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Berg P, Heiden M, Müller S, Meyer B, Witzenhausen C, Ruppert-Seipp G, Kehr S, Funk MB. A national surveillance system for continuous monitoring of blood transfusion safety: German haemovigilance data. Vox Sang 2024; 119:953-962. [PMID: 38889998 DOI: 10.1111/vox.13694] [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: 12/09/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND AND OBJECTIVES Haemovigilance (HV) systems aim to improve transfusion outcomes in patients and donor safety. An important question for blood regulators is how to ensure an effective HV system. MATERIALS AND METHODS We retrospectively analysed the HV reports submitted to Paul-Ehrlich-Institut over the last two decades. RESULTS Between 2011 and 2020, 50.86 million units of blood components were used, and 8931 suspected serious donor and recipient adverse reactions (SARs), 874 serious adverse events (SAEs) and 12,073 donor look-backs were reported. Following implementation of specific risk-minimization measures (RMMs) between 2000 and 2010, SAR reporting rates decreased for transfusion-transmitted viral infections (TTVIs), transfusion-related acute lung injury (TRALI) and transfusion-transmitted bacterial infections (TTBIs), while increasing for other serious adverse transfusion reactions. Within this decade, the overall blood component use decreased. CONCLUSION Long-term data collection forms the basis to establish trends and changes in reporting and to evaluate the effect of RMM. Standardized criteria for reaction types, seriousness and imputability assessments and availability of a denominator are important elements. Central data collection and independent assessment allow for monitoring HV data in a nationwide context over time. Stakeholder involvement and transparent feedback on the benefit of RMM will help to achieve the objectives of HV.
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Affiliation(s)
- Philipp Berg
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Margarethe Heiden
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Susanne Müller
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Britta Meyer
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Cornelia Witzenhausen
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Gabriele Ruppert-Seipp
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Sarah Kehr
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Markus B Funk
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
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2
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Engelhardt LJ, Olbricht C, Niemann M, Graw JA, Hunsicker O, Weiss B, Bünger V, Weber-Carstens S, Boie SD, Piper SK, Balzer F, Menk M. Outcome Comparison of Acute Respiratory Distress Syndrome (ARDS) in Patients with Trauma-Associated and Non-Trauma-Associated ARDS: A Retrospective 11-Year Period Analysis. J Clin Med 2022; 11:jcm11195734. [PMID: 36233603 PMCID: PMC9571015 DOI: 10.3390/jcm11195734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Acute respiratory distress syndrome (ARDS) is a rare complication in multiply injured patients. Due to the rarity of ARDS development after trauma, little is known about outcomes of patients with trauma-associated ARDS compared to patients with non-trauma-associated ARDS. (2) Methods: This retrospective analysis included n = 1038 ARDS patients admitted to the ARDS center of Charité—Universitätsmedizin Berlin between 2007 and 2018. Patients with trauma-associated ARDS (n = 62) were compared to patients with non-trauma-associated ARDS (n = 976). In a secondary analysis, patients from the group with non-trauma-associated ARDS were 1:1 nearest neighbor matched to patients with trauma-associated ARDS. The primary outcomes were 28-day in-hospital mortality, 60-day in-hospital mortality, and overall in-hospital mortality. (3) Results: Overall in-hospital mortality in trauma-associated ARDS was 29.0% compared to 40.5% in all patients with non-trauma-associated ARDS (p = 0.074). The in-hospital mortality rate in matched patients with non-trauma-associated ARDS (33.9%) was comparable to the trauma-associated ARDS cohort (p = 0.701). Kaplan–Meier curves indicated time-sensitive variations in 28-day and 60-day in-hospital survival. (4) Conclusion: Mortality was not different in patients with trauma-associated ARDS compared to patients with non-trauma-associated ARDS. Survival rate in the Kaplan–Meier curves stabilized after the critical initial phase and throughout the further 60-day period in patients with trauma-associated ARDS compared to patients with non-trauma-associated ARDS. Since this divergence was less pronounced in the matched cohort, it may be related to the younger age, fewer comorbidities, and lower ARDS severity in patients with trauma-associated ARDS. Patients with trauma-associated ARDS remain a very different cohort compared to patients with non-trauma-associated ARDS. Therefore, the outcome comparison is limited, even after matching.
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Affiliation(s)
- Lilian Jo Engelhardt
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Claudio Olbricht
- Klinik für Anästhesie und Intensivmedizin, Evangelische Elisabeth Klinik Johannesstift Diakonie, Lützowstraße 24–26, 10785 Berlin, Germany
| | - Marcel Niemann
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jan Adriaan Graw
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
| | - Oliver Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
| | - Victoria Bünger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
| | - Sebastian Daniel Boie
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophie K. Piper
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany or
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Correspondence:
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3
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Dietrich M, Hölle T, Lalev LD, Loos M, Schmitt FCF, Fiedler MO, Hackert T, Richter DC, Weigand MA, Fischer D. Plasma Transfusion in Septic Shock—A Secondary Analysis of a Retrospective Single-Center Cohort. J Clin Med 2022; 11:jcm11154367. [PMID: 35955987 PMCID: PMC9369152 DOI: 10.3390/jcm11154367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/09/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
In sepsis, both beneficial and detrimental effects of fresh frozen plasma (FFP) transfusion have been reported. The aim of this study was to analyze the indication for and effect of FFP transfusion in patients with septic shock. We performed a secondary analysis of a retrospective single-center cohort of all patients treated for septic shock at the interdisciplinary surgical intensive care unit (ICU) of the Heidelberg University Hospital. Septic shock was defined according to sepsis-3 criteria. To assess the effects of FFP administration in the early phase of septic shock, we compared patients with and without FFP transfusion during the first 48 h of septic shock. Patients who died during the first 48 h of septic shock were excluded from the analysis. Primary endpoints were 30- and 90-day mortality. A total of 261 patients were identified, of which 100 (38.3%) received FFP transfusion within the first 48 h after septic shock onset. The unmatched analysis showed a trend toward higher 30- and 90-d mortality in the FFP group (30 d: +7% p = 0.261; 90 d: +11.9% p = 0.061). In the propensity-matched analysis, 30- and 90-day mortality were similar between groups. Plasma administration did not influence fluid or vasopressor need, lactate levels, ICU stay, or days on a ventilator. We found no significant harm or associated benefit of FFP use in the early phase of septic shock. Finally, plasma should only be used in patients with a strong indication according to current recommendations, as a conclusive evaluation of the risk-benefit ratio for plasma transfusion in septic shock cannot be made based on the current data.
