1
|
McElfresh DC, Bennett J, Enriquez K, Pham TD. Measuring the effectiveness of online search ads on blood donor recruitment and donation. Transfusion 2024; 64:1016-1024. [PMID: 38693096 DOI: 10.1111/trf.17850] [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: 01/09/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Acutely highlighted during the COVID-19 pandemic, the tenuousness of the blood supply continues to be a lynchpin of the most important medical procedures. Online advertisements have become a mainstay in donor recruitment. We set out to determine the effectiveness of online search ads and variations thereof on blood donations with an emphasis on first-time donors. STUDY DESIGN AND METHODS From September 01, 2022 through March 31, 2023, we performed a campaign comparison experiment through a major search-ads platform with two distinct messages: one altruistic ("Altruistic") and one with a prospect of rewards ("Promotion"). We developed a method to track donation outcomes and associated them with impressions, click-throughs, and conversions. We compared the performance of the Altruistic and Promotion arms to a control group that was not associated with any search-ads ("Baseline"). RESULTS Analyzing 34,157 donations during the study period, the Promotion group, and not Altruistic, had a significant difference of first-time donors over Baseline (24% vs. 12%, p = 7e-6). We analyzed 49,305 appointments and discovered that appointments made from the Altruistic arm resulted in a significantly higher percentage of donations when compared to Baseline (57% vs. 53%, p = .009); however, the Promotion group had a higher percentage of donations from first-time donors when compared to Baseline (12% vs. 8%, p = .006). CONCLUSION We developed a method for determining the effectiveness of online search ads on donation outcomes. Rewards/promotions messaging was most effective at recruiting first-time donors. Our methodology is generalizable to different blood centers to explore messaging effectiveness among their unique communities.
Collapse
Affiliation(s)
- Duncan C McElfresh
- Department of Health Policy, Center for Innovation to Implementation, Veterans Affairs Health Care, Palo Alto, California, USA
| | - Jenn Bennett
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
| | - Kay Enriquez
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
| | - Tho D Pham
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Gammon RR, Dubey R, Gupta GK, Hinrichsen C, Jindal A, Lamba DS, Mangwana S, Radhakrishnan Nair A, Nalezinski S, Bocquet C. Patient Blood Management and Its Role in Supporting Blood Supply. J Blood Med 2023; 14:595-611. [PMID: 38053640 PMCID: PMC10695136 DOI: 10.2147/jbm.s387322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Blood donors and voluntary blood donations are essential for ensuring the blood supply that can be maintained by good patient blood management (PBM) practices. This review article explores the role of blood donation in PBM and highlights the importance of donor screening and selection processes in different regions worldwide. The donor health questionnaires and the focused physical examination guidelines have changed in the last decade to increase donor and recipient safety. This article also discusses the status of transfusion practices, including the challenges of ensuring a safe blood supply. Significant among these are the effects of the COVID-19 pandemic on the blood supply chain and the impact of an aging donor population, especially. Promoting autologous donations and other blood conservation strategies are suggested to mitigate these issues. The role of replacement donors and the upper age limit for voluntary blood donation may be decided based on the demography and donor pool. The involvement of C-suite executives is also critical in implementing and running a successful PBM program. The review highlights how these different aspects of blood donation are integral to a successful PBM program and the safety of patients who receive blood transfusions.
Collapse
Affiliation(s)
- Richard R Gammon
- Scientific, Medical and Technical Department, OneBlood, Orlando, FL, USA
| | - Rounak Dubey
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Gaurav K Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen Hinrichsen
- Department of Transfusion Medicine, Princeton Medical Center at Penn Medicine, Plainsboro, NJ, USA
| | - Aikaj Jindal
- Department of Transfusion Medicine, Mohandas Oswal Hospital, Ludhiana, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhana Mangwana
- Department of Transfusion Medicine and Immunohematology, Sri Balaji Action Medical Institute, New Delhi, India
| | - Amita Radhakrishnan Nair
- Department of Transfusion Medicine Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - Shaughn Nalezinski
- Department of Laboratory Medicine - Transfusion Services, Concord Hospital, Concord, NH, USA
| | - Christopher Bocquet
- Association for the Advancement of Blood and Biotherapies, Bethesda, MD, USA
| |
Collapse
|
3
|
Kim CY, Larsen HJ, Spitalnik SL, Hod EA, Francis RO, Hudson KE, Gordy DE, Stone EF, Peltier S, Amireault P, D’Alessandro A, Zimring JC, Buehler PW, Fu X, Thomas T. Low-Dose Dietary Fish Oil Improves RBC Deformability without Improving Post-Transfusion Recovery in Mice. Nutrients 2023; 15:4456. [PMID: 37892532 PMCID: PMC10610231 DOI: 10.3390/nu15204456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Long-chain polyunsaturated fatty acids (LC-PUFAs) are important modulators of red blood cell (RBC) rheology. Dietary LC-PUFAs are readily incorporated into the RBC membrane, improving RBC deformability, fluidity, and hydration. Female C57BL/6J mice consumed diets containing increasing amounts of fish oil (FO) ad libitum for 8 weeks. RBC deformability, filterability, and post-transfusion recovery (PTR) were evaluated before and after cold storage. Lipidomics and lipid peroxidation markers were evaluated in fresh and stored RBCs. High-dose dietary FO (50%, 100%) was associated with a reduction in RBC quality (i.e., in vivo lifespan, deformability, lipid peroxidation) along with a reduced 24 h PTR after cold storage. Low-dose dietary FO (6.25-12.5%) improved the filterability of fresh RBCs and reduced the lipid peroxidation of cold-stored RBCs. Although low doses of FO improved RBC deformability and reduced oxidative stress, no improvement was observed for the PTR of stored RBCs. The improvement in RBC deformability observed with low-dose FO supplementation could potentially benefit endurance athletes and patients with conditions resulting from reduced perfusion, such as peripheral vascular disease.
Collapse
Affiliation(s)
- Christopher Y. Kim
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | | | - Steven L. Spitalnik
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Richard O. Francis
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Krystalyn E. Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Dominique E. Gordy
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Elizabeth F. Stone
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Sandy Peltier
- Biologie Intégrée du Globule Rouge, Institut National de la Santé et de la Recherche Médicale, Université Paris Cité et Université des Antilles, 75014 Paris, France
| | - Pascal Amireault
- Biologie Intégrée du Globule Rouge, Institut National de la Santé et de la Recherche Médicale, Université Paris Cité et Université des Antilles, 75014 Paris, France
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Institut Imagine, INSERM, Université Paris Cité, 75005 Paris, France
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - James C. Zimring
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Paul W. Buehler
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Xiaoyun Fu
- Bloodworks Research Institute, Seattle, WA 98102, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Tiffany Thomas
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| |
Collapse
|
4
|
Entzel P, Nielsen M, Weiss S, Park YA, Lu R, Baskin-Miller J, Hutchinson B, Obioma P, An X, Balfanz G. How do I reduce variation in red blood cell transfusion practices in a large integrated health care system? Transfusion 2023. [PMID: 37190781 DOI: 10.1111/trf.17383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Reducing variation in transfusion practices can prevent unwarranted transfusions, an outcome that improves quality of care and patient safety, while lowering costs and eliminating waste of blood. We developed and assessed a system-wide initiative to reduce variation in red blood cell (RBC) transfusion in terms of both transfusion utilization and the number of units transfused. INTERVENTION DESIGN AND METHODS Our initiative combined a single-unit default order for RBC transfusion in hemodynamically stable, non-bleeding patients with a "Why Give 2 When 1 Will Do?" Choosing Wisely campaign, while also promoting a restrictive hemoglobin threshold (Hb <7 g/dl). This multimodal intervention was implemented across an academic medical center (AMC) with over 950 beds and 10 community hospitals. RESULTS Between our baseline (CY 2020) and intervention period (CY 2021), single-unit orders increased from 57% to 70% of all RBC transfusion orders (p < .001). The greatest change in ordering practices was at community hospitals, where single-unit orders increased from 46% to 65% (p < .001). Over the same time period, the system-wide mean (SD) Hb result prior to transfusion fell from 7.3 (0.05) to 7.2 g/dl (0.04) (p < .05). We estimate this effort saved over 4000 units of blood and over $4 million in direct and indirect costs in its first year. DISCUSSION By combining a single-unit default setting in the RBC order with a restrictive hemoglobin threshold, we significantly reduced variation in ordering practices. This effort demonstrates the value of single-unit policies and "nudges" in system-wide patient blood management initiatives.
Collapse
Affiliation(s)
- Pamela Entzel
- Care Redesign Department, UNC Health, Morrisville, North Carolina, USA
| | - Matthew Nielsen
- Department of Urology, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Susan Weiss
- Carolinas Pathology Group, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Yara A Park
- Department of Pathology and Laboratory Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Rommel Lu
- UNC Rex Hematology Oncology, Raleigh, North Carolina, USA
| | - Jacquelyn Baskin-Miller
- Department of Pediatrics, Hematology/Oncology, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Blake Hutchinson
- Department of Pathology, UNC Rex Healthcare, Raleigh, North Carolina, USA
| | - Prestige Obioma
- Care Redesign Department, UNC Health, Morrisville, North Carolina, USA
| | - Xinming An
- Department of Anesthesiology, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Greg Balfanz
- Department of Anesthesiology, UNC School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
5
|
Lasky B, Singh U, Young PP. Young apheresis platelet donors show significant and sustained growth over the last decade in the US, 2010-2019: A favorable sign of the resiliency of the platelet supply. Transfusion 2023. [PMID: 37191295 DOI: 10.1111/trf.17400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Platelet demand continues to rise and US hospitals frequently face shortages. The peak median age of apheresis platelet donors (APD) is believed to have increased over the last decade, raising concerns that the APD base is not being adequately replenished with young donors. STUDY DESIGN/METHODS American Red Cross (ARC) apheresis platelet collections were evaluated from calendar years 2010 through 2019. APD, products per procedure/split rate (PPP) and donation frequencies were stratified into age groups. RESULTS/FINDINGS The number of unique APD from calendar year 2010 through 2019 in the ARC donor pool increased from 87,573 to 115,372 donors, representing a 31.7% overall growth. Donors in the 16-40 year-old (y) age group increased by 78.8% overall, with the largest absolute increases seen in the 26-30 y (4852 donors, 99.9% growth), followed by the 31-35 y (3991, 94.1%) group. Donors aged 56+ increased by 50.4% overall, with the largest increase seen in the 66-70 y (5988 donors, 108.1% growth) group. Middle-aged donors, aged 41-55 y, demonstrated a decrease of 16.5%. Over the last decade, the youngest age groups (16-40 y) comprised 61.3% of first-time donors (FTD). Annual donation frequency increased with increasing age and PPP. The highest donation frequencies were seen in the oldest age groups. CONCLUSION Although the peak median age of APD increased over the study period, relative contribution of the 16-40 y APD base also increased. Older donors exhibited the highest donation frequencies and thus contributed the largest volume of apheresis platelet units. Platelet donor activity declined in the middle age (41-55 y) group.
