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Fu MX, Ingram J, Roberts C, Nurmi V, Watkins E, Dempsey N, Golubchik T, Breuer J, Brailsford S, Irving WL, Andersson M, Simmonds P, Harvala H. Blood donation screening for hepatitis B virus core antibodies: The importance of confirmatory testing and initial implication for rare blood donor groups. Vox Sang 2024; 119:447-459. [PMID: 38419267 DOI: 10.1111/vox.13608] [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: 01/02/2024] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Exclusion of blood donors with hepatitis B virus (HBV) core antibodies (anti-HBc) prevents transfusion-transmitted HBV infection but can lead to significant donor loss. As isolated anti-HBc positivity does not always indicate true past HBV infection, we have investigated the effectiveness of confirmatory anti-HBc testing and the representation of rare blood groups in anti-HBc-positive donors. MATERIALS AND METHODS Three hundred ninety-seven HBV surface antigen-negative and anti-HBc initially reactive blood donor samples were tested by five different anti-HBc assays. RESULTS Eighty percentage of samples reactive in Architect anti-HBc assay were positive by the Murex assay and anti-HBc neutralization. Eleven out of 397 samples showed discordant results in supplementary testing from the Murex confirmatory test result, and five remained undetermined following extensive serological testing. Thirty-eight percentage of anti-HBc-positive donors identified as minority ethnic groups compared with 11% representation in anti-HBc-negative donors (p < 0.0001); the frequency of the Ro blood group in anti-HBc-positive donors was 18 times higher in non-white ethnic groups. CONCLUSION Using two anti-HBc assays effectively enabled the identification of HBV-exposed and potentially infectious donors, their deferral and potential clinical follow-up. However, the exclusion of confirmed anti-HBc-positive donors will still impact the supply of rare blood such as Ro.
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Affiliation(s)
- Michael X Fu
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jennifer Ingram
- Donor Testing Department, NHS Blood and Transplant, Manchester, UK
| | | | - Visa Nurmi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Emma Watkins
- Clinical Services, NHS Blood and Transplant, Birmingham, UK
| | - Nina Dempsey
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Tanya Golubchik
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Sydney Infectious Diseases Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Su Brailsford
- Microbiology Services, NHS Blood and Transplant, Colindale, UK
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Monique Andersson
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Heli Harvala
- Division of Infection and Immunity, University College London, London, UK
- Microbiology Services, NHS Blood and Transplant, Colindale, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Susila S, Ilmakunnas M, Lauronen J, Vuorinen P, Ångerman S, Sainio S. Low titer group O whole blood and risk of RhD alloimmunization: Rationale for use in Finland. Transfusion 2024; 64 Suppl 2:S119-S125. [PMID: 38240146 DOI: 10.1111/trf.17700] [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: 12/04/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Prehospital low-titer group O whole blood (LTOWB) used for patients with life-threatening hemorrhage is often RhD positive. The most important complication following RhD alloimmunization is hemolytic disease of the fetus and newborn (HDFN). Preceding clinical use of RhD positive LTOWB, we estimated the risk of HDFN due to LTOWB prehospital transfusion in the Finnish population. STUDY DESIGN AND METHODS We collected data on prehospital transfusions in Tampere and Helsinki University Hospital areas. Using the mean of reported alloimmunization rates in trauma studies (24%) and a higher reported rate representing trauma patients of 13-50 years old (42.7%), we estimated the risk of HDFN and extrapolated it to the whole of Finland. RESULTS We estimated that in Finland, with the current prehospital transfusion rate we would see 1-3 cases of severe HDFN due to prehospital LTOWB transfusions every 10 years, and fetal death due to HDFN caused by LTOWB transfusion less than once in 100 years. DISCUSSION The estimated risk of serious HDFN due to prehospital LTOWB transfusion in the Finnish population is similar to previous estimates. As Finland routinely screens expectant mothers for red blood cell antibodies and as the contemporary treatment of HDFN is very effective, we support the prehospital use of RhD positive LTOWB in all patient groups.
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Affiliation(s)
- Sanna Susila
- Finnish Red Cross Blood Service, Vantaa, Finland
- Emergency Medical Service and Emergency Department, Päijät-Häme wellbeing services county, Lahti, Finland
| | - Minna Ilmakunnas
- Finnish Red Cross Blood Service, Vantaa, Finland
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Pauli Vuorinen
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa wellbeing services county, Tampere, Finland
| | - Susanne Ångerman
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Wali JA, Abdelmonem M, Nguyen A, Shan H, Pandey S, Yunce M. Incidence of formation of anti-D between patients with and without a history of solid organ transplant. Vox Sang 2024; 119:363-367. [PMID: 38245847 DOI: 10.1111/vox.13589] [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: 10/05/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND OBJECTIVES Solid organ transplant surgeries including liver transplants constitute a substantial risk of bleeding complications and given frequent national blood shortages, supporting D-negative transplant recipients with D-negative red blood cell products perioperatively can be difficult for the transfusion services. This study was designed to compare the incidence of alloimmunization after D-mismatched red cell transfusions between patients with and without a history of solid organ transplant at a single tertiary care hospital. The patients undergoing solid organ transplants are on strong immunosuppressive regimens perioperatively to help reduce the risk of rejection. We hypothesized that the use of these immunosuppressive agents makes these patients very less likely to mount an immune response and form anti-D antibodies when exposed to the D-positive red blood cell products perioperatively. STUDY DESIGN AND METHODS At our center, D-negative patients who received ≥1 unit of D-positive red blood cell products were identified using historical transfusion records. Antibody testing results were examined to determine the incidence of the formation of anti-D and any other red cell alloantibodies after transfusion and these results were compared between patients with and without a history of solid organ transplant. RESULTS We were able to identify a total of 22 patients over 10 years with D-negative phenotype who had undergone a solid organ transplant and had received D-positive red blood cell products during the transplant surgeries. We also identified a second group of 54 patients with D-negative phenotype who had received D-positive red blood cell products for other indications including medical and surgical. A comparison of the data showed no new anti-D formation among patients with a history of D mismatched transfusion during solid organ transplant surgeries. CONCLUSION Among our limited study population, we observed a very low likelihood of D alloimmunization among solid organ transplant recipients. A larger, prospective study could help further evaluate the need for prophylactic D matching for red cell transfusions during solid organ transplant surgeries.
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Affiliation(s)
- Junaid Ahmad Wali
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Mohamed Abdelmonem
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - AnhThu Nguyen
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Hua Shan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Suchitra Pandey
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Blood Center, Stanford University, Stanford, California, USA
| | - Muharrem Yunce
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
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Clements TW, Van Gent JM, Menon N, Roberts A, Sherwood M, Osborn L, Hartwell B, Refuerzo J, Bai Y, Cotton BA. Use of Low-Titer O-Positive Whole Blood in Female Trauma Patients: A Literature Review, Qualitative Multidisciplinary Analysis of Risk/Benefit, and Guidelines for Its Use as a Universal Product in Hemorrhagic Shock. J Am Coll Surg 2024; 238:347-357. [PMID: 37930900 DOI: 10.1097/xcs.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Whole blood transfusion is associated with benefits including improved survival, coagulopathy, and decreased transfusion requirements. The majority of whole blood transfusion is in the form of low-titer O-positive whole blood (LTOWB). Practice at many trauma centers withholds the use of LTOWB in women of childbearing potential due to concerns of alloimmunization. The purpose of this article is to review the evidence for LTOWB transfusion in female trauma patients and generate guidelines for its application. STUDY DESIGN Literature and evidence for LTOWB transfusion in hemorrhagic shock are reviewed. The rates of alloimmunization and subsequent obstetrical outcomes are compared to the reported outcomes of LTOWB vs other resuscitation media. Literature regarding patient experiences and preferences in regards to the risk of alloimmunization is compared to current trauma practices. RESULTS LTOWB has shown improved outcomes in both military and civilian settings. The overall risk of alloimmunization for Rhesus factor (Rh) - female patients in hemorrhagic shock exposed to Rh + blood is low (3% to 20%). Fetal outcomes in Rh-sensitized patients are excellent compared to historical standards, and treatment options continue to expand. The majority of female patients surveyed on the risk of alloimmunization favor receiving Rh + blood products to improve trauma outcomes. Obstetrical transfusion practices have incorporated LTOWB with excellent results. CONCLUSIONS The use of whole blood resuscitation in trauma is associated with benefits in the resuscitation of severely injured patients. The rate at which severely injured, Rh-negative patients develop anti-D antibodies is low. Treatments for alloimmunized pregnancies have advanced, with excellent results. Fears of alloimmunization in female patients are likely overstated and may not warrant the withholding of whole blood resuscitation. The benefits of whole blood resuscitation likely outweigh the risks of alloimmunization.