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Affiliation(s)
- Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
- Correspondence:
| | - Tobias Hölle
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Lazar Detelinov Lalev
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (M.L.); (T.H.)
| | - Felix Carl Fabian Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Mascha Onida Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (M.L.); (T.H.)
| | - Daniel Christoph Richter
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Markus Alexander Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Dania Fischer
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
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Abstract
The term transfusion-related acute lung injury (TRALI) was coined in 1985 to describe acute respiratory distress syndrome (ARDS) after transfusion, when another ARDS risk factor was absent; TRALI cases were mostly associated with donor leukocyte antibody. In 2001, plasma from multiparous donors was implicated in TRALI in a randomized controlled trial in Sweden. In 2003 and in many years thereafter, the FDA reported that TRALI was the leading cause of death from transfusion in the United States. In 2003, the United Kingdom was the first among many countries to successfully reduce TRALI using male-predominant plasma. These successes are to be celebrated. Nevertheless, questions remain about the mechanisms of non-antibody TRALI, the role of blood products in the development of ARDS in massive transfusion patients, the causes of unusual TRALI cases, and how to reduce inaccurate clinical diagnoses of TRALI in clinical practice. Regarding the latter, a study in 2013-2015 at 169 US hospitals found that many TRALI diagnoses did not meet clinical definitions. In 2019, a consensus panel established a more precise terminology for clinical diagnosis: TRALI type I and TRALI type II are cases where transfusion is the likely cause, and ARDS are cases where transfusion is not the likely cause. For accurate diagnosis using these clinical definitions, critical care expertise is needed to distinguish between permeability versus hydrostatic pulmonary edema, to determine whether an ARDS risk factor is present and, if so, whether respiratory function was stable within the 12 hours before transfusion.
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5
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Lu W. A Concise Synopsis of Current Literature and Guidelines on the Practice of Plasma Transfusion. Clin Lab Med 2021; 41:635-645. [PMID: 34689970 DOI: 10.1016/j.cll.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence-based indications for plasma transfusion are limited, and much of the clinical practice relies on expert opinion. This article highlights key studies, meta-analyses, and guidelines for plasma transfusion in adults. The goal is to limit non-evidence-based plasma transfusion that is outside of clinical guideline, because as with all transfusions, the administration of plasma is not without risk. Any intended potential benefit must be appraised against the real risks associated with transfusion. Moving forward, the practice of plasma transfusion would benefit greatly from randomized controlled trials to update and expand the existing guidelines.
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Affiliation(s)
- Wen Lu
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street Cotran 260, Boston, MA 02115, USA.
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6
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Adam EH, Fischer D. Plasma Transfusion Practice in Adult Surgical Patients: Systematic Review of the Literature. Transfus Med Hemother 2020; 47:347-359. [PMID: 33173453 DOI: 10.1159/000511271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background Plasma transfusions are most commonly used therapeutically for bleeding or prophylactically in non-bleeding patients prior to invasive procedures or surgery. Although plasma transfusions generally seem to decline, plasma usage for indications that lack evidence of efficacy prevail. Summary There is wide international, interinstitutional, and interindividual variance regarding the compliance with guidelines based on published references, supported by appropriate testing. There is furthermore a profound lack of evidence from randomized controlled trials comparing the effect of plasma transfusion with that of other therapeutic interventions for most indications, including massive bleeding. The expected benefit of a plasma transfusion needs to be balanced carefully against the associated risk of adverse events. In light of the heterogeneous nature of bleeding conditions and their rapid evolvement over time, fibrinogen and factor concentrate therapy, directed at specific phases of coagulation identified by alternative laboratory assays, may offer advantages over conventional blood product ratio-driven resuscitation. However, their outcome benefit has not been demonstrated in well-powered prospective trials. This systematic review will detail the current evidence base for plasma transfusion in adult surgical patients.
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Affiliation(s)
- Elisabeth Hannah Adam
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Dania Fischer
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
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7
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Luckhurst CM, Saillant NN. Plasma: a Brief History, the Evidence, and Current Recommendations. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00181-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Weinstock C, Schnaidt M. Human Leucocyte Antigen Sensitisation and Its Impact on Transfusion Practice. Transfus Med Hemother 2019; 46:356-369. [PMID: 31832061 DOI: 10.1159/000502158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/13/2019] [Indexed: 01/25/2023] Open
Abstract
Human leucocyte antigen (HLA) sensitisation, including the formation of antibodies against HLA, can cause serious effects in patients receiving blood. Under certain circumstances, donor HLA antibodies in the blood product can trigger the patient's granulocytes to release mediators that cause transfusion-associated lung injury (TRALI), a serious complication of transfusion. The HLA systems of both donor and patient are involved in transfusion-associated graft-versus-host disease, which is a rare disease with a high mortality. Patient HLA antibodies can destroy incompatible platelets and may cause refractoriness to platelet transfusion. Identification of a patient's HLA antibody specificities is necessary for issuing compatible platelets to overcome refractoriness. Many techniques for the detection and identification of HLA antibodies have been developed, including complement-dependent cytotoxicity assay, bead-based assays, the platelet adhesion immunofluorescence test, and the monoclonal antibody-specific immobilisation of platelet antigens assay. Different strategies for the selection of HLA-compatible platelets are applied. These strategies depend on the breadth of antibody reactivity and range from avoiding single HLA antigens in the platelet concentrates issued to apheresis of platelets from HLA-identical donors. The mechanisms of HLA sensitisation and the efforts made to provide compatible blood products to sensitised patients are reviewed in this article from the perspective of clinical transfusion medicine.
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Affiliation(s)
- Christof Weinstock
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Ulm, Institute of Transfusion Medicine, Ulm University, Ulm, Germany
| | - Martina Schnaidt
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
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9
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Vlaar APJ, Toy P, Fung M, Looney MR, Juffermans NP, Bux J, Bolton-Maggs P, Peters AL, Silliman CC, Kor DJ, Kleinman S. A consensus redefinition of transfusion-related acute lung injury. Transfusion 2019; 59:2465-2476. [PMID: 30993745 PMCID: PMC6850655 DOI: 10.1111/trf.15311] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and mortality in most developed countries. In the past decade, the pathophysiology of this potentially life-threatening syndrome has been increasingly elucidated, large cohort studies have identified associated patient conditions and transfusion risk factors, and preventive strategies have been successfully implemented. These new insights provide a rationale for updating the 2004 consensus definition of TRALI. STUDY DESIGN AND METHODS An international expert panel used the Delphi methodology to develop a redefinition of TRALI by modifying and updating the 2004 definition. Additionally, the panel reviewed issues related to TRALI nomenclature, patient conditions associated with acute respiratory distress syndrome (ARDS) and TRALI, TRALI pathophysiology, and standardization of reporting of TRALI cases. RESULTS In the redefinition, the term "possible TRALI" has been dropped. The terminology of TRALI Type I (without an ARDS risk factor) and TRALI Type II (with an ARDS risk factor or with mild existing ARDS) is proposed. Cases with an ARDS risk factor that meet ARDS diagnostic criteria and where respiratory deterioration over the 12 hours before transfusion implicates the risk factor as causative should be classified as ARDS. TRALI remains a clinical diagnosis and does not require detection of cognate white blood cell antibodies. CONCLUSIONS Clinicians should report all cases of posttransfusion pulmonary edema to the transfusion service so that further investigation can allow for classification of such cases as TRALI (Type I or Type II), ARDS, transfusion-associated circulatory overload (TACO), or TRALI or TACO cannot distinguish or an alternate diagnosis.
