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Pérez-Aliaga AI, Ayerra I, Sánchez-Guillén J, López FJ, Puente F, Aranda A, Domingo JM, Garcés C. Routine results of an algorithm for managing the production of blood components. Vox Sang 2024; 119:541-547. [PMID: 38410835 DOI: 10.1111/vox.13609] [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: 10/23/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVES The variability in the number of donations together with a growing demand for platelet concentrates and plasma-derived medicines make us seek solutions aimed at optimizing the processing of blood. Some mathematical models to improve efficiencies in blood banking have been published. The goal of this work is to validate and evaluate an algorithm's impact in the production of blood components in the Blood and Tissues Bank of Aragon (BTBA). MATERIALS AND METHODS A mathematical algorithm was designed, implemented and validated through simulations with real data. It was incorporated into the fractionation area, which uses the Reveos® fractionation system (Terumo BCT) to split blood into its components. After 9 months of daily routine validation, retrospective activity data from the Blood Bank and Transfusion Services before and during the use of the algorithm were compared. RESULTS Using the algorithm, the outdating rate of platelet concentrates (PC) decreased by 87.8% in the blood bank. The average shelf life remaining of PC supplied to Transfusion Services increased by almost 1 day. As a consequence, the outdating rate in the Aragon Transfusion Network decreased by 33%. In addition, extra 100 litres of plasma were obtained in 9 months. CONCLUSIONS The algorithm improves the blood establishment's workflow and facilitates the decision-making process in whole blood processing. It resulted in a decrease in PC outdating rate, increase in PC shelf life and finally an increase in the volume of recovered plasma, leading to significant cost savings.
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Affiliation(s)
| | | | | | - F Javier López
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Aragón, Spain
| | - Fernando Puente
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | - Alfonso Aranda
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | | | - Carmen Garcés
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
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Tran MH, Niu C, Kelley W. Why are we donating less? Transfusion 2024; 64:1154-1160. [PMID: 38693100 DOI: 10.1111/trf.17861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Minh-Ha Tran
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - ChenChen Niu
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Walter Kelley
- American National Red Cross, Salt Lake City, Utah, USA
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Jacobs JW, Raza S, Woo JS. Managing blood product shortages: Unprecedented challenges require novel solutions. Transfusion 2024; 64:565-566. [PMID: 38488299 DOI: 10.1111/trf.17723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sheharyar Raza
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
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4
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Taylor JS. Platelets, Puppies, and Payment: How Surveys can be Misleading in the Remuneration Debate. HEC Forum 2024; 36:91-98. [PMID: 35438470 DOI: 10.1007/s10730-022-09481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
In a recent article ("The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages") published in Transfusion, Stubbs et al. have argued that platelet donors should be paid. Dodd et al. have argued against this proposal, supporting their response with survey data that shows that blood donors (and by extension platelet donors) and potential platelet donors are uninterested in receiving incentives to encourage them to donate. Instead, argue Dodd et al., prospective platelet donors are motivated more by the ease of donation than the prospect of payment. This article defends Stubbs et al. from the criticisms of Dodd et al. It first argues that the preferences that persons state they have in response to survey questions might not reflect the preferences that their actions would reveal they have in actual rather than hypothetical situations. This hypothetical bias is especially likely when persons respond to surveys that ask them about the performance of morally commendable actions (such as platelet donation). This article then argues that the survey that Dodd et al. rely on exhibits serious selection bias with respect to the set of persons it considers to be potential platelet donors.
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Affiliation(s)
- James Stacey Taylor
- Department of Philosophy, The College of New Jersey, 2000 Pennington Rd, 08534, Ewing, NJ, United States.
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Vandenbroeke T, Gloor C, Wingfield T, Leite C, Carr K, Turner C, Ngamsuntikul S, Sutor L, Compton F, Nestheide S, Rugg N, Cancelas JA, Dumont LJ. In vitro quality parameters of whole blood-derived platelets pooled using two different platelet pooling sets and stored up to 7 days are similar. Transfusion 2024; 64:132-140. [PMID: 37991217 DOI: 10.1111/trf.17591] [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: 06/22/2023] [Revised: 09/28/2023] [Accepted: 10/14/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Increasing the number of collections of whole blood-derived platelets (WBDP) and lengthening the allowable storage time may alleviate platelet (PLT) shortages. There is a need for new PLT pooling sets that can provide acceptable quality on Day 7 of storage. STUDY DESIGN AND METHODS This pool-and-split study compared WBDP prepared using the platelet-rich plasma method with the novel IMUGARD WB PLT pooling set and a control pooling set. After pooling and filtration, PLT products were tested on Days 1, 5, and 7. Large volume delayed sampling (LVDS) cultures were taken on Day 2. RESULTS The median postfiltration residual white blood cell (rWBC) content was 0.18 million per product (maximum 1.26 million; n = 69) with mean PLT recovery of 88.5 ± 2.8% for the new set and median 0.23 million (maximum 1.83 million) rWBC with 87.5 ± 2.5% recovery for the control. Day 5 mean pH22°C were 7.18 ± 0.12 and 7.13 ± 0.10 for the new and control set, respectively. Day 5 in vitro quality parameters were within 20% between the two pooling sets. The new set Day 7 pH22°C was acceptable (7.07 ± 0.17, 100% ≥ 6.3), and most parameters were within 20% of Day 5 values. CONCLUSION WBDP quality for the new pooling set is acceptable across a battery of in vitro tests when stored up to 7 days and meets FDA regulatory criteria. The quality parameters were similar between the new pooling set and the control set on Day 5. This new set is compatible with LVDS.
