1
|
Crowe EP, Goel R, Al-Mozain N, Josephson CD. Neonatal Blood Banking Practices. Clin Perinatol 2023; 50:821-837. [PMID: 37866850 DOI: 10.1016/j.clp.2023.07.008] [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] [Indexed: 10/24/2023]
Abstract
There is little formal guidance to direct neonatal blood banking practices and, as a result, practices vary widely across institutions. In this vulnerable patient population with a high transfusion burden, considerations for blood product selection include freshness, extended-storage media, pathogen inactivation, and other modifications. The authors discuss the potential unintended adverse impacts in the neonatal recipient. Concerns such as immunodeficiency, donor exposures, cytomegalovirus transmission, volume overload, transfusion-associated hyperkalemia, and passive hemolysis from ABO incompatibility have driven modifications of blood components to improve safety.
Collapse
Affiliation(s)
- Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Room 3081-A, Baltimore, MD 21287, USA
| | - Ruchika Goel
- Corporate Medical Affairs, Vitalant National Office, Scottsdale, AZ, USA; Division of Hematology/Oncology, Department of Internal Medicine and Pediatrics, Simmons Cancer Institute at SIU School of Medicine, 704 Lismore Lane, Springfield, IL 62704, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nour Al-Mozain
- Hematopathology & Transfusion Medicine, Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, 7652, Riyadh, Riyadh, 12713, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cassandra D Josephson
- Department of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cancer and Blood Disorders Institute, Blood Bank and Transfusion Medicine, Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
| |
Collapse
|
2
|
Arora S, Dua S, Goel R. Neonatal and pediatric transfusion practices and policies in India: A survey-based cross-sectional assessment of blood centers. Transfusion 2022; 62:1000-1009. [PMID: 35357016 DOI: 10.1111/trf.16857] [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: 12/18/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood centers play a critical role in supporting neonatal and pediatric transfusions. We aim to study the variation in pediatric/neonatal transfusion policies and practices for blood centers in India. STUDY DESIGN AND METHODS This is a survey-based (45 question) cross-sectional assessment of blood centers in India supporting pediatric/neonatal transfusions. RESULTS One hundred three centers responded to the survey (response rate 51.2%; 103/201). As a part of pretransfusion testing, use of "microtainers" was reported by 58.4% (59/101) centers and only 57.4% (58/101) centers provide antibody screening. In case of absence of maternal sample, type O negative blood is most commonly used (48.5%; 49/101), and in case of ABO incompatibility, 68.3% (69/101) use units compatible with both mother and newborn. Leukoreduced RBCs are provided by 89% (90/101) centers and irradiated products are provided by 48.5% (49/101). 82% (83/101) of centers reported not receiving requests for CMV negative units considering the high incidence of CMV-seropositivity in donors. Fresh units are defined as <7 days old by 44.5% (45/101) and <5 days old by 31.6% (32/101) centers. 97% centers reported SAGM suspended RBCs in inventory but only 67.3% (68/101) use them for top-up transfusions to neonates. Overall >80% centers use the buffy-coat method for platelet concentrates preparation. Volume-based (ml/kg) aliquots preparation is done by 88% (89/101), mainly using the sterile connecting device (84.6%; 83/98). CONCLUSION This survey shows heterogeneity and lack of standardization in practices across blood centers in India and highlights the need for more studies to establish best practices for this vulnerable age group.