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Affiliation(s)
- Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, the Netherlands
| | - Pearl Toy
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | - Mark R Looney
- Departments of Medicine and Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, the Netherlands
| | - Juergen Bux
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Paula Bolton-Maggs
- Serious Hazards of Transfusion Office, Manchester Blood Centre, Manchester, United Kingdom
| | - Anna L Peters
- Division Vital Functions, Department of Anesthesiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Christopher C Silliman
- School of Medicine, Pediatrics and Surgery, University of Colorado Denver, Denver, Colorado
| | - Daryl J Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steve Kleinman
- Department of Pathology, University British Columbia, Vancouver, British Columbia, Canada
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10
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Kopko PM, Bux J, Toy P. Antibodies associated with TRALI: differences in clinical relevance. Transfusion 2018; 59:1147-1151. [PMID: 30548883 DOI: 10.1111/trf.15094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Patricia M Kopko
- Department of Pathology, University of California, San Diego, San Diego, California
| | | | - Pearl Toy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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11
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Edens C, Haass KA, Cumming M, Osinski A, O'Hearn L, Passanisi K, Eaton L, Visintainer P, Savinkina A, Kuehnert MJ, Basavaraju SV, Andrzejewski C. Evaluation of the National Healthcare Safety Network Hemovigilance Module for transfusion-related adverse reactions in the United States. Transfusion 2018; 59:524-533. [PMID: 30427540 DOI: 10.1111/trf.15008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/13/2018] [Accepted: 09/16/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The National Healthcare Safety Network (NHSN) Hemovigilance Module (HM) collects data on the frequency, severity, and imputability of transfusion-associated adverse events. These events contribute to significant morbidity and mortality among transfusion patients. We report results from the first systematic assessment of eight attributes of the HM. MATERIALS AND METHODS Standard methods were used to assess the HM. Evaluation data included training materials, system modification history, and facility survey information. A concordance analysis was performed using data from the Baystate Medical Center's (Springfield, MA) electronic transfusion reporting system. RESULTS In 2016, system representativeness remained low, with 6% (277 of 4690) of acute care facilities across 43 jurisdictions enrolled in the HM. In 2016, 48% (2147 of 4453) and 89% (3969 of 4,453) of adverse reactions were reported within 30 and 90 days of the reaction date, respectively, compared to 21% (109 of 511) and 56% (284 of 511) in 2010, demonstrating improved reporting timeliness. Data quality from most reactions was adequate, with 10% (45 of 442) misclassified transfusion-associated circulatory overload reactions, and no incomplete transfusion-transmitted infection data reported from 2010 to 2013. When compared to the Baystate system to assess concordance, 43% (24 of 56) of NHSN-reported febrile reactions were captured in both systems (unweighted kappa value, 0.47; confidence interval, 0.33-0.61). CONCLUSION Since the 2010 HM pilot, improvements have led to enhanced simplicity, timeliness, and strengthened data quality. The HM serves an important and unique role despite incomplete adoption nationwide. Facility efforts to track and prevent transfusion-associated adverse events through systems like the NHSN HM are a key step toward improving transfusion safety in the United States.
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Affiliation(s)
- Chris Edens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Epidemic Intelligence Service, CDC, Atlanta, Georgia
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Melissa Cumming
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Anthony Osinski
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | | | - Lynn Eaton
- Baystate Medical Center, Springfield, Massachusetts
| | | | - Alexandra Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Matthew J Kuehnert
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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12
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Nguyen XD, Schulze TJ, Bugert P, Lauber-Härtl S, Schulz-Linkholt M, González-Schulze K, Reil A, Dengler T, Panzer S, Seifried E. Granulocyte antibodies in male blood donors: can they trigger transfusion-related acute lung injury? Transfusion 2018; 58:1894-1901. [PMID: 29707799 DOI: 10.1111/trf.14630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND White blood cell-associated antibodies can lead to transfusion-related acute lung injury (TRALI). Female donors with a history of pregnancies have been identified as a main cause for these antibodies. Male or female donors without a history of pregnancy are considered as safe donors. STUDY DESIGN AND METHODS Following the identification of two TRALI cases associated with blood products from male donors, we investigated the frequency of granulocyte-specific and human leukocyte antigen (HLA) antibodies in the entire blood donor population using a high throughput automated flow-cytometry-based granulocyte immunofluorescence test (Flow-GIFT). We investigated sera from 14,343 whole blood donors (female, n = 6974, 48.7%; male, n = 7369, 51.3%) using automated Flow-GIFT. Of the female blood donors, 60.4% had a history of pregnancy. Positive sera were retested by the standard granulocyte immunofluorescence test and granulocyte agglutination test. For the detection of HLA Class I and II immunoglobulin G antibodies, we used a commercial screening enzyme-linked immunosorbent assay. RESULTS We detected in 924 (21.9%) of the 4212 females with a history of pregnancy antibodies against granulocyte antigens (n = 62, 1.5%), HLA Class I and/or II antigens (n = 864, 20.5%). Notably, in 3.5% (n = 96) of 2762 females without a history of pregnancy and in 2.1% (n = 154) of 7369 males antibodies against granulocyte antigens (n = 13, 0.47% and n = 45, 0.6%), HLA Class I and/or II (n = 83, 3% and n = 109, 1.4%, respectively), were also detected. CONCLUSION Human neutrophil antigen antibodies are rare in male and females without a history of pregnancy compared to females with a history of pregnancy, but their relevance is not negligible.
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Affiliation(s)
- Xuan-Duc Nguyen
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Torsten J Schulze
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany.,German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Peter Bugert
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Stephanie Lauber-Härtl
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Monika Schulz-Linkholt
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Karen González-Schulze
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | | | - Thomas Dengler
- Institute of Transfusion Medicine and Immunohematology, Baden-Baden, German Red Cross Blood Service Baden-Württemberg-Hessen, Baden-Baden, Germany
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg-Hessen, Goethe University Hospital, Frankfurt am Main, Germany
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13
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Abstract
Traumatic hemorrhage is the leading cause of preventable death after trauma. Early transfusion of plasma and balanced transfusion have been shown to optimize survival, mitigate the acute coagulopathy of trauma, and restore the endothelial glycocalyx. There are a myriad of plasma formulations available worldwide, including fresh frozen plasma, thawed plasma, liquid plasma, plasma frozen within 24 h, and lyophilized plasma (LP). Significant equipoise exists in the literature regarding the optimal plasma formulation. LP is a freeze-dried formulation that was originally developed in the 1930s and used by the American and British military in World War II. It was subsequently discontinued due to risk of disease transmission from pooled donors. Recently, there has been a significant amount of research focusing on optimizing reconstitution of LP. Findings show that sterile water buffered with ascorbic acid results in decreased blood loss with suppression of systemic inflammation. We are now beginning to realize the creation of a plasma-derived formulation that rapidly produces the associated benefits without logistical or safety constraints. This review will highlight the history of plasma, detail the various types of plasma formulations currently available, their pathophysiological effects, impacts of storage on coagulation factors in vitro and in vivo, novel concepts, and future directions.
