1
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Das N, Prakash S, Sahu A, Panigrahi A, Mishra D, Mukherjee S. Impact of dose and storage duration of platelet concentrates on platelet recovery between ABO identical and ABO non-identical random donor platelet transfusions in hemato-oncology patients. Hematol Transfus Cell Ther 2024; 46:228-236. [PMID: 36941173 PMCID: PMC11221252 DOI: 10.1016/j.htct.2023.01.011] [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: 07/25/2022] [Revised: 10/11/2022] [Accepted: 01/16/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES It is challenging to adopt a policy of ABO identical platelet transfusion in hemato-oncological patients because of the high demand. Moreover, there are no global standards for the management of ABO non-identical platelet transfusions due to limited evidence. The current study compared the impact of dose and storage duration of platelets on percent platelet recovery (PPR) at 1 h and 24 h between ABO identical and ABO non-identical platelet transfusions in hemato-oncological conditions. The other objectives were to assess the clinical efficacy and compare adverse reactions between the two groups. METHODS A total of 130 random donor platelet transfusion episodes (81 ABO identical and 49 ABO non-identical) were evaluated in 60 eligible patients with different malignant, as well as non-malignant, hematological conditions. All analysis was performed using two-sided tests, and p-values <0.05 were considered significant. RESULTS The PPR at 1 h and 24 h was significantly higher in ABO identical platelet transfusion. Platelet recovery and survival were not affected by the gender, dose or storage duration of platelet concentrate. Aplastic anemia and myelodysplastic syndrome (MDS) disease conditions were observed to be independent risk predictors for 1-h post-transfusion refractoriness. CONCLUSION ABO identical platelets have higher platelet recovery and survival. Both ABO identical and ABO non-identical platelet transfusions have similar efficacy in controlling bleeding episodes up to World Health Organization (WHO) grade two. Assessment of other factors, such as platelet functional properties in the donor, anti-HLA and anti-HPA antibodies, may be needed to better understand the platelet efficacy of platelet transfusions.
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Affiliation(s)
- Niladri Das
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satya Prakash
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ansuman Sahu
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashutosh Panigrahi
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debasish Mishra
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somnath Mukherjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
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2
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Blumberg N, Asante AA, Nguyen PLT, Heal JM. Platelet Transfusions: The Good, the Bad, and the Ugly. Anesth Analg 2024; 138:921-924. [PMID: 38621279 DOI: 10.1213/ane.0000000000006918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Neil Blumberg
- From the Transfusion Medicine Division, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York
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3
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Bougie DW, Reese SE, Birch RJ, Bookwalter DB, Mitchell PK, Roh D, Kreuziger LB, Cable RG, Goel R, Gottschall J, Hauser RG, Hendrickson JE, Hod EA, Josephson CD, Kahn S, Kleinman SH, Mast AE, Ness PM, Roubinian NH, Sloan S. Associations between ABO non-identical platelet transfusions and patient outcomes-A multicenter retrospective analysis. Transfusion 2023; 63:960-972. [PMID: 36994786 PMCID: PMC10175171 DOI: 10.1111/trf.17319] [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: 11/17/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Due to platelet availability limitations, platelet units ABO mismatched to recipients are often transfused. However, since platelets express ABO antigens and are collected in plasma which may contain ABO isohemagglutinins, it remains controversial as to whether ABO non-identical platelet transfusions could potentially pose harm and/or have reduced efficacy. STUDY DESIGN AND METHODS The large 4-year publicly available Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) database was used to investigate patient outcomes associated with ABO non-identical platelet transfusions. Outcomes included mortality, sepsis, and subsequent platelet transfusion requirements. RESULTS Following adjustment for possible confounding factors, no statistically significant association between ABO non-identical platelet transfusion and increased risk of mortality was observed in the overall cohort of 21,176 recipients. However, when analyzed by diagnostic category and recipient ABO group, associations with increased mortality for major mismatched transfusions were noted in two of eight subpopulations. Hematology/Oncology blood group A and B recipients (but not group O) showed a Hazard Ratio (HR) of 1.29 (95%CI: 1.03-1.62) and intracerebral hemorrhage group O recipients (but not groups A and B) showed a HR of 1.75 (95%CI: 1.10-2.80). Major mismatched transfusions were associated with increased odds of receiving additional platelet transfusion each post-transfusion day (through day 5) regardless of the recipient blood group. DISCUSSION We suggest that prospective studies are needed to determine if specific patient populations would benefit from receiving ABO identical platelet units. Our findings indicate that ABO-identical platelet products minimize patient exposure to additional platelet doses.