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Affiliation(s)
- Thomas W Clements
- From the Departments of Surgery (Clements, Van Gent, Cotton), McGovern Medical School, Houston, Texas
| | - Jan-Michael Van Gent
- From the Departments of Surgery (Clements, Van Gent, Cotton), McGovern Medical School, Houston, Texas
| | - Neethu Menon
- Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School (Menon, Roberts, Refuerzo), McGovern Medical School, Houston, Texas
| | - Aaron Roberts
- Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School (Menon, Roberts, Refuerzo), McGovern Medical School, Houston, Texas
| | | | - Lesley Osborn
- Emergency Medicine (Osborn), McGovern Medical School, Houston, Texas
| | - Beth Hartwell
- Gulf Coast Regional Blood Center, Houston, Texas (Hartwell)
| | - Jerrie Refuerzo
- Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School (Menon, Roberts, Refuerzo), McGovern Medical School, Houston, Texas
| | - Yu Bai
- Pathology and Laboratory Medicine (Bai), McGovern Medical School, Houston, Texas
| | - Bryan A Cotton
- From the Departments of Surgery (Clements, Van Gent, Cotton), McGovern Medical School, Houston, Texas
- Center for Translational Injury Research, Houston, Texas (Cotton)
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Luyten U, Peeraer S, Pirlet C, Khaouch Y, Streel C, Deneys V. O-negative blood shortage management in a university hospital: Impact of transfusing RhD-positive red blood cells to RhD-negative patients. Transfus Clin Biol 2023; 30:402-409. [PMID: 37453488 DOI: 10.1016/j.tracli.2023.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Shortages of O-negative red blood cells are becoming increasingly common, forcing hospitals' blood transfusion services to find solutions to conserve this blood group for patients who need it most. The present study aimed to retrospectively evaluate the practice of transfusing selected RhD-negative patients with RhD-positive red blood cells and to assess the impact of this measure on patients and blood transfusion service management. METHODOLOGY Transfusion data of 1199 RhD-negative patients hospitalised at Cliniques Universitaires Saint-Luc between 2019 and 2022 were analysed. For patients who received RhD-positive red blood cells, age, gender, reason for hospital admission, indication for transfusion, and immunohematology analyses were recorded. These data enabled an assessment of transfusion practices over the years, characterisation of patients who received RhD-mismatched transfusions, determination of the alloimmunisation rate, and calculation of the total number of RhD-negative red blood cells saved. RESULTS During the study period, 141 RhD-negative patients received 604 RhD-positive red blood cells. A change in transfusion practices was observed over the years, with a greater proportion of RhD-negative patients being transfused with RhD-positive red blood cells in 2022 (28%) compared to 2019 (2%). The overall alloimmunisation rate was at least 20%, and 416 red blood cells were saved without any consequences. Patients undergoing cardiovascular surgery received the highest number of RhD-positive red blood cells. CONCLUSION The transfusion of selected RhD-negative patients with RhD-positive red blood cells is a low-risk practice that helps conserve RhD-negative red blood cells. However, there is a minimum 20% risk of alloimmunisation, which could have clinical and transfusion-related consequences in the future.
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Affiliation(s)
- Urszula Luyten
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Sarah Peeraer
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Christine Pirlet
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Youssra Khaouch
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Corentin Streel
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Véronique Deneys
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
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6
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Polzin A, Smith K, Rumpza T. Whole Blood Administration for Obstetric-Related Hemorrhage During Prehospital Transport. Obstet Gynecol 2023; 142:1248-1251. [PMID: 37562035 DOI: 10.1097/aog.0000000000005320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Whole blood transfusion has been used for resuscitation in trauma patients; however, case reports of whole blood transfusion for obstetric-related hemorrhage are limited. Whole blood transfusion typically is accomplished with low titer O-positive whole blood, and, despite success in trauma, use in persons with childbearing potential is of concern due to risk of alloimmunization. CASE We present a case series of patients who received low titer O-positive whole blood for obstetric hemorrhage. One patient was Rh-negative and received immune globulin treatment after whole blood transfusion. All patients survived to hospital discharge. None experienced transfusion-related complications. CONCLUSION Whole blood can be successfully administered both in and out of the hospital setting, even for obstetric hemorrhage. The benefits of easily administered balanced resuscitation, limited donor exposure, and improved patient outcomes likely outweigh potential alloimmunization, especially in resource-limited settings. Addressing concerns of alloimmunization cannot be accomplished without more research, and we encourage others to investigate using whole blood in this population.
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Affiliation(s)
- Abigail Polzin
- Department of Emergency Medicine and the University of South Dakota Sanford School of Medicine, Sanford Health, Sioux Falls, South Dakota; and Sanford Health, Bismarck, North Dakota
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7
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Streel C, Pouplard M, Laporte F, Bertrand O, Luyten U, Pirlet C, Khaouch Y, Deneys V. There is an urgent need to adopt a pull-flow logic for the supply of RBCs to meet patients' needs: A single center study. Transfus Clin Biol 2023; 30:410-416. [PMID: 37451610 DOI: 10.1016/j.tracli.2023.06.008] [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] [Received: 02/11/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Despite major demographic changes, several decisions and initiatives, among which Patient Blood Management, have led to a significant reduction in the transfusion of packed red blood cells (RBCs) in Belgium, as it has been observed in many countries. Unfortunately, not all blood groups were proportionately impacted and shortage in O D-negative RBCs is regularly or chronically observed. The goal of this study was to examine how to optimize the use and the supply of O D-negative blood in our academic hospital. METHODOLOGY All blood transfusions performed at Cliniques universitaires Saint-Luc between January 1, 2019 and December 31, 2021 were reviewed. The blood group of the patients was compared with the blood group of the RBCs actually supplied and transfused. RESULTS 49.823 RBCs transfusions were analyzed. The patients' needs didn't reflect those of a Caucasian population, with an increase of O (47.9%) and B (10.3%) for the ABO blood group, and a quite high proportion of R0r (8.6%) for the Rh blood group. Only two thirds of O D-negative RBCs were transfused to O rr or R0r patients. CONCLUSION The application of PBM and the ethnic imbalance between blood donor and patient populations are two important risk factors for chronic shortages of O D-negative blood. To adapt blood component resources, it is essential to have a complete picture of the real needs of patients according to their blood group profile. Blood donor centers must adapt to the evolving needs of hospitals in order to plan future supplies in a "pull-flow" approach.
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Affiliation(s)
- Corentin Streel
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research, UCLouvain, 1200 Brussels, Belgium
| | - Marie Pouplard
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | | | | | - Urszula Luyten
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Christine Pirlet
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Youssra Khaouch
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Véronique Deneys
- Blood Transfusion Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research, UCLouvain, 1200 Brussels, Belgium.
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8
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Yin Q. DEL variants: review of molecular mechanisms, clinical consequences and molecular testing strategy. Funct Integr Genomics 2023; 23:318. [PMID: 37840046 DOI: 10.1007/s10142-023-01249-z] [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: 10/02/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Patients with DEL phenotype, a D variant with a low number of D antigens per red blood cell, are routinely typed as RhD-negative in serology testing and are detectable only by adsorption and elution techniques or molecular methods. DEL is of clinical importance worldwide, as indicated by its genotype-phenotype discrepancies among different populations and its potential to cause anti-D alloimmunization when DEL phenotype individuals are inadvertently managed as RhD-negative. This narrative review summarized the DEL alleles causing DEL phenotype and the underlying mechanisms. The clinical consequences and current molecular testing approach were discussed to manage the transfusion needs of patients and donors with DEL phenotype.