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14
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Andreu G, Boudjedir K, Muller JY, Pouchol E, Ozier Y, Fevre G, Gautreau C, Quaranta JF, Drouet C, Rieux C, Mertes PM, Clavier B, Carlier M, Sandid I. Analysis of Transfusion-Related Acute Lung Injury and Possible Transfusion-Related Acute Lung Injury Reported to the French Hemovigilance Network From 2007 to 2013. Transfus Med Rev 2018; 32:16-27. [DOI: 10.1016/j.tmrv.2017.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/13/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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15
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Otrock ZK, Liu C, Grossman BJ. Transfusion-related acute lung injury risk mitigation: an update. Vox Sang 2017; 112:694-703. [PMID: 28948604 DOI: 10.1111/vox.12573] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/11/2017] [Accepted: 08/11/2017] [Indexed: 02/04/2023]
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening complication of transfusion. Greater understanding of the pathophysiology of this syndrome has much improved during the last two decades. Plasma-containing components from female donors with leucocyte antibodies were responsible for the majority of TRALI fatalities before mitigation strategies were implemented. Over the past 15 years, measures to mitigate risk for TRALI have been implemented worldwide and they continued to evolve with time. The AABB requires that all plasma containing components and whole blood for transfusion must be collected from men, women who have not been pregnant, or women who have tested negative for human leucocyte antigen antibodies. Although the incidence of TRALI has decreased following the institution of TRALI mitigation strategies, TRALI is still the most common cause of transfusion-associated death in the United States. In this review, we focus on TRALI risk mitigation strategies. We describe the measures taken by blood collection facilities to reduce the risk of TRALI in the United States, Canada and European countries. We also review the literature for the effectiveness of these measures.
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Affiliation(s)
- Z K Otrock
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - C Liu
- Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, MO, USA
| | - B J Grossman
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
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16
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Saadah NH, van Hout FM, Schipperus MR, le Cessie S, Middelburg RA, Wiersum-Osselton JC, van der Bom JG. Comparing transfusion reaction rates for various plasma types: a systematic review and meta-analysis/regression. Transfusion 2017; 57:2104-2114. [DOI: 10.1111/trf.14245] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas H. Saadah
- Center for Clinical Transfusion Research, Sanquin Blood Supply
- Department of Clinical Epidemiology; Leiden University Medical Center
| | - Fabienne M.A. van Hout
- Center for Clinical Transfusion Research, Sanquin Blood Supply
- Department of Clinical Epidemiology; Leiden University Medical Center
- Department of Cardiothoracic Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Martin R. Schipperus
- Haga Teaching Hospital, Department of Hematology; The Hague the Netherlands
- TRIP National Hemovigilance Foundation, Hemovigilance and Biovigilance Office
| | - Saskia le Cessie
- Department of Clinical Epidemiology; Leiden University Medical Center
| | - Rutger A. Middelburg
- Center for Clinical Transfusion Research, Sanquin Blood Supply
- Department of Clinical Epidemiology; Leiden University Medical Center
| | - Johanna C. Wiersum-Osselton
- TRIP National Hemovigilance Foundation, Hemovigilance and Biovigilance Office
- Donor Services Unit, Sanquin Blood Supply; Leiden the Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion Research, Sanquin Blood Supply
- Department of Clinical Epidemiology; Leiden University Medical Center
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17
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Cicchetti A, Berrino A, Casini M, Codella P, Facco G, Fiore A, Marano G, Marchetti M, Midolo E, Minacori R, Refolo P, Romano F, Ruggeri M, Sacchini D, Spagnolo AG, Urbina I, Vaglio S, Grazzini G, Liumbruno GM. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:287-386. [PMID: 27403740 PMCID: PMC4942318 DOI: 10.2450/2016.0065-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed.
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Affiliation(s)
- Americo Cicchetti
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Alexandra Berrino
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Marina Casini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Codella
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Alessandra Fiore
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Marco Marchetti
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuela Midolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Minacori
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Refolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Romano
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Ruggeri
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Irene Urbina
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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18
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Tariket S, Sut C, Hamzeh-Cognasse H, Laradi S, Pozzetto B, Garraud O, Cognasse F. Transfusion-related acute lung injury: transfusion, platelets and biological response modifiers. Expert Rev Hematol 2016; 9:497-508. [DOI: 10.1586/17474086.2016.1152177] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | - Sandrine Laradi
- Université de Lyon, Saint Etienne, France
- Etablissement Français du Sang - Rhônes-Alpes-Auvergne, Saint-Etienne, France
| | | | - Olivier Garraud
- Université de Lyon, Saint Etienne, France
- INTS - Institut National de la Transfusion Sanguine, Paris, France
| | - Fabrice Cognasse
- Université de Lyon, Saint Etienne, France
- Etablissement Français du Sang - Rhônes-Alpes-Auvergne, Saint-Etienne, France
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19
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Xia W, Ye X, Xu X, Chen D, Deng J, Chen Y, Ding H, Shao Y, Wang J, Liu J, Li H, Huang YF, Fu Y, Santoso S. The prevalence of leucocyte alloantibodies in blood donors from South China. Transfus Med 2016; 25:385-92. [PMID: 26876912 DOI: 10.1111/tme.12276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/29/2015] [Accepted: 01/02/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Several studies had demonstrated that leucocyte antibodies including anti-human leucocyte antigen (anti-HLA) antibodies (class I and class II) and anti-human neutrophil antigen (anti-HNA) antibodies (HNA-1, -2 and -3) present in the blood products are responsible for transfusion-related acute lung injury (TRALI). Therefore, selection of blood products exclusive of anti-HLA and anti-HNA antibodies may lower the risk of TRALI reaction. However, the prevalence of leucocyte antibodies among blood donors in China is currently not known. STUDY DESIGN AND METHODS Blood samples were collected from 454 male and 560 female donors (143 nulliparous and 417 multiparous female). HLA class I and II antibodies were analyzed by bead assays. Anti-HNA-1 and -2 antibodies were screened by the LABScreen assay (One Lambda Inc.), and HNA-3 were detected by antigen capture assay, and confirmed by the granulocyte agglutination test (GAT). RESULTS Screening of the total cohort showed higher prevalence of HLA antibodies in female compared with male donors (19.64 vs. 4.63%). We found antibodies against HLA class I (13.21%) and HLA class II (11.43%) in 560 female donors. The most frequent antibodies against HLA class I and II in parous females (n = 69) reacted with were A*11 (28.81%), B*07 (42.37%), Cw*07 (20.34%) and DRB1*04 (40.43%) molecules. Among 778 donors (randomly selected from 1014 donors), we found three donors with neutrophil reactive antibodies, two against HNA-2 and one without known specificity. Anti-HNA-3 antibodies were not found so far. CONCLUSION In this study, we found alloimmunization against HLA class I, II and HNA in 4.63, 24.70 and 0.39%, respectively, in our female blood donors, indicating that the use of plasma containing blood products from parous female blood donors without HLA antibodies pre-testing may increase the risk of TRALI reaction. Although immunization against HNA seems to be a rare event in China, further observation is necessary to decide the necessity of HNA antibodies screening in our blood donors.