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Affiliation(s)
| | - Christina Gloor
- Research & Development, Terumo BCT, Inc., Lakewood, Colorado, USA
| | - Tyler Wingfield
- Research & Development, Terumo BCT, Inc., Lakewood, Colorado, USA
| | - Caroline Leite
- Vitalant Research Institute, Vitalant, Denver, Colorado, USA
| | - Kathlynn Carr
- Administrative and Components Divisions, South Texas Blood & Tissue, San Antonio, Texas, USA
| | - Chris Turner
- Administrative and Components Divisions, South Texas Blood & Tissue, San Antonio, Texas, USA
| | - Samantha Ngamsuntikul
- Administrative and Components Divisions, South Texas Blood & Tissue, San Antonio, Texas, USA
| | - Laurie Sutor
- Department of Medical Services, Carter BloodCare, Bedford, Texas, USA
| | - Frances Compton
- Department of Medical Services, Carter BloodCare, Bedford, Texas, USA
| | - Shawnagay Nestheide
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neeta Rugg
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Larry J Dumont
- Vitalant Research Institute, Vitalant, Denver, Colorado, USA
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Shea SM, Mihalko EP, Lu L, Thomas KA, Schuerer D, Brown JB, Bochicchio GV, Spinella PC. Doing more with less: low-titer group O whole blood resulted in less total transfusions and an independent association with survival in adults with severe traumatic hemorrhage. J Thromb Haemost 2024; 22:140-151. [PMID: 37797692 PMCID: PMC10841654 DOI: 10.1016/j.jtha.2023.09.025] [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: 12/01/2022] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Low-titer group O whole blood (LTOWB) or component therapy (CT) may be used to resuscitate hemorrhaging trauma patients. LTOWB may have clinical and logistical benefits and may improve survival. OBJECTIVES We hypothesized LTOWB would improve 24-hour survival in hemorrhaging patients and would be safe and equally efficacious in non-group O compared with group O patients. METHODS Adult trauma patients with massive transfusion protocol activations were enrolled in this observational study. The primary outcome was 24-hour mortality. Secondary outcomes included 72-hour total blood product use. A Cox regression determined the independent associations with 24-hour mortality. RESULTS In total, 348 patients were included (CT, n = 180; LTOWB, n = 168). Demographics were similar between cohorts. Unadjusted 24-hour mortality was reduced in LTOWB vs CT: 8% vs 19% (P = .003), but 6-hour and 28-day mortality were similar. In an adjusted analysis with multivariable Cox regression, LTOWB was independently associated with reduced 24-hour mortality (hazard ratio, 0.21; 95% CI, 0.07-0.67; P = .004). LTOWB patients received significantly less 72-hour total blood products (80.9 [41.6-139.3] mL/kg vs 48.9 [25.9-106.9] mL/kg; P < .001). In stratified 24-hour survival analyses, LTOWB was associated with improved survival for patients in shock or with coagulopathy. LTOWB use in non-group O patients was not associated with increased mortality, organ injury, or adverse events. CONCLUSION In this hypothesis-generating study, LTOWB use was independently associated with improved 24-hour survival, predominantly in patients with shock or coagulopathy. LTOWB also resulted in a 40% reduction in blood product use which equates to a median 2.4 L reduction in transfused products.
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Affiliation(s)
- Susan M Shea
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Emily P Mihalko
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Liling Lu
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Douglas Schuerer
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Joshua B Brown
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Grant V Bochicchio
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Dhillon NS, Jeon N, Gurkan UA, Gupta AS, Bonomo RA, Drummy LF, Zhang M, Chance MR. Military Medicine and Medical Research as a Source of Inspiration and Innovation to Solve National Security and Health Challenges in the 21st Century. Pathog Immun 2023; 8:51-63. [PMID: 37799210 PMCID: PMC10550252 DOI: 10.20411/pai.v8i1.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 10/07/2023] Open
Abstract
The history of military medicine and research is rife with examples of novel treatments and new approaches to heal and cure soldiers and others impacted by war's devastation. In the 21st century, new threats, like climate change, are combined with traditional threats, like geopolitical conflict, to create novel challenges for our strategic interests. Extreme and inaccessible environments provide heightened risks for warfighter exposure to dangerous bacteria, viruses, and fungi, as well as exposure to toxic substances and extremes of temperature, pressure, or both providing threats to performance and eroding resilience. Back home, caring for our veterans is also a health-care priority, and the diseases of veterans increasingly overlap with the health needs of an aging society. These trends of climate change, politics, and demographics suggest performance evaluation and resilience planning and response are critical to assuring both warfighter performance and societal health. The Cleveland ecosystem, comprising several hospitals, a leading University, and one of the nation's larger Veteran's Health Administration systems, is ideal for incubating and understanding the response to these challenges. In this review, we explore the interconnections of collaborations between Defense agencies, particularly Air Force and Army and academic medical center-based investigators to drive responses to the national health security challenges facing the United States and the world.