Collapse
Affiliation(s)
- Baia Lasky
- American Red Cross, Biomedical Services Division, Washington, District of Columbia, USA
| | - Umesh Singh
- American Red Cross, Biomedical Services Division, Washington, District of Columbia, USA
| | - Pampee P Young
- American Red Cross, Biomedical Services Division, Washington, District of Columbia, USA
| |
Collapse
|
6
|
Transfusion-free Strategies in Liver and Pancreatic Surgery: A Predictive Model of Blood Conservation for Transfusion Avoidance in Mainstream Populations. Ann Surg 2023; 277:469-474. [PMID: 36538643 DOI: 10.1097/sla.0000000000005757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this study is to (1) describe the techniques and prove the feasibility of performing complex hepatobiliary and pancreatic surgery on a Jehovah Witness (JW) population. (2) Describe a strategy that offsets surgical blood loss by the manipulation of circulating blood volume to create reserve whole blood upon anesthesia induction. BACKGROUND Major liver and pancreatic resections often require operative transfusions. This limits surgical options for patients who do not accept major blood component transfusions. There is also growing recognition of the negative impact of allogenic blood transfusions. METHODS A 23-year, single-center, retrospective review of JW patients undergoing liver and pancreatic resections was performed. We describe perioperative management and patient outcomes. Acute normovolemic hemodilution (ANH) is proposed as an important strategy for offsetting blood losses and preventing the need for blood transfusion. A quantitative mathematical formula is developed to provide guidance for its use. RESULTS One hundred one major resections were analyzed (liver n=57, pancreas n=44). ANH was utilized in 72 patients (liver n=38, pancreas n=34) with median removal of 2 units that were returned for hemorrhage as needed or at the completion of operation. There were no perioperative mortalities. Morbidity classified as Clavien grade 3 or higher occurred in 7.0% of liver resection and 15.9% of pancreatic resection patients. CONCLUSIONS Deliberate perioperative management makes transfusion-free liver and pancreatic resections feasible. Intraoperative whole blood removal with ANH specifically preserves red cell mass, platelets, and coagulation factors for timely reinfusion. Application of the described JW transfusion-free strategy to a broader general population could lessen blood utilization costs and morbidities.
Collapse
|
7
|
Transfusion Management in Trauma: What is Current Best Practice? CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
8
|
Choudhury A, Asan O, Medow JE. Clinicians' Perceptions of an Artificial Intelligence-Based Blood Utilization Calculator: Qualitative Exploratory Study. JMIR Hum Factors 2022; 9:e38411. [PMID: 36315238 PMCID: PMC9664323 DOI: 10.2196/38411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/17/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND According to the US Food and Drug Administration Center for Biologics Evaluation and Research, health care systems have been experiencing blood transfusion overuse. To minimize the overuse of blood product transfusions, a proprietary artificial intelligence (AI)-based blood utilization calculator (BUC) was developed and integrated into a US hospital's electronic health record. Despite the promising performance of the BUC, this technology remains underused in the clinical setting. OBJECTIVE This study aims to explore how clinicians perceived this AI-based decision support system and, consequently, understand the factors hindering BUC use. METHODS We interviewed 10 clinicians (BUC users) until the data saturation point was reached. The interviews were conducted over a web-based platform and were recorded. The audiovisual recordings were then anonymously transcribed verbatim. We used an inductive-deductive thematic analysis to analyze the transcripts, which involved applying predetermined themes to the data (deductive) and consecutively identifying new themes as they emerged in the data (inductive). RESULTS We identified the following two themes: (1) workload and usability and (2) clinical decision-making. Clinicians acknowledged the ease of use and usefulness of the BUC for the general inpatient population. The clinicians also found the BUC to be useful in making decisions related to blood transfusion. However, some clinicians found the technology to be confusing due to inconsistent automation across different blood work processes. CONCLUSIONS This study highlights that analytical efficacy alone does not ensure technology use or acceptance. The overall system's design, user perception, and users' knowledge of the technology are equally important and necessary (limitations, functionality, purpose, and scope). Therefore, the effective integration of AI-based decision support systems, such as the BUC, mandates multidisciplinary engagement, ensuring the adequate initial and recurrent training of AI users while maintaining high analytical efficacy and validity. As a final takeaway, the design of AI systems that are made to perform specific tasks must be self-explanatory, so that the users can easily understand how and when to use the technology. Using any technology on a population for whom it was not initially designed will hinder user perception and the technology's use.
Collapse
Affiliation(s)
- Avishek Choudhury
- Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV, United States
| | - Onur Asan
- Systems Engineering, School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Joshua E Medow
- Neurocritical Care, Neurosurgery, Pathology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| |
Collapse
|
9
|
Kumar B, Afshar-Kharghan V, Mendt M, Sackstein R, Tanner MR, Popat U, Ramdial J, Daher M, Jimenez J, Basar R, Melo Garcia L, Shanley M, Kaplan M, Wan X, Nandivada V, Reyes Silva F, Woods V, Gilbert A, Gonzalez-Delgado R, Acharya S, Lin P, Rafei H, Banerjee PP, Shpall EJ. Engineered cord blood megakaryocytes evade killing by allogeneic T-cells for refractory thrombocytopenia. Front Immunol 2022; 13:1018047. [PMID: 36203567 PMCID: PMC9530569 DOI: 10.3389/fimmu.2022.1018047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
The current global platelet supply is often insufficient to meet all the transfusion needs of patients, in particular for those with alloimmune thrombocytopenia. To address this issue, we have developed a strategy employing a combination of approaches to achieve more efficient production of functional megakaryocytes (MKs) and platelets collected from cord blood (CB)-derived CD34+ hematopoietic cells. This strategy is based on ex-vivo expansion and differentiation of MKs in the presence of bone marrow niche-mimicking mesenchymal stem cells (MSCs), together with two other key components: (1) To enhance MK polyploidization, we used the potent pharmacological Rho-associated coiled-coil kinase (ROCK) inhibitor, KD045, resulting in liberation of increased numbers of functional platelets both in-vitro and in-vivo; (2) To evade HLA class I T-cell-driven killing of these expanded MKs, we employed CRISPR-Cas9-mediated β-2 microglobulin (β2M) gene knockout (KO). We found that coculturing with MSCs and MK-lineage-specific cytokines significantly increased MK expansion. This was further increased by ROCK inhibition, which induced MK polyploidization and platelet production. Additionally, ex-vivo treatment of MKs with KD045 resulted in significantly higher levels of engraftment and donor chimerism in a mouse model of thrombocytopenia. Finally, β2M KO allowed MKs to evade killing by allogeneic T-cells. Overall, our approaches offer a novel, readily translatable roadmap for producing adult donor-independent platelet products for a variety of clinical indications.
Collapse
Affiliation(s)
- Bijender Kumar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vahid Afshar-Kharghan
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mayela Mendt
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert Sackstein
- Department of Translational Medicine, Translational Glycobiology Institute, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Mark R. Tanner
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - May Daher
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Jimenez
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rafet Basar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luciana Melo Garcia
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mayra Shanley
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mecit Kaplan
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Xinhai Wan
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vandana Nandivada
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Francia Reyes Silva
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vernikka Woods
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - April Gilbert
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ricardo Gonzalez-Delgado
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sunil Acharya
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paul Lin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hind Rafei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pinaki Prosad Banerjee
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J. Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Elizabeth J. Shpall,
| |
Collapse
|
10
|
Hopkins CK, Townsend M, Vassallo RR. Leukoreduction filters: Still stuck on sickle trait red cells. Transfusion 2022; 62:1683-1687. [PMID: 36039825 DOI: 10.1111/trf.17077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
|
11
|
Wu S, Chen Q, Pan J, Zhou A. Platelet transfusion and mortality in patients with sepsis‐induced thrombocytopenia: A propensity score matching analysis. Vox Sang 2022; 117:1187-1194. [PMID: 35851699 DOI: 10.1111/vox.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Shanshan Wu
- Medical Research Center The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Qin Chen
- Department of Intensive Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Jingye Pan
- Department of Intensive Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Aiming Zhou
- Department of Intensive Care Unit The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| |
Collapse
|
12
|
Sayers M. Donor motivation and psychosocial research. Transfusion 2022; 62:1912-1916. [PMID: 35811303 PMCID: PMC9545312 DOI: 10.1111/trf.17024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Merlyn Sayers
- Carter BloodCare, Bedford, Texas, USA.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
13
|
Stapleton JT. Human Pegivirus Type 1: A Common Human Virus That Is Beneficial in Immune-Mediated Disease? Front Immunol 2022; 13:887760. [PMID: 35707535 PMCID: PMC9190258 DOI: 10.3389/fimmu.2022.887760] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/03/2022] [Indexed: 12/25/2022] Open
Abstract
Two groups identified a novel human flavivirus in the mid-1990s. One group named the virus hepatitis G virus (HGV) and the other named it GB Virus type C (GBV-C). Sequence analyses found these two isolates to be the same virus, and subsequent studies found that the virus does not cause hepatitis despite sharing genome organization with hepatitis C virus. Although HGV/GBV-C infection is common and may cause persistent infection in humans, the virus does not appear to directly cause any other known disease state. Thus, the virus was renamed “human pegivirus 1” (HPgV-1) for “persistent G” virus. HPgV-1 is found primarily in lymphocytes and not hepatocytes, and several studies found HPgV-1 infection associated with prolonged survival in people living with HIV. Co-infection of human lymphocytes with HPgV-1 and HIV inhibits HIV replication. Although three viral proteins directly inhibit HIV replication in vitro, the major effects of HPgV-1 leading to reduced HIV-related mortality appear to result from a global reduction in immune activation. HPgV-1 specifically interferes with T cell receptor signaling (TCR) by reducing proximal activation of the lymphocyte specific Src kinase LCK. Although TCR signaling is reduced, T cell activation is not abolished and with sufficient stimulus, T cell functions are enabled. Consequently, HPgV-1 is not associated with immune suppression. The HPgV-1 immunomodulatory effects are associated with beneficial outcomes in other diseases including Ebola virus infection and possibly graft-versus-host-disease following stem cell transplantation. Better understanding of HPgV-1 immune escape and mechanisms of inflammation may identify novel therapies for immune-based diseases.
