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Qadri SM, Liu Y, Barty RL, Heddle NM, Sheffield WP. A positive blood culture is associated with a lower haemoglobin increment in hospitalized patients after red blood cell transfusion. Vox Sang 2023; 118:33-40. [PMID: 36125492 DOI: 10.1111/vox.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Abundant clinical evidence supports the safety of red blood cell (RBC) concentrates for transfusion irrespective of storage age, but still, less is known about how recipient characteristics may affect post-transfusion RBC recovery and function. Septic patients are frequently transfused. We hypothesized that the recipient environment in patients with septicaemia would blunt the increase in post-transfusion blood haemoglobin (Hb). The main objective was to compare the post-transfusion Hb increment in hospitalized patients with or without a positive blood culture. MATERIALS AND METHODS A retrospective cohort study using data from the Transfusion Research, Utilization, Surveillance, and Tracking database (TRUST) was performed. All adult non-trauma in-patients transfused between 2010 and 2017 with ≥1 RBC unit, and for whom both pre- and post-transfusion complete blood count and pre-transfusion blood culture data were available were included. A general linear model with binary blood culture positivity was fit for continuous Hb increment after transfusion and was adjusted for patient demographic parameters and transfusion-related covariates. RESULTS Among 210,263 admitted patients, 6252 were transfused: 596 had positive cultures, and 5656 had negative blood cultures. A modelled Hb deficit of 1.50 g/L in blood culture-positive patients was found. All covariates had a significant effect on Hb increment, except for the age of the transfused RBC. CONCLUSION Recipient blood culture positivity was associated with a statistically significant but modestly lower post-transfusion Hb increment in hospitalized patients. In isolation, the effect is unlikely to be clinically significant, but it could become so in combination with other recipient characteristics.
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Affiliation(s)
- Syed M Qadri
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Yang Liu
- Department of Medicine and McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca L Barty
- Department of Medicine and McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Southwest Region, Ontario Regional Blood Coordinating Network, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Department of Medicine and McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - William P Sheffield
- Canadian Blood Services, Medical Affairs and Innovation, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Kang X, Jiang H, Peng X, Tang B, Wei S. The impact of blood Transfusion on T Helper Cells and Cytokines in Transfusion-Refractory Patients: a Prospective Study. Indian J Hematol Blood Transfus 2023; 39:132-140. [PMID: 36699442 PMCID: PMC9868220 DOI: 10.1007/s12288-022-01559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/08/2022] [Indexed: 01/28/2023] Open
Abstract
Red blood cell (RBC) transfusion can increase patients' hemoglobin levels and improve hypoxia. The factors affecting the transfusion efficacy include immune and nonimmune factors. The objective of this study was to explore the impact of blood transfusion on T helper (Th) cell ratios and levels of serum cytokines in RBC transfusion-refractory patients. In this prospective study, anemic patients receiving RBC transfusion were enrolled. Peripheral venous blood samples were extracted from patients before RBC transfusion and within 24 h after transfusion. Th cell ratios and levels of serum cytokines were detected by flow cytometry. Differences in Th cell ratios and levels of serum cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ) between pretransfusion and posttransfusion were compared. A total of 47 patients agreed to participate in this study. They were grouped according to incremental Hb levels, 20 (42.55%) patients were divided into the RBC transfusion refractory group, while 27 (57.45%) patients were in the validity group. The expected Hb increment was defined by a panel of Chinese experts. In RBC transfusion-refractory patients, Th1 and Th2 cell ratios increased while levels of serum IL-2 and IL-10 decreased after transfusion. In RBC transfusion validity patients, there were no significant changes in Th cell ratios or levels of serum cytokines between pretransfusion and posttransfusion. We found that Th1 and Th2 cell ratios increased while serum IL-2 and IL-10 levels decreased after transfusion in RBC-refractory patients.
