- Clinical Research, Intermountain Health, Murray, UT, USA.
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | | | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jake Krong
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | - Lindsey C Carlton
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | - Erick Henry
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Mark J Sheffield
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Erick Gerday
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Sarah J Ilstrup
- Transfusion Services and Department of Pathology, Intermountain Health, Murray, UT, USA
| | - Walter E Kelley
- American National Red Cross, Salt Lake City, UT, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
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20
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Tran MH, Niu C, Kelley W. Why are we donating less? Transfusion 2024; 64:1154-1160. [PMID: 38693100 DOI: 10.1111/trf.17861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Minh-Ha Tran
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - ChenChen Niu
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Walter Kelley
- American National Red Cross, Salt Lake City, Utah, USA
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21
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Ortiz JLC, Griffin I, Kazakova SV, Stewart PB, Kracalik I, Basavaraju SV. Transfusion-related errors and associated adverse reactions and blood product wastage as reported to the National Healthcare Safety Network Hemovigilance Module, 2014-2022. Transfusion 2024; 64:627-637. [PMID: 38476028 PMCID: PMC11299550 DOI: 10.1111/trf.17775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Transfusion-related errors are largely preventable but may lead to blood product wastage and adverse reactions, resulting in patient harm. In the United States, the incidence of transfusion-related errors is poorly understood nationally. We used data from the National Healthcare Safety Network (NHSN) Hemovigilance Module to describe and quantify transfusion-related errors, as well as associated transfusion-related adverse reactions and blood product wastage. METHODS During 2014-2022, data from the NHSN Hemovigilance Module were used to analyze errors, including near misses (errors with no transfusion), incidents (errors with transfusion), and associated serious adverse reactions (severe, life-threatening, or death). RESULTS During 2014-2022, 80 acute care facilities (75 adult; 5 pediatric) reported 63,900 errors. Most errors occurred during patient blood sample collection (21,761, 34.1%) and blood sample handling (16,277, 25.5%). Less than one-fifth of reported errors (9822, 15.4%) had a completed incident form. Of those, 8780 (89.3%) were near misses and 1042 (10.7%) incidents. More than a third of near misses (3363, 38.3%) were associated with a discarded blood product, resulting in 4862 discarded components. Overall, 87 adverse reactions were associated with errors; six (7%) were serious. CONCLUSIONS Over half of the transfusion-related errors reported to the Hemovigilance Module occurred during blood sample collection or sample handling. Some serious adverse reactions identified were associated with errors, suggesting that additional safety interventions may be beneficial. Increased participation in the Hemovigilance Module could enhance generalizability and further inform policy development regarding error prevention.
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Affiliation(s)
- Joel L. Chavez Ortiz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Atlanta, Georgia, USA
| | - Isabel Griffin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sophia V. Kazakova
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phylicia B. Stewart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Corporation, Atlanta, Georgia, USA
| | - Ian Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar V. Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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22
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Shea SM, Reisz JA, Mihalko EP, Rahn KC, Rassam RMG, Chitrakar A, Gamboni F, D'Alessandro A, Spinella PC, Thomas KA. Cold-stored platelet hemostatic capacity is maintained for three weeks of storage and associated with taurine metabolism. J Thromb Haemost 2024; 22:1154-1166. [PMID: 38072374 DOI: 10.1016/j.jtha.2023.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND Platelet (PLT) product transfusion is a life-saving therapy for actively bleeding patients. There is an urgent need to maintain PLT function and extend shelf life to improve outcomes in these patients. Cold-stored PLT (CS-PLT) maintain hemostatic potential better than room temperature-stored PLT (RT-PLT). However, whether function in long-term CS-PLT is maintained under physiological flow regimes and/or determined by cold-induced metabolic changes is unknown. OBJECTIVES This study aimed to (i) compare the function of RT-PLT and CS-PLT under physiological flow conditions, (ii) determine whether CS-PLT maintain function after 3 weeks of storage, and (iii) identify metabolic pathways associated with the CS-PLT lesion. METHODS We performed phenotypic and functional assessments of RT- and CS-PLT (22 °C and 4 °C storage, respectively; N = 10 unique donors) at storage days 0, 5, and/or 21 via metabolomics, flow cytometry, aggregation, thrombin generation, viscoelastic testing, and a microfluidic assay to measure primary hemostatic function. RESULTS Day 21 4 °C PLT formed an occlusive thrombus under arterial shear at a similar rate to day 5 22 °C PLT. Day 21 4 °C PLTs had enhanced thrombin generation capacity compared with day 0 PLT and maintained functionality comparable to day RT-PLT across all assays performed. Key metrics from microfluidic assessment, flow cytometry, thrombin generation, and aggregation were associated with 4 °C storage, and metabolites involved in taurine and purine metabolism significantly correlated with these metrics. Taurine supplementation of PLT during storage improved hemostatic function under flow. CONCLUSION CS-PLT stored for 3 weeks maintain hemostatic activity, and storage-induced phenotype and function are associated with taurine and purine metabolism.