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Affiliation(s)
| | - Sarah E. Reese
- Public Health and Epidemiology Practice, Westat, Rockville, MD
| | | | | | | | | | | | | | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ronald George Hauser
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA
| | - Eldad A. Hod
- Columbia University Irving Medical Center, New York, NY
| | - Cassandra D. Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL., and Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Alan E Mast
- Blood Research Institute, Versiti Milwaukee WI
| | - Paul M. Ness
- American Red Cross Scientific Affairs, Farmington, CT
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4
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Raycraft T, Bartoszko J, Karkouti K, Callum J, Lin Y. Practice patterns of ABO-matching for cryoprecipitate and patient outcomes after ABO-compatible versus incompatible cryoprecipitate. Vox Sang 2022; 117:1105-1111. [PMID: 35791670 DOI: 10.1111/vox.13330] [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: 09/13/2021] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES This sub-study of the FIBRES trial sought to examine the patterns of ABO-compatible cryoprecipitate administration and to identify adverse consequences of ABO-incompatible cryoprecipitate. MATERIALS AND METHODS This was a post hoc analysis of data collected from the FIBRES randomized clinical trial comparing fibrinogen concentrate with cryoprecipitate in the treatment of bleeding related to hypofibrinogenemia after cardiac surgery. The primary outcome was the percentage of administered cryoprecipitate that was ABO-compatible. Secondary outcomes were adverse events at 28 days. A follow-up survey was distributed to the FIBRES participating sites to examine the rationale behind the identified cryoprecipitate ABO-matching practice patterns. RESULTS A total of 363 patients were included: 53 (15%) received ABO-incompatible cryoprecipitate and 310 (85%) received ABO-compatible cryoprecipitate. There was an increased incidence of post-operative anaemia in the ABO-incompatible group (15; 28.3%) in comparison to the ABO-compatible (44; 14.2%) group (p = 0.01) at 28 days, which was unrelated to haemolysis, without a significant difference in transfusion requirement. In the multivariable logistic regression models accounting for clustering by site, there was no observed statistically significant association between the administration of ABO-incompatible cryoprecipitate and any other adverse outcomes. Nine out of 11 sites did not have a policy requiring ABO-matched cryoprecipitate. CONCLUSION This sub-study demonstrated that most cryoprecipitate administered in practice is ABO-compatible, despite the absence of guidelines or blood bank policies to support this practice. A signal towards increased risk of post-operative anaemia may be explained by higher rates of urgent surgery (vs. elective) in the ABO-incompatible group. Future studies should prospectively examine the impact of ABO-compatible versus incompatible cryoprecipitate to conclusively establish if there is a meaningful clinical impact associated with the administration of ABO-incompatible cryoprecipitate.
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Affiliation(s)
- Tyler Raycraft
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justyna Bartoszko
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
| | - Keyvan Karkouti
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, Ontario, Canada
| | - Yulia Lin
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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5
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Davenport P, Fan HH, Nolton E, Feldman HA, Lorenz V, Canas J, Acosta-Zaldívar M, Yakah W, Arthur C, Martin C, Stowell S, Koehler J, Mager D, Sola-Visner M. Platelet transfusions in a murine model of neonatal polymicrobial sepsis: Divergent effects on inflammation and mortality. Transfusion 2022; 62:1177-1187. [PMID: 35522536 DOI: 10.1111/trf.16895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Platelet transfusions (PTxs) are often given to septic preterm neonates at high platelet count thresholds in an attempt to reduce bleeding risk. However, the largest randomized controlled trial (RCT) of neonatal transfusion thresholds found higher mortality and/or major bleeding in infants transfused at higher thresholds. Using a murine model, we investigated the effects of adult PTx on neonatal sepsis-induced mortality, systemic inflammation, and platelet consumption. STUDY DESIGN AND METHODS Polymicrobial sepsis was induced via intraperitoneal injection of cecal slurry preparations (CS1, 2, 3) into P10 pups. Two hours after infection, pups were transfused with washed adult Green Flourescent Protein (GFP+) platelets or control. Weights, platelet counts, and GFP% were measured before 4 and 24 h post-infection. At 24 h, blood was collected for quantification of plasma cytokines. RESULTS The CS batches varied in 24 h mortality (11%, 73%, and 30% in CS1, 2, and 3, respectively), due to differences in bacterial composition. PTx had differential effects on sepsis-induced mortality and systemic inflammatory cytokines, increasing both in mice infected with CS1 (low mortality) and decreasing both in mice infected with CS2 and 3. In a mathematical model of platelet kinetics, the consumption of transfused adult platelets was higher than that of endogenous neonatal platelets, regardless of CS batch. DISCUSSION Our findings support the hypothesis that transfused adult platelets are consumed faster than endogenous neonatal platelets in sepsis and demonstrate that PTx can enhance or attenuate neonatal inflammation and mortality in a model of murine polymicrobial sepsis, depending on the composition of the inoculum and/or the severity of sepsis.