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Affiliation(s)
- Qinan Yin
- Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
- Precision Medicine Laboratory, School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
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9
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Chowdhury R, Williams BA, Williams S, Casey J. Quality improvement review of O positive blood in emergency transfusion. Transfusion 2023; 63:1841-1848. [PMID: 37698202 DOI: 10.1111/trf.17537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/08/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND We recently introduced a policy to use O positive red cells in emergency transfusions for males >16 years of age and females >50 years of age. Here, we investigate changes in emergency transfusion practice and rates of red cell alloimmunization with the use of O positive blood for emergency transfusion. STUDY DESIGN AND METHODS State-wide retrospective review of emergency transfusions between June 2020 and June 2021. The laboratory information system and patient medical records were used to collect demographic details, indications for transfusion, usage of O positive and O negative blood and rates of alloimmunization. RESULTS There were 2354 red cell units transfused to 1013 patients (male = 59%, average age = 53 years) during the 12-month period. O positive units accounted for 46.9% (1103 units) of emergency transfusions. However, 726 (30.8%) O negative units were transfused to patients without a mandatory indication for O negative blood. Twenty-eight patients (2.9%) had a red cell alloantibody prior to transfusion including anti-E (n = 10), anti-D (n = 4), and anti-K (n = 4). One patient with prior anti-D had mild delayed hemolysis. There were 19 patients (4.3%, median follow-up 22 days) who developed a red cell alloantibody after emergency transfusion and include anti-E (n = 10), anti-D (n = 7), and anti-C (n = 5). DISCUSSION The use of O positive blood for emergency transfusion has saved 1103 O negative red cell units with no detriment to patient outcome. There remains potential to optimize use of O positive blood in emergency transfusion and to understand red cell alloimmunization rates in a prospective fashion.
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Affiliation(s)
- Rakin Chowdhury
- Princess Alexandra Hospital, Pathology Queensland, Brisbane, Australia
| | - Bronwyn A Williams
- Central Pathology Laboratory (Royal Brisbane and Women's Hospital), Pathology Queensland, Brisbane, Australia
| | - Sue Williams
- Central Pathology Laboratory (Royal Brisbane and Women's Hospital), Pathology Queensland, Brisbane, Australia
| | - John Casey
- Townsville University Hospital, Pathology Queensland, Townsville, Australia
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10
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Porter JM, Hazelton JP. What is the Role of Whole Blood Transfusions on Trauma Patients? Adv Surg 2023; 57:257-266. [PMID: 37536857 DOI: 10.1016/j.yasu.2023.04.006] [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: 08/05/2023]
Abstract
Whole blood use in trauma has historically been limited to military use, but in recent years, there has been increasing data for use in civilian trauma. Emerging clinical data demonstrate an associated survival benefit, while some authors have also identified decreased use of an overall number of blood products and decreased complications. Use of whole blood is gradually moving toward becoming the standard of care in the hemorrhaging trauma patient.
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Affiliation(s)
- John M Porter
- Cooper Medical School of Rowan University; Center for Trauma Services, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ 08103, USA
| | - Joshua P Hazelton
- Division of Trauma, Department of Surgery, Acute Care & Critical Care Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Dr, Box 850, Hershey, PA 17033, USA.
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Gammon RR, Meena-Leist C, Al Mozain N, Cruz J, Hartwell E, Lu W, Karp JK, Noone S, Orabi M, Tayal A, Bocquet C, Tanhehco Y. Whole blood in civilian transfusion practice: A review of the literature. Transfusion 2023; 63:1758-1766. [PMID: 37465986 DOI: 10.1111/trf.17480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Richard R Gammon
- OneBlood, Scientific, Medical, Technical Direction, Florida, USA
| | - Claire Meena-Leist
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicinee, Louisville, Kentucky, USA
| | - Nour Al Mozain
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julie Katz Karp
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Susan Noone
- Administration, Vitalant, Ventura, California, USA
| | - Mustafa Orabi
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicinee, Louisville, Kentucky, USA
| | | | | | - Yvette Tanhehco
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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12
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Coyle C, Zitek T, Pepe PE, Stotsenburg M, Scheppke KA, Antevy P, Giroux R, Farcy DA. The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results. Prehosp Disaster Med 2023; 38:513-517. [PMID: 37357937 DOI: 10.1017/s1049023x23005952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION In far-forward combat situations, the military challenged dogma by using whole blood transfusions (WBTs) rather than component-based therapy. More recently, some trauma centers have initiated WBT programs with reported success. There are a few Emergency Medical Service (EMS) systems that are using WBTs, but the vast majority are not. Given the increasing data supporting the use of WBTs in the prehospital setting, more EMS systems are likely to consider or begin WBT programs in the future. OBJECTIVE A prehospital WBT program was recently implemented in Palm Beach County, Florida (USA). This report will discuss how the program was implemented, the obstacles faced, and the initial results. METHODS This report describes the process by which a prehospital WBT program was implemented by Palm Beach County Fire Rescue and the outcomes of the initial case series of patients who received WBTs in this system. Efforts to initiate the prehospital WBT program for this system began in 2018. The program had several obstacles to overcome, with one of the major obstacles being the legal team's perception of potential liability that might occur with a new prehospital blood transfusion program. This obstacle was overcome through education of local elected officials regarding the latest scientific evidence in favor of prehospital WBTs with potential life-saving benefits to the community. After moving past this hurdle, the program went live on July 6, 2022. The initial indications for transfusion of cold-stored, low titer, leukoreduced O+ whole blood in the prehospital setting included traumatic injuries with systolic blood pressure (SBP) < 70mmHg or SBP < 90mmHg plus heart rate (HR) > 110 beats per minute. FINDINGS From the date of onset through December 31, 2022, Palm Beach County Fire Rescue transported a total of 881 trauma activation patients, with 20 (2.3%) receiving WBT. Overall, nine (45%) of the patients who had received WBTs so far remain alive. No adverse events related to transfusion were identified following WBT administration. A total of 18 units of whole blood reached expiration of the unit's shelf life prior to transfusion. CONCLUSION Despite a number of logistical and legal obstacles, Palm Beach County Fire Rescue successfully implemented a prehospital WBT program. Other EMS systems that are considering a prehospital WBT program should review the included protocol and the barriers to implementation that were faced.
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Affiliation(s)
- Charles Coyle
- Palm Beach County Fire Rescue, West Palm Beach, FloridaUSA
| | - Tony Zitek
- Department of Emergency Medicine, Mt. Sinai Medical Center, Miami Beach, FloridaUSA
| | - Paul E Pepe
- Palm Beach County Fire Rescue, West Palm Beach, FloridaUSA
| | - Madonna Stotsenburg
- Department of Trauma Services and Emergency Management, St. Mary's Medical Center, West Palm Beach, FloridaUSA
| | | | - Peter Antevy
- Palm Beach County Fire Rescue, West Palm Beach, FloridaUSA
| | - Richard Giroux
- Palm Beach County Fire Rescue, West Palm Beach, FloridaUSA
| | - David A Farcy
- Palm Beach County Fire Rescue, West Palm Beach, FloridaUSA
- Department of Emergency Medicine, Mt. Sinai Medical Center, Miami Beach, FloridaUSA
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13
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Ilmakunnas M, Salmela K, Kivipuro T, Sareneva H, Sainio S. Use of O
RhD
‐negative red blood cells: A nationwide, prospective audit. Vox Sang 2022; 117:1279-1286. [DOI: 10.1111/vox.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Minna Ilmakunnas
- Department of Anesthesiology and Intensive Care Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, HUS Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Katja Salmela
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, HUS Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki Finland
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14
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Seheult JN, Callum J, Delaney M, Drake R, Dunbar NM, Harm SK, Hess JR, Jackson BP, Javanbakht A, Moore SA, Murphy MF, Raval JS, Staves J, Tuott EE, Wendel S, Ziman A, Yazer MH. Rate of D-alloimmunization in trauma does not depend on the number of RhD-positive units transfused: The BEST collaborative study. Transfusion 2022; 62 Suppl 1:S185-S192. [PMID: 35748692 DOI: 10.1111/trf.16952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence indicates the life-saving benefits of early blood product transfusion in severe trauma resuscitation. Many of these products will be RhD-positive, so understanding the D-alloimmunization rate is important. METHODS This was a multicenter, retrospective study whereby injured RhD-negative patients between 18-50 years of age who received at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB) during their resuscitation between 1 January, 2010 through 31 December, 2019 were identified. If an antibody detection test was performed ≥14 days after the index RhD-positive transfusion then basic demographic information was collected, including whether the patient became D-alloimmunized. The overall D-alloimmunization rate, and the rate stratified by the number of units transfused, were calculated. RESULTS Data were collected from nine institutions. Five institutions reported fewer than 10 eligible patients each and were excluded. From the remaining four institutions, all from the USA, there were 235 eligible patients; 77 (random effects estimate: 32.7%; 95% CI: 19.1-50.1%) became D-alloimmunized. Three of the institutions reported D-alloimmunization rates ≥38.6%, while the remaining institution's rate was 12.2%. In both random and fixed-effects models, the rate of D-alloimmunization was not significantly different between those who received one RhD-positive unit and those who received multiple RhD-positive units. CONCLUSION In this large, multicenter study of injured patients, the overall rate of D-alloimmunization fell within the range previously reported. The rate of D-alloimmunization did not increase as the number of transfused RhD-positive units increased. These data can help to inform RhD type selection decisions.