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Affiliation(s)
- Susan M Shea
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri, USA; Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. https://twitter.com/SMSheaLab
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily P Mihalko
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katelin C Rahn
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rassam M G Rassam
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Fabia Gamboni
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. https://twitter.com/dalessandrolab
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri, USA; Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. https://twitter.com/PhilSpinellaMD
| | - Kimberly A Thomas
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri, USA; Vitalant Research Institute, Denver, Colorado, USA; Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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23
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Khan MS, Spertus JA, Chan PS. Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med 2024; 390:960-961. [PMID: 38446689 DOI: 10.1056/nejmc2400982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Mirza S Khan
- University of Missouri, Kansas City, Kansas City, MO
| | | | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO
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24
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Pandey S, Goel R, Kapral J, Kieffer T, Kang J, Shaffer H, Hermelin D, Hartwell B. The use of mixed reality technology within the donor collection experience. Transfusion 2024; 64:315-324. [PMID: 38284641 DOI: 10.1111/trf.17712] [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: 08/31/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Mixed reality (MR), a form of virtual reality (VR), provides an immersive and interactive experience for the user. Given VR's benefits in patients undergoing needle insertion procedures, MR's usability, impact on anxiety, and safety were evaluated in the blood donation setting. STUDY DESIGN AND METHODS Whole blood donors ≥18 years old (yo) were enrolled at two blood centers and provided a MR headset with independently developed software to wear during blood donation. Pre- and post-donation questionnaires were conducted, and reaction data were reviewed. A post-study questionnaire was also completed by staff who assisted donors with MR. Descriptive statistics, bivariate analyses, and multinomial logistic regression were performed, and p values determined statistical significance between variables. RESULTS A total of 282 donors completed the study. 84% wanted to try MR because it seemed fun/different/cool/interesting, and most staff (69%) and donors (68%) found MR easy to use. Baseline subjective anxiety, reported by 50.3% (more often in females, first-time donors, and donors <20 yo), was reduced by MR in 68.4% of donors, and there was a 3.6 times higher odds of anxiety reduction with MR. 54% of donors with baseline anxiety would use MR again with the highest future interest in young donors. Donor reactions while using MR were mild and included pre-faint reactions and hematomas. CONCLUSION This study demonstrates the potential of MR in reducing donor anxiety, its feasibility during blood donation, and its safety in blood donors. MR is an innovative technology that holds promise to increase donor engagement, satisfaction, and retention.
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Affiliation(s)
- Suchitra Pandey
- Department of Pathology and Stanford Blood Center, Stanford University, Palo Alto, California, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, Southern Illinois University, Springfield, Illinois, USA
| | | | | | - Jason Kang
- Abbott Laboratories, Abbott Park, Illinois, USA
| | - Hunter Shaffer
- Blood Centers of America, West Warwick, Rhode Island, USA
| | | | - Beth Hartwell
- Gulf Coast Regional Blood Center, Houston, Texas, USA
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25
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Jacobs MR, Zhou B, Tayal A, Maitta RW. Bacterial Contamination of Platelet Products. Microorganisms 2024; 12:258. [PMID: 38399662 PMCID: PMC10891786 DOI: 10.3390/microorganisms12020258] [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: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Transfusion of bacterially contaminated platelets, although rare, is still a major cause of mortality and morbidity despite the introduction of many methods to limit this over the past 20 years. The methods used include improved donor skin disinfection, diversion of the first part of donations, use of apheresis platelet units rather than whole-blood derived pools, primary and secondary testing by culture or rapid test, and use of pathogen reduction. Primary culture has been in use the US since 2004, using culture 24 h after collection of volumes of 4-8 mL from apheresis collections and whole-blood derived pools inoculated into aerobic culture bottles, with limited use of secondary testing by culture or rapid test to extend shelf-life from 5 to 7 days. Primary culture was introduced in the UK in 2011 using a "large-volume, delayed sampling" (LVDS) protocol requiring culture 36-48 h after collection of volumes of 16 mL from split apheresis units and whole-blood derived pools, inoculated into aerobic and anaerobic culture bottles (8 mL each), with a shelf-life of 7 days. Pathogen reduction using amotosalen has been in use in Europe since 2002, and was approved for use in the US in 2014. In the US, recent FDA guidance, effective October 2021, recommended several strategies to limit bacterial contamination of platelet products, including pathogen reduction, variants of the UK LVDS method and several two-step strategies, with shelf-life ranging from 3 to 7 days. The issues associated with bacterial contamination and these strategies are discussed in this review.