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Affiliation(s)
- Patricia Davenport
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Hsuan-Hao Fan
- Department of Pharmaceutical Sciences, University of Buffalo, State University of New York, Buffalo, New York, USA
| | - Emily Nolton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Henry A Feldman
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Viola Lorenz
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge Canas
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - William Yakah
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Neonatology, Beth Israel Medical Center, Boston, Massachusetts, USA
| | - Connie Arthur
- Division of Transfusion Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Camilia Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Neonatology, Beth Israel Medical Center, Boston, Massachusetts, USA
| | - Sean Stowell
- Division of Transfusion Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Koehler
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Donald Mager
- Department of Pharmaceutical Sciences, University of Buffalo, State University of New York, Buffalo, New York, USA
| | - Martha Sola-Visner
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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6
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Ahn A, Yang JJ, Youk HJ, Cho D, Oh HB, Ko DH, Hwang SH. Rh(D) Alloimmunization Risk After Rh(D)-Incompatible Solid Organ Transplantations in Rh(D)-Negative Recipients. Am J Clin Pathol 2022; 158:8-12. [PMID: 35099531 DOI: 10.1093/ajcp/aqac002] [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: 10/15/2021] [Accepted: 01/03/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Rh(D)-incompatible (Rh-i) solid organ transplantations are not considered for organ matching, but no consensus guidelines exist regarding the need for anti-D immunoglobulin (RhIG) prophylaxis. METHODS We reviewed 35 Rh(D)-negative patients who had received Rh-i solid organ transplantation. We divided the patients into a RhIG-administered group and a nonadministered group. All patients also underwent an antibody screening test to assess Rh alloimmunization. Graft function was monitored with serum creatinine or bilirubin and kidney or liver biopsy whenever a rejection was suspected. Overall survival was also assessed. RESULTS The median (range) age of transplant recipients was 48.5 (4-69) years, and 73.5% of patients were male. Median (range) follow-up time after transplantation was 60 (2-246) months. In the RhIG nonadministered group (n = 16), anti-D was not detected in any of the patients. More rejection episodes occurred in the RhIG-administered group among those undergoing kidney transplant (P = .0278). CONCLUSIONS The low rate of Rh(D) alloimmunization is associated with the immunosuppressive state of the patients. RhIG prophylaxis seems to have no clinical benefit in Rh-i solid organ transplantation.
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Affiliation(s)
- Ari Ahn
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - John Jeongseok Yang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Youk
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Heung-Bum Oh
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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8
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Chung Y, Ko DH, Lim J, Kim KH, Kim H. Choice of ABO Group for Blood Component Transfusion in ABO-Incompatible Solid Organ Transplantation: A Questionnaire Survey in Korea and Guideline Proposal. Ann Lab Med 2022; 42:105-109. [PMID: 34374356 PMCID: PMC8368232 DOI: 10.3343/alm.2022.42.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/17/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
The number of ABO-incompatible solid organ transplantations (ABOi SOTs) has markedly increased worldwide since the early 2000s. We investigated the choice of ABO group for blood component transfusion in ABOi SOT. We conducted a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea, among whom 34 responded to the survey. In major ABOi SOT, for red blood cells (RBCs), the recipient’s type (70.6%) was the most common choice, followed by group O (29.4%); for platelets, group AB (50.0%) was the most common choice, followed by the donor type (38.2%); for plasma, group AB (55.9%) was the most common choice, followed by the donor type (32.4%). In bidirectional ABOi SOT, for RBCs, the recipient’s type (55.9%) was the most common choice, followed by group O (44.1%); for platelets and plasma, group AB was the most common choice (94.1% and 97.1%, respectively). The policies for transfusion in ABOi SOT were diverse. We suggest a guideline on the choice of ABO group for transfusion in ABOi SOT to secure patient health and enable an efficient use of blood components.