Collapse
Affiliation(s)
- Satyam Arora
- Department of Transfusion Medicine, Post Graduate Institute of Child Health (PGICH), Noida, Uttar Pradesh, India
| | - Seema Dua
- Department of Transfusion Medicine, Post Graduate Institute of Child Health (PGICH), Noida, Uttar Pradesh, India
| | - Ruchika Goel
- Department of Internal Medicine, Division of Hematology/Oncology, Simmons Cancer, Institute at SIU School of Medicine, Springfield, Illinois, USA.,Department of Pathology, Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Abou-Jaoudé M, El Hage S, Akiki D, Fadlallah M, Ghaith AK, Dib A. Cytomegalovirus infection in kidney transplant patients: Prevalence, risk factors, and impact on outcome - A local multicentre experience. Transpl Immunol 2021; 69:101473. [PMID: 34547416 DOI: 10.1016/j.trim.2021.101473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND CMV infection prevalence in kidney transplant recipients (KTR) is reported to be high in the literature, reaching rates of over 80%. OBJECTIVES The primary endpoints were the evaluation of the prevalence, the risks factors, and the effects of CMV infection on graft function and survival, as well as patient survival at three years after kidney transplantation. MATERIAL AND METHODS We retrospectively reviewed the medical records of 288 kidney transplant patients operated in three Lebanese transplant centers between 1998 and 2017 with three years of follow-up. The patients were divided into two groups: those free of any CMV infection (271 patients (94%); Group I) and those who suffered from CMV infection (17 patients (6%); Group II). RESULTS Baseline demographics of the two groups were similar, including recipient and donor gender and age, cause of renal disease, recipient body mass index, pre-transplant fasting blood sugar and dialysis duration, HLA matching between donor and recipient, degree of sensitization in the recipient, type of CMV prophylaxis, maintenance immunosuppression and immunological characteristics. The prevalence of CMV infection is 5.9% among KTR. There were significant differences between the two groups concerning the type of induction therapy and the duration of anti-CMV prophylaxis. The rate of infected patients and infectious episodes were significantly higher in Group II. At 3-years, graft function and survival, patient survival, and the rate of new-onset diabetes were similar between the two groups. CONCLUSION The present study is the first to explore the incidence and risk factors of CMV in kidney transplant patients in Lebanon. Comprehensive nationwide studies are therefore necessary to determine the epidemiology and risk factors of CMV infection after kidney transplantation in Lebanon.
Collapse
Affiliation(s)
- Maroun Abou-Jaoudé
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon; Department of Surgery, Sacre Coeur Hospital, Hazmieh, Lebanon; Department of Surgery, Middle East Institute of Health, Bsalim, Lebanon.
| | - Said El Hage
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Sector of Public Health and Epidemiology, Department of Public Health, Beirut, Lebanon
| | - Dany Akiki
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Mahdi Fadlallah
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | | | - Abbas Dib
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| |
Collapse
|
4
|
Long X, Qiu Y, Zhang Z, Wu M. Insight for Immunotherapy of HCMV Infection. Int J Biol Sci 2021; 17:2899-2911. [PMID: 34345215 PMCID: PMC8326118 DOI: 10.7150/ijbs.58127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Human cytomegalovirus (HCMV), a ubiquitous in humans, has a high prevalence rate. Young people are susceptible to HCMV infection in developing countries, while older individuals are more susceptible in developed countries. Most patients have no obvious symptoms from the primary infection. Studies have indicated that the virus has gradually adapted to the host immune system. Therefore, the control of HCMV infection requires strong immune modulation. With the recent advances in immunotherapy, its application to HCMV infections is receiving increasing attention. Here, we discuss the immune response to HCMV infection, the immune escape mechanism, and the different roles that HCMV plays in various types of immunotherapy, including vaccines, adoptive cell therapy, checkpoint blockade therapy, and targeted antibodies.