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Affiliation(s)
- Michael R. Jacobs
- Department of Pathology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (B.Z.); (A.T.); (R.W.M.)
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26
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Gordy D, Swayne T, Berry GJ, Thomas TA, Hudson KE, Stone EF. Characterization of a Novel Mouse Platelet Transfusion Model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.10.566577. [PMID: 38014145 PMCID: PMC10680660 DOI: 10.1101/2023.11.10.566577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Platelet transfusions are increasing with advances in medical care. Based on FDA criteria, platelet units are assessed by in vitro measures; however, it is not known how platelet processing and storage duration affect function in vivo. To address this, we developed a novel platelet transfusion model that meets FDA criteria adapted to mice, and transfused fresh and stored platelets are detected in clots in vivo. STUDY DESIGN AND METHODS Platelet units stored in mouse plasma were prepared using a modified platelet rich plasma collection protocol. Characteristics of fresh and stored units, including pH, cell count, in vitro measures of activity, including activation and aggregation, and post-transfusion recovery (PTR), were determined. Lastly, a tail transection assay was conducted using mice transfused with fresh or stored units, and transfused platelets were identified by confocal imaging. RESULTS Platelet units had acceptable platelet and white cell counts and were negative for bacterial contamination. Fresh and 1-day stored units had acceptable pH; the platelets were activatable by thrombin and ADP, aggregable with thrombin, had acceptable PTR, and were present in vivo in clots of recipients after tail transection. In contrast, 2-day stored units had clinically unacceptable quality. DISCUSSION We developed mouse platelets for transfusion analogous to human platelet units using a modified platelet rich plasma collection protocol with maximum storage of 1 day for an "old" unit. This provides a powerful tool to test how process modifications and storage conditions affect transfused platelet function in vivo.
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Affiliation(s)
- Dominique Gordy
- Columbia University Irving Medical Center, Department of Pathology & Cell Biology, New York, New York
| | - Theresa Swayne
- Columbia University Irving Medical Center, Department of Pathology & Cell Biology, New York, New York
| | - Gregory J. Berry
- Columbia University Irving Medical Center, Department of Pathology & Cell Biology, New York, New York
| | - Tiffany A. Thomas
- Columbia University Irving Medical Center, Department of Pathology & Cell Biology, New York, New York
| | - Krystalyn E. Hudson
- Columbia University Irving Medical Center, Department of Pathology & Cell Biology, New York, New York
| | - Elizabeth F. Stone
- Columbia University Irving Medical Center, Department of Pathology & Cell Biology, New York, New York
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27
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Kracalik I, Sapiano MRP, Wild RC, Ortiz JC, Stewart P, Berger JJ, Basavaraju SV, Free RJ. Supplemental findings of the 2021 National Blood Collection and Utilization Survey. Transfusion 2023; 63 Suppl 4:S19-S42. [PMID: 37702255 PMCID: PMC10783319 DOI: 10.1111/trf.17509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The Department of Health and Human Services' National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and use. Supplemental data from the 2021 NBCUS not presented elsewhere are presented here. METHODS Data on survey participation, donor characteristics, blood component cost, transfusion-associated adverse reactions, and implementation of blood safety measures, including pathogen-reduction of platelets, during 2021, were analyzed. Comparisons are made to 2019 survey data where available (2013-2019 for survey participation). RESULTS During 2021, there were 11,507,000 successful blood donations in the United States, a 4.8% increase from 2019. Persons aged 45-64 years accounted for 42% of all successful blood donations. Donations by persons aged 65 years and older increased by 40.7%, while donations among minorities and donors aged <25 years decreased. From 2019 to 2021, the median price hospitals paid per unit of leukoreduced red blood cells, leukoreduced and pathogen-reduced apheresis platelets, and fresh frozen plasma increased. The largest increase in price per unit of blood component in 2021 was for leukoreduced apheresis platelets, which increased by ~$51. Between 2019 and 2021, the proportion of transfusing facilities reporting use of pathogen-reduced platelets increased, from 13% to 60%. Transfusion-related adverse reactions declined slightly between 2019 and 2021, although the rate of transfusion-transmitted bacterial infections remained unchanged. CONCLUSION During 2021, blood donations increased nationally, although donations from those aged <25 years and minorities declined. The prices hospitals paid for most blood products increased, as did the use of pathogen-reduced platelets.
