Conservation of O- red blood cells: a fresh look at a shared responsibility

There is an urgent need to adopt a pull-flow logic for the supply of RBCs to meet patients' needs: A single center study

BACKGROUND

Despite major demographic changes, several decisions and initiatives, among which Patient Blood Management, have led to a significant reduction in the transfusion of packed red blood cells (RBCs) in Belgium, as it has been observed in many countries. Unfortunately, not all blood groups were proportionately impacted and shortage in O D-negative RBCs is regularly or chronically observed. The goal of this study was to examine how to optimize the use and the supply of O D-negative blood in our academic hospital.

METHODOLOGY

All blood transfusions performed at Cliniques universitaires Saint-Luc between January 1, 2019 and December 31, 2021 were reviewed. The blood group of the patients was compared with the blood group of the RBCs actually supplied and transfused.

RESULTS

49.823 RBCs transfusions were analyzed. The patients' needs didn't reflect those of a Caucasian population, with an increase of O (47.9%) and B (10.3%) for the ABO blood group, and a quite high proportion of R0r (8.6%) for the Rh blood group. Only two thirds of O D-negative RBCs were transfused to O rr or R0r patients.

CONCLUSION

The application of PBM and the ethnic imbalance between blood donor and patient populations are two important risk factors for chronic shortages of O D-negative blood. To adapt blood component resources, it is essential to have a complete picture of the real needs of patients according to their blood group profile. Blood donor centers must adapt to the evolving needs of hospitals in order to plan future supplies in a "pull-flow" approach.

Utilisation patterns of group O red blood cell transfusion by ABO and D non-identical recipients in large academic hospital

OBJECTIVES

Several studies have raised concerns that transfusion of O red blood cells (RBCs) to ABO and D non-identical recipients can intensify group O inventory shortages. The aim of this study was to retrospectively analyse particular clinical indications and polices responsible for O RBCs use by ABO and D non-identical recipients, as well as to assess the impact of this practice on the overall utilisation of O RBCs.

MATERIAL AND METHODS

Data of all transfused RBCs from 2014 to 2018 were extracted from the comprehensive database of transfusion service. Extracted variables included date of transfusion, ABO and D group of the transfused RBCs and recipients, recipient's demographic, and specific characteristics regarding transfusion requirements.

RESULTS

Over a 5-year period, 124,220 RBCs were transfused: 38,962 (31.4%) group O D+ and 9109 (7.3%) group O D-. ABO and D non-identical recipient received 4842 (10.1%) of all administered O RBCs: 2880 (7.4%) of all transfused O D+ and 1962 (21.5%) of all transfused O D- RBCs. The common indications for this practice were: ABO and D mismatched hematopoietic stem cell transplantation (HSCT) (52.5%), infants under the age of 4 months (18.6%), shortage of ABO identical RBCs (9.0%), phenotype-matched RBCs (8,1%), and urgent transfusion (7.2%).

CONCLUSIONS

A significant proportion of O RBCs was transfused to ABO and D non-identical recipients, mainly due to transfusion of ABO and D mismatched HSCT recipients. However, the proportion of all transfused RBCs O D+ and especially O D- remained relatively low.

Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice

BACKGROUND

Despite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer's (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO₂), and optimal MAP remain undefined.

METHODS

C57BL/6 mice (n = 72) underwent controlled cortical impact followed by HS (MAP = 25-27 mmHg). Ipsilateral hippocampal PbtO₂ (n = 40) was measured by microelectrode. Mice were assigned to four groups (n = 18/group) for "prehospital" resuscitation (90 min) with LR or autologous WB, and target MAPs of 60 or 70 mmHg (LR₆₀, WB₆₀, LR₇₀, WB₇₀). Additional LR (10 ml/kg) was bolused every 5 min for MAP below target.

RESULTS

LR requirements in WB₆₀ (7.2 ± 5.0 mL/kg) and WB₇₀ (28.3 ± 9.6 mL/kg) were markedly lower than in LR₆₀ (132.8 ± 5.8 mL/kg) or LR₇₀ (152.2 ± 4.8 mL/kg; all p < 0.001). WB₇₀ MAP (72.5 ± 2.9 mmHg) was higher than LR₇₀ (59.8 ± 4.0 mmHg, p < 0.001). WB₆₀ MAP (68.7 ± 4.6 mmHg) was higher than LR₆₀ (53.5 ± 3.2 mmHg, p < 0.001). PbtO₂ was higher in WB₆₀ (43.8 ± 11.6 mmHg) vs either LR₆₀ (25.9 ± 13.0 mmHg, p = 0.04) or LR₇₀ (24.1 ± 8.1 mmHg, p = 0.001). PbtO₂ in WB₇₀ (40.7 ± 8.8 mmHg) was higher than in LR₇₀ (p = 0.007). Despite higher MAP in WB₇₀ vs WB₆₀ (p = .002), PbtO₂ was similar.

CONCLUSION

WB resuscitation after TBI + HS results in robust improvements in brain oxygenation while minimizing fluid volume when compared to standard LR resuscitation. WB resuscitation may allow for a lower prehospital MAP without compromising brain oxygenation when compared to LR resuscitation. Further studies evaluating the effects of these physiologic benefits on outcome after TBI with HS are warranted, to eventually inform clinical trials.