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Affiliation(s)
- Nanak S. Dhillon
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Nayeon Jeon
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Anirban Sen Gupta
- Department of Biomedical Engineering, School of Medicine, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Robert A. Bonomo
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Case Western Reserve University, Cleveland, OH; VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES); Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, and Biochemistry, Case Western Reserve University, Cleveland, Ohio
| | - Lawrence F. Drummy
- Materials and Manufacturing Directorate, Air Force Research Laboratory, Dayton, Ohio
| | - Mei Zhang
- Department of Biomedical Engineering, School of Medicine, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Mark R. Chance
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Biomedical Engineering, School of Medicine, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
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8
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Mansour A, Beurton A, Godier A, Rozec B, Zlotnik D, Nedelec F, Gaussem P, Fiore M, Boissier E, Nesseler N, Ouattara A. Combined Platelet and Red Blood Cell Recovery during On-pump Cardiac Surgery Using same™ by i-SEP Autotransfusion Device: A First-in-human Noncomparative Study (i-TRANSEP Study). Anesthesiology 2023; 139:287-297. [PMID: 37294939 DOI: 10.1097/aln.0000000000004642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Centrifugation-based autotransfusion devices only salvage red blood cells while platelets are removed. The same™ device (Smart Autotransfusion for ME; i-SEP, France) is an innovative filtration-based autotransfusion device able to salvage both red blood cells and platelets. The authors tested the hypothesis that this new device could allow a red blood cell recovery exceeding 80% with a posttreatment hematocrit exceeding 40%, and would remove more than 90% of heparin and 75% of free hemoglobin. METHODS Adults undergoing on-pump elective cardiac surgery were included in a noncomparative multicenter trial. The device was used intraoperatively to treat shed and residual cardiopulmonary bypass blood. The primary outcome was a composite of cell recovery performance, assessed in the device by red blood cell recovery and posttreatment hematocrit, and of biologic safety assessed in the device by the washout of heparin and free hemoglobin expressed as removal ratios. Secondary outcomes included platelet recovery and function and adverse events (clinical and device-related adverse events) up to 30 days after surgery. RESULTS The study included 50 patients, of whom 18 (35%) underwent isolated coronary artery bypass graft, 26 (52%) valve surgery, and 6 (12%) aortic root surgery. The median red blood cell recovery per cycle was 86.1% (25th percentile to 75th percentile interquartile range, 80.8 to 91.6) with posttreatment hematocrit of 41.8% (39.7 to 44.2). Removal ratios for heparin and free hemoglobin were 98.9% (98.2 to 99.7) and 94.6% (92.7 to 96.6), respectively. No adverse device effect was reported. Median platelet recovery was 52.4% (44.2 to 60.1), with a posttreatment concentration of 116 (93 to 146) · 109/l. Platelet activation state and function, evaluated by flow cytometry, were found to be unaltered by the device. CONCLUSIONS In this first-in-human study, the same™ device was able to simultaneously recover and wash both platelets and red blood cells. Compared with preclinical evaluations, the device achieved a higher platelet recovery of 52% with minimal platelet activation while maintaining platelet ability to be activated in vitro. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation, Research Institute for Environmental and Occupational Health, Mixed Research Unit S1085, University Hospital Federation Survival Optimization in Organ Transplantation, Univ Rennes, Rennes, France
| | - Antoine Beurton
- CHU Bordeaux, Department of Cardiovascular Anaesthesia and Critical Care, Haut-Lévêque hospital, University Bordeaux, National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Anne Godier
- Université Paris Cité, Department of Anesthesiology and Critical Care, European Hospital Georges Pompidou, Public Hospitals of Paris, National Institute of Health and Medical Research, Mixed Research Unit S1140, Innovative Therapies in Haemostasis, Paris, France
| | - Bertrand Rozec
- Department of Anesthesia and Critical Care, University Hospital of Nantes, France, CHU Nantes
| | - Diane Zlotnik
- Paris Cité University, Department of Anaesthesiology and Critical Care, Hospital Georges Pompidou, Public Hospitals of Paris, Paris, France
| | - Fabienne Nedelec
- Department of Hematology, Pontchaillou, University Hospital of Rennes, France; Univ Rennes, Rennes, France
| | - Pascale Gaussem
- Paris Cité University, Innovative Therapies in Haemostasis, Department of Hematology, National Institute of Health and Medical Research, Mixed Research Unit S1140, European Hospital Georges Pompidou, Public Hospitals of Paris, Paris, France
| | - Mathieu Fiore
- Hematology Laboratory, Reference Centre for Platelet Disorders, Haut-Lévêque Hospital, University Hospital of Bordeaux, Pessac, France; National Institute of Health and Medical Research U1034, Biology of Cardiovascular Diseases, Bordeaux University, Pessac, France
| | - Elodie Boissier
- Department of Hematology, University Hospital of Nantes, France, CHU Nantes
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation, Nutrition, Metabolism, Cancer, Mixed Research Unit S1241, University Hospital Federation Survival Optimization in Organ Transplantation), Univ Rennes, Rennes, France
| | - Alexandre Ouattara
- University Hospital of Bordeaux, CHU Bordeaux, Department of Cardiovascular Anaesthesia and Critical Care, Haut-Lévêque Hospital, National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France
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Thompson W, Papoutsakis ET. Similar but distinct: The impact of biomechanical forces and culture age on the production, cargo loading, and biological efficacy of human megakaryocytic extracellular vesicles for applications in cell and gene therapies. Bioeng Transl Med 2023; 8:e10563. [PMID: 37693047 PMCID: PMC10486331 DOI: 10.1002/btm2.10563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 09/12/2023] Open
Abstract
Megakaryocytic extracellular vesicles (MkEVs) promote the growth and megakaryopoiesis of hematopoietic stem and progenitor cells (HSPCs) largely through endogenous miR-486-5p and miR-22-3p cargo. Here, we examine the impact of biomechanical force and culture age/differentiation on the formation, properties, and biological efficacy of MkEVs. We applied biomechanical force to Mks using two methods: shake flask cultures and a syringe pump system. Force increased MkEV production in a magnitude-dependent manner, with similar trends emerging regardless of whether flow cytometry or nanoparticle tracking analysis was used for MkEV counting. Both methods produced MkEVs that were relatively depleted of miR-486-5p and miR-22-3p cargo. However, while the shake flask-derived MkEVs were correspondingly less effective in promoting megakaryocytic differentiation of HSPCs, the syringe pump-derived MkEVs were more effective in doing so, suggesting the presence of unique, unidentified miRNA cargo components. Higher numbers of MkEVs were also produced by "older" Mk cultures, though miRNA cargo levels and MkEV bioactivity were unaffected by culture age. A reduction in MkEV production by Mks derived from late-differentiating HSPCs was also noted. Taken together, our results demonstrate that biomechanical force has an underappreciated and deeply influential role in MkEV biology, though that role may vary significantly depending on the nature of the force. Given the ubiquity of biomechanical force in vivo and in biomanufacturing, this phenomenon must be grappled with before MkEVs can attain clinical relevance.