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Affiliation(s)
- Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
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9
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Essential Role of Rho-Associated Kinase in ABO Immune Complex-Mediated Endothelial Barrier Disruption. Biomedicines 2021; 9:biomedicines9121851. [PMID: 34944667 PMCID: PMC8698390 DOI: 10.3390/biomedicines9121851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
ABO immune complexes (ABO-IC) formed by ABO-incompatible antigen-antibody interaction are associated with hemolysis and platelet destruction in patients transfused with ABO-nonidentical blood products. However, the effects of ABO-IC on endothelial cells (EC) are unclear. ABO-IC were formed in vitro from normal donor-derived plasma and serum. Human pulmonary artery EC (HPAEC) were cultured and treated with media, ABO-identical and –non-identical plasma, and ABO-IC. EC barrier integrity was evaluated using transendothelial electrical resistance (TEER), scanning electron microscopy (SEM), vascular endothelial (VE)-cadherin and phalloidin staining, and Rho-associated Kinase (ROCK) inhibitor treatment. TEER revealed significant/irreversible barrier disruption within 1–2 h of exposure to ABO non-identical plasma and ABO-IC; this occurred independently of EC ABO type. Treatment with ABO-IC resulted in decreased VE-cadherin staining and increased phalloidin staining in a time-dependent manner, suggesting that the resultant increased EC barrier permeability is secondary to actin stress fiber formation and loss of cell surface VE-cadherin. Inhibition of ROCK was effective in protecting against IC-induced barrier disruption even two hours after ABO-IC exposure. ABO-IC causes increased EC barrier permeability by decreasing cell surface VE-cadherin and promoting stress fiber formation, which is preventable by inhibiting ROCK activation to protect against EC contraction and gap formation.
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10
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Ruby KN, Harm SK, Dunbar NM. Risk of ABO-Incompatible Plasma From Non-ABO-Identical Components. Transfus Med Rev 2021; 35:118-122. [PMID: 34544619 DOI: 10.1016/j.tmrv.2021.06.006] [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: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 01/16/2023]
Abstract
The last several decades have seen significant changes in the approach to resuscitation of bleeding patients. These include the adoption of ABO-incompatible plasma transfusion in the form of group A plasma and/or low titer group O whole blood for trauma patients of unknown ABO group. Studies to date have examined the impact of these practices on patient outcomes and clinical markers of hemolysis in recipients of ABO-incompatible plasma compared to those for whom the plasma is ABO-compatible. Risk for increased mortality and/or overt hemolysis appear to be low among recipients of ABO-incompatible plasma; however, nearly all of studies are retrospective and most have focused only on adult trauma patients so results may not be generalizable to other bleeding patients. Work continues to evaluate the role of various titer thresholds in decreasing hemolytic risk and opportunities remain to improve our understanding of anti-A and anti-B antibody interactions with complement/endothelium and identify strategies to minimize risk.
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Affiliation(s)
- Kristen N Ruby
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sarah K Harm
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA; University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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11
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Liker M, Bojanić I, Plenković F, Lukić M, Tomac G, Raos M, Ćepulić BG. Platelet transfusion practice and related transfusion reactions in a large teaching hospital. Transfus Clin Biol 2021; 29:37-43. [PMID: 34411746 DOI: 10.1016/j.tracli.2021.08.004] [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: 06/29/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Platelet transfusion practice varies widely since many aspects of platelet concentrate (PC) use have not been definitively determined. The objectives of this retrospective study were to present platelet transfusion practice and evaluate PC and patient characteristics, as well as their association with transfusion reaction (TR) rate. MATERIAL AND METHODS Platelet transfusions over a 5-year period were analysed regarding PC characteristics (the ABO and RhD compatibility, product type, and storage duration), patient characteristics (most responsible diagnosis, age, and gender), and TR type. RESULTS A total of 46,351 PCs were transfused: 76.4% whole blood-derived (WBD) and 23.6% single donor apheresis (SDA). Three thousand seven hundred seventy-six patients received platelet transfusions: 24.7% paediatric and 75.3% adult patients, 79.6% outpatients and 20.4% inpatients. As much as 63.1% of all transfused PCs were fresh (stored for≤3 days), 98.0% ABO-identical, and 87.3% of all PCs given to RhD- patients were RhD-. PCs were mainly transfused to haemato-oncology (76.8%) and cardiovascular surgery patients (6.5%). Overall, 84 (0.18%) TRs were reported, with allergic TRs (ATRs) being the most common. Although PC ABO compatibility and storage duration, as well as patient age and gender, showed differences in TR rate, only the use of PCs in platelet additive solution (PAS) showed a statistically significant reduction of TRs (P<0.001). CONCLUSION Transfusion practice at the University Hospital Centre Zagreb resulted in almost all patients receiving ABO and RhD identical PCs, and most of them were fresh PCs. The most important factor affecting the incidence of TRs was platelet storage solution. The use of PAS effectively reduced the rate of TRs, particularly allergic TRs.