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Affiliation(s)
- Ian Kracalik
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| | - Mathew R. P. Sapiano
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- Lantana Consulting Group, East Thetford, Vermont, USA
| | - Robert C. Wild
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- CACI International, Reston, Virginia, USA
| | - Joel Chavez Ortiz
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- Oakridge Institute for Science and Education, Atlanta,
Georgia, USA
| | - Phylicia Stewart
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- Chenega Corporation, Atlanta, Georgia, USA
| | - James J. Berger
- Office of Infectious Disease and HIV/AIDS Policy, Office of
the Assistant Secretary for Health, Department of Health and Human Services,
Washington, District of Columbia, USA
| | - Sridhar V. Basavaraju
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| | - Rebecca J. Free
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
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28
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Kracalik I, Kent AG, Villa CH, Gable P, Annambhotla P, McAllister G, Yokoe D, Langelier CR, Oakeson K, Noble-Wang J, Illoh O, Halpin AL, Eder AF, Basavaraju SV. Posttransfusion Sepsis Attributable to Bacterial Contamination in Platelet Collection Set Manufacturing Facility, United States. Emerg Infect Dis 2023; 29:1979-1989. [PMID: 37561399 PMCID: PMC10521617 DOI: 10.3201/eid2910.230869] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
During May 2018‒December 2022, we reviewed transfusion-transmitted sepsis cases in the United States attributable to polymicrobial contaminated apheresis platelet components, including Acinetobacter calcoaceticus‒baumannii complex or Staphylococcus saprophyticus isolated from patients and components. Transfused platelet components underwent bacterial risk control strategies (primary culture, pathogen reduction or primary culture, and secondary rapid test) before transfusion. Environmental samples were collected from a platelet collection set manufacturing facility. Seven sepsis cases from 6 platelet donations from 6 different donors were identified in patients from 6 states; 3 patients died. Cultures identified Acinetobacter calcoaceticus‒baumannii complex in 6 patients and 6 transfused platelets, S. saprophyticus in 4 patients and 4 transfused platelets. Whole-genome sequencing showed environmental isolates from the manufacturer were closely related genetically to patient and platelet isolates, indicating the manufacturer was the most probable source of recurrent polymicrobial contamination. Clinicians should maintain awareness of possible transfusion-transmitted sepsis even when using bacterial risk control strategies.
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29
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Hughes SD, France CL, West-Mitchell KA, Pina T, McElfresh D, Sayers M, Bryant BJ. Advancing Understandings of Blood Donation Motivation and Behavior. Transfus Med Rev 2023; 37:150780. [PMID: 37996288 DOI: 10.1016/j.tmrv.2023.150780] [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: 08/22/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
In this review, we provide critical analysis of social science research into blood donation motivation and behavior. We first share an understanding of the existing literature and recommendations for future research collectively developed by members of the Working Group on Blood Donors and the Supply: Diversifying while Maintaining the Donor Pool, Donor Selection, and Optimizing Blood Availability and Safety, as part of the National Heart, Lung, and Blood Institute's 2022 State of the Science in Transfusion Medicine symposium. Then, rather than aim for a comprehensive treatment, we review 4 newer manuscripts that exemplify aspects of the group's recommendations and report results from countries where the blood supply is based on voluntary, nonremunerated donations. From the substantial existing literature, we selected: (1) a study that employed motivational interviewing techniques, thematic analysis, and surveys to link donation motivations and barriers reported by diverse young donors in the United States to actual donation behavior over a year of subsequent eligibility; (2) a survey regarding donation motivations and barriers and monetary amounts associated with willingness to participate in whole blood, plasma, or platelet collection; (3) a survey-based assessment of various emotional states reported by donors at 2 time points during donation and the relationship between emotional experience and subsequent vasovagal reactions; and (4) an interpretive discourse analysis of blood collection agency messaging to donors and the public in the beginning of the COVID-19 pandemic. We close by noting several challenges posed by the structure of the United States blood system and the current funding environment to conducting rigorous research and translating findings into practice.
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Affiliation(s)
- Shana D Hughes
- Vitalant Research Institute, University of California San Francisco, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.
| | | | - Kamille A West-Mitchell
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Theresa Pina
- Gulf Coast Regional Blood Center, Houston, TX, USA
| | - Duncan McElfresh
- Department of Medicine, Stanford University, Stanford, CA, USA; US Department of Veterans Affairs, Program Evaluation Resource Center, Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA
| | - Merlyn Sayers
- University of Texas Southwestern Medical Center, Dallas, TX, USA; Carter BloodCare, Bedford, TX, USA
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