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Affiliation(s)
- W Xia
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - X Ye
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - X Xu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - D Chen
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Deng
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Y Chen
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - H Ding
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Y Shao
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Wang
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Liu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - H Li
- Department of Biotechnology, Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Y F Huang
- Department of Surgery, Guangzhou First Municipal People's Hospital Affiliated to Guangzhou Medical College, Guangzhou, China
| | - Y Fu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - S Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, Giessen, Germany
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20
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Effect of Blood Donor Characteristics on Transfusion Outcomes: A Systematic Review and Meta-Analysis. Transfus Med Rev 2016; 30:69-80. [PMID: 26920039 DOI: 10.1016/j.tmrv.2016.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/30/2015] [Accepted: 01/09/2016] [Indexed: 01/12/2023]
Abstract
Optimal selection of blood donors is critical for ensuring the safety of blood products. The current selection process is concerned principally with the safety of the blood donor at the time of donation and of the recipient at the time of transfusion. Recent evidence suggests that the characteristics of the donor may affect short- and long-term transfusion outcomes for the transfused recipient. We conducted a systematic review with the primary objective of assessing the association between blood donor characteristics and red blood cell (RBC) transfusion outcomes. We searched MEDLINE, EMBASE, and Cochrane Central databases and performed manual searches of top transfusion journals for all available prospective and retrospective studies. We described study characteristics, methodological quality, and risk of bias and provided study-level effect estimates and, when appropriate, pooled estimates with 95% confidence intervals using the Mantel-Haenszel or inverse variance approach. The overall quality of the evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. From 6121 citations identified by our literature search, 59 studies met our eligibility criteria (50 observational, 9 interventional). We identified the evaluation of association of 17 donor characteristics on RBC transfusion outcome. The risk of bias and confounding of the included studies was high. The quality of evidence was graded as very low to low for all 17 donor characteristics. Potential associations were observed for donor sex with reduced survival at 90 days and 6 months in male recipients that receive donated blood from females (hazard ratio 2.60 [1.09, 6.20] and hazard ratio 2.40 [1.10, 5.24], respectively; n = 1), Human Leukocyte Antigen - antigen D Related (HLA-DR) selected transfusions (odds ratio [OR] 0.39 [0.15, 0.99] for the risk of transplant alloimmunization, n = 9), presence of antileukocyte antibodies (OR 5.84 [1.66, 20.59] for risk of transfusion-related acute lung injury, n = 4), and donor RBC antigens selection (OR 0.20 [0.08, 0.52] for risk of alloimmunization, n = 4). Based on poor quality evidence, positive antileukocyte antibodies, female donor to male recipients, HLA-DR selected RBC transfusion, or donor RBC antigen selection may affect RBC transfusion outcome. Our findings that donor characteristics may be associated with transfusion outcomes warrant establishing vein-to-vein data infrastructure to allow for large robust evaluations. PROSPERO registration number: CRD42013006726.
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21
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Eder AF, Dy BA, O'Neill EM. Predicted effect of selectively testing female donors for HLA antibodies to mitigate transfusion-related acute lung injury risk from apheresis platelets. Transfusion 2016; 56:1608-15. [DOI: 10.1111/trf.13482] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Anne F. Eder
- National Headquarters, Biomedical Services, Medical Office, American Red Cross, National Headquarters; Washington DC
| | - Beth A. Dy
- National Headquarters, Biomedical Services, Medical Office, American Red Cross, National Headquarters; Washington DC
| | - E. Mary O'Neill
- National Headquarters, Biomedical Services, Medical Office, American Red Cross, National Headquarters; Washington DC
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22
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Curtis BR, Roman AS, Sullivan MJ, Raven CS, Larison J, Weitekamp LA. Two cases of maternal alloimmunization against human neutrophil alloantigen-4b, one causing severe alloimmune neonatal neutropenia. Transfusion 2015; 56:101-6. [DOI: 10.1111/trf.13287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/02/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Brian R. Curtis
- Platelet & Neutrophil Immunology Laboratory; BloodCenter of Wisconsin; Milwaukee Wisconsin
- Blood Research Institute; BloodCenter of Wisconsin; Milwaukee Wisconsin
| | | | - Mia J. Sullivan
- Platelet & Neutrophil Immunology Laboratory; BloodCenter of Wisconsin; Milwaukee Wisconsin
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23
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Bost V, Chavarin P, Boussoulade F, Fabrigli P, Chabre C, Benamara H, Odent-Malaure H, Legrand D, Cognasse F, Garraud O. Independent evaluation of tolerance of therapeutic plasma inactivated by amotosalen-HCl-UVA (Intercept ™) over a 5-year period of extensive delivery. Vox Sang 2015; 109:414-6. [PMID: 26031441 DOI: 10.1111/vox.12300] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
Amotosalen-HCl-UVA (AI) is a process to inactivate pathogens in therapeutic plasma (FFP). Tolerance is the main residual issue in FFP transfusion, and only large series observations are powered enough to identify significantly elevated levels of hazards. We report here on 15,133 new transfusions of AI-FFP, over the previously published 36,035, which in all represents one of the largest series observed by means of a highly standardized surveillance (51.168 observations). There is no noticeable difference in terms of tolerance of AI-FFP compared to 5875 transfusions of Quarantine (Q)-FFP. There was no significant difference in terms of advance events, between the two types of FFP (P = 0.98); further, no difference was recorded either when the total number of AI-FFP (51,168) was compared to the corresponding number of Q-FFP (5875; P = 0.62).
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Affiliation(s)
- V Bost
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - P Chavarin
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - F Boussoulade
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - P Fabrigli
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - C Chabre
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - H Benamara
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - H Odent-Malaure
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - D Legrand
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - F Cognasse
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France.,GIMAP-EA3064, Université de Lyon, Saint Etienne, France
| | - O Garraud
- GIMAP-EA3064, Université de Lyon, Saint Etienne, France.,Institut National de la Transfusion Sanguine, Paris, France
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24
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Peters AL, Van Stein D, Vlaar APJ. Antibody-mediated transfusion-related acute lung injury; from discovery to prevention. Br J Haematol 2015; 170:597-614. [PMID: 25921271 DOI: 10.1111/bjh.13459] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transfusion-related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion-related mortality. The majority of TRALI cases have been related to passive infusion of human leucocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies in donor blood. In vitro, ex vivo and in vivo animal models have provided insight in TRALI pathogenesis. The various classes of antibodies implicated in TRALI appear to have different pathophysiological mechanisms for the induction of TRALI involving endothelial cells, neutrophils, monocytes and, as very recently has been discovered, lymphocytes. The HLA and HNA-antibodies are found mainly in blood from multiparous women as they have become sensitized during pregnancy. The incidence of TRALI has decreased rapidly following the introduction of a male-only strategy for plasma donation. This review focuses on pre-clinical and clinical studies investigating the pathophysiology of antibody-mediated TRALI.