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Affiliation(s)
- M Liker
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
| | - I Bojanić
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia; School of Medicine, University of Zagreb, Croatia
| | - F Plenković
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - M Lukić
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - G Tomac
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - M Raos
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia
| | - B G Ćepulić
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia; School of Medicine, University of Zagreb, Croatia; Department of Health Studies, University of Split, Croatia
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12
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Cardigan R, New HV, Estcourt L, Zhiburt E, Dubey R, Bengtsson J, Jöud M, Castillo C, Cid J, Lozano M, Gounder D, Flanagan P, Morley S, Clarke G, Devine D, Hindawi S, AlOtaibi A, Bub CB, Kutner JM, Ikeda T, Goto N, Okazaki H, Fontaine MJ, Pasion J, Song L, Latham T, Kerkhoffs JL, de Haas M, Zwaginga JJ, Gathof BS, Ommer K, Pirenne F, Raba M, Francois A, Daly J, Powley T, Dunbar N. International Forum on Policies and Practice for Transfusion of ABO and RhD Non-Identical Platelets: Summary. Vox Sang 2021; 117:136-144. [PMID: 34258783 DOI: 10.1111/vox.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023]
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13
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Impacts of ABO-incompatible platelet transfusions on platelet recovery and outcomes after intracerebral hemorrhage. Blood 2021; 137:2699-2703. [PMID: 33649761 DOI: 10.1182/blood.2020008381] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/07/2021] [Indexed: 11/20/2022] Open
Abstract
Acute platelet transfusion after intracerebral hemorrhage (ICH) given in efforts to reverse antiplatelet medication effects and prevent ongoing bleeding does not appear to improve outcome and may be associated with harm. Although the underlying mechanisms are unclear, the influence of ABO-incompatible platelet transfusions on ICH outcomes has not been investigated. We hypothesized that patients with ICH who receive ABO-incompatible platelet transfusions would have worse platelet recovery (using absolute count increment [ACI]) and neurological outcomes (mortality and poor modified Rankin Scale [mRS 4-6]) than those receiving ABO-compatible transfusions. In a single-center cohort of consecutively admitted patients with ICH, we identified 125 patients receiving acute platelet transfusions, of whom 47 (38%) received an ABO-incompatible transfusion. Using quantile regression, we identified an association of ABO-incompatible platelet transfusion with lower platelet recovery (ACI, 2 × 103cells per μL vs 15 × 103cells per μL; adjusted coefficient β, -19; 95% confidence interval [CI], -35.55 to -4.44; P = .01). ABO-incompatible platelet transfusion was also associated with increased odds of mortality (adjusted odds ratio [OR], 2.59; 95% CI, 1.00-6.73; P = .05) and poor mRS (adjusted OR, 3.61; 95% CI, 0.97-13.42; P = .06); however, these estimates were imprecise. Together, these findings suggest the importance of ABO compatibility for platelet transfusions for ICH, but further investigation into the mechanism(s) underlying these observations is required.
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Refaai MA, Cahill C, Masel D, Schmidt AE, Heal JM, Kirkley SA, Blumberg N. Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions? Anesth Analg 2019; 126:2135-2138. [PMID: 29099432 DOI: 10.1213/ane.0000000000002600] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Majed A Refaai
- From the Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester Medical Center, Rochester, New York
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15
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Nellis ME, Goel R, Karam O, Cushing MM, Davis PJ, Steiner ME, Tucci M, Stanworth SJ, Spinella PC. Effects of ABO Matching of Platelet Transfusions in Critically Ill Children. Pediatr Crit Care Med 2019; 20:e61-e69. [PMID: 30422914 PMCID: PMC6709973 DOI: 10.1097/pcc.0000000000001779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. DESIGN Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. SETTING Eighty-two PICUs in 16 countries. PATIENTS Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 10 cells/L (8-68 × 10 cells/L), for transfusions with major incompatibility 26 × 10 cells/L (7-74 × 10 cells/L), and for transfusions with minor incompatibility 54 × 10 cells/L (14-81 × 10 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07). CONCLUSIONS No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
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Affiliation(s)
- Marianne E Nellis
- Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Peter J Davis
- Paediatric Intensive Care Unit, Department of Pediatrics, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marie E Steiner