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Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
| | - Rosanna Drake
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah K Harm
- Department of pathology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - John R Hess
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bryon P Jackson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ayda Javanbakht
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah A Moore
- Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Michael F Murphy
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Julie Staves
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Erin E Tuott
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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15
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Rangrass G. Whole blood use in trauma resuscitation: targeting prehospital transfusion. Curr Opin Anaesthesiol 2022; 35:146-149. [PMID: 35102044 DOI: 10.1097/aco.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Trauma resuscitation management has evolved over the years with a more nuanced understanding of the injured patient's physiologic state of shock. The purpose of this review is to discuss the role of whole blood administration in the prehospital setting in the resuscitation of the trauma patient. RECENT FINDINGS In traumatically injured patients, whole blood administration initiated in the prehospital setting may improve early shock severity, coagulopathy, and survival when used over traditional resuscitation fluids such as crystalloid administration or component therapy. SUMMARY The timing of resuscitation and its components deserve special attention when improving outcomes for trauma patients requiring massive transfusion.
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Affiliation(s)
- Govind Rangrass
- Anesthesia and Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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16
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Wardman JF, Bains RK, Rahfeld P, Withers SG. Carbohydrate-active enzymes (CAZymes) in the gut microbiome. Nat Rev Microbiol 2022; 20:542-556. [PMID: 35347288 DOI: 10.1038/s41579-022-00712-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Abstract
The 1013-1014 microorganisms present in the human gut (collectively known as the human gut microbiota) dedicate substantial percentages of their genomes to the degradation and uptake of carbohydrates, indicating the importance of this class of molecules. Carbohydrates function not only as a carbon source for these bacteria but also as a means of attachment to the host, and a barrier to infection of the host. In this Review, we focus on the diversity of carbohydrate-active enzymes (CAZymes), how gut microorganisms use them for carbohydrate degradation, the different chemical mechanisms of these CAZymes and the roles that these microorganisms and their CAZymes have in human health and disease. We also highlight examples of how enzymes from this treasure trove have been used in manipulation of the microbiota for improved health and treatment of disease, in remodelling the glycans on biopharmaceuticals and in the potential production of universal O-type donor blood.
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Affiliation(s)
- Jacob F Wardman
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada.,Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajneesh K Bains
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Rahfeld
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen G Withers
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada. .,Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada. .,Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada.
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17
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Safic Stanic H, Dogic V, Bingulac-Popovic J, Kruhonja Galic Z, Stojic Vidovic M, Puljic K, Jukic I. RhD alloimmunization by DEL variant missed in donor testing. Transfusion 2022; 62:1084-1088. [PMID: 35318689 DOI: 10.1111/trf.16862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/13/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Exposure to normal or variably expressed RhD antigens in an antigen-negative individual can elicit an immune response and lead to the formation of clinically significant anti-D alloantibodies. We present the case of anti-D alloimmunization by DEL variant missed in routine blood donor screening. MATERIAL AND METHODS Blood donors were typed for D antigen using the direct serologic micromethod. Nonreactive samples were confirmed in the indirect antiglobulin method with an IgM/IgG anti-D monoclonal reagent. Genomic DNA was extracted using a commercial QIAamp DNA Blood Mini kit on the QIAcube device (Qiaqen, Germany). RHD genotyping was performed using the PCR-SSP genotyping kits- Ready Gene D weak, Ready Gene D weak screen, Ready Gene CDE, and Ready Gene D AddOn (Inno-Train, Germany). Unidentified alleles were sent for DNA genome sequencing. RESULTS After identifying DEL positive blood units in RhD negative blood donor pool, a look-back study was performed to determine if their previous donations caused alloimmunization in recipients. Out of 40 D negative recipients, one developed anti-D alloantibody after 45 days. The patient did not receive other RhD positive blood products. Blood donor typed D negative in direct and indirect agglutination method. RHD screening was positive, but RHD genotyping and DNA sequencing showed no mutation indicating the normal genotype. CONCLUSION Currently used methods in RHD genotyping are insufficient to identify many variant alleles, especially intronic variations. We suggest additional gene investigation including yet unexplored regions of regulation and intron regions to justify our serological finding.
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Affiliation(s)
- Hana Safic Stanic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Vesna Dogic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Jasna Bingulac-Popovic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Zrinka Kruhonja Galic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Miljana Stojic Vidovic
- Department for Blood donor testing, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Kresimir Puljic
- Department for woman's psychotic disorders, University Psychiatric Hospital "Vrapče", Zagreb, Croatia
| | - Irena Jukic
- Medical Department, Croatian Institute of Transfusion Medicine, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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18
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Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. THE LANCET HAEMATOLOGY 2022; 9:e250-e261. [PMID: 35271808 PMCID: PMC8960285 DOI: 10.1016/s2352-3026(22)00040-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/22/2022]
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19
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Anti-D Alloimmunization After RhD Positive Red Cell Transfusion to Selected RhD Negative Patients. Indian J Hematol Blood Transfus 2022; 38:577-584. [DOI: 10.1007/s12288-021-01506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/05/2021] [Indexed: 10/19/2022] Open
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20
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Martinaud C, Fleuriot E, Pasquier P. Implementation of Low Titer Whole Blood for French overseas operations: O positive or negative products in massive hemorrhage? Transfus Clin Biol 2022; 29:164-167. [DOI: 10.1016/j.tracli.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
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21
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Cardigan R, Latham T, Weaver A, Yazer M, Green L. Estimating the risks of prehospital transfusion of D-positive whole blood to trauma patients who are bleeding in England. Vox Sang 2022; 117:701-707. [PMID: 35018634 PMCID: PMC9306525 DOI: 10.1111/vox.13249] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 01/13/2023]
Abstract
Background and Objectives D‐negative red cells are transfused to D‐negative females of childbearing potential (CBP) to prevent haemolytic disease of the foetus and newborn (HDFN). Transfusion of low‐titre group O whole blood (LTOWB) prehospital is gaining interest, to potentially improve clinical outcomes and for logistical benefits compared to standard of care. Enhanced donor selection requirements and reduced shelf‐life of LTOWB compared to red cells makes the provision of this product challenging. Materials and Methods A universal policy change to the use of D‐positive LTOWB across England was modelled in terms of risk of three specific harms occurring: risk of haemolytic transfusion reaction now or in the future, and the risk of HDFN in future pregnancies for all recipients or D‐negative females of CBP. Results The risk of any of the three harms occurring for all recipients was 1:14 × 103 transfusions (credibility interval [CI] 56 × 102–42 × 103) while for females of CBP it was 1:520 transfusions (CI 250–1700). The latter was dominated by HDFN risk, which would be expected to occur once every 5.7 years (CI 2.6–22.5). We estimated that a survival benefit of ≥1% using LTOWB would result in more life‐years gained than lost if D‐positive units were transfused exclusively. These risks would be lower, if D‐positive blood were only transfused when D‐negative units are unavailable. Conclusion These data suggest that the risk of transfusing RhD‐positive blood is low in the prehospital setting and must be balanced against its potential benefits.