Collapse
Affiliation(s)
- Jack T. Stapleton
- Medicine Service, Iowa City Veterans Administration Healthcare, Iowa City, IA, United States
- Departments of Internal Medicine, Microbiology & Immunology, University of Iowa, Iowa City, IA, United States
- *Correspondence: Jack T. Stapleton,
| |
Collapse
|
14
|
There and Back Again: The Once and Current Developments in Donor-Derived Platelet Products for Products for Hemostatic Therapy. Blood 2022; 139:3688-3698. [PMID: 35482959 DOI: 10.1182/blood.2021014889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
Over 100 years ago, Duke transfused whole blood to a thrombocytopenic patient to raise the platelet count and prevent bleeding. Since then, platelet transfusions have undergone numerous modifications from whole blood-derived platelet-rich plasma to apheresis-derived platelet concentrates. Similarly, the storage time and temperature have changed. The mandate to store platelets for a maximum of 5-7 days at room temperature has been challenged by recent clinical trial data, ongoing difficulties with transfusion-transmitted infections, and recurring periods of shortages, further exacerbated by the COVID-19 pandemic. Alternative platelet storage approaches are as old as the first platelet transfusions. Cold-stored platelets may offer increased storage times (days) and improved hemostatic potential at the expense of reduced circulation time. Frozen (cryopreserved) platelets extend the storage time to years but require storage at -80 °C and thawing before transfusion. Lyophilized platelets can be powder-stored for years at room temperature and reconstituted within minutes in sterile water but are probably the least explored alternative platelet product to date. Finally, whole blood offers the hemostatic spectrum of all blood components but has challenges, such as ABO incompatibility. While we know more than ever before about the in vitro properties of these products, clinical trial data on these products are accumulating. The purpose of this review is to summarize the findings of recent preclinical and clinical studies on alternative, donor-derived platelet products.
Collapse
|
15
|
Kalkwarf KJ, Cardenas JC, Wade CE, Cotton BA. Green Plasma has a Superior Hemostatic Profile Compared With Standard Color Plasma. Am Surg 2022; 88:1970-1975. [PMID: 35476552 DOI: 10.1177/00031348221096571] [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: 11/15/2022]
Abstract
BACKGROUND Limitations in available donors have dramatically reduced plasma availability over the past several decades, concurrent with increasing demand for some types of plasma. Plasma from female donors who are pregnant or taking oral contraceptives often has a green appearance, which frequently results in these units being discarded. This pilot study aimed to evaluate the hemostatic potential of green compared to standard-color plasma. MATERIALS AND METHODS Plasma from twelve blood group-matched female and twelve male donors was obtained from the local blood center. Six of the female and all of the male units of plasma had a normal appearance (STANDARD), while six of the female units were grossly green (GREEN). The hemostatic potential was evaluated by thrombelastography (TEG), calibrated automated thrombogram (CAT), and coagulation factor level measurements. Univariate analysis was performed using Wilcoxon Rank-Sum. RESULTS GREEN plasma was more procoagulant for all TEG values (r-value, k-time, angle, mA) when compared to STANDARD plasma. Differences were also observed in coagulation factor levels, with GREEN plasma having higher than STANDARD (factors II; VII, IX; X, XI, Protein S, and plasminogen); conversely, GREEN plasma had a longer lag time in CAT. DISCUSSION This pilot study demonstrates that female donors with green plasma have a superior hemostatic profile than standard plasma. GREEN plasma should be further investigated for its safety profile and hemostatic potential, so if it is found to be a safe and functionally non-inferior product, it should be actively re-introduced for transfusion in bleeding patients.
Collapse
Affiliation(s)
- Kyle J Kalkwarf
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jessica C Cardenas
- Center for Translational Injury Research, 12340University of Texas Health Science Center, Houston, TX, USA
| | - Charles E Wade
- Center for Translational Injury Research, 12340University of Texas Health Science Center, Houston, TX, USA
| | - Bryan A Cotton
- Department of Surgery, 12340University of Texas Health Science Center, Houston, TX, USA
| |
Collapse
|
16
|
Liu Y, Hesse LE, Geiger MK, Zinn KR, McMahon TJ, Chen C, Spence DM. A 3D-printed transfusion platform reveals beneficial effects of normoglycemic erythrocyte storage solutions and a novel rejuvenating solution. LAB ON A CHIP 2022; 22:1310-1320. [PMID: 35258064 PMCID: PMC9235508 DOI: 10.1039/d2lc00030j] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A set of 3D-printed analytical devices were developed to investigate erythrocytes (ERYs) processed in conventional and modified storage solutions used in transfusion medicine. During storage, prior to transfusion into a patient recipient, ERYs undergo many chemical and physical changes that are not completely understood. However, these changes are thought to contribute to an increase in post-transfusion complications, and even an increase in mortality rates. Here, a reusable fluidic device (fabricated with additive manufacturing technologies) enabled the evaluation of ERYs prior to, and after, introduction into a stream of flowing fresh ERYs, thus representing components of an in vivo ERY transfusion on an in vitro platform. Specifically, ERYs stored in conventional and glucose-modified solutions were assayed by chemiluminescence for their ability to release flow-induced ATP. The ERY's deformability was also determined throughout the storage duration using a novel membrane transport approach housed in a 3D-printed scaffold. Results show that hyperglycemic conditions permanently alter ERY deformability, which may explain the reduced ATP release, as this phenomenon is related to cell deformability. Importantly, the reduced deformability and ATP release were reversible in an in vitro model of transfusion; specifically, when stored cells were introduced into a flowing stream of healthy cells, the ERY-derived release of ATP and cell deformability both returned to states similar to that of non-stored cells. However, after 1-2 weeks of storage, the deleterious effects of the storage were permanent. These results suggest that currently approved hyperglycemic storage solutions are having adverse effects on stored ERYs used in transfusion medicine and that normoglycemic storage may reduce the storage lesion, especially for cells stored for longer than 14 days.
Collapse
Affiliation(s)
- Yueli Liu
- Departments of Chemistry, Michigan State University, East Lansing, MI, 48824, USA
| | - Laura E Hesse
- Departments of Chemistry, Michigan State University, East Lansing, MI, 48824, USA
| | - Morgan K Geiger
- Biomedical Engineering, Michigan State University, East Lansing, MI, 48824, USA.
- Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI, 48824, USA
| | - Kurt R Zinn
- Biomedical Engineering, Michigan State University, East Lansing, MI, 48824, USA.
- Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI, 48824, USA
| | - Timothy J McMahon
- Department of Medicine, Duke University, Durham, North Carolina, 27710, USA
| | - Chengpeng Chen
- Department of Chemistry and Biochemistry, University of Maryland Baltimore County, Baltimore, MD, 21250, USA
| | - Dana M Spence
- Biomedical Engineering, Michigan State University, East Lansing, MI, 48824, USA.
- Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI, 48824, USA
| |
Collapse
|
17
|
Turecek PL, Hibbett D, Kreil TR. Plasma procurement and plasma product safety in light of the COVID-19 pandemic from the perspective of the plasma industry. Vox Sang 2022; 117:780-788. [PMID: 35298841 PMCID: PMC9115499 DOI: 10.1111/vox.13267] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/12/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022]
Abstract
This review, written from the perspective of the plasma industry, discusses plasma procurement and plasma product safety in light of the COVID‐19 pandemic. The COVID‐19 pandemic impacted the whole world and, therefore, not unexpectedly, the pharmaceutical industry too. In spite of this, the plasma protein industry has continued to provide life saving therapies to critically ill patients. Moreover, companies have collected COVID convalescent plasma (CP) to support development of investigational therapies, for example, hyperimmune globulins to potentially treat SARS‐CoV‐2 infection, and collaborated with those collecting COVID CP for direct transfusion, which has been made available under emergency use in the United States. For plasma that is fractionated to become a therapy, general knowledge of coronaviruses and numerous new studies on the structure and function of SARS‐CoV‐2 provide reassurance that existing industry precautions, including donor selection, as well as virus inactivation and removal steps during the manufacturing process are sufficient to maintain the high standards of virus safety of plasma products. The pandemic also revealed the vulnerability and inadequacy of the current plasma ecosystem. There is a need for more plasma to be collected around the world to meet the growing need for safe and efficacious plasma‐derived therapies. This requires outdated regulatory and policy restrictions to be realigned with current scientific evidence. More countries around the world should be in a position to contribute to global supply of plasma so that patients with life‐threatening conditions ‐ and often no alternative therapeutic solutions ‐ have better access to care.
Collapse
Affiliation(s)
- Peter L Turecek
- Plasma-Derived Therapies R&D, Baxalta Innovations GmbH, part of Takeda, Vienna, Austria
| | - Deborah Hibbett
- Global Communications and Public Affairs, Takeda Pharmaceutical Company Limited, Zurich, Switzerland
| | - Thomas R Kreil
- Global Pathogen Safety, Takeda Manufacturing Austria AG, Vienna, Austria
| |
Collapse
|
18
|
Ramirez GA, Gautam-Goyal P, Shariatmadar S, Khatri A, McCann-Pineo M, Rasul R, Karkenny G, Chang T, Sfakianos M, Cassiere H, Epstein M. Passive transfer of SARS-CoV-2 antibodies with platelet transfusions. Transfusion 2022; 62:764-769. [PMID: 35191047 PMCID: PMC9115505 DOI: 10.1111/trf.16841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
Background Although over 5000 platelet transfusions occur daily in the United States, the presence of SARS‐CoV‐2 antibodies in platelet units is not commonly evaluated for. The effects of platelet transfusions with SARS‐CoV‐2 antibodies remain largely unknown. We evaluated single‐donor (apheresis) platelet units for SARS‐CoV‐2 antibodies and determined if platelet transfusions passively transferred antibodies to seronegative recipients. Study Design and Methods We conducted a retrospective analysis as part of a quality assurance initiative during February to March 2021 at a tertiary referral academic center in suburban New York. Platelet units and platelet recipients were evaluated for the presence of SARS‐CoV‐2 antibodies using the DiaSorin LIASON SARS‐CoV‐2 S1/S2 IgG assay. There were 47 platelet recipients eligible for study inclusion. The primary outcome was the presence of SARS‐CoV‐2 spike protein IgG antibodies in the recipient's blood after platelet transfusion. Results Twenty‐three patients received platelets with SARS‐CoV‐2 spike protein IgG antibodies; 13 recipients had detection of SARS‐COV‐2 antibodies (56.5%), and 10 recipients did not. The median antibody titer in the platelet units given to the group with passive antibodies detected was significantly higher compared to the median antibody titer in the platelet units given to the group without antibodies detected (median [interquartile range]: 306 AU/ml [132, 400] vs. 96.1 AU/ml [30.6, 186], p = .027). Conclusions Our study demonstrated a significant rate of passive transfer of SARS‐CoV‐2 spike protein IgG antibodies through platelet transfusions. Considering the volume of daily platelet transfusions, this is something all clinicians should be aware of.