- Divisions of Pediatric Critical Care and Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Marisa Tucci
- Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Philip C Spinella
- Department of Pediatrics, Division Critical Care, Washington University in St Louis, St Louis, MO
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16
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Sut C, Hamzeh-Cognasse H, Arthaud CA, Eyraud MA, Chettab K, Dumontet C, Laradi S, Burnouf T, Garraud O, Cognasse F. Platelet concentrate supernatants alter endothelial cell mRNA and protein expression patterns as a function of storage length. Transfusion 2018; 58:2635-2644. [PMID: 30325037 DOI: 10.1111/trf.14973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Platelet transfusions are safe but can nevertheless cause serious adverse reactions (SARs). This study investigated the effects of platelet biological response modifiers (BRMs) that accumulate during storage and are commonly associated with transfusion adverse reactions. STUDY DESIGN AND METHODS Endothelial cells (ECs), that is, EA.hy926, were exposed in vitro to supernatants of platelet components (PCs) that had been either implicated or not in SARs. The EC Biology RT2 Profiler PCR Array was used at the same time to study 84 genes related to functions of ECs. Soluble cytokines and surface expression of EC markers were determined by Luminex/enzyme-linked immunosorbent assay technology and flow cytometry, respectively. Apoptosis and scratch wound assays were performed using IncuCyte technology. RESULTS In vitro exposure of EA.hy926 monolayers with Day 0, 1-2, and 3-4 stored PC supernatants resulted in decreases in surface expression of markers of ECs. There was differential production of soluble BRMs in the tested cell line. Exposure to the supernatants of PCs that had been implicated in SARs showed a significant difference in the expression of the EC surface markers. EC mediators also responded differently when exposed to PC supernatants of different storage times and PCs involved in SARs. CONCLUSION PC supernatants collected at Day 1-2 activate fewer cell lines of ECs compared with supernatants collected at Day 3-4. Moreover, PC supernatants involved in SARs appear to alter EC activation compared with the control and storage length.
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Affiliation(s)
- Caroline Sut
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | | | | | - Marie-Ange Eyraud
- Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Kamel Chettab
- Centre de Recherche en Cancérologie de Lyon, Equipe Anticorps Anticancer, UMR INSERM 1052-CNRS 5286, Lyon, France
| | - Charles Dumontet
- Centre de Recherche en Cancérologie de Lyon, Equipe Anticorps Anticancer, UMR INSERM 1052-CNRS 5286, Lyon, France
| | - Sandrine Laradi
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Olivier Garraud
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Institut National de la Transfusion Sanguine, Paris, France
| | - Fabrice Cognasse
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
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17
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Abstract
Red cell transfusions are amongst the most common therapeutic procedures in seriously ill children, particularly in the inpatient setting. This is despite the fact that there is no evidence base for most clinical settings, with the exception of patients with hemoglobinopathies, particularly thalassemia and sickle cell anemia. Obviously exsanguinating hemorrhage and life threatening anemia are urgent indications for which no other therapeutic approach is currently available. Most transfusions are, however, given prophylactically to prevent the complications of hypoxia or hemodynamic stability, based upon expert opinion and a faith in the oxygen carrying capacity and beneficial hemodynamic properties of transfused red cells. The question confronting current day pediatric practice is to what extent transfused red cells prevent adverse events, other than in thalassemia and sickle cell anemia, as opposed to causing them. Do transfusions of red cells prevent organ failure, stroke, etc. or not? There is epidemiologic evidence in the adult randomized trial literature that liberal red cell transfusion likely causes more such adverse events than it prevents. The relevance of such studies to children, particularly neonates, is uncertain. Randomized trials in critically ill neonates have yielded little to no evidence that liberal red cell transfusion is beneficial, but the data are not definitive. In critically ill older children the data suggest there is no benefit to liberal red cell transfusion, but the indications for red cell transfusion are uncertain. Most practitioners would agree that combining laboratory data such hemoglobin/hematocrit with clinical indications for transfusions (evidence of end organ hypoxia such as tachycardia, shortness of breath, etc.) is the only viable strategy at present, until more definitive randomized trial data are available.