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Affiliation(s)
- Rebecca Cardigan
- Clinical Services, NHS Blood and Transplant, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
| | - Tom Latham
- Clinical Services, NHS Blood and Transplant, London, UK
| | - Anne Weaver
- Department of Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laura Green
- Clinical Services, NHS Blood and Transplant, London, UK.,Department of Haematology, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
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22
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Ji Y, Luo G, Fu Y. Incidence of anti-D alloimmunization in D-negative individuals receiving D-positive red blood cell transfusion: A systematic review and meta-analysis. Vox Sang 2022; 117:633-640. [PMID: 35014050 DOI: 10.1111/vox.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/30/2021] [Accepted: 12/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The transfusion of D-negative red blood cells (RBCs) to D-negative patients has been widely adopted to prevent anti-D alloimmunization, especially in women of childbearing age. Still, transfusion of D-positive RBCs to D-negative recipients is occasionally inevitable in practice, and the resulting incidence of anti-D in different D-negative groups of patients has not been well summarized. MATERIALS AND METHODS We searched the relevant literature using PubMed, Cochrane Library, and Embase databases from inception date to 30 September 2021. We looked for studies of anti-D occurring in D-negative recipients who received D-positive RBC transfusions. The anti-D incidence was summarized with 95% confidence intervals (CIs). Data with similar characteristics were combined using a random-effects model. RESULTS About 42 studies (2226 cases), which found anti-D, the exact volume of D-positive RBC transfused, and the follow-up time for anti-D detection, met the inclusion criteria. The pooled anti-D incidence was 64% (95% CI, range 55%-74%) in volunteers receiving small volumes of D-positive RBCs, 84% (95% CI, 74%-94%) in those receiving whole units, 26% (95% CI, 19%-32%) in mixed patients, 12% (95% CI, 8%-16%) in oncology patients, 27% (95% CI, 13%-40%) in trauma patients, 4% (95% CI, 0%-8%) in immune-compromised transplant patients, and 6% (95% CI, 1%-39%) in those with AIDS. CONCLUSION Compared with the high frequency of anti-D in healthy D-negative volunteers given D-positive RBCs, we found a lower rate of anti-D immunization in various D-negative patients and almost none in transplant and AIDS patients.
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Affiliation(s)
- Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China
| | - Yongshui Fu
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China
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23
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Moiz B, Ali A, Qadir H, Khalid A. A clinical audit on the utilization of group O-negative red cells and the lesson learnt. Asian J Transfus Sci 2022. [DOI: 10.4103/ajts.ajts_170_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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McCoy CC, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, Kauvar D, Khan M, Kirkpatrick A, Ordonez C, Perreira B, Priouzram A, Cotton BA. Back to the Future: Whole Blood Resuscitation of the Severely Injured Trauma Patient. Shock 2021; 56:9-15. [PMID: 33122511 PMCID: PMC8601673 DOI: 10.1097/shk.0000000000001685] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/09/2019] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
ABSTRACT Following advances in blood typing and storage, whole blood transfusion became available for the treatment of casualties during World War I. While substantially utilized during World War II and the Korean War, whole blood transfusion declined during the Vietnam War as civilian centers transitioned to blood component therapies. Little evidence supported this shift, and recent conflicts in Iraq and Afghanistan have renewed interest in military and civilian applications of whole blood transfusion. Within the past two decades, civilian trauma centers have begun to study transfusion protocols based upon cold-stored, low anti-A/B titer type O whole blood for the treatment of severely injured civilian trauma patients. Early data suggests equivalent or improved resuscitation and hemostatic markers with whole blood transfusion when compared to balanced blood component therapy. Additional studies are taking place to define the optimal way to utilize low-titer type O whole blood in both prehospital and trauma center resuscitation of bleeding patients.
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Affiliation(s)
- Christopher Cameron McCoy
- Department of Surgery and the Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery, Tulane, New Orleans, Louisiana
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Paula Ferrada
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden
| | - Tal Horer
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada
- Canadian Forces Health Services, Calgary, Alberta, Canada
| | - Carlos Ordonez
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Fundacioń Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Valle, Columbia
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
| | - Bryan A. Cotton
- Department of Surgery and the Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas
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25
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Chen IS, Davis SJ, Chang ML, Hung CH, Radenovic A, Chang PL. Rhesus Blood Typing within a Few Seconds by Packing-Enhanced Nanoscattering on Individual Erythrocytes. Anal Chem 2021; 93:15142-15149. [PMID: 34738468 DOI: 10.1021/acs.analchem.1c03590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A method for the ABO and Rhesus (Rh) blood group typing from individual erythrocytes is proposed in this study. Blood-group-specific antibodies immobilized to gold nanoparticles (BG-AuNP) were utilized for the identification of blood groups from individual erythrocytes by objective-type dark-field microscopy (OTDFM). The scattering of free BG-AuNP and their Brownian motion as well as BG-AuNP attached on erythrocytes is easily observed by OTDFM. The strong scattering intensity caused by BG-AuNP packing-enhanced nanoscattering (PENS) on erythrocytes is first demonstrated. PENS combined with OTDFM allows us to identify blood groups within 5 s for all blood group antigens including A, B, D, C, c, E, and e. This was immediately identified by mixing with BG-AuNP without any washing step or waiting for hemoagglutination. Therefore, PENS combined with OTDFM demonstrates feasibility and advantages for use in emergency transfusions where the blood group of patients is unknown. Moreover, matching RhD+ in the case of emergency transfusions may also be beneficial in reducing the shortage of RhD- red blood cell concentrate in the case of a population with a high frequency in RhD-.
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Affiliation(s)
- I-Shin Chen
- Department of Chemistry, National Sun Yat-sen University, No. 70 Lienhai Road, Kaohsiung 80424, Taiwan.,Department of Chemistry, Tunghai University, Taichung 40704, Taiwan
| | - Sebastian J Davis
- Laboratory of Nanoscale Biology, Institute of Bioengineering, School of Engineering, EPFL, Lausanne 1015, Switzerland
| | - Man-Ling Chang
- Department of Chemistry, National Sun Yat-sen University, No. 70 Lienhai Road, Kaohsiung 80424, Taiwan.,Department of Chemistry, Tunghai University, Taichung 40704, Taiwan
| | - Chao-Hsuan Hung
- Department of Chemistry, National Sun Yat-sen University, No. 70 Lienhai Road, Kaohsiung 80424, Taiwan
| | - Aleksandra Radenovic
- Laboratory of Nanoscale Biology, Institute of Bioengineering, School of Engineering, EPFL, Lausanne 1015, Switzerland
| | - Po-Ling Chang
- Department of Chemistry, National Sun Yat-sen University, No. 70 Lienhai Road, Kaohsiung 80424, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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26
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Yazer MH, Triulzi DJ, Sperry JL, Seheult JN. Rate of RhD-alloimmunization after the transfusion of multiple RhD-positive primary red blood cell-containing products. Transfusion 2021; 61 Suppl 1:S150-S158. [PMID: 34269438 DOI: 10.1111/trf.16495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products transfused. METHODS RhD-negative patients between 13 and 50 years who were transfused with ≥1 RhD-positive red blood cell (RBC) or whole blood units between January 1, 2000 and December 31, 2019 in a healthcare network were identified. Study patients had to have had at least one antibody detection test performed ≥14 days after the index RhD-positive transfusion and not receive RhIg. Patients were stratified into groups that received 1, 2, 3-5, 6-10, 11-20, and >20 RhD-positive transfusions and the RhD-alloimmunization rate was determined for each group. RESULTS There were 335 patients included; 52/335 (15.5%) were females. Overall, there were 117/335 (34.9%, CI: 29.8%-40.3%) recipients who became RhD-alloimmunized. There was no significant dosage effect in the RhD-alloimmunization rates as the exposure to RhD-positive units increased from one RhD-positive unit to more than 20 RhD-positive units (p = .270 for non-parametric trend test). In an exploratory analysis, patients who received 100% of their RhD-positive transfusions within 72 h of the index transfusion had a significantly higher rate of RhD-alloimmunization compared to those who were transfused over a longer period of time (42.3% vs. 21.4%, respectively; p = .001). CONCLUSION These results suggest that there may not be an increased RhD-alloimmunization risk with transfusing multiple RhD-positive units after one RhD-positive unit has been transfused. These findings need confirmation in larger studies.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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27
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Raval JS, Madden KM, Neal MD, Moore SA. Anti-D alloimmunization in Rh(D) negative adults with severe traumatic injury. Transfusion 2021; 61 Suppl 1:S144-S149. [PMID: 34269429 DOI: 10.1111/trf.16493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Widely varying rates of alloimmunization associated with transfusing uncrossmatched RBC products to trauma patients as part of hemostatic resuscitation have been reported. We characterized the rates of RBC alloimmunization in our severely injured Rh(D) negative trauma population who received uncrossmatched Rh(D) positive RBC products. METHODS In a 10-year retrospective analysis to assess Rh(D) alloimmunization risks, Rh(D) negative adult trauma patients initially requiring uncrossmatched group O Rh(D) positive RBC products with either RBC units or low titer group O whole blood as part of massive transfusion protocol (MTP) activation were identified. Only those Rh(D) negative patients whose initial antibody screenings were negative were included. Duration of serologic follow-up from date of MTP activation to either date of anti-D detection or most recent negative antibody screening was calculated. RESULTS There were 129 eligible Rh(D) negative trauma patients identified. Median injury severity score was 25. Anti-D was detected in 10 (7.8%) patients after a median of 161.5 days; the median duration of serologic follow-up in those who did not have anti-D detected was 220 days. Patients who had anti-D detected were less severely injured and received fewer Rh(D) positive RBC products versus those who did not. DISCUSSION In our severely injured adult trauma patients with MTP activation requiring uncrossmatched group O Rh(D) positive RBC products, the rate of anti-D detection was low. Additional studies are necessary to determine generalizability of these findings and fully characterize alloimmunization risks in trauma patients with varying extents of injury.