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Affiliation(s)
- Will Thompson
- Department of Chemical and Biomolecular EngineeringUniversity of DelawareNewarkDelawareUSA
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Klompas AM, Zec S, Hanson AC, Weister T, Stubbs J, Kor DJ, Warner MA. Postoperative Transfusions after Administration of Delayed Cold-stored Platelets versus Room Temperature Platelets in Cardiac Surgery: A Retrospective Cohort Study. Anesthesiology 2023; 139:153-163. [PMID: 37155364 PMCID: PMC10524875 DOI: 10.1097/aln.0000000000004605] [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] [Indexed: 05/10/2023]
Abstract
BACKGROUND Delayed cold storage of room temperature platelets may extend shelf life from 5 to 14 days. The study hypothesized that the use of delayed cold-stored platelets in cardiac surgery would be associated with decreased postoperative platelet count increments but similar transfusion and clinical outcomes compared to room temperature-stored platelets. METHODS This is an observational cohort study of adults transfused with platelets intraoperatively during elective cardiac surgery between April 2020 and May 2021. Intraoperative platelets were either room temperature-stored or delayed cold-stored based on blood bank availability rather than clinical features or provider preference. Differences in transfusion and clinical outcomes, including a primary outcome of allogenic transfusion exposure in the first 24 h postoperatively, were compared between groups. RESULTS A total of 713 patient encounters were included: 529 (74%) room temperature-stored platelets and 184 (26%) delayed cold-stored platelets. Median (interquartile range) intraoperative platelet volumes were 1 (1 to 2) units in both groups. Patients receiving delayed cold-stored platelets had higher odds of allogeneic transfusion in the first 24 h postoperatively (81 of 184 [44%] vs. 169 of 529 [32%]; adjusted odds ratio, 1.65; 95% CI, 1.13 to 2.39; P = 0.009), including both erythrocytes (65 of 184 [35%] vs. 135 of 529 [26%]; adjusted odds ratio, 1.54; 95% CI, 1.03 to 2.29; P = 0.035) and platelets (48 of 184 [26%] vs. 79 of 529 [15%]; adjusted odds ratio, 1.91; 95% CI, 1.22 to 2.99; P = 0.005). There was no difference in the number of units administered postoperatively among those transfused. Platelet counts were modestly lower in the delayed cold-stored platelet group (-9 × 109/l; 95% CI, -16 to -3]) through the first 3 days postoperatively. There were no significant differences in reoperation for bleeding, postoperative chest tube output, or clinical outcomes. CONCLUSIONS In adults undergoing cardiac surgery, delayed cold-stored platelets were associated with higher postoperative transfusion utilization and lower platelet counts compared to room temperature-stored platelets without differences in clinical outcomes. The use of delayed cold-stored platelets in this setting may offer a viable alternative when facing critical platelet inventories but is not recommended as a primary transfusion approach. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Allan M. Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Simon Zec
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Andrew C. Hanson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Tim Weister
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - James Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Daryl J. Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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11
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Kim JS, Casem CF, Baral E, Inaba K, Kuza CM. Narrative Review: Is There a Transfusion Cutoff Value After Which Nonsurvivability Is Inevitable in Trauma Patients Receiving Ultramassive Transfusion? Anesth Analg 2023; 137:354-364. [PMID: 37115716 DOI: 10.1213/ane.0000000000006504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The institution of massive transfusion protocols (MTPs) has improved the timely delivery of large quantities of blood products and improves patient outcomes. In recent years, the cost of blood products has increased, compounded by significant blood product shortages. There is practical need for identification of a transfusion volume in trauma patients that is associated with increased mortality, or a threshold after which additional transfusion is futile and associated with nonsurvivability. This transfusion threshold is often described in the setting of an ultramassive transfusion (UMT). There are few studies defining what constitutes amount or outcomes associated with such large volume transfusion. The purpose of this narrative review is to provide an analysis of existing literature examining the effects of UMT on outcomes including survival in adult trauma patients and to determine whether there is a threshold transfusion limit after which mortality is inevitable. Fourteen studies were included in this review. The data examining the utility of UMT in trauma are of poor quality, and with the variability inherent in trauma patients, and the surgeons caring for them, no universally accepted cutoff for transfusion exists. Not surprisingly, there is a trend toward increasing mortality with increasing transfusions. The decision to continue transfusing is multifactorial and must be individualized, taking into consideration patient characteristics, institution factors, blood bank supply, and most importantly, constant reevaluation of the need for ongoing transfusion rather than blind continuous transfusion until the heart stops.