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Affiliation(s)
- Anna L Peters
- Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
| | - Danielle Van Stein
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexander P J Vlaar
- Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
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25
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Male-predominant plasma transfusion strategy for preventing transfusion-related acute lung injury: a systematic review. Crit Care Med 2015; 43:205-25. [PMID: 25514705 DOI: 10.1097/ccm.0000000000000675] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess 1) the effectiveness of male-predominant plasma transfusion strategy for preventing transfusion-related acute lung injury and related mortality; and 2) whether this effect varies across different patient subgroups. DESIGN Systematic Review and meta-analysis: Data were identified by querying MEDLINE and EMBASE (including proceedings of major conferences on blood transfusions), searching the Internet for hemovigilance reports, reviewing reference lists of eligible articles and contacting experts in the field. Eligible were all studies reporting transfusion-related acute lung injury incidence, all-cause mortality (primary outcomes), hospital length of stay, time to extubation, PaO2/FIO2-ratio or blood pressure changes (secondary outcomes) in recipients of plasma transfusions containing relatively more plasma from individuals at low risk of carrying leukocyte-antibodies ("male plasma") than those receiving comparator plasma ("control plasma"). No limits were placed on study design, population or language. The only exclusion criteria were non-human subjects and lack of control group. Prespecified study quality indicators (including risk of bias assessment) and potential effect modifiers were tested using Cochran's Q Test. Final analyses using random-effects models and I2 to assess heterogeneity were performed in the subset of studies judged to provide the best evidence and separately for significantly different subgroups using STATA 12.1 (StataCorp, College Station, TX). SETTING As per primary studies. PATIENTS/SUBJECTS As per primary studies. INTERVENTIONS As per primary studies (generally: exposure to plasma containing relatively more male plasma than comparator plasma). MEASUREMENTS AND MAIN RESULTS From a total of 850 retrieved records, we identified 45 eligible studies. For transfusion-related acute lung injury incidence, final analysis was restricted to 13 cohort studies and one randomized controlled trial in which transfusion-related acute lung injury cases only involved plasma transfusions. Risk of transfusion-related acute lung injury and mortality in plasma recipients exposed to men when compared with control plasma were 0.27 (95% CI, 0.20-0.38; p < 0.001; I = 0%; n = 14; 286 events) and 0.89 (95% CI, 0.80-1.00; p = 0.04; I = 79%; n = 7; 5, 710 events), respectively. No other significant interactions were found. Secondary outcomes showed similar results but were less reported and the studies were more heterogeneous. Sensitivity analyses did not alter the results. There was no evidence of publication bias. DISCUSSION More than 800 million people in 17 countries are subject to male-predominant plasma transfusion policy and at least three more countries are planning or considering adoption of this strategy. On the basis of most observational data, judged to be of high quality, male-predominant plasma transfusion strategy reduces plasma-related transfusion-related acute lung injury incidence and possibly mortality. There was no evidence that the effect differs across patient subgroups, but power to detect such differences was low.
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Abstract
The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products. Simple patient identification issues and clerical error continue to be the primary causes of ABO-incompatible transfusions. Rigorous donor screening as well as serologic and nucleic acid testing for transfusion transmitted infection have brought the blood supply to a very safe level, although transmission of these agents continues to be a problem in underdeveloped countries. Emerging infectious diseases, beyond current laboratory detection capabilities, combined with global travel, pose unknown imminent risks everywhere. We also briefly discuss the current risks of transfusion-transmitted infections. We review currently available hemostatic blood products, their compositions, and their clinical indications; we mention product modifications currently in development; and we touch upon the hemostatic properties and drawbacks of whole blood, which is currently gaining popularity as an alternative to split blood products. We conclude with an in-depth overview of the risks associated with transfusion, including incompatibility, hemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).
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Affiliation(s)
| | - Patrick Schoettker
- Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland
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Müller MC, van Stein D, Binnekade JM, van Rhenen DJ, Vlaar AP. Low-risk transfusion-related acute lung injury donor strategies and the impact on the onset of transfusion-related acute lung injury: a meta-analysis. Transfusion 2014; 55:164-75. [DOI: 10.1111/trf.12816] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Marcella C.A. Müller
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA); Academic Medical Center; Amsterdam The Netherlands
| | - Danielle van Stein
- Department of Transfusion Medicine; Sanquin Blood Bank South West Region; Rotterdam The Netherlands
| | - Jan M. Binnekade
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Dick J. van Rhenen
- Department of Transfusion Medicine; Sanquin Blood Bank South West Region; Rotterdam The Netherlands
| | - Alexander P.J. Vlaar
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA); Academic Medical Center; Amsterdam The Netherlands
- Department of Internal Medicine; Academic Medical Center; Amsterdam The Netherlands
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Wood EM, Stevenson L, Bielby L, Wiersum-Osselton JC. Haemovigilance: concepts and frameworks. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. M. Wood
- Transfusion Research Unit; Monash University; Melbourne Vic. Australia
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
| | - L. Stevenson
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
| | - L. Bielby
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
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Weber LL, Roberts LD, Sweeney JD. Residual plasma in red blood cells and transfusion-related acute lung injury. Transfusion 2014; 54:2425-30. [PMID: 24762170 DOI: 10.1111/trf.12662] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/13/2014] [Accepted: 02/23/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is the most common cause of death from blood transfusion and red blood cells (RBCs) now account for approximately 50% of these fatalities. RBCs from female donors have been implicated in large series and HLA Class II antibodies to cognate recipient antigens identified in small series and case reports. The absolute volume of residual plasma in these RBCs is unknown. STUDY DESIGN AND METHODS Two confirmed cases of RBC-associated TRALI in which the implicated donors had Class II antibodies were investigated, and the antibody strength against recipient cognate antigens was assessed using a fluorescent bead assay. RBCs in additive solution (AS) were studied on Day 42 of liquid storage to calculate residual anticoagulated plasma. RESULTS Both RBC units were stored in AS-1 and were from female donors who had anti-HLA Class II antibodies of high strength against cognate antigens in the recipients. Anti-DR4 was identified in both cases. Nineteen AS-1 RBC units manufactured from whole blood donations using a hard spin had a mean (±1SD) residual plasma content of 38 ± 8 mL, and 26 AS-3 RBC units manufactured using a soft spin had 66 ± 13 mL (p < 0.01). CONCLUSION RBCs continue to be manufactured from female donors of unknown or even known anti-HLA status. The residual plasma content of these RBCs may approach 100 mL. A combination of a high-strength antibody and large residual plasma volume could explain severe or even fatal RBC-associated TRALI.