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Affiliation(s)
- Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kathleen M Madden
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah A Moore
- Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA
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Yazer M, Triulzi D, Sperry J, Corcos A, Seheult J. Rate of RhD-alloimmunization after the transfusion of RhD-positive red blood cell containing products among injured patients of childbearing age: single center experience and narrative literature review. ACTA ACUST UNITED AC 2021; 26:321-327. [PMID: 33775237 DOI: 10.1080/16078454.2021.1905395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the rate of RhD-alloimmunization in injured RhD-negative patients in the age range of childbearing potential who were transfused with at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB). METHODS Injured RhD-negative patients between the ages of 13-50 at an American Level 1 trauma center who were transfused with at least one unit of RBCs or LTOWB during their resuscitation and who had an antibody detection test performed at least 14 days afterwards were included. RESULTS Over a 20-year period, 96 study-eligible patients were identified, of which 90/96 (93.8%) were male. The median age of these 96 patients was 33 (5th-95th percentiles: 19-49) years. The majority of these patients (71/96, 74.0%) had an injury severity score (ISS) greater than 15. Overall, 41/96 (42.7%; 95% CI: 32.7%-53.2%) of these patients became alloimmunized after receipt of a median of 3 (5th-95th percentiles: 1-35) units of RhD-positive RBCs and/or LTOWB. There was no association between receipt of leukoreduced RBCs or receipt of LTOWB and the RhD-alloimmunization rate. DISCUSSION The rate of RhD-alloimmunization in this study was at the higher end of rates that have been reported. None of the previous studies focused exclusively on trauma patients in the childbearing age range. CONCLUSION The 42.7% rate of RhD-alloimmunization in a predominantly male trauma population could probably be extrapolated to women in the same age range when estimating their risk of RhD-alloimmunization following RhD-positive transfusion.
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Affiliation(s)
- Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darrell Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alain Corcos
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jansen Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
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29
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Hasan RA, Asif M, Tuott EE, Stansbury LG, Hess JR. Rates of delayed hemolytic transfusion reactions observed in a trauma center. Transfusion 2021; 61:2035-2040. [PMID: 33983627 DOI: 10.1111/trf.16433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Delayed hemolytic transfusion reactions (DHTRs) are reported to be rare occurrences but may be more frequently observed in the trauma setting where patients are heavily transfused, followed over long inpatient admissions, and have frequent subsequent blood counts as they undergo multiple surgical interventions. STUDY DESIGN AND METHODS We examined the rates of DHTRs on a per transfusion and per patient basis in an academic county hospital with a level 1 trauma center serving a four-state region and over a 3-year period. DHTRs were entered sequentially into a registry as they were observed, and a retrospective review of all new alloantibodies detected was performed to identify any additional DHTRs. The number of units of red blood cells (RBCs), the number of unique patients, types of alloantibodies, and number of transfusions were extracted from blood bank records. RESULTS Twenty-nine DHTRs were observed from January 1, 2017, through December 31, 2019, from newly observed alloantibodies after a median of 12 red blood cells (RBCs) transfusions per patient. These reactions occurred in response to 24,633 unique transfusions in 6905 unique patients, so the observed rates were about 1:849 RBC transfusions and 1:238 transfused patients. Evidence of delayed hemolysis was seen in five additional patients who were transfused during emergency resuscitation and later found to have had known RBC antibodies. DISCUSSION We report a higher rate of DHTRs than previously described to demonstrate that DHTRs are not rare in trauma centers.
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Affiliation(s)
| | - Maryam Asif
- Bloodworks Northwest, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center, Department of Anesthesia and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
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Alalshaikh M, Almalki Y, Hasanato R, Almomen A, Alsughayir A, Alabdullateef A, Sabbar A, Alsuhaibani O. Frequency of Rh and K antigens in blood donors in Riyadh. Hematol Transfus Cell Ther 2021; 44:555-559. [PMID: 33992594 PMCID: PMC9605887 DOI: 10.1016/j.htct.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/17/2021] [Accepted: 03/17/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Investigate the prevalence of Rh and the K antigens and their phenotypes in the red blood cells of blood donors in Riyadh, Saudi Arabia. Methods This is a retrospective study. The five principal Rh antigens (D, C, c, E, e) and the Kell antigen from the Kell blood group were tested in 4,675 random samples collected from four blood bank centers in Riyadh. Data were collected for seven weeks (from January 4, 2019 to February 28, 2019). Antigens were tested using the TANGO Optimo system. Results We found that approximately 86% of the donors had the D antigen, 66% had C, 78% had c, 26% had E, 97% had e and 14% had K. The most common Rh phenotypes were R1r (31%) and R1R1 (22%). Conclusion The differences in the results between the study population and other populations, such as Caucasian, Indian and African populations indicate the importance of establishing a population-specific database.
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31
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Greinacher J, Selleng K. Antikörper-Adsorptionsmethoden für die Diagnostik von erythrozytären Alloantikörpern bei Patienten mit panreaktiven Autoantikörpern. TRANSFUSIONSMEDIZIN 2021. [DOI: 10.1055/a-1258-1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDer Nachweis und die Differenzierung von erythrozytären Alloantikörpern bei Patienten mit freien wärmereaktiven Autoantikörpern (WAK) im Plasma stellt das immunhämatologische Labor vor eine Herausforderung. Eine Allo- und/oder Autoadsorption kann die Autoantikörperreaktivität des Patientenplasmas reduzieren oder vollständig entfernen und vorhandene Alloantikörper demaskieren. Wir schlagen einen diagnostischen Stufenplan vor, der diese Methoden besonders berücksichtigt, und eine Transfusionsstrategie, die sich an der Dringlichkeit der Transfusion orientiert. Eine indizierte Transfusion darf durch die Diagnostik nicht verzögert werden.
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Affiliation(s)
- Jan Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald
| | - Kathleen Selleng
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald
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Troughton M, Young PP. Conservation of Rh negative Low Titer O Whole Blood (LTOWB) and the need for a national conversation to define its use in trauma transfusion protocols. Transfusion 2021; 61:1966-1971. [PMID: 33780020 PMCID: PMC8251973 DOI: 10.1111/trf.16380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/07/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
Low‐titer group O whole blood (LTOWB) use is growing steadily in the United States. Although the percentage of O negative LTOWB use by Red Cross hospitals has remained steady at ~23% over the last 2 years, this elevated use rate is twice that of O negative RBC components. Given the more restricted group O donor pool, this level of use will make it difficult to expand the use of this product. Evaluation of hospital practices regarding females of childbearing potential show significant variability with some hospitals transfusing O positive, with others choosing to restrict this population to O negative LTOWB or only O negative RBC component therapy. To ensure access of LTOWB to all patients who may benefit and to maintain sufficient supplies, we recommend developing standardized practice recommendations for its use.