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Affiliation(s)
- Xiaozhen Kang
- Department of Blood Transfusion, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352100 China
| | - Huangzhou Jiang
- Department of Blood Transfusion, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352100 China
| | - Xianxiang Peng
- Department of Blood Transfusion, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352100 China
| | - Baojia Tang
- Department of Blood Transfusion, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352100 China
| | - Shouzhong Wei
- Department of Blood Transfusion, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352100 China
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Carter PW, Dunham AJ. Modelling haemoglobin incremental loss on chronic red blood cell transfusions. Vox Sang 2022; 117:831-838. [PMID: 35238052 DOI: 10.1111/vox.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding the impact of red blood cell (RBC) lifespan, initial RBC removal, and transfusion intervals on patient haemoglobin (Hb) levels and total iron exposure is not accessible for chronic transfusion scenarios. This article introduces the first model to help clinicians optimize chronic transfusion intervals to minimize transfusion frequency. MATERIALS AND METHODS Hb levels and iron exposure from multiple transfusions were calculated from Weibull residual lifespan distributions, the fraction effete RBC removed within 24-h (Xe ) and the nominal Hb increment. Two-unit transfusions of RBCs initiated at patient [Hb] = 7 g/dl were modelled for different RBC lifespans and transfusion intervals from 18 to 90 days, and Xe from 0.1 to 0.5. RESULTS Increased Xe requires shorter transfusion intervals to achieve steady-state [Hb] of 9 g/dl as follows: 30 days between transfusions at Xe = 0.5, 36 days at Xe = 0.4, 42 days at Xe = 0.3, 48 days at Xe = 0.2 and 54 days at Xe = 0.1. The same transfusion interval/Xe pairs result in a steady-state [Hb] = 8 g/dl when the RBC lifespan was halved. By reducing transfused RBC increment loss from 30% to 10%, annual transfusions were decreased by 22% with iron addition decreased by 24%. Acute dosing of iron occurs at the higher values of Xe on the day after a transfusion event. CONCLUSION Systematic trends in fractional Hb incremental loss Xe have been modelled and have a significant and calculatable impact on transfusion intervals and associated introduction of iron.
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Gamberini MR, Fortini M, Stievano A, Calori E, Riontino MV, Ceccherelli G, Venturelli D, Chicchi R, Biguzzi R, Fagnoni F, Portararo GA, Lasagni D, Borotti E, Buonocore R, Govoni M, Reverberi R. Impact of the preparation method of red cell concentrates on transfusion indices in thalassemia patients: A randomized crossover clinical trial. Transfusion 2021; 61:1729-1739. [PMID: 33948969 PMCID: PMC8252500 DOI: 10.1111/trf.16432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The average hemoglobin content of red cell concentrates (RCC) varies depending on the method of preparation. Surprisingly less data are available concerning the clinical impact of those differences. STUDY DESIGN AND METHODS The effects of two types of RCC (RCC-A, RCC-B) on transfusion regime were compared in a non-blinded, prospective, randomized, two-period, and crossover clinical trial. RCC-A was obtained by whole blood leukoreduction and subsequent plasma removal, RCC-B removing plasma and buffy coat first, followed by leukoreduction. Eligible patients were adult, with transfusion-dependent thalassemia (TDT). RESULTS RCC-A contained 63.9 (60.3-67.8) grams of hemoglobin per unit (median with 1st and 3rd quartile), RCC-B 54.5 (51.0-58.2) g/unit. Fifty-one patients completed the study. With RCC-B, the average pre-transfusion hemoglobin concentration was 9.3 ± 0.5 g/dl (mean ± SD), the average transfusion interval 14.2 (13.7-16.3) days, the number of RCC units transfused per year 39.3 (35.4-47.3), and the transfusion power index (a composite index) 258 ± 49. With RCC-A, the average pre-transfusion hemoglobin concentration was 9.6 ± 0.5 g/dl (+2.7%, effect size 0.792), the average transfusion interval 14.8 (14.0-18.5) days (+4.1%, effect size 0.800), the number of RCC units transfused per year 34.8 (32.1-42.5) (-11.4%, effect size -1.609), and the transfusion power index 272 ± 61 (+14.1%, effect size 0.997). All differences were statistically highly significant (p < .00001). The frequency of transfusion reactions was 0.59% with RCC-A and 0.56% with RCC-B (p = 1.000). CONCLUSION To reduce the number of RCC units consumed per year and the number of transfusion episodes, TDT patients should receive RCC with the highest average hemoglobin content.