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Edavettal M, Rogers A, Rogers F, Horst M, Leng W. Prothrombin Complex Concentrate Accelerates International Normalized Ratio Reversal and Diminishes the Extension of Intracranial Hemorrhage in Geriatric Trauma Patients. Am Surg 2014. [DOI: 10.1177/000313481408000419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Warfarin therapy increases the incidence intracranial hemorrhage (ICH), especially in the geriatric population. Timely reversal of international normalized ratio (INR) is integral in the management of these patients for whom fresh frozen plasma (FFP) with vitamin K is the standard of treatment. We hypothesized that implementing a protocol that used prothrombin complex concentrate (PCC) would reverse INR values more swiftly and decrease the amount of FFP administered. In November 2011, a protocol was implemented for administering PCC to the geriatric population on warfarin admitted for life-threatening bleeds. These patients received 25 IU/kg ideal body weight of a three-factor PCC (Profilnine SD) if their INR was over 1.5 or greater. FFP was given if follow-up INR revealed an INR of 1.5 or greater. Retrospectively the data from 29 patients who received PCC were compared with a historical control group of 34 patients. Protocol use resulted in a significantly faster INR reversal (PCC: 151.6 ± 84.3 minutes vs control: 485.0 ± 321 minutes; P < 0.001), time to achieve an INR less than 1.5 (PCC: 484 ± 242 minutes vs control: 971 ± 1208 minutes; P = 0.036), and less FFP administered (PCC: 1.3 ± 1.0 vs control:3.3 ± 1.5; P < 0.001). PCC patients had a decreased incidence of progression of their ICH (PCC: 17.2% vs control: 44.2%; P = 0.031). Rapid reversal of coagulopathy in geriatric patients on warfarin is vital to limit the extent of ICH. PCC allows a much more rapid reversal than standard treatment with only FFP and vitamin K. Adopting such a protocol is associated not only with a more rapid reversal and less FFP use, but also less patients went on to extend their head bleeds.
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Affiliation(s)
| | - Amelia Rogers
- From Lancaster General Health, Lancaster, Pennsylvania
| | | | - Michael Horst
- From Lancaster General Health, Lancaster, Pennsylvania
| | - Wichitah Leng
- From Lancaster General Health, Lancaster, Pennsylvania
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31
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Kalimeris K. Lung preconditioning in anesthesia: Review of the literature. World J Anesthesiol 2014; 3:105-110. [DOI: 10.5313/wja.v3.i1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/19/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
Lung injury can arise during or after anesthesia and can lead to a complicated postoperative course with great implications for the patient. Unfortunately, treatment of acute lung injury is at the moment mainly supportive and rates of recovery have not really improved in the recent years. In many cases, lung injury can be anticipated and preventive measures seem possible. This represents a unique challenge to the anesthesiologist, as some new opportunities to reduce the frequency and/or severity of lung injury seem now available. These chances may arise from the potency of preconditioning the lungs before the main injury, with smaller injurious insults. Although preconditioning began to be applicated first on the myocardium, experimental studies have shown potentially beneficial results also for the lungs. This review summarizes the main methods of lung preconditioning that have been tried in experimental studies in the literature and the main mechanisms that are perhaps involved. Emphasis is given in the two main methods of preconditioning that seem readily applicable in the clinical praxis, that is ischemic preconditioning, as well as preconditioning with volatile anesthetics. The few, but interesting clinical studies are also summarized and the future research points in this evolving field of anesthesia are stressed.
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Abstract
PURPOSE OF REVIEW This review summarizes the current evidence base for commonly transfused blood components with a particular focus on the nonacutely bleeding patient. RECENT FINDINGS There remains little definitive evidence to guide transfusion practices in the critically ill. The most rigorous evidence to guide red blood cell (RBC) transfusion practice is derived from the Transfusion in Critical Care Trial (TRICC Trial) that was published in 1999. Specific subgroups of patients may be at particular risk of the adverse effects of anemia, and require further study. There are no randomized controlled trials addressing clinically important outcomes evaluating frozen plasma, platelet thresholds, or impaired platelet activity in the critically ill. SUMMARY As all blood components have some level of risk, the general approach to transfusion should be one of minimization. For the nonacutely bleeding critically ill patient, a RBC transfusion trigger of 70 g/l is clinically acceptable. For patients at potentially higher risk of adverse effects related to anemia such as those with septic shock, severe and/or acute ischemic heart disease, or brain injury, a higher threshold (80-90 g/l) may be considered. There is insufficient evidence to recommend specific thresholds for transfusion of frozen plasma or platelets in the critically ill.
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Abstract
Transfusion-related acute lung injury (TRALI) developed into the leading cause of transfusion-related morbidity and mortality after the first description by Popovsky et al. approximately three decades ago. It was the most frequent reason for transfusion-related fatalities worldwide before implementation of risk minimization strategies by donor selection. Plasma-rich blood products, such as fresh frozen plasma and apheresis platelets seem to be the leading triggers of TRALI. Hypoxemia and development of pulmonary edema within 6 h of transfusion are the diagnostic criteria for TRALI. The differentiation between cardiac failure and other transfusion-related lung injuries, such astransfusion-associated circulatory overload ( TACO) is difficult and causal treatment is not available. Therapy is based on supportive measures, such as oxygen insufflationor mechanical ventilation. The exactly pathogenesis is still unknown but the most propagated hypothesis is the two-event-model. Neutrophils are primed by the underlying condition, e.g. sepsis or trauma during the first event and these primed neutrophils are activated by transfused leukoagglutinating antibodies (immunogen) or bioreactive mediators (non-immunogen) during the second-event. Transfusion of leukoagglutinating antibodies from female donors with one or more previous pregnancies is the most frequent reason. No more TRALI fatalities were reported after implementation of the donor selection in Germany in 2009.