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Affiliation(s)
- Marla Troughton
- American Red Cross, Biomedical Services Headquarters, Washington, District of Columbia, USA
| | - Pampee P Young
- American Red Cross, Biomedical Services Headquarters, Washington, District of Columbia, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Flegel WA, Wagner FF, Ó Donghaile DP. Anti-D immunization rates may exceed 50% in many clinically relevant settings, despite varying widely among patient cohorts. Transfusion 2020; 60:1109-1110. [PMID: 32421874 DOI: 10.1111/trf.15788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Selleng K. Der Blutungsnotfall – Versorgungskonzepte für Patienten mit unbekannter Blutgruppe. TRANSFUSIONSMEDIZIN 2020. [DOI: 10.1055/a-1090-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie Mortalität von Patienten, die mit lebensbedrohlichen Blutungen ins Krankenhaus aufgenommen werden, beträgt bis zu 50%. Für die Verbesserung der Überlebenschancen dieser Patienten ist ein gut etabliertes Hämotherapiekonzept für jedes Krankenhaus unabdingbar. Dies schließt ein, dass die Blutprodukte schnell am Patienten ankommen, d. h. klare Meldewege zwischen Versorgungsort und Blutdepot, dass der Dokumentationsaufwand minimal ist, aber auch dass die Empfehlungen der deutschen Hämotherapie-Richtlinien beachtet werden. In der Praxis eignen sich kleine Blutproduktdepots in Schockraumnähe und eine einfache Anforderungslogistik mit fest zusammengestellter Lieferung von Blutprodukten. Neue Ansätze sind Transportdepots für Rettungshubschrauber und Notarztwagen. Typischerweise werden 0 Rhesus-negative (RhD-negative) Erythrozytenkonzentrate (EKs) für die Notfallversorgung von Patienten mit unbekannter Blutgruppe verwendet, aber häufig stehen diese nicht in ausreichendem Maß zur Verfügung. An der Universitätsmedizin Greifswald werden seit dem Jahr 2000 Rhesus-positive (RhD-positive) EKs für die Transfusion von Patienten mit unbekannter Blutgruppe verwendet, um nicht unnötig RhD-positive Patienten mit 0 RhD-negativen EKs zu transfundieren. Wir konnten zeigen, dass die Verwendung von 0 RhD-positiven EKs keinen Einfluss auf die Überlebenschance der 0 RhD-negativen Patienten hatte und hämolytische Transfusionsreaktionen nicht vermehrt auftraten. Die Anti-D-Immunisierungsrate lag bei 3 – 5% aller Notfallpatienten. Die geforderte frühe Plasmatransfusion und Transfusionsratio FFP : EK von ≥ 1 : 2 kann durch eine Flüssigplasmabank gewährleistet werden. Um die Lagerzeit der aufgetauten Plasmen kurz zu halten, verwenden wir für alle Plasmatransfusionen Plasma aus der Flüssigplasmabank. Krankenhäuser sollten für ihre Gegebenheiten Standards für die Therapie von Blutungsnotfällen im Schockraum und im Rettungsdienst entwickeln.
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Affiliation(s)
- Kathleen Selleng
- Institut für Immunologie und Transfusionsmedizin, Abteilung Transfusionsmedizin, Universitätsmedizin Greifswald
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35
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Zalba Marcos S, Antelo Caamaño ML, Galbete Jiménez A, Rodriguez Wilhelmi P, Aranguren Azparren A, García Erce JA. Transfusion of D positive red cells to selected D-negative patients. Med Clin (Barc) 2020; 154:425-432. [PMID: 31791806 DOI: 10.1016/j.medcli.2019.07.023] [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: 03/20/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND To transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. However, when there is not enough D negative blood available, we can transfuse positive red blood cells to negative patients. Immunocompetent D negative individuals may develop serologically detectable anti-D antibodies within 3 months after exposure to D positive red blood cells. MATERIAL AND METHOD Over the last 18 years, we have experienced situations of D negative blood cell scarcity. In these situations, we have applied a clinical assistance protocol, selecting patients with lower risk of alloimmunization and chronic transfusion requirements. We have retrospectively evaluated this policy for the use of D positive red blood cells in D negative patients, focussing on alloinmunization and mortality. RESULTS Applying the protocol, 3% of D negative patients were transfused with D positive units, with an alloimmunization rate of 12.3%. The rate of alloimmunization was higher in the younger age group and in those transfused with more units. No haemolytic reactions were reported. Mortality in the alloimmunized group was lower. CONCLUSION The use of D positive red blood cells in selected D negative patients does not induce adverse reactions, is a safe practice and allows saving of a product that is sometimes limited.
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Affiliation(s)
- Saoia Zalba Marcos
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - Arkaitz Galbete Jiménez
- Unidad de Metodología, Fundación Miguel Servet, NAVARRABIOMED-Centro de Investigación Biomédica, Unidad de Metodología, Pamplona, Navarra, España
| | - Pablo Rodriguez Wilhelmi
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - José Antonio García Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común»; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España.
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36
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Chhibber VG, Fischman J, Benedetto AT, Nikolis NM, Indrikovs AJ, Shariatmadar S. How do I manage O- red blood cell inventory. Transfusion 2020; 60:1356-1363. [PMID: 32500565 DOI: 10.1111/trf.15849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
Currently there are no widely accepted guidelines regarding the appropriate use of O- red blood cells (RBCs). Although there has been a decline in overall RBC utilization since 2010, the use of O- RBCs has continued to proportionally increase over this time period resulting in frequent shortages. When faced with these shortages, we implemented some simple strategies that resulted in a significant decrease in annual O- RBC utilization from 10% to 7.5% despite an increase in total RBC utilization. These strategies included collaboration with the clinical staff, improving practices within the blood bank, and having our health system partner with our blood supplier. Herein, we detail our strategies for hospital transfusion services to improve O- RBC utilization. Most of these can be easily implemented and do not require additional resources.
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Affiliation(s)
| | - Jane Fischman
- North Shore University Hospital, Manhasset, New York, USA
| | | | | | | | - Sherry Shariatmadar
- Northwell Health, Manhasset, New York, USA.,North Shore University Hospital, Manhasset, New York, USA
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37
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Fisher AD, Dunn J, Pickett JR, Garza J, Miles EA, Diep V, Escott M. Implementation of a low titer group O whole blood program for a law enforcement tactical team. Transfusion 2020; 60 Suppl 3:S36-S44. [DOI: 10.1111/trf.15625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Andrew D. Fisher
- Medical Command, Texas Army National Guard Austin Texas
- Texas A&M College of Medicine Temple Texas
- Prehospital Research in Military and Expeditionary Environments (PRIME2) San Antonio Texas
| | - John Dunn
- Texas Department of Public Safety Austin Texas
| | - Jason R. Pickett
- Texas Department of Public Safety Austin Texas
- Austin‐Travis County Office of the Medical Director Austin Texas
| | | | | | | | - Mark Escott
- Texas Department of Public Safety Austin Texas
- Austin‐Travis County Office of the Medical Director Austin Texas
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Zhang Y, Xu H, Wang X, Wang L, Liu R, Li L, Zhou H. Single‑strained DNA aptamers mask RhD antigenic epitopes on human RhD+ red blood cells to escape alloanti‑RhD immunological recognition. Mol Med Rep 2020; 21:1841-1848. [PMID: 32319623 PMCID: PMC7057830 DOI: 10.3892/mmr.2020.10985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
Rhesus D‑ (RhD‑) individuals should receive Rh‑matched blood to prevent hemolytic anemia. However, there is a shortage of RhD‑ blood. This study aimed to generate RhD antigen‑specific single‑stranded DNA (ssDNA) aptamers, and test their efficacy in masking RhD antigens on RhD+ red blood cells (RBCs) to prevent their immunoreactivity in vitro. In the present study, ssDNA aptamer candidates were synthesized as a central randomized sequence of 40 nucleotides (nt) flanked by 21‑nt primer hybridization sequences. The functional aptamers were screened using the cell‑based systematic evolution of ligands by exponential enrichment technique and RhD+ RBCs. Two bioactive ssDNA aptamers significantly inhibited the binding of an anti‑RhD antibody to RhD+ RBCs and bound to RhD antigens with high affinity (dissociation constant values of 580.5±142.0 and 737.7±161.8 nM, respectively). Furthermore, treatment with both ssDNA aptamers (500 pmol) effectively masked RhD antigens on 4,000,000 RhD+ RBCs to prevent human anti‑RhD alloantibody‑mediated binding, RBC agglutination and monocyte recognition in vitro. Collectively, such data suggested that these ssDNA aptamers may be feasible for masking RhD antigens on RBCs, and thus valuable for prevention or at least amelioration of RhD+‑related hemolytic anemia in RhD‑ individuals.