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18
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Implementation of a Standardized Transfusion Protocol for Cardiac Patients Treated With Venoarterial Extracorporeal Membrane Oxygenation Is Associated With Decreased Blood Component Utilization and May Improve Clinical Outcome. Anesth Analg 2018; 126:1262-1267. [DOI: 10.1213/ane.0000000000002238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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19
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Blumberg N, Heal JM, Masel D, Refaai MA. The precautionary principle and use of Group A plasma in recipients of unknown ABO blood group. Transfusion 2018. [PMID: 29528152 DOI: 10.1111/trf.14466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Neil Blumberg
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Joanna M Heal
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Debra Masel
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
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20
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Sahai T, Henrichs K, Refaai M, Heal JM, Kirkley SA, Schmidt AE, Mendler JH, Masel D, Liesveld J, Aquina C, Blumberg N. ABO identical and washed blood transfusions as candidate strategies to reduce early mortality in acute promyelocytic leukemia. Leuk Res 2017; 62:1-3. [DOI: 10.1016/j.leukres.2017.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/21/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
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21
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Potential impact of complement regulator deficiencies on hemolytic reactions due to minor ABO-mismatched transfusions. Blood Adv 2017; 1:1977-1982. [PMID: 29296844 DOI: 10.1182/bloodadvances.2017008805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022] Open
Abstract
Minor ABO-mismatched transfusions are a common occurrence, although infrequent transfusion reactions occur. We sought to investigate the regulation of complement C3 activation induced by anti-A. In vitro complement C3 activation was observed with 10 of 30 group O samples and correlated with immunoglobulin M (IgM) anti-A titers. We developed an in vitro paroxysmal nocturnal hemoglobinuria (PNH) model of hemolysis in which group A1 red blood cells (RBCs) were chemically treated with 2-aminoethylisothiouronium (AET) to alter regulators of complement C3 activation. Intravascular hemolysis was simulated by incubating an IgG nonhemolytic group O plasma (titer = 32) with A1 RBCs. IgG was detected on the RBCs, but hemolysis was observed with AET-treated RBCs only. When treated and untreated RBCs were tested together (1:4), we determined that the failure to observe C3b/d deposition on RBCs was due to the complete hemolysis of the AET-treated minor RBC population. A group O patient with a 9% CD59-deficient PNH clone was sensitized with an IgM anti-I. Hemolysis, with a weak positive direct antiglobulin test (DAT) resulting from C3b/d, was observed after incubation with fresh AB serum. Flow cytometry showed an 86% reduction of the PNH clone. Our work indicates that the transfusion of minor ABO-mismatched plasma could cause hemolysis with a negative DAT C3b/d. We propose that the presence of a PNH clone is 1 possible cause of unexplained anemia for recipients of ABO-mismatched product. This work suggests that other acquired or inherited defects of decay-accelerating factor and membrane inhibitor of reactive lysis could be responsible for infrequent but clinically important hemolysis after ABO-mismatched transfusions.
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22
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Blumberg N, Cholette JM, Schmidt AE, Phipps RP, Spinelli SL, Heal JM, Pietropaoli AP, Refaai MA, Sime PJ. Management of Platelet Disorders and Platelet Transfusions in ICU Patients. Transfus Med Rev 2017; 31:252-257. [PMID: 28501326 DOI: 10.1016/j.tmrv.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 01/04/2023]
Abstract
Thrombocytopenia or receipt of antiplatelet drugs, with or without bleeding, is a common indication for platelet transfusions in the ICU. However, there is almost no evidence base for these practices other than expert opinion. Also common is use of platelet transfusions prior to invasive procedures or surgery in patients with thrombocytopenia. Likewise, there is no high-quality evidence that such practices are efficacious or safe. Recently, it has become clear that, whether causal or not, patients receiving prophylactic platelet transfusions experience high rates of nosocomial infection, thrombosis, organ failure, and mortality, which increase the urgency and need for randomized trials to assess these practices. Investigational methods of improving the safety and efficacy of platelet transfusions include use of alternate strategies such as antifibrinolytics; use of ABO-identical, leukoreduced, and washed platelet transfusions; and improved storage solutions.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY.
| | - Jill M Cholette
- Critical Care and Cardiology, Department of Pediatrics, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Amy E Schmidt
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Richard P Phipps
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY; Department of Environmental Medicine, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY; Department of Microbiology and Immunology, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Sherry L Spinelli
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Joanna M Heal
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Anthony P Pietropaoli
- Pulmonary and Critical Care, Department of Medicine, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Patricia J Sime
- Pulmonary and Critical Care, Department of Medicine, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
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23
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Variables That Affect Results of PFA-100 in a Group of Healthy Blood Donors in the Slovak Population. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background: The platelet function analyzer (PFA-100) is a system analyzing platelet function determined for detection of the functional inherited and acquired platelet disorders, screening of von Willebrand disease (vWD) and recently also considered as useful for monitoring of antiplatelet treatment. The PFA-100 test uses a high shear flow system to simulate in vitro the conditions to which platelets are subjected at the site of a damaged blood vessel wall.