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Affiliation(s)
- Jennie S Kim
- From the Department of Surgery, University of Southern California Trauma and Acute Care Surgery, Los Angeles, California
| | - Christleen F Casem
- Department of Surgery, University of California San Francisco East Bay Surgery, Oakland, Californiaand
| | - Erika Baral
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kenji Inaba
- From the Department of Surgery, University of Southern California Trauma and Acute Care Surgery, Los Angeles, California
| | - Catherine M Kuza
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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12
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Riley W, Cohn CS, Love K, McCullough J. Ensuring a Reliable Platelet Supply in the United States. N Engl J Med 2023. [PMID: 37247369 DOI: 10.1056/nejmp2302523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- William Riley
- From the College of Health Solutions (W.R., K.L.) and the National Safety Net Advancement Center (W.R.), Arizona State University, Phoenix; and the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (C.S.C., J.M.)
| | - Claudia S Cohn
- From the College of Health Solutions (W.R., K.L.) and the National Safety Net Advancement Center (W.R.), Arizona State University, Phoenix; and the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (C.S.C., J.M.)
| | - Kailey Love
- From the College of Health Solutions (W.R., K.L.) and the National Safety Net Advancement Center (W.R.), Arizona State University, Phoenix; and the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (C.S.C., J.M.)
| | - Jeffrey McCullough
- From the College of Health Solutions (W.R., K.L.) and the National Safety Net Advancement Center (W.R.), Arizona State University, Phoenix; and the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (C.S.C., J.M.)
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13
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Haile SA, Rose WN. An open-access laboratory medicine course for medical students. Acad Pathol 2023; 10:100066. [PMID: 36915644 PMCID: PMC10006535 DOI: 10.1016/j.acpath.2022.100066] [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: 08/04/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 03/06/2023] Open
Abstract
The senior author created a 2-week online laboratory medicine course for fourth-year medical students to meet an unmet need at our institution for a brief survey course of clinical pathology in an online format. The course includes online videos, reading assignments, study questions, and a rubric for written assignments that apply the key principles to topics that are customized based on the specialty interests of each student. Anonymous course evaluation surveys were completed by 42 of 60 students (70%), and 92% of respondents stated that they strongly agree with the quality metrics statements in the survey. The complete course materials are shared in this article in the spirit of open access and may be used for medical students, pathology residents, and other learners.
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Affiliation(s)
- Sofia A. Haile
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - William N. Rose
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital, Madison, WI, USA
- Corresponding author. Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital, 600 Highland Ave, Madison, WI, 53792, USA.
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14
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Stubbs JR, Shaz BH, Vassallo RR, Roback JD. Expanding the platelet inventory to mitigate the impact of severe shortages. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:424-429. [PMID: 36485081 PMCID: PMC9821291 DOI: 10.1182/hematology.2022000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The platelet collection and distribution system, based on volunteer nonremunerated donors, apheresis platelet collections, and primarily 1-directional distribution of platelets for up to 5-day room temperature storage at hospitals, typically performs well and provides therapeutic support for hundreds of thousands of patients annually. However, direct and indirect effects of the coronavirus disease 2019 pandemic, particularly during the Omicron wave, produced dramatic systemic failures and severe shortages. We propose 4 initiatives to reinforce the existing platelet pipeline and buffer the platelet supply against future unexpected disruptions.
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Affiliation(s)
- James R. Stubbs
- Division of Transfusion Medicine, Mayo Clinic, Rochester, MN
| | - Beth H. Shaz
- Department of Pathology, Duke University School of Medicine, Durham, NC
| | | | - John D. Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
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15
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Qin J, Zhang J, Jiang J, Zhang B, Li J, Lin X, Wang S, Zhu M, Fan Z, Lv Y, He L, Chen L, Yue W, Li Y, Pei X. Direct chemical reprogramming of human cord blood erythroblasts to induced megakaryocytes that produce platelets. Cell Stem Cell 2022; 29:1229-1245.e7. [PMID: 35931032 DOI: 10.1016/j.stem.2022.07.004] [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: 06/03/2021] [Revised: 06/08/2022] [Accepted: 07/13/2022] [Indexed: 11/19/2022]
Abstract
Reprogramming somatic cells into megakaryocytes (MKs) would provide a promising source of platelets. However, using a pharmacological approach to generate human MKs from somatic cells remains an unmet challenge. Here, we report that a combination of four small molecules (4M) successfully converted human cord blood erythroblasts (EBs) into induced MKs (iMKs). The iMKs could produce proplatelets and release functional platelets, functionally resembling natural MKs. Reprogramming trajectory analysis revealed an efficient cell fate conversion of EBs into iMKs by 4M via the intermediate state of bipotent precursors. 4M induced chromatin remodeling and drove the transition of transcription factor (TF) regulatory network from key erythroid TFs to essential TFs for megakaryopoiesis, including FLI1 and MEIS1. These results demonstrate that the chemical reprogramming of cord blood EBs into iMKs provides a simple and efficient approach to generate MKs and platelets for clinical applications.