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Affiliation(s)
- Yinze Zhang
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Hua Xu
- Shaanxi Blood Center, Institute of Transfusion Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Xin Wang
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Lin Wang
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Ruiqi Liu
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Lu Li
- Department of Transfusion, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong 518055, P.R. China
| | - Huayou Zhou
- Department of Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Williams LA, Sikora J, Aldrees R, Pham HP, Marques MB. Anti-Rh alloimmunization after trauma resuscitation. Transfus Apher Sci 2019; 58:102652. [PMID: 31672466 DOI: 10.1016/j.transci.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
The AABB recently posted a bulletin (19-02) regarding their recommendations for the use of group O red blood cells (RBCs) during trauma. Though group O Rh(D)-negative RBC units are considered the 'safest', the demand of such units often exceeds the supply. Therefore, O Rh(D)-positive units are often used during the first parts of a massive transfusion protocol (MTP) or patients with particularly severe hemorrhage are switched over from O Rh(D)-negative to O Rh(D)-positive RBC units in order to preserve the O Rh(D)-negative supply. In light of these limitations, it is important to understand the risk of such policies to the patient. The reported risk of alloimmunization after exposure to Rh(D)-positive RBCs ranges widely from 3 to 70%. In response, we performed a retrospective review of 1,198 patients in our institution that had a MTP activation due to trauma. Of those patients, we focused on Rh(D)-negative patients that received at least 1 unit of Rh(D)-positive RBCs. Seventy-two patients met the criteria for inclusion, accounting for 6% of the total population. Of the 72 Rh(D)-negative patients, we identified 17% that formed new Rh group antibodies after exposure to Rh(D)-positive RBCS. All 10 of our alloimmunized patients (two of which were females of childbearing age) formed anti-D, while 3 patients also formed either anti-E or anti-C. Since this was a retrospective review, we did not perform repeated antibody screens for the entire study period, but did review all records for the entire period. We did note that we were more likely to detect an novel alloantibody if more antibody screens were performed during the patient's initial stay and during follow-up visits. We conclude that providing Rh(D) negative patients Rh(D) positive RBC units is not without risk and policies regarding such provisions should be carefully considered. As RBC shortages continue to be a part of daily practice, such issues may continue to be a challenge for the blood bank community.
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Affiliation(s)
- Lance A Williams
- Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, United States.
| | - James Sikora
- Division of Laboratory Medicine, Department of Pathology, Emory University, United States
| | - Rana Aldrees
- Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, United States
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine, University of Southern California, United States
| | - Marisa B Marques
- Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, United States
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DeSimone RA, Sachais BS. Conservation of O- red blood cells: a fresh look at a shared responsibility. Transfusion 2018; 58:1333-1334. [PMID: 29949194 DOI: 10.1111/trf.14619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Robert A DeSimone
- New York Blood Center, New York, NY.,Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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41
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Prehospital low-titer cold-stored whole blood: Philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury. J Trauma Acute Care Surg 2018; 84:S115-S119. [DOI: 10.1097/ta.0000000000001905] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flommersfeld S, Mand C, Kühne CA, Bein G, Ruchholtz S, Sachs UJ. Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients. Transfus Med Hemother 2018; 45:158-161. [PMID: 29928169 DOI: 10.1159/000485388] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Immediate supply of red blood cell (RBC) concentrates is crucial in the initial treatment of exsanguinating patients in the emergency room. General shortage of RhD- RBCs has led to protocols in which patients with unknown blood groups are initially transfused with group O, RhD+ RBCs. Limited data are available regarding the safety of such an approach. Methods Transfusion protocols for all multiple injured patients from the regional polytrauma database were retrospectively analyzed over a period of 5 years. Data on side effects were retrieved from the local safety update registry. Follow-up data were obtained from patients with identified RhD-incompatible transfusions. Results In total, 823 patients were registered as multiple injured in the database. An immediate transfusion of 259 units (mean number of units 4, range 1-6) group O, RhD+ RBCs was initiated in 62 of them. 14 of these patients were RhD- and received 60 units of RhD-incompatible RBCs in the emergency room. In the later course RhD- patients received additional 185 incompatible transfusions (13; 1-31). The overall seroconversion rate was 50%. No adverse outcome due to incompatible transfusion was observed. Conclusions Initial supply with group O, RhD+ RBCs in multiple injured patients appears to be safe. Significant numbers of RhD- units can be saved for use in other patients.
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Affiliation(s)
- Sabine Flommersfeld
- Center for Transfusion Medicine and Hemotherapy, University Hospital Gießen and Marburg, Marburg Campus, Marburg, Germany
| | - Carsten Mand
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg, Campus Marburg, Marburg, Germany
| | | | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Gießen, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg, Campus Marburg, Marburg, Germany
| | - Ulrich J Sachs
- Center for Transfusion Medicine and Hemotherapy, University Hospital Gießen and Marburg, Marburg Campus, Marburg, Germany.,Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Gießen, Germany
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Dunbar NM, Yazer MH. O- product transfusion, inventory management, and utilization during shortage: the OPTIMUS study. Transfusion 2018; 58:1348-1355. [DOI: 10.1111/trf.14547] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Mark H. Yazer
- The Institute for Transfusion Medicine and the Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania
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Yazer MH, Cap AP, Spinella PC, Alarcon L, Triulzi DJ. How do I implement a whole blood program for massively bleeding patients? Transfusion 2018; 58:622-628. [PMID: 29332316 DOI: 10.1111/trf.14474] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 12/14/2022]
Abstract
Building on the successful military experience, interest has been rekindled in transfusing whole blood (WB) early in the resuscitation of traumatically injured civilians, often before their ABO group is known. WB efficiently provides treatment for shock and coagulopathy, as well as platelet hemostatic function, to patients losing large volumes of blood. Unlike group O uncrossmatched red blood cells (RBCs), group O WB contains a substantial amount of plasma, which is incompatible with the RBCs of all non-group O recipients. Thus, when implementing a WB program, it is important to decide how to mitigate the risk of immune-mediated hemolysis. Other questions that a hospital needs to answer before implementing a WB program include determining which patients will be eligible for this product, how many units eligible patients can receive, for how long it should be stored and under what conditions, and how to monitor for adverse events. The donor center needs to consider if the WB should be leukoreduced, how to comply with the AABB's transfusion-related acute lung injury risk mitigation standard, and into which storage solution it should be collected. This report describes the multidisciplinary approach taken to implementing a civilian WB program at a multihospital health care system in the United States.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, JBSA-FT Sam Houston, Texas
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, Missouri
| | - Louis Alarcon
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
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Liu J, Zhang S, Wang Q, Shen H, Zhang Y, Liu M. Frequencies and ethnic distribution of ABO and RhD blood groups in China: a population-based cross-sectional study. BMJ Open 2017; 7:e018476. [PMID: 29203504 PMCID: PMC5736034 DOI: 10.1136/bmjopen-2017-018476] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES ABO and RhD blood groups are key factors affecting blood transfusion safety. The distribution of ABO and RhD blood groups varies globally, but limited data exist for ethnic distributions of these blood groups in Asian populations. We aimed to evaluate the distribution of ABO and RhD blood groups among Chinese ethnic groups. DESIGN A population-based cross-sectional study. SETTING Data on ABO groups and ethnicities were obtained from the National Free Preconception Health Examination Project (NFPHEP) with participants from 220 counties of 31 provinces in China PARTICIPANTS: There were 3 832 034 participants aged 21-49 years who took part in the NFPHEP from January 2010 to December 2012 and were included in this study. OUTCOME MEASURES The proportion of ABO and RhD blood groups among different ethnic groups was calculated. RESULTS ABO and RhD blood distribution was significantly different among nine ethnic groups (P<0.001). Compared with other ethnic groups, the Yi group had more A phenotypes (34.0%), and the Manchu (33.7%) and Mongolian (33.3%) ethnic groups had more B phenotypes. The Zhuang group had the greatest proportion of O phenotypes (41.8%), followed by the Miao group (37.7%). AB phenotypes were more frequent in the Uygur ethnic group (10.6%) but lower in the Zhuang group (5.5%). Meanwhile, RhD negativity (RhD-) was greater in the Uygur group (3.3%) than in the Mongolian (0.3%) and Manchu ethnic groups (0.4%). O RhD- blood groups were more frequent in the Uygur group (0.8%) than in the other ethnic groups (0.1%-0.4%, P<0.001). CONCLUSION ABO and RhD blood phenotypes vary across different ethnic groups in China. The diversity in the distribution of the ABO and RhD blood groups in different ethnic groups should be considered when developing rational and evidence-based strategies for blood collection and management.
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Affiliation(s)
- Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shikun Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the Peoples Republic of China, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the Peoples Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the Peoples Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the Peoples Republic of China, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Conservation of the group O, Rhesus D negative blood supply. THE LANCET HAEMATOLOGY 2017; 4:e195-e196. [DOI: 10.1016/s2352-3026(17)30057-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
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