Presence of aspirin in blood units

Antihypertensive drugs in blood donations in Serbia - Observational study

INTRODUCTION

Most of the blood banks worldwide do not defer donors for their medication, with the exception of the teratogenic and platelet aggregation-inhibiting drugs use. In Serbia, where around 245.000 units of blood are collected each year, it is not common practice to consider the medication of potential blood donors. Therefore, the aim of this study was to quantify the presence of antihypertensive drugs in blood samples collected from blood donors treated for hypertension and to raise the issue of the recipient risks posed by drug residues in blood products.

METHODS

Serum samples were obtained from 450 volunteer blood donors collected during the year 2017 who reported the use of antihypertensive drugs. All blood donors were required to interrupt regular antihypertensive therapy for 24 h before blood donation and LCMS determination of antihypertensive drugs was performed.

RESULTS

Beta blockers were detected in 81 out of 203 samples which tested positive for the presence of antihypertensive drugs. Concentrations above the limit of quantification were determined in 58% of samples positive on beta blockers, containing metoprolol and bisoprolol in amounts sufficient to produce a therapeutic effect in the recipient.

CONCLUSION

Therefore, the obtained results suggested that the safety of blood donation from individuals with treated hypertension should not be neglected. A solution for this problem might be the establishment of a standard LCMS screening procedure as a tool for testing the blood of donors taking drugs.

The impact of platelet additive solution apheresis platelets on allergic transfusion reactions and corrected count increment (CME)

BACKGROUND

Allergic transfusion reaction (ATR) incidence ranges from 1% to 3% of all transfusions. We evaluated the impact of InterSol platelet additive solution (PAS) apheresis platelets (APs) on the incidence of ATRs and the posttransfusion platelet (PLT) increment.

STUDY DESIGN AND METHODS

This retrospective study evaluated all ATRs among patients at a university hospital that maintained a mixed inventory of PAS APs and non-PAS APs (standard plasma-suspended PLTs). Corrected count increments (CCIs) were calculated for AP transfusions of individuals who received both a PAS and a non-PAS AP transfusion within a 7-day period. Hypothesis testing was performed with chi-square test for dichotomous variables and t tests for continuous variables.

RESULTS

The incidence of ATRs among the non-PAS APs was 1.85% (72 ATRs/3884 transfusions) and 1.01% (12 ATRs/1194 transfusions) for PAS APs (risk ratio [RR], 0.54; 95% confidence interval [CI]=0.30-0.99; p=0.04). However, there was no difference in the incidence of febrile nonhemolytic transfusion reactions between non-PAS APs (incidence, 0.70%; 27/3884) compared to PAS APs (incidence, 0.59%; 7/1194; p=0.69). Among 223 individuals with paired non-PAS and PAS AP transfusions, the mean CCI at 1 to 4 hours after transfusion was 4932 (95% CI, 4452-5412) for non-PAS APs and was lower for PAS APs (CCI, 3766; 95% CI, 3375-4158; p ≤ 0.001). However, there was no significant difference in mean CCI at 12 to 24 hours between non-PAS (CCI, 2135; 95% CI, 1696-2573) and PAS APs (CCI, 1745; 95% CI, 1272-2217; p=0.14).

CONCLUSIONS

PAS APs substantially reduce the number of ATRs. CCIs for PAS APs were lower immediately after transfusion, but not significantly different at 12 to 24 hours.

Pregnancy outcome of women transfused during pregnancy with blood products inadvertently obtained from donors treated with acitretin

We assessed the pregnancy outcome of nine women inadvertently transfused with acitretin-contaminated blood products in South Korea. A total of 18 women matched to cases by age, gravidity, and singleton- or twin-pregnancy, and who were transfused with blood products not contaminated with acitretin, was also recruited. There were nine babies born in the case group. No differences (p > 0.05) were observed between cases and controls in the gestational age at delivery (38.3 +/- 1.6 weeks vs 37.8 +/- 2.2 weeks), birth weight (3,146 +/- 874 g vs 3,106 +/- 568 g), rate of pre-term deliveries (22.2% vs 11.1%) and rate of low birth weight (<2,500 g) (33.3% vs 16.7%). There was no case of malformation or neurological abnormalities born in either group. In conclusion, inadvertent exposure to acitretin-contaminated blood products was not associated with adverse pregnancy outcomes, probably because of the removal of acitretin and etretinate during the manufacturing process of blood products.

Blood Donors on Medication - an Approach to Minimize Drug Burden for Recipients of Blood Products and to Limit Deferral of Donors

BACKGROUND: Blood products derived from donors on medication can contain drugs which might pose a risk for the recipients or influence the quality of the product itself. MATERIAL AND METHODS: To judge the eligibility of blood donors on medication, 4 drug classes have been formed with respect to their pharmacological properties, and blood products have been divided in accordance with their single-donor plasma contents. RESULTS: For drugs with dose-dependent pharmacodynamics, no deferral periods are necessary for donation of blood products containing less than 50 ml single-donor plasma for application to adults. Waiting periods of t(max) + 5 t(1/2) were calculated for the other blood products. Teratogenic drugs do not require special considerations (exception: retinoids, thalidomide and lenalidomide, dutasteride or finasteride with waiting periods for all blood products). A deferral period of t(max) + 24 t(1/2) is proposed for every blood product from blood donors on genotoxic drugs. Drugs without systemic effects can be neglected. Irreversible inhibitors of platelet function cause a 10-day waiting period if production of platelet concentrates is intended. CONCLUSION: Donors on medication are allowed to donate blood for blood products containing less than 50 ml plasma of a single donor, like red blood cell concentrates, for the use in adults without deferral periods, except those taking retinoids, thalidomide, lenalidomide, dutasteride, finasteride, or genotoxic drugs.