Collapse
Affiliation(s)
- Guillermo A Ramirez
- Karin and Dayton Brown, Jr. Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Pranisha Gautam-Goyal
- Karin and Dayton Brown, Jr. Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Sherry Shariatmadar
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, North Shore University Hospital, Manhasset, New York, USA
| | - Akshay Khatri
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine/Jackson Health System, Miami, Florida, USA
| | - Molly McCann-Pineo
- Department of Occupational Medicine, Epidemiology and Prevention, The Feinstein Institutes for Medical Research Northwell Health, Great Neck, New York, USA
| | - Rehana Rasul
- Department of Occupational Medicine, Epidemiology and Prevention, The Feinstein Institutes for Medical Research Northwell Health, Great Neck, New York, USA
| | - Gabriel Karkenny
- Karin and Dayton Brown, Jr. Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Tylis Chang
- Department of Pathology and Laboratory Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Maria Sfakianos
- Department of Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Hugh Cassiere
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Marcia Epstein
- Karin and Dayton Brown, Jr. Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| |
Collapse
|
19
|
Ding J, Krey R, Malone L, Merrill V, Krouss M, O'Brien J, Fontaine MJ. Educational and Electronic-Based Tools to Mitigate the Risk of Transfusion Adverse Events. J Healthc Qual 2021; 43:e84-e90. [PMID: 33560046 DOI: 10.1097/jhq.0000000000000297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The transfusion of blood products is a widely used practice but comes with the risk of transfusion-associated adverse events and fatalities. The primary aim of this study was to evaluate if strict adherence to transfusion guidelines would lead to a decrease in the rate of transfusion reactions that occurred when blood products were given outside of established indications. Hospital-wide educational programs and dedicated electronic transfusion order sets were used to encourage adherence to guidelines. A secondary aim of this study was to evaluate if a decrease in the incidence of transfusion reactions also lead to a decrease in associated healthcare costs.
Collapse
|
20
|
Bulle EB, Klanderman RB, Pendergrast J, Cserti-Gazdewich C, Callum J, Vlaar APJ. The recipe for TACO: A narrative review on the pathophysiology and potential mitigation strategies of transfusion-associated circulatory overload. Blood Rev 2021; 52:100891. [PMID: 34627651 DOI: 10.1016/j.blre.2021.100891] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/31/2022]
Abstract
Transfusion associated circulatory overload (TACO) is one of the leading causes of transfusion related morbidity and mortality. TACO is the result of hydrostatic pulmonary edema following transfusion. However, up to 50% of all TACO cases appear after transfusion of a single unit, suggesting other factors, aside from volume, play a role in its pathophysiology. TACO follows a two-hit model, in which the first hit is an existing disease or comorbidity that renders patients volume incompliant, and the second hit is the transfusion. First hit factors include, amongst others, cardiac and renal failure. Blood product factors, setting TACO apart from crystalloid overload, include colloid osmotic pressure effects, viscosity, pro-inflammatory mediators and storage lesion byproducts. Differing hemodynamic changes, glycocalyx injury, endothelial damage and inflammatory reactions can all contribute to developing TACO. This narrative review explores pathophysiological mechanisms for TACO, discusses related therapeutic and preventative measures, and identifies areas of interest for future research.
Collapse
Affiliation(s)
- Esther B Bulle
- Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), University of Amsterdam, Amsterdam UMC, the Netherlands.
| | - Robert B Klanderman
- Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), University of Amsterdam, Amsterdam UMC, the Netherlands.
| | - Jacob Pendergrast
- Laboratory Medicine Program, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
| | - Christine Cserti-Gazdewich
- Laboratory Medicine Program, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Canada.
| | - Alexander P J Vlaar
- Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), University of Amsterdam, Amsterdam UMC, the Netherlands.
| |
Collapse
|
21
|
Liu WJ, Chen YY, Hsu LI, Chen JW, Wei ST, Hou SM. An imbalance in blood collection and demand is anticipated to occur in the near future in Taiwan. J Formos Med Assoc 2021; 121:1610-1614. [PMID: 34407921 DOI: 10.1016/j.jfma.2021.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
Due to excessive clinical blood usage and a rapidly aging population, an impending blood shortage in Taiwan is inevitable. This study aimed to determine the potential blood deficit in Taiwan in 2030. The numbers of units of whole blood (WB) donated and red blood cells (RBC) transfused will increase from 1,182,973 to 1,115,803 in 2018 to 1,230,500 and 1,250,760 in 2030, respectively. Considering the gap between donation and transfusion, we estimate a deficit of 97,633 units of WB in 2030. Blood collection will increasingly rely on donors over the age of 40. Moreover, we observed a large decline in units of WB donated among people less than 25 years old. A growing demand for RBC is attributed to the aging population and limited decreases in age-specific units of RBC transfused per capita. Scrutinizing and forecasting changes in blood collection and transfusion are necessary for generating strategies to mitigate blood shortages.
Collapse
Affiliation(s)
- Wen-Jie Liu
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Yun-Yuan Chen
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Ling-I Hsu
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Jen-Wei Chen
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Sheng-Tang Wei
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Sheng-Mou Hou
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan; Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
22
|
Anthon CT, Sivapalan P, Granholm A, Pène F, Puxty K, Perner A, Møller MH, Russell L. Prophylactic platelet transfusions in hospitalised patients with thrombocytopenia-Protocol for a systematic review with meta-analysis. Acta Anaesthesiol Scand 2021; 65:988-994. [PMID: 33840095 DOI: 10.1111/aas.13826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 02/27/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prophylactic platelet transfusions are frequently used to prevent bleeding in hospitalised patients with thrombocytopenia. Recommendations regarding the use of prophylactic platelet transfusions in non-haematological patients are based on extrapolations, observational studies, and expert opinions, and transfusion with platelets has been associated with adverse effects. We aim to assess the overall benefits and harms of prophylactic platelet transfusions in hospitalised patients with thrombocytopenia. METHODS/DESIGN We will conduct a systematic review with meta-analyses and trial sequential analyses in compliance with the recommendations by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We will prepare the manuscript in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We will include randomised clinical trials assessing prophylactic platelet transfusion versus no prophylaxis or placebo in hospitalised patients with thrombocytopenia. The primary outcome is mortality at longest follow-up. Secondary outcomes include episodes of clinically important bleeding, nosocomial infections, transfusion-related adverse events, thromboembolic events, length of hospital stay, quality of life, and days alive without the use of life support. We will conduct prespecified subgroup analyses and sensitivity analyses and assess the risk of random errors by trial sequential analyses. DISCUSSION The proposed systematic review will provide an overview of the certainty of evidence for the benefits and harms of prophylactic platelet transfusion in hospitalised patients with thrombocytopenia.
Collapse
Affiliation(s)
- Carl T. Anthon
- Department of Intensive Care RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Praleene Sivapalan
- Department of Intensive Care RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Frédéric Pène
- Médecine Intensive & Réanimation Faculté de Médecine Paris Descartes Hôpital CochinAP‐HP Paris France
| | | | - Anders Perner
- Department of Intensive Care RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Lene Russell
- Department of Intensive Care RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| |
Collapse
|
23
|
Dodd RY, Spencer BR, Xu M, Foster GA, Saá P, Brodsky JP, Stramer SL. Characteristics of US Blood Donors Testing Reactive for Antibodies to SARS-CoV-2 Prior to the Availability of Authorized Vaccines. Transfus Med Rev 2021; 35:1-7. [PMID: 34373145 PMCID: PMC8321690 DOI: 10.1016/j.tmrv.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
In the United States, many blood collection organizations initiated programs to test all blood donors for antibodies to SARS-CoV-2, as a measure to increase donations and to assist in the identification of potential donors of COVID-19 convalescent plasma (CCP). As a result, it was possible to investigate the characteristics of healthy blood donors who had previously been infected with SARS-CoV-2. We report the findings from all blood donations collected by the American Red Cross, representing 40% of the national blood supply covering 44 States, in order to characterize the seroepidemiology of SARS-CoV-2 infection among blood donors in the United States, prior to authorized vaccine availability. We performed an observational cohort study from June 15th to November 30th, 2020 on a population of 1.531 million blood donors tested for antibodies to the S1 spike antigen of SARS-CoV-2 by person, place, time, ABO group and dynamics of test reactivity, with additional information from a survey of a subset of those with reactive test results. The overall seroreactivity was 4.22% increasing from 1.18 to 9.67% (June 2020 - November 2020); estimated incidence was 11.6 per hundred person-years, 1.86-times higher than that based upon reported cases in the general population over the same period. In multivariable analyses, seroreactivity was highest in the Midwest (5.21%), followed by the South (4.43%), West (3.43%) and Northeast (2.90%). Seroreactivity was highest among donors aged 18-24 (Odds Ratio 3.02 [95% Confidence Interval 2.80-3.26] vs age >55), African-Americans and Hispanics (1.50 [1.24-1.80] and 2.12 [1.89-2.36], respectively, vs Caucasian). Group O frequency was 51.5% among nonreactive, but 46.1% among seroreactive donors (P< .0001). Of surveyed donors, 45% reported no COVID-19-related symptoms, but 73% among those unaware of testing. Signal levels of antibody tests were stable over 120 days or more and there was little evidence of reinfection. Evaluation of a large population of healthy, voluntary blood donors provided evidence of widespread and increasing SARS-CoV-2 seroprevalence and demonstrated that at least 45% of those previously infected were asymptomatic. Epidemiologic findings were similar to those among clinically reported cases.
Collapse
Affiliation(s)
- Roger Y Dodd
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA
| | - Bryan R Spencer
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA
| | - Meng Xu
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA
| | | | - Paula Saá
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA
| | | | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA.
| |
Collapse
|
24
|
Pandey S, Belanger GA, Rajbhandary S, Cohn CS, Benjamin RJ, Bracey AW, Katz LM, Menitove JE, Mintz PD, Gammon RR. A survey of US hospitals on platelet inventory management, transfusion practice, and platelet availability. Transfusion 2021; 61:2611-2620. [PMID: 34287930 DOI: 10.1111/trf.16561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND A survey of US hospitals was conducted to increase our understanding of the current state of platelet (PLT) practice and supply. The survey captures information on transfusion practice and inventory management, including stock levels, outdate rates, ability to return or transfer PLTs, and low dose PLTs. Notably, the survey also elucidates PLT availability challenges and impact to patient care. STUDY DESIGN AND METHODS A 27 question online survey was distributed directly to over 995 US hospitals and indirectly through blood centers to many more between September 27 and October 25, 2019. Descriptive statistics were used for respondent characteristics. Bivariate analysis was performed and correlation coefficients, chi square tests, and p values determined statistical significance of relationships between variables. RESULTS Four hundred and eighty-one hospitals completed the survey of which 21.6%, 53.2%, and 25.2% were characterized as small, medium, and large hospitals, respectively. Some key observations from this survey include: (1) there is an opportunity for greater adherence to evidence-based guidelines; (2) higher outdate rates occur in hospitals stocking less than five PLTs and the ability to return or transfer PLTs lowers outdates; (3) use of low dose apheresis PLTs varies; and (4) decreased PLT availability is commonly reported, especially in hospitals with high usage, and can lead to delays in transfusions or surgeries. CONCLUSION This survey represents a comprehensive national assessment of inventory management practices and PLT availability challenges in US hospitals. Findings from this survey can be used to guide further research, help shape future guidance for industry, and assist with policy decisions.