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Affiliation(s)
- Jinhua Qin
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Jian Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, China
| | - Jianan Jiang
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Bowen Zhang
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Jisheng Li
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Xiaosong Lin
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Sihan Wang
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Meiqi Zhu
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Zeng Fan
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Yang Lv
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Lijuan He
- South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China; Institute of Health Service and Transfusion Medicine, Beijing 100850, China
| | - Lin Chen
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Wen Yue
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China
| | - Yanhua Li
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China.
| | - Xuetao Pei
- Stem Cell and Regenerative Medicine Lab, Beijing Institute of Radiation Medicine, Beijing 100850, China; South China Research Center for Stem Cell & Regenerative Medicine, SCIB, Guangzhou 510005, China.
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16
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Shea SM, Spinella PC, Thomas KA. Cold-stored platelet function is not significantly altered by agitation or manual mixing. Transfusion 2022; 62:1850-1859. [PMID: 35898113 DOI: 10.1111/trf.17005] [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: 01/05/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cold storage of platelets (CS-PLT), results in better maintained hemostatic function compared to room-temperature stored platelets (RT-PLT), leading to increased interest and use of CS-PLT for actively bleeding patients. However, questions remain on best storage practices for CS-PLT, as agitation of CS-PLT is optional per the United States Food and Drug Administration. CS-PLT storage and handling protocols needed to be determined prior to upcoming clinical trials, and blood banking standard operating procedures need to be updated accordingly for the release of units due to potentially modified aggregate morphology without agitation. STUDY DESIGN AND METHODS We visually assessed aggregate formation, then measured surface receptor expression (GPVI, CD42b (GPIbα), CD49 (GPIa/ITGA2), CD41/61 (ITGA2B/ITGB3; GPIIB/GPIIIA; PACI), CD62P, CD63, HLAI), thrombin generation, aggregation (collagen, adenosine diphosphate [ADP], and epinephrine activation), and viscoelastic function (ExTEM, FibTEM) in CS-PLT (Trima collection, 100% plasma) stored for 21 days either with or without agitation (Phase 1, n = 10 donor-paired units) and then without agitation with or without daily manual mixing to minimize aggregate formation and reduce potential effects of sedimentation (Phase 2, n = 10 donor-paired units). RESULTS Agitation resulted in macroaggregate formation, whereas no agitation caused film-like sediment. We found no substantial differences in CS-PLT function between storage conditions, as surface receptor expression, thrombin generation, aggregation, and clot formation were relatively similar between intra-Phase storage conditions. DISCUSSION Storage duration and not condition impacted phenotype and function. CS-PLT can be stored with or without agitation, and with or without daily mixing and standard metrics of hemostatic function will not be significantly altered.
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Affiliation(s)
- Susan M Shea
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Thomas
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri, USA.,Vitalant Research Institute, Denver, CO, USA
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17
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Cannon JW, Igra NM, Borge PD, Cap AP, Devine D, Doughty H, Geng Z, Guzman JF, Ness PM, Jenkins DH, Rajbhandary S, Schmulevich D, Stubbs JR, Wiebe DJ, Yazer MH, Spinella PC. U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR-AABB working party prospective analysis. Transfusion 2022; 62 Suppl 1:S12-S21. [PMID: 35730720 DOI: 10.1111/trf.16960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mass casualty incidents (MCIs) create an immediate surge in blood product demand. We hypothesize local inventories in major U.S. cities would not meet this demand. STUDY DESIGN AND METHODS A simulated blast in a large crowd estimated casualty numbers. Ideal resuscitation was defined as equal amounts of red blood cells (RBCs), plasma, platelets, and cryoprecipitate. Inventory was prospectively collected from six major U.S. cities at six time points between January and July 2019. City-wide blood inventories were classified as READY (>1 U/injured survivor), DEFICIENT (<10 U/severely injured survivor), or RISK (between READY and DEFICIENT), before and after resupply from local distribution centers (DC), and features of DEFICIENT cities were identified. RESULTS The simulated blast resulted in 2218 injured survivors including 95 with severe injuries. Balanced resuscitation would require between 950 and 2218 units each RBC, plasma, platelets and cryoprecipitate. Inventories in 88 hospitals/health systems and 10 DCs were assessed. Of 36 city-wide surveys, RISK inventories included RBCs (n = 16; 44%), plasma (n = 24; 67%), platelets (n = 6; 17%), and cryoprecipitate (n = 22; 61%) while DEFICIENT inventories included platelets (n = 30; 83%) and cryoprecipitate (n = 12; 33%). Resupply shifted most RBC and plasma inventories to READY, but some platelet and cryoprecipitate inventories remained at RISK (n = 24; 67% and n = 12; 33%, respectively) or even DEFICIENT (n = 11; 31% and n = 6; 17%, respectively). Cities with DEFICIENT inventories were smaller (p <.001) with fewer blood products per trauma bed (p <.001). DISCUSSION In this simulated blast event, blood product demand exceeded local supply in some major U.S. cities. Options for closing this gap should be explored to optimize resuscitation during MCIs.