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Affiliation(s)
- Maria Rita Gamberini
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliera Universitaria, Ferrara, Italy
| | - Monica Fortini
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliera Universitaria, Ferrara, Italy
| | - Alice Stievano
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliera Universitaria, Ferrara, Italy
| | - Eleonora Calori
- Blood Transfusion Service, Area Metropolitana, Bologna, Italy
| | | | | | | | - Roberta Chicchi
- Blood Transfusion Service, Azienda USL della Romagna, Cesena, Italy
| | - Rino Biguzzi
- Blood Transfusion Service, Azienda USL della Romagna, Cesena, Italy
| | - Francesco Fagnoni
- Blood Transfusion Service, Azienda Ospedaliera Universitaria, Parma, Italy
| | | | - Daniela Lasagni
- Blood Transfusion Service, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Elena Borotti
- Blood Transfusion Service, Azienda USL, Piacenza, Italy
| | | | - Maurizio Govoni
- Blood Transfusion Service, Azienda Ospedaliera Universitaria, Ferrara, Italy
| | - Roberto Reverberi
- Blood Transfusion Service, Azienda Ospedaliera Universitaria, Ferrara, Italy
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Roubinian NH, Plimier C, Woo JP, Lee C, Bruhn R, Liu VX, Escobar GJ, Kleinman SH, Triulzi DJ, Murphy EL, Busch MP. Effect of donor, component, and recipient characteristics on hemoglobin increments following red blood cell transfusion. Blood 2019; 134:1003-13. [PMID: 31350268 DOI: 10.1182/blood.2019000773] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/17/2019] [Indexed: 01/28/2023] Open
Abstract
Significant research has focused individually on blood donors, product preparation and storage, and optimal transfusion practice. To better understand the interplay between these factors on measures of red blood cell (RBC) transfusion efficacy, we conducted a linked analysis of blood donor and component data with patients who received single-unit RBC transfusions between 2008 and 2016. Hemoglobin levels before and after RBC transfusions and at 24- and 48-hour intervals after transfusion were analyzed. Generalized estimating equation linear regression models were fit to examine hemoglobin increments after RBC transfusion adjusting for donor and recipient demographic characteristics, collection method, additive solution, gamma irradiation, and storage duration. We linked data on 23 194 transfusion recipients who received one or more single-unit RBC transfusions (n = 38 019 units) to donor demographic and component characteristics. Donor and recipient sex, Rh-D status, collection method, gamma irradiation, recipient age and body mass index, and pretransfusion hemoglobin levels were significant predictors of hemoglobin increments in univariate and multivariable analyses (P < .01). For hemoglobin increments 24 hours after transfusion, the coefficient of determination for the generalized estimating equation models was 0.25, with an estimated correlation between actual and predicted values of 0.5. Collectively, blood donor demographic characteristics, collection and processing methods, and recipient characteristics accounted for significant variation in hemoglobin increments related to RBC transfusion. Multivariable modeling allows the prediction of changes in hemoglobin using donor-, component-, and patient-level characteristics. Accounting for these factors will be critical for future analyses of donor and component factors, including genetic polymorphisms, on posttransfusion increments and other patient outcomes.
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Karafin MS, Bruhn R, Roubinian NH, Chowdhury D, Qu L, Snyder EL, Murphy EL, Brambilla D, Cable RG, Hilton JF, St Lezin E. The impact of recipient factors on the lower-than-expected hemoglobin increment in transfused outpatients with hematologic diseases. Transfusion 2019; 59:2544-2550. [PMID: 31270827 DOI: 10.1111/trf.15439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with cancer or chronic hematologic disorders frequently receive red blood cell (RBC) transfusions. Based on long-standing assumptions, each RBC unit is thought to increase recipient hemoglobin by 1 g/dL, but smaller increments can occur. A better understanding of recipient factors affecting hemoglobin increments could help providers manage these patients. METHODS Data were collected as a part of the observational Red Cells in Outpatients Transfusion Outcomes (RETRO) study of outpatients with hematologic or cancer-related diagnoses. Hemoglobin was measured before transfusion and 30 minutes after transfusion. A classification and regression tree (CART) analysis was performed to identify statistically significant associations with clinical variables. A corresponding prediction equation was developed and validated using linear regression. RESULTS A total of 195 participants had both pre- and posttransfusion hemoglobin values for analysis. The median age was 66 years, and patients received one (73%) or two (27%) RBC units during the transfusion episode. The overall median change in hemoglobin was 0.6 g/dL per RBC unit. Both CART analysis and linear regression identified the following significant predictors of hemoglobin increment: number of units received (positive correlation), patient estimated circulating blood volume (negative correlation), pretransfusion hemoglobin (negative correlation), and patient age (negative correlation). CONCLUSION In this study of outpatients with hematologic disease, most patients had a hemoglobin increment of less than 1 g/dL/unit. Recipient-specific factors influenced the hemoglobin increment at 30 minutes, and providers should consider circulating blood volume, pretransfusion hemoglobin, and recipient age, when developing patient-specific RBC transfusion plans for this unique cohort.
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Affiliation(s)
- Matthew S Karafin
- Versiti, Medical Sciences Institute, Milwaukee, Wisconsin.,Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, California
| | - Nareg H Roubinian
- Vitalant Research Institute, San Francisco, California.,Division of Research Northern California, Kaiser Permanente, San Francisco, California
| | - Dhuly Chowdhury
- Department of Pathology, Division of Transfusion Medicine, RTI International, Rockville, Maryland
| | - Lirong Qu
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward L Snyder
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut
| | - Edward L Murphy
- Vitalant Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | - Don Brambilla
- Department of Pathology, Division of Transfusion Medicine, RTI International, Rockville, Maryland
| | | | - Joan F Hilton
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Elizabeth St Lezin
- Department of Laboratory Medicine, University of California, San Francisco, California.,Laboratory Medicine, SF Veterans Affairs HCS, San Francisco, California
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