Collapse
Affiliation(s)
- Suchitra Pandey
- Department of Pathology, Stanford University, Palo Alto, California, USA.,Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | - Geoffrey A Belanger
- Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | | | - Claudia S Cohn
- Department of Research, AABB, Bethesda, Maryland, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard J Benjamin
- Clinical Research and Medical Affairs, Cerus Corporation, Concord, California, USA
| | - Arthur W Bracey
- Department of Pathology, Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Louis M Katz
- Medical Affairs, ImpactLife (formerly Mississippi Valley Regional Blood Center), Davenport, Iowa, USA
| | - Jay E Menitove
- Department of Pathology and Lab Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul D Mintz
- Medical Affairs, Verax Biomedical, Inc, Marlborough, Massachusetts, USA
| | | |
Collapse
|
25
|
Savinkina AA, Haass KA, Sapiano MRP, Henry RA, Berger JJ, Basavaraju SV, Jones JM. Transfusion-associated adverse events and implementation of blood safety measures - findings from the 2017 National Blood Collection and Utilization Survey. Transfusion 2021; 60 Suppl 2:S10-S16. [PMID: 32134123 DOI: 10.1111/trf.15654] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serious transfusion-associated adverse events are rare in the United States. To enhance blood safety, various measures have been developed. With use of data from the 2017 National Blood Collection and Utilization Survey (NBCUS), we describe the rate of transfusion-associated adverse events and the implementation of specific blood safety measures. STUDY DESIGN AND METHODS Data from the 2017 NBCUS were used with comparison to already published estimates from 2015. Survey weighting and imputation were used to obtain national estimates of transfusion-associated adverse events, and the number of units treated with pathogen reduction technology (PRT), screened for Babesia, and leukoreduced. RESULTS The rate of transfusion-associated adverse events requiring any diagnostic or therapeutic interventions was stable (275 reactions per 100,000 transfusions in 2015 and 282 reactions per 100,000 transfusions in 2017). In 2017 among US blood collection centers, 16 of 141 (11.3%) reported screening units for Babesia and 28 of 144 (19.4%) reported PRT implementation; 138 of 2279 (6.1%) hospitals reported transfusing PRT-treated platelets. In 2017, 134 of 2336 (5.7%) hospitals reported performing secondary bacterial testing of platelets (50,922 culture-based and 63,220 rapid immunoassay tests); in 2015, 71 of 1877 (3.8%) hospitals performed secondary testing (87,155 culture-based and 21,779 rapid immunoassay tests). Nearly all whole blood/red blood cell units and platelet units were leukoreduced. CONCLUSIONS Besides leukoreduction, implementation of most blood safety measures reported in this study remains low. Nationally, hospitals might be shifting from culture-based secondary bacterial testing to rapid immunoassays.
Collapse
Affiliation(s)
- Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A Henry
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - James J Berger
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
26
|
Kracalik I, Mowla S, Katz L, Cumming M, Sapiano MRP, Basavaraju SV. Impact of the early coronavirus disease 2019 pandemic on blood utilization in the United States: A time-series analysis of data reported to the National Healthcare Safety Network Hemovigilance Module. Transfusion 2021; 61 Suppl 2:S36-S43. [PMID: 33990963 PMCID: PMC8242767 DOI: 10.1111/trf.16451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services worldwide. However, little has been reported regarding the impact on blood utilization. We quantified the impact of COVID-19 on blood utilization and discards among facilities reporting to the National Healthcare Safety Network Hemovigilance Module. METHODS Facilities continuously reporting data, during January 2016-June 2020, on transfused and discarded blood components, stratified by component type (red blood cells [RBC], platelets, and plasma), were included. Interrupted time-series analysis with generalized estimating equations, adjusting for facility surgical volume and seasonality, was used to quantify changes in blood utilization and discards relative to a Centers for Medicare & Medicaid Services notification delaying nonessential medical procedures (March 2020). RESULTS Seventy-two facilities included in the analyses, on average, transfused 44,548 and discarded 2,202 blood components monthly. Following the March 2020 notification and after multivariable adjustment, RBC and platelet utilization declined, -9.9% (p < .001) and -13.6% (p = .014), respectively. Discards increased for RBCs (30.2%, p = .047) and platelets (60.4%, p = .002). No statistically significant change in plasma was found. Following these abrupt changes, blood utilization and discards rebounded toward baseline with RBC utilization increasing by 5.7% (p < .001), and platelet and RBC discards decreasing -16.4% (<0.001) and -12.7 (p = .001), respectively. CONCLUSION Following notification delaying elective surgical procedures, blood utilization declined substantially while blood discards increased, resulting in substantial wastage of blood products. Ongoing and future pandemic response efforts should consider the impact of interventions on blood supply and demand to ensure blood availability.
Collapse
Affiliation(s)
- Ian Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanjida Mowla
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Louis Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
| | - Melissa Cumming
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Matthew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Lantana Consulting Group, Inc, East Thetford, Vermont, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
27
|
Dodd RY, Stramer SL, Smith R, Young PP. Paid platelet donors: Points to consider. Transfusion 2021; 61:1000-1003. [PMID: 33831224 DOI: 10.1111/trf.16329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Roger Y Dodd
- American Red Cross, Biomedical Services Headquarters, Washington, District of Columbia, USA.,Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | - Rachel Smith
- American Red Cross, Biomedical Services Headquarters, Washington, District of Columbia, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pampee P Young
- American Red Cross, Biomedical Services Headquarters, Washington, District of Columbia, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
28
|
Adedayo T, O'Mahony D, Adeleke O, Mabunda S. Doctors' practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study. Afr J Prim Health Care Fam Med 2021; 13:e1-e8. [PMID: 34212740 PMCID: PMC8252156 DOI: 10.4102/phcfm.v13i1.2889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 01/28/2023] Open
Abstract
Background Unnecessary blood transfusion exposes recipients to potential harms. Aim The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion. Setting A hospital providing level 1 and 2 services. Methods A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews. Results Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. Conclusion Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines.
Collapse
Affiliation(s)
- Temitope Adedayo
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
| | | | | | | |
Collapse
|
29
|
Khan J, Dunbar NM. Time to stop worrying about ABO incompatible cryoprecipitate transfusions in adults. Transfusion 2021; 61:1-4. [PMID: 33616962 DOI: 10.1111/trf.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
30
|
Platelet Transfusion-Insights from Current Practice to Future Development. J Clin Med 2021; 10:jcm10091990. [PMID: 34066360 PMCID: PMC8125287 DOI: 10.3390/jcm10091990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Since the late sixties, therapeutic or prophylactic platelet transfusion has been used to relieve hemorrhagic complications of patients with, e.g., thrombocytopenia, platelet dysfunction, and injuries, and is an essential part of the supportive care in high dose chemotherapy. Current and upcoming advances will significantly affect present standards. We focus on specific issues, including the comparison of buffy-coat (BPC) and apheresis platelet concentrates (APC); plasma additive solutions (PAS); further measures for improvement of platelet storage quality; pathogen inactivation; and cold storage of platelets. The objective of this article is to give insights from current practice to future development on platelet transfusion, focusing on these selected issues, which have a potentially major impact on forthcoming guidelines.
Collapse
|
31
|
Kracalik I, Mowla S, Basavaraju SV, Sapiano MRP. Transfusion-related adverse reactions: Data from the National Healthcare Safety Network Hemovigilance Module - United States, 2013-2018. Transfusion 2021; 61:1424-1434. [PMID: 33880771 DOI: 10.1111/trf.16362] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/03/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite current blood safety measures, transfusion recipients can experience transfusion-related adverse reactions. Monitoring these reactions can aid in understanding the effectiveness of current transfusion safety measures. Data from the National Healthcare Safety Network Hemovigilance Module were used to quantify adverse reaction risk. METHODS Facilities reporting at least one month of transfused blood components and transfusion-related adverse reactions during January 2013-December 2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for transfused components stratified by component type, collection, and modification methods. RESULTS During 2013-2018, 201 facilities reported 18,308 transfusion-related adverse reactions among 8.34 million blood components transfused (220/100,000). Adverse reactions were higher among apheresis (486/100,000) and pathogen-reduced platelets (579/100,000) than apheresis red blood cells (197/100,000). Allergic reactions (41%) were most common. There were 23 fatalities and 9% of all adverse reactions were serious (severe, life-threatening, or fatal). Reactions involving pulmonary complications (transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnea) accounted for 35% of serious reactions but 65% of fatalities. Most (76%) of the 37 transfusion-transmitted infections were serious; none involved pathogen-reduced components. CONCLUSIONS One in 455 blood components transfused was associated with an adverse reaction although the risk of serious reactions (1 in 6224) or transfusion-transmitted infections (1 in 225,440) was lower. Some serious reactions identified were preventable, suggesting additional safety measures may be beneficial. Higher reaction rates identified among pathogen-reduced platelets require further study. These findings highlight the importance of monitoring reactions through national hemovigilance to inform current safety measures and the need for strategies to increase healthcare facility participation.
Collapse
Affiliation(s)
- Ian Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanjida Mowla
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Lantana Consulting Group, Inc., East Thetford, Vermont, USA
| |
Collapse
|
32
|
Mowla SJ, Kracalik IT, Sapiano MRP, O'Hearn L, Andrzejewski C, Basavaraju SV. A Comparison of Transfusion-Related Adverse Reactions Among Apheresis Platelets, Whole Blood-Derived Platelets, and Platelets Subjected to Pathogen Reduction Technology as Reported to the National Healthcare Safety Network Hemovigilance Module. Transfus Med Rev 2021; 35:78-84. [PMID: 33934903 DOI: 10.1016/j.tmrv.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
Despite advances in transfusion safety, concerns with safety of platelet transfusions remain including platelet-related sepsis and higher reaction rates observed among patients receiving apheresis platelets (APLTs). National Healthcare Safety Network (NHSN) Hemovigilance Module (HM) data were analyzed to quantify the burden and severity of adverse reactions occurring from APLTs and whole blood-derived platelets (WBD-PLTs). Facilities participating in NHSN HM during 2010-2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for APLTs and WBD-PLTs stratified by severity, use of platelet additive solution (PAS), and pathogen reduction technology (PRT). Chi-square tests were used to compare rates. During the study interval, 2,000,589 platelets were transfused: 1,435,154 APLTs; 525,902 WBD-PLTs; and among APLTs, 39,533 PRT-APLTs. APLT adverse reaction rates were higher (478 vs 70/ 100,000, P< .01) and more often serious (34 vs 6/100,000; P< .01) compared with WBD-PLTs. Adverse reactions were higher among PRT-APLTs (572/100,000) and were less often serious (18/100,000) compared with non-PRT-APLTs (35/100,000) although this association was not statistically significant. Among components implicated in adverse reactions, 92% of APLTs were suspended in plasma. Compared with PRT-APLTs stored in PAS, rates were higher among units stored in plasma (760 vs 525/100,000). Most serious reactions (75%) were allergic. No transfusion-transmitted infections were reported among PRT-APLTs. APLTs were associated with a 6-fold and 2-fold higher serious adverse reaction risks compared with WBD-PLTs and PRT-APLTs, respectively. These findings demonstrate the importance of monitoring transfusion-related adverse reactions to track the safety of platelet transfusions and quantify the impact of mitigation strategies through national hemovigilance systems.