Collapse
Affiliation(s)
- Xinmiao Long
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410008 , Hunan, China
- Department of Pathogeny Biology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China
| | - Yi Qiu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410008 , Hunan, China
- Department of Pathogeny Biology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China
| | - Zuping Zhang
- Department of Pathogeny Biology, School of Basic Medical Science, Central South University, Changsha, 410078, Hunan, China
| | - Minghua Wu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, Central South University, Changsha, 410008 , Hunan, China
| |
Collapse
|
5
|
Reeves HM, Goodhue Meyer E, Harm SK, Lieberman L, Pyles R, Rajbhandary S, Whitaker BI, Delaney M. Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey. Transfusion 2021; 61:2265-2276. [PMID: 34110629 DOI: 10.1111/trf.16520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/05/2021] [Accepted: 04/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are limited standards guiding the selection and processing of blood components specific for neonatal and pediatric transfusions. Therefore, blood banks (BBs) and transfusion services must create their own policies and procedures. STUDY DESIGN AND METHODS The American Association of Blood Banks (AABB) Pediatric Transfusion Medicine Subsection Committee developed a 74-question survey to capture neonatal and pediatric BB practices in the United States. RESULTS Thirty-five centers completed the survey: a response rate 15.8%. Responses indicated that most carry a mixed inventory of red blood cells (RBCs); 94.2% allow more than one type of RBC product for small-volume (SV) and large-volume (LV) transfusions to neonatal and pediatric patients. Many had storage age thresholds for RBCs transfused to neonates (SV = 60%, LV = 67.7%) but not older pediatric patients. The use of Group O for nonurgent RBC transfusion in neonates was common (74.2%). Responses related to special processing of RBCs and platelets indicated that 100% RBC and platelets are leukocyte-reduced (LR) for neonates and 97% for non-neonates. Irradiation of RBCs and platelets was commonly performed for neonatal transfusion (88.6%). Providing cytomegalovirus (CMV) seronegative products, volume reduction, and washing were variable. All centers transfused single-donor apheresis platelets; 20% allowed pathogen reduction (PR). The majority of centers have strategies limiting the amount of incompatible plasma transfused; however, few titrate ABO isoagglutinins in plasma-containing products (20% for platelets and 9.1% for plasma). CONCLUSIONS Variability exists in BB practice for neonatal and pediatric transfusion. Future studies are needed to understand and define best BB practices in these patient populations.
Collapse
Affiliation(s)
- Hollie M Reeves
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Erin Goodhue Meyer
- American Red Cross Biomedical Services, Columbus, Ohio, USA.,Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah K Harm
- University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Ryan Pyles
- SSM Health Cardinal Glennon Children's Hospital, Fenton, Missouri, USA
| | | | - Barbee I Whitaker
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine Division, Children's National Medical Center, Washington, DC, USA.,Pathology and Pediatrics Departments, The George Washington University, Washington, DC, USA
| |
Collapse
|
6
|
Buren N. Laboratory Testing of Donated Blood. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Reece JT, Sesok-Pizzini D. Inventory Management and Product Selection in Pediatric Blood Banking. Clin Lab Med 2020; 41:69-81. [PMID: 33494886 DOI: 10.1016/j.cll.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood banks need to understand patterns of use and ordering practices to provide the blood donor centers with the best information with which to develop daily scheduled deliveries of blood products. Blood use is a large component of this process through maximizing physician education about appropriate ordering practices and use of appropriate tools. Simple measures can help provide guidance on the number of available components and the need to order more from the blood donor center. Special product requests in pediatrics, such as fresh blood, leukoreduction, irradiation, and antigen-negative units can also drive inventory practices and use patterns.
Collapse
Affiliation(s)
- Jenna T Reece
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Deborah Sesok-Pizzini
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, 5136 Main Hospital, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
| |
Collapse
|
8
|
Mabilangan C, Burton C, Nahirniak S, O'Brien S, Preiksaitis J. Transfusion-transmitted and community-acquired cytomegalovirus infection in seronegative solid organ transplant recipients receiving seronegative donor organs. Am J Transplant 2020; 20:3509-3519. [PMID: 32428296 DOI: 10.1111/ajt.16066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/19/2020] [Accepted: 05/03/2020] [Indexed: 01/25/2023]
Abstract
Solid organ transplant (SOT) recipients who are cytomegalovirus (CMV) seronegative (R-) and receive seronegative donor (D-) organs have a small but currently unquantified risk of both transfusion-transmitted CMV (TT-CMV) and community-acquired CMV (CA-CMV). We retrospectively studied the incidence and clinical symptoms of TT-CMV (infection <1 year posttransplant) and CA-CMV (infection >1 year posttransplant) in a cohort of D-/R- adult and pediatric SOT recipients receiving leukoreduced blood products not screened for CMV seronegativity transplanted at our center between 2000 and 2011. CMV infection was defined as IgG seroconversion or detectable CMV antigenemia/DNAemia. Among 536 consecutive D-/R- recipients, 398 (81.8%) had adequate follow-up, and 231 (58%) received cellular blood products (total: 1626 red blood cell units, 470 platelet units) 30 days pretransplant to 90 days posttransplant. We observed no confirmed TT-CMV cases, but 14 CA-CMV cases (64% symptomatic) were seen. The estimated incidence rate of CA-CMV was higher in children (3.0/100 patient years) than adults (0.46/100 patient years, incident rate ratio of 6.52). The absence of TT-CMV over 11 years suggests neither seronegative blood products nor CMV DNA blood donor screening would provide significant incremental safety when blood is already leukoreduced. D-/R- SOT recipients, particularly children, have a significantly higher and ongoing risk of CA-CMV.