Pulmonary transfusion reactions

Transfusion reactions remain a common complication of transfusion therapy; reactions affecting the lungs are some of the most serious. Several different mechanisms are responsible for pulmonary transfusion reactions, and most cause adverse effects in addition to lung injury. Fluid overload can lead to pulmonary edema, antibodies reacting with plasma proteins can cause bronchospasm and anaphylaxis, and particulate matter can produce microemboli. These reactions are well understood and usually can be prevented. Transfusions are also associated with acute lung injury and acute respiratory distress syndrome (ARDS), but their etiology is poorly understood and they remain clinically problematic. Neutrophil antibodies cause some of these serious as well as mild pulmonary reactions, but the exact role of leukocyte antibodies in pulmonary reactions remains unclear. Other blood donor, blood component, and transfusion recipient factors likely play a contributing or modulating role in pulmonary transfusion reactions, but prospective studies are needed to better understand their role.

Does blood donor history accurately reflect the use of prescription medications? A comparison of donor history and serum toxicologic analysis

BACKGROUND

Blood donor screening is performed to accomplish several goals, including donor safety during collection and recipient safety during transfusion. Donors taking certain medications such as teratogens or platelet-inhibiting drugs are deferred from donation. Studies investigating the accuracy of the donor history are limited and only provide data on select groups of drugs. This study compares the results of an extended serum toxicology analysis to the medication use reported on the donor questionnaire.

STUDY DESIGN AND METHODS

Whole-blood samples were collected from 108 volunteer blood donors. A serum toxicology analysis was performed with high-performance liquid chromatography with photodiode array detection. The results were compared to those reported on the donor history questionnaire.

RESULTS

The medication history was consistent with the reported medications in 96 (89%) donors. Serum toxicology testing detected medications that were not reported on the donor history form in 12 (11%) donors. Most of the donors who did not accurately report their medication use (8 or 67%) were taking psychotropic medications.

CONCLUSION

Eleven percent of the donors did not fully disclose their recent medication history. Although none of the omitted medications would have been grounds for deferral, the finding of underreporting questions the reliability of donor screening. Despite a negative medication history, blood donor centers cannot assume that donors are medication-free. This study reveals a bias to omit psychotropic medications such as antidepressants and anxiolytics.

Risks and side effects of therapy with plasma and plasma fractions

Transfusion of plasma can lead to adverse reactions or events. Immune-mediated reactions are most common--these include allergic and anaphylactic reactions, transfusion-related acute lung injury (TRALI) and haemolysis. They can range in severity from mild to fatal. Fluid overload and citrate toxicity can occur after rapid or massive transfusion. In developed countries, microbial transmission rates are low because of donor selection and testing. Pathogen reduction processes can be applied to either single-unit components (methylene blue) or plasma pools (solvent-detergent). They have the unwanted effect of reducing some coagulation factors but reduce viral transmission risk even further. Reactions associated with plasma products or fractions also include allergic reactions, although TRALI is rare. Viral transmission risk is very low because of the use of two independent viral inactivation steps. Different products have particular specific unwanted effects: intravenous immunoglobulin has been associated with thrombotic events, renal toxicity and aseptic meningitis; coagulation factors are associated with development of inhibitors and thrombotic events. The risk of transmission of variant Creutzfeldt-Jakob disease in both plasma components and pooled plasma products is as yet unknown. If anything, the low titre of prion infectivity in the blood of an infected individual (approximately 10 infectious units/ml) will be massively diluted by the thousands of units of plasma in the pool. Subsequent manufacturing processes also remove prions from the final product.

The effect of ASA on platelet activation during apheresis and on in-vitro properties of stored platelet concentrates

BACKGROUND

Preventing the activation of PLTs may ameliorate (or mitigate) the PLT storage lesion (PSL), which encloses all structural and biochemical changes caused by collection, processing, and storage of PLT concentrates (PCs). Partial inhibition of PLT function due to ingestion of aspirin (ASA) by blood donors reduces the functional activity of the collected PLTs, however, by preventing premature PLT activation, it might reduce the PSL as well.

STUDY DESIGN AND METHODS

In a randomized crossover study, 10 healthy donors donated two single-donor PCs (SDPCs) each, taking 500 mg ASA 12 hours before one of the aphereses (Group A) and taking no medication before the other donation (Group B). In-vitro tests of PLT function were performed in donors before and after apheresis and in SDPCs during storage (Days 1, 3, and 5).