Collapse
Affiliation(s)
- Sanjida J Mowla
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Ian T Kracalik
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynne O'Hearn
- Department of Pathology, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Chester Andrzejewski
- Department of Pathology, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
33
|
Hofmann A, Ozawa S, Shander A. Activity-based cost of platelet transfusions in medical and surgical inpatients at a US hospital. Vox Sang 2021; 116:998-1004. [PMID: 33772793 DOI: 10.1111/vox.13095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies by the Cost of Blood Consensus Conference (COBCON) have used a comprehensive, standardized and generalizable activity-based costing (ABC) model to estimate the cost of red blood cell transfusions and plasma transfusion. The objective of this study was to determine the total cost of platelet transfusions in a real-world US hospital inpatient setting. MATERIALS AND METHODS This database analysis study retrospectively collected costs for all activities related to platelet transfusion in a single-acute care US teaching hospital in 2017. Costs were collected in a stepwise manner using a custom ABC model which mapped the technical, administrative and clinical processes involved in the transfusion of platelets. RESULTS For the 15 024 inpatients included in the analysis, 6335 (42·2%) were given a blood type and screen, and 941 (6·3%) received a transfusion of one or more blood products. A total of 333 platelet units were transfused in 131 patients (mean 2·54 units per patient): 211 (63·4%) units in medical inpatients and 122 (36·6%) in surgical inpatients. The total cost was $1359·99 per platelet unit, corresponding to $3457·06 per inpatient. Acquisition costs made up the largest proportion of the total cost (45·1%) followed by direct and indirect overheads (38·7%) and hospital processes costs (16·3%). CONCLUSION This is the first study to use an ABC costing model to determine the full cost of platelet transfusions within a US inpatient setting. This provides a useful reference point for comparisons with other transfusion products, and considerations for cost reduction.
Collapse
Affiliation(s)
- Axel Hofmann
- Institute for Bloodless Medicine and Patient Blood Management, Englewood Hospital & Medical Center, Englewood, NJ, USA.,Medical School and Division of Surgery, The University of Western Australia, Perth, Australia.,Institute of Anesthesiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sherri Ozawa
- Institute for Bloodless Medicine and Patient Blood Management, Englewood Hospital & Medical Center, Englewood, NJ, USA
| | - Aryeh Shander
- Institute for Bloodless Medicine and Patient Blood Management, Englewood Hospital & Medical Center, Englewood, NJ, USA.,Department of Anesthesiology, Critical Care and Hyperbaric Medicine, TeamHealth, Englewood Hospital and Medical Center, Englewood, NJ, USA.,Clinical Professor of Anesthesiology, Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
34
|
Sadana D, Kummangal B, Moghekar A, Banerjee K, Kaur S, Balasubramanian S, Tolich D, Han X, Wang X, Hanane T, Mireles-Cabodevila E, Quraishy N, Duggal A, Krishnan S. Adherence to blood product transfusion guidelines-An observational study of the current transfusion practice in a medical intensive care unit. Transfus Med 2021; 31:227-235. [PMID: 33749043 DOI: 10.1111/tme.12771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Blood transfusions though life-saving are not entirely benign. They are the most overused procedure in the hospital and have been under scrutiny by the 'Choosing Wisely campaign'. The strict adoption of restrictive transfusion guidelines could improve patient outcomes while reducing cost. OBJECTIVES In this study, we evaluate adherence to restrictive transfusion guidelines, along with hospital mortality and length of stay (LOS) in transfusion events with a pre-transfusion haemoglobin (Hb) ≥7 g/dl. Additionally, we evaluated associated costs accrued due to unnecessary transfusions. METHODS We conducted a retrospective observational study in a 64-bed medical intensive care unit (MICU) of an academic medical centre involving all adult patients (N = 957) requiring packed red blood cell transfusion between January 2015 and December 2015. RESULTS In total, 3140 units were transfused with a mean pre-transfusion Hb of 6.75 ± 0.86 g/dl. Nine hundred forty-four (30%) transfusion events occurred with a pre-transfusion Hb ≥7 g/dl, and 385 (12.3%) of these occurred in patients without hypotension, tachycardia, use of vasopressors, or coronary artery disease. Forgoing them could have led to a savings of approximately 0.3 million dollars. Transfusion events with pre-transfusion Hb ≥7 g/dl were associated with an increased mortality in patients with acute blood loss (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11-3.88; p = 0.02) and LOS in patients with chronic blood loss (β1 .8.26, 95% CI 4.09-12.43; p < 0.01). CONCLUSION A subset of anaemic patients in the MICU still receive red blood cell transfusions against restrictive guidelines offering hospitals the potential for effective intervention that has both economic and clinical implications.
Collapse
Affiliation(s)
- Divyajot Sadana
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Basheer Kummangal
- Department of Hospital Medicine, Detroit Receiving Hospital, Detroit, Michigan, USA
| | - Ajit Moghekar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Simrat Kaur
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shailesh Balasubramanian
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah Tolich
- Department of Surgical Operations, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaozhen Han
- Department of Quantitative Health Sciences, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tarik Hanane
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - NurJehan Quraishy
- Department of Clinical Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudhir Krishnan
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
35
|
Perioperative Cryoprecipitate Waste Reduction. J Med Syst 2021; 45:37. [PMID: 33566170 PMCID: PMC7873515 DOI: 10.1007/s10916-021-01719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
Improvement of operating room efficiency regarding perioperative blood product transfusion is fundamental for surgical patients. The aim of this study was to 1) assess the use of cryoprecipitate in the operating room at our institution 2) identify and address gaps in knowledge regarding the process of ordering and returning cryoprecipitate 3) aim to reduce cryoprecipitate wastage by 50% over a 14-month period. Institutional data from Dec. 2017 to April 2020 was retrieved on cryoprecipitate that was ordered, thawed, and delivered to the operating room. Additionally, data was collected regarding cryoprecipitate that was wasted. A retrospective analysis of weekly intraoperative cryoprecipitate utilization was performed to compare wastage before and after implementation of interventions. Pre-intervention (Dec 2017 - March 2019), a total of 453 units of cryoprecipitate were issued with 14 units wasted (3% wastage). Between March 2019 and April 2020, the 14 months after our intervention, there were 402 units of cryoprecipitate issued with only 1 unit wasted (0.25% wastage). The overall cryoprecipitate waste rate was reduced by 91.66%. Month-to-month comparison of pre-intervention and post-intervention data identified significant reduction in average monthly wastage (0.875 vs 0.071 units respectively, p < 0.05). Appropriately, there was not a significant change in the mean monthly cryoprecipitate issued to the operating room (28.31 vs. 28.7 units, p = 0.94). These results demonstrate that utilizing educational initiatives for optimization of blood product management can reduce unnecessary ordering, transfusions, and wastage; an outcome that could ultimately reduce costs.
Collapse
|
36
|
Trépanier P, Chevrier MC, Constanzo Yanez J, Baillargeon N, St-Pierre C, Perreault J. Adapting to supply-and-demand emerging trends for antigen-negative red blood cell units. Transfusion 2021; 61:1489-1494. [PMID: 33515215 DOI: 10.1111/trf.16285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND A global downtrend in blood usage has been observed by many countries, while the demand for antigen-negative red blood cell (RBC) units used in antigen-matched transfusions keeps increasing. The declining number of units collected exposes blood providers to a rapidly evolving supply challenge. METHODS This study was conducted retrospectively with use of internal data analysis to weigh Québec's situation regarding global and antigen-negative RBC demand, to measure the effects of community-directed recruitment and blood drives, and to evaluate the benefits of mass-scale RBC genotyping. RESULTS Our findings confirm a global RBC usage downtrend of over 20% total in the past 10 years with a steady antigen-negative usage and highlight the most requested negative antigen combinations. Our data also show our +39.5% progress regarding the number of Black donors recruited for antigen matching of patients with sickle cell disease in the past 3 years, as well as a constantly growing number of just-in-time blood collection for complex orders. Finally, our data summarize the efficiency of our mass-scale RBC genotyping efforts. CONCLUSION Altogether, this study confirms the demand trends for regular and antigen-negative RBC units in Québec and the efficient effects of our recruitment and typing strategies.
Collapse
Affiliation(s)
- Patrick Trépanier
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| | | | | | | | - Christine St-Pierre
- Héma-Québec, Customer Experience and Business Intelligence, St-Laurent, Québec, Canada
| | - Josée Perreault
- Héma-Québec, Medical Affairs and Innovation, Québec City, Québec, Canada
| |
Collapse
|
37
|
Burke M, Sinha P, Luban NLC, Posnack NG. Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients. Front Pediatr 2021; 9:765306. [PMID: 34778153 PMCID: PMC8586075 DOI: 10.3389/fped.2021.765306] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 01/05/2023] Open
Abstract
Red blood cell (RBC) transfusions are a life-saving intervention, with nearly 14 million RBC units transfused in the United States each year. However, the safety and efficacy of this procedure can be influenced by variations in the collection, processing, and administration of RBCs. Procedures or manipulations that increase potassium (K+) levels in stored blood products can also predispose patients to hyperkalemia and transfusion-associated hyperkalemic cardiac arrest (TAHCA). In this mini review, we aimed to provide a brief overview of blood storage, the red cell storage lesion, and variables that increase extracellular [K+]. We also summarize cases of TAHCA and identify potential mitigation strategies. Hyperkalemia and cardiac arrhythmias can occur in pediatric patients when RBCs are transfused quickly, delivered directly to the heart without time for electrolyte equilibration, or accumulate extracellular K+ due to storage time or irradiation. Advances in blood banking have improved the availability and quality of RBCs, yet, some patient populations are sensitive to transfusion-associated hyperkalemia. Future research studies should further investigate potential mitigation strategies to reduce the risk of TAHCA, which may include using fresh RBCs, reducing storage time after irradiation, transfusing at slower rates, implementing manipulations that wash or remove excess extracellular K+, and implementing restrictive transfusion strategies.