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Affiliation(s)
- Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Surgery, Uniformed Services University F. Edward Hébert School of Medicine, Bethesda, Maryland, USA
| | - Noah M Igra
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
| | - P Dayand Borge
- Biomedical Services, American Red Cross, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Joint Base San Antonio-FT Sam, Houston, Texas, USA
| | - Dana Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Heidi Doughty
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Zhi Geng
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica F Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Paul M Ness
- Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald H Jenkins
- Department of Surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Daniela Schmulevich
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Douglas J Wiebe
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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France CR, France JL, Himawan LK. What would it take to convince you to donate? A survey study of the relationship between motivators, barriers, and payment for whole blood, plasma, and platelet donation. Transfusion 2022; 62:1251-1260. [PMID: 35467768 PMCID: PMC9322277 DOI: 10.1111/trf.16886] [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: 02/21/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 01/05/2023]
Abstract
Background With growing discussion about blood donor remuneration, the present study examined the level of payment that may be required to convince individuals to engage in whole blood, plasma, and platelet donations. Study Design and Methods Anonymous online surveys were completed by a college sample [n = 490; 76.9% female; Mean Age = 20.3 (SD = 4.9) years; 32.9% whole blood donors] and a ResearchMatch sample [n = 323; 70.6% female; Mean Age = 50.7 (SD = 16.6) years; 82.7% whole blood donors]. Level of payment needed to motivate whole blood, plasma, and platelet donation was examined as a function of donation history, sample, and gender. In addition, path analyses examined associations between donation motivators, barriers, and payment level. Results Across all types of donation, history of whole blood donation was related to a greater willingness to donate without payment. At the same time, however, sizeable portions of prior donors indicated that monetary payment would convince them to donate whole blood (24%), plasma (51%), or platelets (57%). Across all types of donation, donation‐related barriers (i.e., anxiety, fear) were indirectly related to higher payment levels via lower self‐efficacy and more negative donation attitudes. Donation‐related motivators (i.e., warm glow, regret, and altruism) were indirectly related to lower payment levels via higher self‐efficacy and more positive donation attitudes. Conclusion Despite reporting a strong commitment to nonremunerated blood donation, many respondents with and without a history of blood donation indicated that money would convince them to engage in whole blood, plasma, and platelet donation.
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Affiliation(s)
| | - Janis L France
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Lina K Himawan
- Department of Psychology, Ohio University, Athens, Ohio, USA
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19
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Shortage of plasma-derived products: a looming crisis? Blood 2022; 139:3222-3225. [PMID: 35259239 DOI: 10.1182/blood.2021015370] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022] Open
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20
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Stefely JA, Manis JP. Form follows function for freeze-dried platelets. Am J Hematol 2022; 97:253-255. [PMID: 35007360 DOI: 10.1002/ajh.26460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Jonathan A Stefely
- Joint Program in Transfusion Medicine, Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John P Manis
- Joint Program in Transfusion Medicine, Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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21
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Jimenez-Marco T, Castrillo A, Hierro-Riu F, Vicente V, Rivera J. Frozen and cold-stored platelets: reconsidered platelet products. Platelets 2021; 33:27-34. [PMID: 34423718 DOI: 10.1080/09537104.2021.1967917] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Platelet transfusion, both prophylactic and therapeutic, is a key element in modern medicine. Currently, the standard platelet product for clinical use is platelet concentrates at room temperature (20-24°C) under gentle agitation. As this temperature favors bacterial growth, storage is limited to 5-7 days, which result in high wastage rate, and complicates inventory and product availability at remote areas. Frozen and/or cold storage would ameliorate those disadvantages by reducing the risk of bacterial contamination and by extending the product shelf-life to weeks or even years. Consequently, the usefulness in transfusion medicine of platelet cryopreservation and refrigeration, two old and scarcely used platelet storage approaches, is reemerging. Indeed, there have been substantial recent research efforts to characterize both cold and cryopreserved platelets. Most recent studies indicate that cryopreserved and cold platelets display a pro-coagulant profile that may produce the rapid hemostatic response which is needed in bleeding patients. Thus, it seems appropriate that blood banks and blood transfusion centers explore the possibility of split platelet inventories consisting of platelets stored at room temperature and cryopreserved and cold-stored platelets.
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Affiliation(s)
- Teresa Jimenez-Marco
- Fundació Banc De Sang I Teixits De Les Illes Balears, Majorca, Spain.,Institut d'Investigació Sanitària Illes Balears (Idisba), Majorca, Spain
| | - Azucena Castrillo
- Axencia Galega De Sangue, Órganos E Tecidos. Santiago De Compostela, A Coruña, Spain
| | | | - Vicente Vicente
- Servicio De Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional De Hemodonación, Universidad De Murcia, IMIB-Arrixaca, Murcia, Spain
| | - José Rivera
- Servicio De Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional De Hemodonación, Universidad De Murcia, IMIB-Arrixaca, Murcia, Spain
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22
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Leung J, Cau MF, Kastrup CJ. Emerging gene therapies for enhancing the hemostatic potential of platelets. Transfusion 2021; 61 Suppl 1:S275-S285. [PMID: 34269451 DOI: 10.1111/trf.16519] [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: 12/31/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 01/03/2023]
Abstract
Platelet transfusions are an integral component of balanced hemostatic resuscitation protocols used to manage severe hemorrhage following trauma. Enhancing the hemostatic potential of platelets could lead to further increases in the efficacy of transfusions, particularly for non-compressible torso hemorrhage or severe hemorrhage with coagulopathy, by decreasing blood loss and improving overall patient outcomes. Advances in gene therapies, including RNA therapies, are leading to new strategies to enhance platelets for better control of hemorrhage. This review will highlight three approaches for creating modified platelets using gene therapies: (i) direct transfection of transfusable platelets ex vivo, (ii) in vitro production of engineered platelets from platelet-precursor cells, and (iii) modifying the bone marrow for in vivo production of modified platelets. In summary, modifying platelets to enhance their hemostatic potential is an exciting new frontier in transfusion medicine, but more preclinical development as well as studies testing the safety and efficacy of these agents are needed.