RESULTS

ASA ingestion resulted in a significant decrease of induced PLT aggregation in donors (p < 0.005) and SDPCs on Day 1 (p < 0.01). TRAP-6-induced expression of p-selectin (CD62p) was significantly reduced in Group A SDPCs only on Day 1 (p < 0.02). There were no significant differences of in-vitro function (LDH, lactate, pH, morphology score, CD62p expression, fibrinogen binding) between Group A and B (SDPCs and donors). Apheresis did not result in a significant activation of PLTs in donors or SDPCs.

CONCLUSIONS

These limited data do not show a detectable beneficial effect of ASA ingestion on the PSL but do suggest that ASA ingestion before apheresis may not be detrimental to the clinical effectiveness of the stored product.

Non-infectious complications of transfusion therapy

Blood transfusion is considered safe when the infused blood is tested using state of the art viral assays developed over the past several decades. Only rarely are known viruses like HIV and hepatitis C transmitted by transfusion when blood donors are screened using these sensitive laboratory tests. However, there are a variety of transfusion risks which still remain that cannot be entirely eliminated, many of which are non-infectious in nature. Predominantly immune-mediated complications include the rapid intravascular or slow extravascular destruction (hemolysis) of transfused red cells or extravascular removal of platelets by pre-formed antibodies carried by the transfusion recipient. Alternatively, red cells can be damaged when exposed to excessive heat or incompatible intravenous fluids before or during the transfusion. Common complications of blood transfusion that at least partly involve the immune system include febrile non-hemolytic and allergic reactions. While these are usually not life-threatening, they can hamper efforts to transfuse a patient. Other complications include circulatory overload, hypothermia and metabolic disturbances. Profound hypotensive episodes have been described in patients on angiotensin-converting enzyme (ACE) inhibitors who receive platelet transfusions through bedside leukoreduction filters. These curious reactions appear to involve dysmetabolism of the vasoactive substance bradykinin. Products contaminated by bacteria during blood collection and transfused can cause life-threatening septic reactions. A long-term complication of blood transfusion therapy unique to chronically transfused patients is iron overload. Less common - but serious - reactions more specific to blood transfusion include transfusion-associated graft-versus-host disease and transfusion-associated acute lung injury. Many of these complications of transfusion therapy can be prevented by adhering to well-established practice guidelines. In addition, individuals who administer blood transfusions should recognize these complications in order to be able to quickly provide appropriate treatment.

Drugs in donated blood

Blood from donors who are or who have been on drug treatment may be hazardous to the recipient. Guidelines are proposed to increase the safety of donated blood without needless rejection of donors, based on the time that should elapse between the last dose and safe blood donation for a range of commonly used drugs.

Self-medication in urban and rural Zimbabwean communities

1. A questionnaire examining the use of, and knowledge about over-the-counter (OTC) drugs was administered verbally to representatives from 200 urban and 200 rural households. Self-medication was common in both groups but there were more drugs present in rural (336 items) than urban homes (231 items) with the differences largely due to the more frequent presence of traditional medicines in rural homes. 2. Analgesics were the commonest items in the homes of both groups. A positive urine screening test for aspirin, chloroquine, or antibiotics was found in 25% of urban and 27% of rural samples tested. Respondents who elected to use an OTC drug for a particular symptom usually chose an appropriate drug. 3. Rural respondents were more likely to use traditional medicines particularly for the treatment of cough, abdominal pain, and diarrhoea. 4. Knowledge about dosages, the possibility of adverse reactions, and the seriousness of potential poisoning with OTC drugs was inadequate and needs to be corrected for more efficient self-medication.

Passive transfusion of human chorionic gonadotropin from plasma donated during pregnancy

Although fresh frozen plasma (FFP) prepared from autologous blood donated during pregnancy has frequently been given to homologous recipients at our institution, one transfusion resulted in an unanticipated diagnostic dilemma. A 31-year-old woman with disseminated intravascular coagulation of unclear etiology was transfused with multiple units of FFP, including 2 from pregnant autologous donors. A serum human chorionic gonadotropin (HCG) assay, performed because of the possibility that the patient's illness was a complication of unrecognized pregnancy, was positive using a blood sample drawn 7 h after the transfusions. An extensive evaluation was completed before the possibility of passive transfer of hormone from blood products was considered. Retrospective testing of serum samples established that HCG appeared in the patient's serum only after the first FFP transfusion from a pregnant autologous donor. In 8 other recipients of 1 or 2 units of FFP from pregnant autologous donors, post-transfusion HCG levels ranged between 96 and 1,750 mIU/ml. Of 15 recipients of packed red blood cells from pregnant autologous donors, only patients with renal failure or recipients of multiple units developed positive HCGs, which were always less than or equal to 85 mIU/ml. The differential diagnosis of a positive pregnancy test in a recently transfused individual should include the possibility of passively acquired hormone.

Incidence of acetaminophen in donated blood

Acetaminophen levels were determined in 1,176 sera separated from donated blood. The analysis was performed by both a colorimetric method and by high performance liquid chromatography. 6.12% of the samples contained acetaminophen levels ranging from 18 to 58 microgram/ml. The possible clinical significance of such a high incidence of this drug among healthy blood donors is discussed.