Collapse
Affiliation(s)
- Morgan Burke
- School of Medicine, George Washington University, Washington, DC, United States
| | - Pranava Sinha
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Division of Cardiac Surgery, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Naomi L C Luban
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Department of Pathology, School of Medicine, George Washington University, Washington, DC, United States.,Division of Hematology and Laboratory Medicine, Children's National Hospital, Washington, DC, United States
| | - Nikki Gillum Posnack
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology & Physiology, School of Medicine, George Washington University, Washington, DC, United States.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States
| |
Collapse
|
38
|
Casadevall A, Grossman BJ, Henderson JP, Joyner MJ, Shoham S, Pirofski LA, Paneth N. The Assessment of Convalescent Plasma Efficacy against COVID-19. MED 2020; 1:66-77. [PMID: 33363284 PMCID: PMC7747676 DOI: 10.1016/j.medj.2020.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antibody-based therapy for infectious diseases predates modern antibiotics and, in the absence of other therapeutic options, was deployed early in the SARS-CoV-2 pandemic through COVID-19 convalescent plasma (CCP) administration. Although most studies have demonstrated signals of efficacy for CCP, definitive assessment has proved difficult under pandemic conditions, with rapid changes in disease incidence and the knowledge base complicating the design and implementation of randomized controlled trials. Nevertheless, evidence from a variety of studies demonstrates that CCP is as safe as ordinary plasma and strongly suggests that it can reduce mortality if given early and with sufficient antibody content.
Collapse
Affiliation(s)
- Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Brenda J Grossman
- Departments of Medicine and Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jeffrey P Henderson
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Liise-Anne Pirofski
- Departments of Medicine and Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nigel Paneth
- Departments of Department of Epidemiology & Biostatistics and Pediatrics & Human Development, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
39
|
Dunbar NM. Does ABO and RhD matching matter for platelet transfusion? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:512-517. [PMID: 33275681 PMCID: PMC7727583 DOI: 10.1182/hematology.2020000135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Platelets express ABO antigens and are collected in plasma, which contains ABO antibodies as would be consistent with the donor ABO group. Platelet ABO antigens that are incompatible with recipient ABO antibodies may have accelerated clearance from circulation and result in lower count increments. ABO antibodies that are passively transferred from donor plasma may result in hemolysis of recipient red blood cells. Although platelets do not express Rh antigens, they contain small numbers of intact red blood cells or fragments, which can lead to alloimmunization in the recipient. Alloimmunization to the RhD antigen may occur when platelets obtained from RhD-positive donors are transfused to RhD-negative recipients. All of these compatibility considerations must be balanced against the available supply, which may be limited due to the 5- to 7-day shelf life of platelets. This articles describes considerations for platelet ABO and RhD selection for platelet transfusions, including the impact of major ABO incompatibility on count increments, the risks of hemolysis associated with minor ABO incompatibility, and the risk of RhD alloimmunization when RhD-negative patients receive platelets obtained from RhD-positive donors.
Collapse
|
40
|
Roberts N, James SL, Delaney M, Fitzmaurice C. Blood transfusion trends by disease category in the United States, 2000 to 2014. Transfus Apher Sci 2020; 60:103012. [PMID: 33309539 DOI: 10.1016/j.transci.2020.103012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Better understanding of blood usage rates could identify trends in transfusion practices over time and inform more efficient management. METHODS Inpatient admissions from the Healthcare Cost and Utilization Project National Inpatient Sample and State Inpatient Databases were analyzed for packed red blood cell (PRBC), plasma, platelet, and whole blood (WB) transfusions. The transfusion rates per admission and per prevalent case were calculated. Prevalence estimates were from the Global Burden of Disease 2017 study (GBD). RESULTS From 2000 to 2014, blood usage rates for most causes peaked around 2010. Across all causes, PRBC were the most commonly transfused component, followed by plasma, platelets, and WB. However, the relative use of each type varied by cause. Nutritional deficiencies (1.75 blood product units across all components per admission; 95 % uncertainty interval (UI) 1.62-1.87), neoplasms (0.95; 0.87-1.04), and injuries (0.92; 0.86 - 0.98) had the greatest blood use per admission. Cardiovascular diseases (96.9 units per 1000 prevalent cases; 89.3-105.0) and neoplasms (92.7 units per 1000 prevalent cases; 84.3-101.5) had the greatest blood use per prevalent case. Across all admissions, over three million blood units were saved in 2014 compared to 2011 due to transfusing at a reduced rate. CONCLUSIONS Blood transfusion rates decreased from 2011 to 2014 in the United States. This decline occurred in most disease categories, which points towards broad strategies like patient blood management systems and disease specific improvements like changes in surgical techniques being effective.
Collapse
Affiliation(s)
- Nicholas Roberts
- Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States.
| | - Spencer L James
- Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Meghan Delaney
- Division of Pathology & Laboratory Medicine, Children's National Medical Center, Washington, DC, United States; Departments of Pathology & Pediatrics, George Washington University Medical School, Washington DC, United States
| | - Christina Fitzmaurice
- Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States; Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, United States
| |
Collapse
|
41
|
Gammon RR, Devine D, Katz LM, Quinley E, Wu Y, Rowe K, Razatos A, Min K, Reichenberg S, Smith R. Buffy coat platelets coming to America: Are we ready? Transfusion 2020; 61:627-633. [PMID: 33174258 DOI: 10.1111/trf.16184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Buffy coat (BC) platelets (PLTs) have been used globally for many years. In 2004 Canadian Blood Services (CBS) made the decision to transition from PLT-rich plasma (PRP) to BC PLTs. We reviewed the benefits and manufacture process of BC and the implementation challenges involved. STUDY DESIGN AND METHODS A literature review was performed in the following areas: BC efficacy, donor population shifts, production and good stewardship of PLTs, logistic considerations with overnight holds, advantages of the overnight hold, the CBS experience, licensure and standards, and changes needed to produce BC PLTs in the United States. The aim was to analyze current practice and identify possible actions for blood centers and hospitals. RESULTS Implementation of BC would offer an additional source of PLTs to address the growing elderly population and the declining apheresis donor base. Substantial logistic, operational, and financial benefits were seen when CBS transitioned to BC with overnight hold. CONCLUSIONS Buffy coat blood products are widely used throughout the world. Recent conversion from PRP to BC by CBS showed that conversion can be accomplished with planning, communication, and partnership from all stakeholders. In conclusion, BC PLTs are worth serious consideration in the United States, but regulatory barriers in the United States will need to be addressed.
Collapse
Affiliation(s)
| | - Dana Devine
- Canadian Blood Services and University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport Iowa and University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Eva Quinley
- Independent Contractor, Knoxville, Tennessee
| | - YanYun Wu
- University of Miami, Coral Gables, Florida
| | | | | | | | | | | |
Collapse
|
42
|
Reilly M, Bruno CD, Prudencio TM, Ciccarelli N, Guerrelli D, Nair R, Ramadan M, Luban NLC, Posnack NG. Potential Consequences of the Red Blood Cell Storage Lesion on Cardiac Electrophysiology. J Am Heart Assoc 2020; 9:e017748. [PMID: 33086931 PMCID: PMC7763412 DOI: 10.1161/jaha.120.017748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
Background The red blood cell (RBC) storage lesion is a series of morphological, functional, and metabolic changes that RBCs undergo following collection, processing, and refrigerated storage for clinical use. Since the biochemical attributes of the RBC unit shifts with time, transfusion of older blood products may contribute to cardiac complications, including hyperkalemia and cardiac arrest. We measured the direct effect of storage age on cardiac electrophysiology and compared it with hyperkalemia, a prominent biomarker of storage lesion severity. Methods and Results Donor RBCs were processed using standard blood-banking techniques. The supernatant was collected from RBC units, 7 to 50 days after donor collection, for evaluation using Langendorff-heart preparations (rat) or human induced pluripotent stem cell-derived cardiomyocytes. Cardiac parameters remained stable following exposure to "fresh" supernatant from red blood cell units (day 7: 5.8±0.2 mM K+), but older blood products (day 40: 9.3±0.3 mM K+) caused bradycardia (baseline: 279±5 versus day 40: 216±18 beats per minute), delayed sinus node recovery (baseline: 243±8 versus day 40: 354±23 ms), and increased the effective refractory period of the atrioventricular node (baseline: 77±2 versus day 40: 93±7 ms) and ventricle (baseline: 50±3 versus day 40: 98±10 ms) in perfused hearts. Beating rate was also slowed in human induced pluripotent stem cell-derived cardiomyocytes after exposure to older supernatant from red blood cell units (-75±9%, day 40 versus control). Similar effects on automaticity and electrical conduction were observed with hyperkalemia (10-12 mM K+). Conclusions This is the first study to demonstrate that "older" blood products directly impact cardiac electrophysiology, using experimental models. These effects are likely caused by biochemical alterations in the supernatant from red blood cell units that occur over time, including, but not limited to hyperkalemia. Patients receiving large volume and/or rapid transfusions may be sensitive to these effects.
Collapse
Affiliation(s)
- Marissa Reilly
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Children’s National Heart InstituteChildren’s National HospitalWashingtonDC
| | - Chantal D. Bruno
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Division of Critical Care MedicineChildren’s National HospitalWashingtonDC
| | - Tomas M. Prudencio
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Children’s National Heart InstituteChildren’s National HospitalWashingtonDC
| | - Nina Ciccarelli
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Children’s National Heart InstituteChildren’s National HospitalWashingtonDC
| | - Devon Guerrelli
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Children’s National Heart InstituteChildren’s National HospitalWashingtonDC
| | - Raj Nair
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
| | - Manelle Ramadan
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Children’s National Heart InstituteChildren’s National HospitalWashingtonDC
| | - Naomi L. C. Luban
- Division of Hematology and Laboratory MedicineChildren’s National HospitalWashingtonDC
- Department of PediatricsGeorge Washington UniversitySchool of MedicineWashingtonDC
- Department of PathologyGeorge Washington UniversitySchool of MedicineWashingtonDC
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National HospitalWashingtonDC
- Children’s National Heart InstituteChildren’s National HospitalWashingtonDC
- Department of PediatricsGeorge Washington UniversitySchool of MedicineWashingtonDC
- Department of Pharmacology & PhysiologyGeorge Washington UniversitySchool of MedicineWashingtonDC
| |
Collapse
|
43
|
Spencer BR, Fox MP, Wise LA, Cable RG, Mast AE. Iron status and self-reported fatigue in blood donors. Transfusion 2020; 61:124-133. [PMID: 32974931 DOI: 10.1111/trf.16095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
Fatigue is a reported symptom of iron depletion, but studies in blood donors show no conclusive link. We conducted an observational analysis of data from the STRIDE randomized trial to evaluate association of iron status with self-reported fatigue. STUDY DESIGN AND METHODS Three blood centers randomly assigned 692 frequent donors to education or iron supplementation treatments. Biomarkers for iron status were measured during 20 to 24 months of follow-up. A fatigue score was derived from an 11-item questionnaire at baseline and final visits, and associations between iron status and fatigue were assessed. RESULTS Final lab and questionnaire data were evaluable from 337 subjects. At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean (±SD) fatigue score change was 0.0 (±0.5). Mean (±SD) increase in iron stores was 1.0 (±3.5) mg/kg, but changes in body iron stores were not associated with fatigue score changes (0.01 per mg/kg; 95% CI, -0.01 to 0.02) or with fatigue (RR, 1.01; 95% CI, 0.99 to 1.04). The only factor associated with fatigue score changes was baseline fatigue (0.36; 95% CI, 0.25 to 0.48). CONCLUSION Among high-frequency donors, neither iron status at baseline nor changes in iron status predicted fatigue during follow-up, with improvements limited to those with higher levels of baseline fatigue. Assessment of the association between iron and fatigue in blood donors benefits from careful consideration of study design and the study population.