Aim of study: We decided to establish the reference intervals of PFA closure time (CT) in the Slovak population of healthy blood donors.
Patients and methods: Fifty age and gender matched healthy blood donors were enrolled in the study. We investigated the relationships between PFA-100 CT, gender and ABO blood groups.
Results: The reference intervals for CT measured on CEPI (collagen/epinephrine) and CADP (collagen/adenosine diphosphate) cartridge in 3.2% citrated blood were 86 - 199 sec. and 42 - 119 sec., respectively. Blood group O was associated with significantly longer CEPI CT (p<0.05) compared to non - O groups. The prolongation of CADP CT in blood donors with blood group O was without significance. The influence of gender as another variable analyzed with CT has not been evaluated as statistically significant.
Conclusion: PFA-100 CT should be interpreted carefully with consideration of both the patient’s clinical presentation and laboratory variables such as ABO blood group.
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Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP, Mumford AD, Stanworth SJ, Tinegate H. Guidelines for the use of platelet transfusions. Br J Haematol 2016; 176:365-394. [DOI: 10.1111/bjh.14423] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lise J. Estcourt
- NHSBT and Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Janet Birchall
- NHSBT and Department of Haematology; North Bristol NHS Trust; Bristol UK
| | - Shubha Allard
- NHSBT and Department of Haematology; Royal London Hospital; London UK
| | - Stephen J. Bassey
- Department of Haematology; Royal Cornwall Hospital Trust; Cornwall UK
| | - Peter Hersey
- Department of Critical Care Medicine & Anaesthesia; City Hospitals Sunderland NHS Foundation Trust; Sunderland UK
| | - Jonathan Paul Kerr
- Department of Haematology; Royal Devon & Exeter NHS Foundation Trust; Exeter UK
| | - Andrew D. Mumford
- School of Cellular and Molecular Medicine; University of Bristol; Bristol UK
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25
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Garraud O, Tariket S, Sut C, Haddad A, Aloui C, Chakroun T, Laradi S, Cognasse F. Transfusion as an Inflammation Hit: Knowns and Unknowns. Front Immunol 2016; 7:534. [PMID: 27965664 PMCID: PMC5126107 DOI: 10.3389/fimmu.2016.00534] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/11/2016] [Indexed: 01/15/2023] Open
Abstract
Transfusion of blood cell components is frequent in the therapeutic arsenal; it is globally safe or even very safe. At present, residual clinical manifestations are principally inflammatory in nature. If some rare clinical hazards manifest as acute inflammation symptoms of various origin, most of them linked with conflicting and undesirable biological material accompanying the therapeutic component (infectious pathogen, pathogenic antibody, unwanted antigen, or allergen), the general feature is subtler and less visible, and essentially consists of alloimmunization or febrile non-hemolytic transfusion reaction. The present essay aims to present updates in hematology and immunology that help understand how, when, and why subclinical inflammation underlies alloimmunization and circumstances characteristic of red blood cells and – even more frequently – platelets that contribute inflammatory mediators. Modern transfusion medicine makes sustained efforts to limit such inflammatory hazards; efforts can be successful only if one has a clear view of each element’s role.
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Affiliation(s)
- Olivier Garraud
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Institut National de la Transfusion Sanguine, Paris, France
| | - S Tariket
- Faculty of Medicine of Saint-Etienne, University of Lyon , Saint-Etienne , France
| | - C Sut
- Faculty of Medicine of Saint-Etienne, University of Lyon , Saint-Etienne , France
| | - A Haddad
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Hôpital du Sacré-Coeur, Beirut, Lebanon
| | - C Aloui
- Faculty of Medicine of Saint-Etienne, University of Lyon , Saint-Etienne , France
| | - T Chakroun
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Centre de Transfusion Sanguine, Sousse, Tunisia; Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - S Laradi
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Etablissement Français du Sang Rhône-Alpes-Auvergne, Saint-Etienne, France
| | - F Cognasse
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Etablissement Français du Sang Rhône-Alpes-Auvergne, Saint-Etienne, France
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26
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Abstract
The spectrum of adverse reactions to blood product transfusion ranges from a benign clinical course to serious morbidity and mortality. There have been many advances in technologies and transfusion strategies to decrease the risk of adverse reactions. Our aim is to address a few of the advancements in increasing the safety of the blood supply, specifically pathogen reduction technologies, bacterial contamination risk reduction, and transfusion associated acute lung injury risk mitigation strategies.
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Affiliation(s)
- Thomas S Rogers
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
| | - Mark K Fung
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
| | - Sarah K Harm
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
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