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Affiliation(s)
- S Tank
- Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Cardiovascular Research Center, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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Sigle JP, Thierbach J, Infanti L, Muriset M, Hunziker G, Chassot K, Niederhauser C, Gowland P, Holbro A, Sunic K, Buser A, Fontana S. Anti-leucocyte antibodies in platelet apheresis donors with and without prior immunizing events: implications for TRALI prevention. Vox Sang 2013; 105:244-52. [DOI: 10.1111/vox.12045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/29/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | - J. Thierbach
- Regional Blood Transfusion Service of the Swiss Red Cross; St. Gallen; Switzerland
| | - L. Infanti
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - M. Muriset
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
| | - G. Hunziker
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - K. Chassot
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - C. Niederhauser
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
| | - P. Gowland
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
| | - A. Holbro
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - K. Sunic
- Regional Blood Transfusion Service of the Swiss Red Cross; St. Gallen; Switzerland
| | - A. Buser
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - S. Fontana
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
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Bost V, Odent-Malaure H, Chavarin P, Benamara H, Fabrigli P, Garraud O. A regional haemovigilance retrospective study of four types of therapeutic plasma in a ten-year survey period in France. Vox Sang 2013; 104:337-41. [DOI: 10.1111/vox.12007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/10/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
- V. Bost
- Etablissement Français du Sang-Auvergne - Loire; Saint-Etienne; France
| | - H. Odent-Malaure
- Etablissement Français du Sang-Auvergne - Loire; Saint-Etienne; France
| | - P. Chavarin
- Etablissement Français du Sang-Auvergne - Loire; Saint-Etienne; France
| | - H. Benamara
- Etablissement Français du Sang-Auvergne - Loire; Saint-Etienne; France
| | - P. Fabrigli
- Etablissement Français du Sang-Auvergne - Loire; Saint-Etienne; France
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Semple E, Bowes-Schmidt A, Yi QL, Shimla S, Devine DV. Transfusion reactions: a comparative observational study of blood components produced before and after implementation of semiautomated production from whole blood. Transfusion 2012; 52:2683-91. [PMID: 22738255 DOI: 10.1111/j.1537-2995.2012.03752.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A semiautomated method of component production from whole blood was implemented at Canadian Blood Services. To assess safety of the new components, the frequency of adverse transfusion events (ATEs) to platelet components (PCs) and red blood cell (RBCs) produced before and after implementation of the new method was surveyed and compared. STUDY DESIGN AND METHODS This retrospective, observational, noninferiority study was conducted in 12 sentinel hospitals across Canada. The control group received RBCs in additive solution-3 (AS-3) and platelet-rich plasma (PRP)-produced platelets (PLTs) for 3 to 11 months before implementation of semiautomated production, and the study group received RBCs in saline-adenine-glucose-mannitol (SAGM) and buffy coat (BC)-produced PLTs for 3 to 11 months after implementation. ATE definitions at each hospital and standard practice for reporting did not change between control and study periods. Data for analysis were obtained from databases and original report forms. RESULTS The pooled risk ratio of a reaction to SAGM versus AS-3 RBCs was 0.77 (95% confidence interval [CI], 0.66-0.90), suggesting that SAGM products had significantly lower reaction rates than AS-3 products (p < 0.01). Reported allergic reactions to RBCs decreased from 0.07% (AS-3) to 0.04% (SAGM). For PLTs, the difference in reaction rates between BC and PRP was not significant (p = 0.37), and the pooled risk ratio of BC versus PRP was 1.14 (95% CI, 0.86-1.50). CONCLUSION The change in manufacturing method was associated with lower reaction rates to SAGM RBCs than to AS-3 RBCs. Pooled BC PLTs were noninferior to random-donor PRP PLTs with respect to ATEs.
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37
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Eder AF, Dy BA, Perez JM, Rambaud M, Benjamin RJ. The residual risk of transfusion-related acute lung injury at the American Red Cross (2008-2011): limitations of a predominantly male-donor plasma mitigation strategy. Transfusion 2012; 53:1442-9. [DOI: 10.1111/j.1537-2995.2012.03935.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/11/2012] [Accepted: 09/17/2012] [Indexed: 12/01/2022]
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Tsai HI, Chou AH, Yang MW. Perioperative transfusion-related acute lung injury: A retrospective analysis. ACTA ACUST UNITED AC 2012; 50:96-100. [DOI: 10.1016/j.aat.2012.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/05/2012] [Accepted: 04/10/2012] [Indexed: 10/27/2022]
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Abstract
Plasma utilization has increased over the past two decades, and there is a growing concern that many plasma transfusions are inappropriate. Plasma transfusion is not without risk, and certain complications are more likely with plasma than other blood components. Clinical and laboratory investigations of the patients suffering reactions after infusion of fresh-frozen plasma (FFP) define the etiology and pathogenesis of the panoply of adverse effects. We review here the pathogenesis, diagnosis, and management of the risks associated with plasma transfusion. Risks commonly associated with FFP include: 1) transfusion-related acute lung injury, 2) transfusion-associated circulatory overload, and 3) allergic and/or anaphylactic reactions. Other less common risks include 1) transmission of infections, 2) febrile nonhemolytic transfusion reactions, 3) red blood cell alloimmunization, and 4) hemolytic transfusion reactions. The effects of pathogen inactivation or reduction methods on these risks are also discussed. Fortunately, a majority of the adverse effects are not lethal and are adequately treated in clinical practice.
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Affiliation(s)
- Suchitra Pandey
- Department of Laboratory Medicine, University of California, San Francisco, California 94143, USA
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40
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Transfusion-related acute lung injury: Current understanding and preventive strategies. Transfus Clin Biol 2012; 19:117-24. [PMID: 22682310 DOI: 10.1016/j.tracli.2012.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/24/2012] [Indexed: 12/23/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is the most serious complication of transfusion medicine. TRALI is defined as the onset of acute hypoxia within 6 hours of a blood transfusion in the absence of hydrostatic pulmonary oedema. The past decades have resulted in a better understanding of the pathogenesis of this potentially life-threating syndrome. The present notion is that the onset of TRALI follows a threshold model in which both patient and transfusion factors are essential. The transfusion factors can be divided into immune and non-immune mediated TRALI. Immune-mediated TRALI is caused by the passive transfer of human neutrophil antibodies (HNA) or human leukocyte antibodies (HLA) present in the blood product reacting with a matching antigen in the recipient. Non-immune mediated TRALI is caused by the transfusion of stored cell-containing blood products. Although the mechanisms behind immune-mediated TRALI are reasonably well understood, this is not the case for non-immune mediated TRALI. The increased understanding of pathways involved in the onset of immune-mediated TRALI has led to the design of preventive strategies. Preventive strategies are aimed at reducing the risk to exposure of HLA and HNA to the recipient of the transfusion. These strategies include exclusion of "at risk" donors and pooling of high plasma volume products and have shown to reduce the TRALI incidence effectively. This review discusses the current understanding of TRALI and preventive strategies available.
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Sachs UJ. A threshold model for the susceptibility to transfusion-related acute lung injury. Transfus Clin Biol 2012; 19:109-16. [PMID: 22677431 DOI: 10.1016/j.tracli.2012.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 03/24/2012] [Indexed: 12/31/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is a serious, often life-threatening pulmonary transfusion reaction characterized by non-cardiogenic lung oedema, hypoxemia and respiratory distress in temporal association with blood transfusion. The critical mechanism in TRALI is the sudden increase in permeability of the pulmonary endothelium and the subsequent, often extensive shift of fluid into the alveolae. The rapid clinical recovery seen in most patients makes it likely that this is a temporary phenomenon. Reactive oxygen species released by neutrophils or other cells are attractive candidate mediators of this process. There is experimental and clinical evidence that several pathways can induce barrier breakdown in TRALI, a concept known as the threshold model of TRALI. Surprisingly, neutrophils may not always be required. Other cells may play a role as multipliers or attenuators of TRALI, depending on recipient-related and transfusion-related factors involved. This review will summarize recent findings on pathophysiology, with a focus on newly discovered or disenchanted recipient-related and transfusion-related risk factors for TRALI and will present the threshold model of TRALI as a unifying concept on how TRALI develops.
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Affiliation(s)
- U J Sachs
- Institute for Clinical Immunlogy and Transfusion Medicine, Justus Liebig University, Langhansstr. 7, 35392 Giessen, Germany.
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