Collapse
Affiliation(s)
- Bryan R Spencer
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ritchard G Cable
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Alan E Mast
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
44
|
Grebe E, Busch MP, Notari EP, Bruhn R, Quiner C, Hindes D, Stone M, Bakkour S, Yang H, Williamson P, Kessler D, Reik R, Stramer SL, Glynn SA, Anderson SA, Williams AE, Custer B. HIV incidence in US first-time blood donors and transfusion risk with a 12-month deferral for men who have sex with men. Blood 2020; 136:1359-1367. [PMID: 32693408 PMCID: PMC7483431 DOI: 10.1182/blood.2020007003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/07/2020] [Indexed: 12/29/2022] Open
Abstract
In 2015, the US Food and Drug Administration published revised guidance that recommended a change in blood donor deferral of men who have sex with men (MSM) from an indefinite to a 12-month deferral since the donor last had sex with a man. We assessed whether HIV incidence in first-time blood donors or associated transfusion risk increased. Donations in 4 major blood collection organizations were monitored for 15 months before and 2 years after implementation of the 12-month MSM deferral policy. HIV-positive donations were classified as recently acquired or long-term using a recent infection testing algorithm and incidence in both periods estimated. Residual transfusion transmission risk was estimated by multiplying incidence by the length of the infectious window period. The latter was estimated using a model based on infectious dose and the sensitivity of nucleic acid testing. Factors associated with incident infection in each period were assessed using Poisson regression. Overall HIV incidence in first-time donors before implementation of the 12-month MSM deferral was estimated at 2.62 cases per 100 000 person-years (105 PY) (95% credible interval [CI], 1.53-3.93 cases/105 PY), and after implementation at 2.85 cases/105 PY (95% CI, 1.96-3.93 cases/105 PY), with no statistically significant change. In male first-time donors, the incidence difference was 0.93 cases/105 PY (95% CI, -1.74-3.58 cases/105 PY). The residual risk of HIV transfusion transmission through components sourced from first-time donors was estimated at 0.32 transmissions per million (106) packed red blood cell transfusions (95% CI, 0.29-0.65 transmissions/106 transfusions) before and 0.35 transmissions/106 transfusions (95% CI, 0.31-0.65 transmissions/106 transfusions) after implementation. The difference was not statistically significant. Factors associated with incident infection were the same in each period. We observed no increase in HIV incidence or HIV transfusion transmission risk after implementation of a 12-month MSM deferral policy.
Collapse
Affiliation(s)
- Eduard Grebe
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Edward P Notari
- Scientific Affairs, American Red Cross, Rockville and Gaithersburg, MD
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Claire Quiner
- Vitalant Research Institute, San Francisco, CA
- RTI International, Research Triangle Park, NC
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Hong Yang
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | | | | | | | - Susan L Stramer
- Scientific Affairs, American Red Cross, Rockville and Gaithersburg, MD
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Alan E Williams
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| |
Collapse
|
45
|
Sen-Crowe B, McKenney K, McKenney M, Elkbuli A. Challenges associated with blood banks and blood donations during the COVID-19 pandemic. Am J Emerg Med 2020; 43:281-282. [PMID: 32674923 PMCID: PMC7832652 DOI: 10.1016/j.ajem.2020.06.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Brendon Sen-Crowe
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Kelly McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
| |
Collapse
|
46
|
Lu W, Delaney M, Dunbar NM, Rossmann SN, Fung M. A national survey of hospital-based transfusion services on their approaches to platelet bacterial risk mitigation in response to the FDA final guidance for industry. Transfusion 2020; 60:1681-1687. [PMID: 32564352 DOI: 10.1111/trf.15851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bacterial contamination of platelets is the leading infectious risk to the United States (US) blood supply. On 30 September 2019, the US Food and Drug Administration (FDA) published a Final Guidance for Industry to reduce the risk of transfusing platelets contaminated by bacteria. A national survey was undertaken to assess readiness, attitudes, and the potential impact on hospital-based transfusion services. STUDY DESIGN AND METHODS A survey was distributed to transfusion services in all 50 US states. Summary statistics were performed along with review and categorization of email feedback and free text comments. RESULTS Eighty-three transfusion services from 48 states participated in this survey study. Currently, the most common approach is primary culture performed at manufacturing (n = 49/83, 59%). Of the bacterial risk mitigation strategies provided by the FDA, the most frequently preferred are (a) pathogen reduced platelets (PRP) for up to 5-day storage (n = 36/77, 47%), (b) large volume delayed sampling (LVDS) ≥48 hours for up to 7-day storage (n = 16/77, 21%), and (c) primary culture ≥24 hours + secondary rapid testing for up to 7-day storage (n = 7/77, 9%). The main motivating factors for the survey participants' selected strategies to comply with FDA final guidance were product availability from supplier, reducing the risk of septic transfusion reactions (STR), and complexity of implementing and performing a new or additional test. CONCLUSION While having platelets to transfuse and preventing STR are of the utmost importance, nationwide, the majority of transfusion services do not want to take on performing new or additional testing in their laboratories.
Collapse
Affiliation(s)
- Wen Lu
- Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| |
Collapse
|
47
|
Wehrli G, Rossmann SN, Waxman DA, Katz LM. Evaluation and improvement of blood donor educational materials: results from a multicenter randomized controlled trial. Transfusion 2020; 60:1756-1764. [PMID: 32562440 DOI: 10.1111/trf.15866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blood collection centers are charged with creating donor educational materials (DnEM) that are easily understood across all prospective donor populations, while addressing mandates and recommendations from regulatory agencies and professional standard setting organizations. Donors must have sufficient information to understand the donation process with its risks and benefits, time to consider options before deciding, and opportunity to choose whether to proceed with or decline donating. The goal of this multisite randomized controlled trial was to evaluate knowledge acquired using standardized DnEM. America's Blood Centers' Working Group (WG) for Donor Education and Communication was formed to evaluate and suggest modifications of these documents. Based on pilot work, a randomized clinical trial was designed to test donor knowledge across a variety of populations. The WG identified several shortcomings in the current DnEM and proposed new DnEM. The new DnEM were tested against the same, current DnEM being used at all three sites (Blood Donor Educational Material, 2016 version 2.0, published in conjunction with the AABB uniform donor history questionnaire). METHODS AND MATERIALS One-hundred sixty-five first time and returning donors were randomized in a 2x2 model to review either new DnEM or current DnEM. Every participant completed a pre- and post-quiz that tested their understanding of the DnEM. RESULTS Returning donors had greater baseline knowledge compared to new donors, but new donors improved more versus returning donors. Donors using the new DnEM showed greater improvement in knowledge than those using current DnEM. CONCLUSION Comprehension of DnEM can be improved. With this sample size the results suggest that the findings are independent of demographic characteristics, but a larger study would be necessary to confirm this.
Collapse
Affiliation(s)
- Gay Wehrli
- University of Virginia Health, Charlottesville, Virginia, USA
| | | | | | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
| |
Collapse
|
48
|
Aftab M, Reece TB. Commentary: Like politics, transfusion practice is local. J Thorac Cardiovasc Surg 2020; 163:1026-1027. [PMID: 33268111 DOI: 10.1016/j.jtcvs.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo.
| |
Collapse
|
49
|
Sapiano MRP, Jones JM, Savinkina AA, Haass KA, Berger JJ, Basavaraju SV. Supplemental findings of the 2017 National Blood Collection and Utilization Survey. Transfusion 2020; 60 Suppl 2:S17-S37. [PMID: 32134122 PMCID: PMC7885895 DOI: 10.1111/trf.15715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This report provides supplemental results from the 2017 National Blood Collection and Utilization Survey on characteristics of the donor population, autologous and directed donations and transfusions, platelets, plasma and granulocyte transfusions, pediatric transfusions, severe donor-related adverse events, cost of blood units, hospitals policies and practices, and inventory, dosing, and supply. METHODS Weighting and imputation were used to generate national estimates including number of donors, donations, donor deferrals, autologous and directed donations and transfusions, severe donor-related adverse events, platelet and plasma collections and transfusions, number of cross-match procedures, irradiation and leukoreduction, and pediatric transfusions. RESULTS Between 2015 and 2017, successful donations decreased slightly by 2.1% with a 10.3% decrease in donations by persons aged 16-18 years and a 14.4% increase in donations by donors aged >65 years. The median price paid for blood components by hospitals decreased from $211 to $207 for leukoreduced red blood cell units, from $523 to $517 for leukoreduced apheresis platelet units, and from $54 to $51 for fresh frozen plasma units. Plasma transfusions decreased 13.6%, but group AB plasma units transfused increased 24.7%. CONCLUSION Between 2015 and 2017, blood donations declined slightly because of decreases in donations from younger donors, but the number of donations from older donors increased. The price hospitals pay for blood has continued to decrease. Plasma transfusions have decreased, but the proportion of plasma transfusions involving group AB plasma have increased.
Collapse
Affiliation(s)
- Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James J Berger
- U.S. Department of Health and Human Services, Office of HIV/AIDS and infectious Disease Policy, Office of the Assistant Secretary for Health, Washington, DC
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
50
|
Kahn S, Chegondi M, Nellis ME, Karam O. Overview of Plasma and Platelet Transfusions in Critically Ill Children. Front Pediatr 2020; 8:601659. [PMID: 33282804 PMCID: PMC7691248 DOI: 10.3389/fped.2020.601659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 01/19/2023] Open
Abstract
Critically ill children are a unique population who frequently receive plasma and platelet transfusions for both active bleeding and mitigation of bleeding risk. While these products are frequently administered, transfusion indications in this population remain unclear, and practice varies across institutions and providers. In this manuscript, we will outline the current evidence regarding plasma and platelet transfusions for hemostasis in the pediatric intensive care setting. For both products, we will describe the product composition, epidemiology, and product indications and discuss the potential risks and benefits involved with the transfusion. We will also discuss knowledge gaps and future areas of research.
Collapse
Affiliation(s)
- Stacie Kahn
- Division of Pediatric Critical Care Medicine, NewYork-Presbyterian, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Madhuradhar Chegondi
- Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital- Carver College of Medicine, University of Iowa, Iowa, IA, United States
| | - Marianne E Nellis
- Pediatric Critical Care Medicine, NewYork-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, United States
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
| |
Collapse
|