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Affiliation(s)
- Jerry Leung
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Massimo F Cau
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian J Kastrup
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Mowla SJ, Sapiano MRP, Jones JM, Berger JJ, Basavaraju SV. Supplemental findings of the 2019 National Blood Collection and Utilization Survey. Transfusion 2021; 61 Suppl 2:S11-S35. [PMID: 34337759 DOI: 10.1111/trf.16606] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). METHODS National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. RESULTS Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. CONCLUSION Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.
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Affiliation(s)
- Sanjida J Mowla
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia, 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, Georgia, USA
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - 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, District of Columbia, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Shopsowitz KE, Lim C, Shih AW, Fishbane N, Berry BR, Bigham M, Petraszko T, Trudeau J, Wyatt M, Yan MTS, Morrison D. Impacts of COVID-19 and elective surgery cancellations on platelet supply and utilization in the Canadian Province of British Columbia. Vox Sang 2021; 117:251-258. [PMID: 34309031 PMCID: PMC8447158 DOI: 10.1111/vox.13180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
Background and Objectives The coronavirus disease 2019 (COVID‐19) pandemic raised concerns about the vulnerability of platelet supply and the uncertain impact of the resumption of elective surgery on utilization. We report the impact of COVID‐19 on platelet supply and utilization across a large, integrated healthcare system in the Canadian province of British Columbia (BC). Materials and Methods Historical platelet use in BC by indication was compiled for fiscal year 2010/2011–2019/2020. Platelet collections, initial daily inventory and disposition data were assessed pre‐COVID‐19 (1 April 2018–15 March 2020) and for two COVID‐19 time periods in BC: a shutdown phase with elective surgeries halted (16 March–17 May, 2020) and a renewal phase when elective surgeries resumed (18 May–27 September 2020); comparisons were made provincially and for individual health authorities. Results Historically, elective surgeries accounted for 10% of platelets transfused in BC. Initial daily supplier inventory increased from baseline during both COVID‐19 periods (93/90 units vs. 75 units pre‐COVID‐19). During the shutdown phase, platelet utilization decreased 10.4% (41 units/week; p < 0.0001), and remained significantly decreased during the ensuing renewal period. Decreased platelet utilization was attributed to fewer transfusions during the shutdown phase followed by a decreased discard/expiry rate during the renewal phase compared to pre‐COVID‐19 (15.2% vs. 18.9% pre‐COVID‐19; p < 0.0001). Differences in COVID‐19 platelet utilization patterns were noted between health authorities. Conclusion Decreased platelet utilization was observed in BC compared to pre‐COVID‐19, likely due to a transient reduction in elective surgery as well as practice and policy changes triggered by pandemic concerns.
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Affiliation(s)
- Kevin E Shopsowitz
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Lim
- BC Provincial Blood Coordinating Office, Vancouver, British Columbia, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Fishbane
- BC Provincial Blood Coordinating Office, Vancouver, British Columbia, Canada
| | - Brian R Berry
- Department of Pathology, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Mark Bigham
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Tanya Petraszko
- Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Trudeau
- Department of Anesthesia, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen Wyatt
- Department of Pathology and Laboratory Medicine, Interior Health Authority, Kelowna, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Douglas Morrison
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,BC Provincial Blood Coordinating Office, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of BC, Vancouver, British Columbia, Canada
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Jones JM, Sapiano MRP, Mowla S, Bota D, Berger JJ, Basavaraju SV. Has the trend of declining blood transfusions in the United States ended? Findings of the 2019 National Blood Collection and Utilization Survey. Transfusion 2021; 61 Suppl 2:S1-S10. [PMID: 34165191 DOI: 10.1111/trf.16449] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Previous iterations of National Blood Collection and Utilization Survey (NBCUS) have demonstrated declines in blood collection and transfusion in the United States since 2008, including declines of 3.0% and 6.1% in red blood cell (RBC) collections and transfusions between 2015 and 2017, respectively. This study describes results of the 2019 NBCUS. METHODS The survey was distributed to all US blood collection centers, all hospitals performing ≥1000 surgeries annually, and a 40% random sample of hospitals performing 100-999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, distributed, transfused, and outdated. RESULTS In 2019, 11,590,000 RBC units were collected (95% confidence interval [CI], 11,151,000-12,029,000 units), a 5.1% decrease compared with 2017, while 10,852,000 RBC units were transfused (95% CI, 10,444-11,259 units), a 2.5% increase from 2017. Between 2017 and 2019, platelet distributions (2,508,000 units; 95% CI, 2,375,000-2,641,000 units) decreased by 2.0%, and plasma distributions (2,679,000 units; 95% CI, 2,525,000-2,833,000 units) decreased by 16.5%. During the same time period, platelet transfusions (2,243,000 units; 95% CI, 1,846,000-2,147,000 units) increased by 15.8% and plasma transfusions (2,185,000 units; 95% CI, 2,068,000-2,301,000 units) decreased by 8.0%. CONCLUSION Utilization of RBC in the United States might have reached a nadir. Between 2017 and 2019, RBC collections declined while RBC transfusions did not significantly change, suggesting a narrowing between blood supply and demand. Monitoring national blood collection and utilization data is integral to understanding trends in blood supply safety and availability.
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Affiliation(s)
- Jefferson M Jones
- 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
| | - Sanjida Mowla
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Atlanta, Georgia, USA
| | - Dorothy Bota
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Northrup Grumman Corporation, Atlanta, Georgia, USA
| | - 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, D.C., USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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