Collapse
Affiliation(s)
- Curtis Mabilangan
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Burton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Nahirniak
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jutta Preiksaitis
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
9
|
Lim MY, Pagano MB, Metcalf RA. Things We Do for No Reason™: Routinely Prescribing Transfusion Premedication to Prevent Acute Transfusion Reactions. J Hosp Med 2020; 15:684-686. [PMID: 32118560 DOI: 10.12788/jhm.3372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/07/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Ming Y Lim
- Division of Hematology and Hematologic Malignancies, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Monica B Pagano
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, Utah
| |
Collapse
|
10
|
McCormick M, Delaney M. Transfusion support: Considerations in pediatric populations. Semin Hematol 2020; 57:65-72. [PMID: 32892845 DOI: 10.1053/j.seminhematol.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 01/19/2023]
Abstract
Over 400,000 units of blood and blood products are transfused to pediatric patients annually, yet only sparse high-quality data exist to guide the preparation and administration of blood products in this population. The direct application of data from studies in adult patients should be undertaken with caution, as there are dissimilarities in the pathology and physiology between adult and pediatric patients. We provide an overview of available evidence in the field of pediatric transfusion medicine, summarizing indications for blood product transfusion, thresholds for transfusion and indications for blood product modifications.
Collapse
Affiliation(s)
- Meghan McCormick
- Division of Hematology-Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Meghan Delaney
- Division of Pathology & Laboratory Medicine, Children's National Medical Center, Washington, DC, USA; Departments of Pathology & Pediatrics, The George Washington University Health Sciences, Washington, DC, USA.
| |
Collapse
|
11
|
Adkins BD, Booth GS, Vasu S. Transfusion support for stem cell transplant recipients. Semin Hematol 2020; 57:51-56. [PMID: 32892843 DOI: 10.1053/j.seminhematol.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell patients regularly require transfusion support. Indications for transfusion in this population are similar to other patients being treated with chemoradiation; however, special considerations must be made in regards to pretransfusion testing, ABO compatibility, product modifications, and anticipated challenges while patients undergo engraftment. Additionally, infusion of hematopoietic stem cells requires acute understanding of product collection, modification, and potential side effects. As these patients often require numerous platelet transfusions, platelet refractoriness may be encountered and practice options are discussed. We review current indications and guidelines for transfusion in hematopoietic stem cell patients and make recommendations for best practice based on current literature.
Collapse
Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| |
Collapse
|
12
|
Godbey EA, Thibodeaux SR. Ensuring safety of the blood supply in the United States: Donor screening, testing, emerging pathogens, and pathogen inactivation. Semin Hematol 2019; 56:229-235. [PMID: 31836028 DOI: 10.1053/j.seminhematol.2019.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Safety of the blood supply has been a critical aspect of the transfusion medicine field since its inception, including infections that can be passed to a blood product recipient. Reactive efforts to identify potentially infected blood products are used throughout the blood donation process and afterward. Before donation, potential donors are provided educational materials about infection risks, examined and then screened through a series of questions that help temporarily, permanently, or indefinitely defer donors who could harbor acute and/or chronic infections. During donation, aseptic technique and diversion pouches reduce the potential to introduce bacteria into the blood product. Before transfusion, the blood products are tested for several infectious diseases by serology, nucleic acid testing, or a combination. During transfusion, the patient is monitored closely, and suspected transfusion reactions should be reported and investigated. The FDA regularly publishes guidance documents to incorporate knowledge gained regarding transfusion-transmitted infections, so that information can be shared and practices updated so that transfusion-related patient care can be optimized over time. Pathogen reduction processes are being developed and deployed that provide a proactive approach to both recognized and emerging pathogens.
Collapse
Affiliation(s)
| | - Suzanne R Thibodeaux
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|