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Zhao G, Zhang H, Kong X, Qi Q, Hou T, Mao P, Luan J, Wang W. Evaluation of stored red blood cell quality after washing using immune indices. Heliyon 2024; 10:e32056. [PMID: 38882340 PMCID: PMC11177123 DOI: 10.1016/j.heliyon.2024.e32056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Washed red blood cells (RBCs) can be used to treat immune-related diseases. However, whether the washing process changes the quality of RBCs and affects the curative effect of transfusion therapy remains unclear. We retrospectively analysed the clinical data of patients who received blood transfusion. The physiological and biochemical parameters of RBCs were tested on an automated haematology-biochemical analyser. CD47 and phosphatidylserine (PS) plasma membrane expression were analysed using flow cytometry. Morphological changes in RBCs were observed using scanning electron microscopy. The results showed that the curative effect on patients who received washed RBCs was weaker than that on those who received non-washed RBCs. Physiological and biochemical parameters of RBCs were not significantly different. RBC immune indices changed significantly after washing. The expression of "don't eat me" signals was weakened, whereas the intensity of "eat me" signals was enhanced. This study suggests that the current use of physiological and biochemical parameters as indicators to evaluate the quality of RBCs may not be comprehensive and that evaluation of the real status of RBCs requires other effective parameters. Immune molecules in RBCs are expected to become supplementary markers for evaluating RBC quality.
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Affiliation(s)
- Guangchao Zhao
- Department of Blood Transfusion Medicine, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Hongmei Zhang
- Department of Blood Transfusion, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaojun Kong
- Department of Blood Transfusion, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Qing Qi
- Department of Blood Transfusion Medicine, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Tao Hou
- Department of Blood Transfusion, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Pingping Mao
- Department of Blood Transfusion Medicine, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jianfeng Luan
- Department of Blood Transfusion Medicine, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Wei Wang
- Department of Laboratory, Suzhou Xiangcheng Centers for Disease Control and Prevention, Suzhou, China
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Limratana P, Maisat W, Tsai A, Yuki K. Perioperative Factors and Radiographic Severity Scores for Predicting the Duration of Mechanical Ventilation After Arterial Switch Surgery. J Cardiothorac Vasc Anesth 2024; 38:992-1005. [PMID: 38365467 PMCID: PMC10947876 DOI: 10.1053/j.jvca.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Cardiac surgery on cardiopulmonary bypass (CPB) during the neonatal period can cause perioperative organ injuries. The primary aim of this study was to determine the incidence and risk factors associated with postoperative mechanical ventilation duration and acute lung injury after the arterial switch operation (ASO). The secondary aim was to examine the utility of the Brixia score for characterizing postoperative acute lung injury (ALI). DESIGN A retrospective study. SETTING A single-center university hospital. PARTICIPANTS A total of 93 neonates with transposition of great arteries with intact ventricular septum (dTGA IVS) underwent ASO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS From January 2015 to December 2022, 93 neonates with dTGA IVS were included in the study. The cohort had a median age of 4.0 (3.0-5.0) days and a mean weight of 3.3 ± 0.5 kg. About 63% of patients had ≥48 hours of postoperative mechanical ventilation after ASO. Risk factors included prematurity, post-CPB transfusion of salvaged red cells, platelets and cryoprecipitate, and postoperative fluid balance by univariate analysis. The larger transfused platelet volume was associated with the risk of ALI by multivariate analysis. The median baseline Brixia scores were 11.0 (9.0-12.0) and increased significantly in the postoperative day 1 in patients who developed moderate ALI 24 hours after admission to the intensive care unit (15.0 [13.0-16.0] v 12.0 [10.0-14.0], p = 0.046). CONCLUSIONS Arterial switch operation results in a high incidence of ≥48-hour postoperative mechanical ventilation. Blood component transfusion is a potentially modifiable risk factor. The Brixia scores also may be used to characterize postoperative acute lung injury.
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Affiliation(s)
- Panop Limratana
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wiriya Maisat
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andy Tsai
- Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
| | - Koichi Yuki
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Huso T, Buban K, Van Denakker TA, Haddaway K, Smetana H, Marshall C, Rai H, Ness PM, Bloch EM, Tobian AAR, Crowe EP. Reevaluation of the medical necessity of washed red blood cell transfusion in chronically transfused adults. Transfusion 2024; 64:216-222. [PMID: 38130071 DOI: 10.1111/trf.17690] [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: 11/18/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Washing red blood cell (RBC) units mitigates severe allergic transfusion reactions. However, washing reduces the time to expiration and the effective dose. Automated washing is time- and labor-intensive. A shortage of cell processor tubing sets prompted review of medical necessity for washed RBC for patients previously thought to require washing. STUDY DESIGN AND METHODS A single-center, retrospective study investigated discontinuing wash RBC protocols in chronically transfused adults. In select patients with prior requirements for washing, due to a history of allergic transfusion reactions, trials of unwashed transfusions were performed. Patient demographic, clinical, laboratory, and transfusion data were compiled. The per-unit washing cost was the sum of the tubing set, saline, and technical labor costs. RESULTS Fifteen patients (median age 34 years interquartile range [IQR] 23-53 years, 46.7% female) were evaluated. These patients had been transfused with a median of 531 washed RBC units (IQR 244-1066) per patient over 12 years (IQR 5-18 years), most commonly for recurrent, non-severe allergic reactions. There were no transfusion reactions with unwashed RBCs aside from one patient with one episode of pruritus and another with recurrent pruritus, which was typical even with washed RBC. We decreased the mean number of washed RBC units per month by 72.9% (104 ± 10 vs. 28.2 ± 25.2; p < .0001) and saved US $100.25 per RBC unit. CONCLUSION Washing of RBCs may be safely reconsidered in chronically transfused patients without a history of anaphylaxis. Washing should be implemented judiciously due to potential lack of necessity and logistical/operational challenges.
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Affiliation(s)
- Tait Huso
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristen Buban
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tayler A Van Denakker
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kathy Haddaway
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Heather Smetana
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christi Marshall
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Herleen Rai
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Ness
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Akiki P, Dedeken L, Ferster A, Doyen V, Dupire G, Nagant C, Smet J, Ghorra N, Ruth I, Lauwers M, Daubie V, Corazza F, El Kenz H. Pilot study on the use of basophil activation tests and skin tests for the prevention of allergic transfusion reactions. FRONTIERS IN ALLERGY 2024; 4:1328227. [PMID: 38260175 PMCID: PMC10801240 DOI: 10.3389/falgy.2023.1328227] [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: 10/26/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Background and objectives Management of severe allergic transfusion reactions (ATR) is challenging. In this study, we investigate the usefulness of skin tests and basophil activation tests (BAT) in chronically transfused patients for the prevention of future ATR. Materials and methods BAT and skin tests were carried with the supernatant of red blood cell (RBC) units for a sickle-cell disease patient under chronic exchange transfusion who has presented a severe ATR, in order to prevent potential future ATR. If the results for both BAT and skin tests were negative, the RBC units could be transfused to the patient. If either one of the results was positive, the tested RBC unit was discarded for the patient. Results 192 RBC units were tested with both tests. The level of results concordance between the two tests was 95%. Out of the 169 negative units with both tests, 118 units were transfused to the patient for which he presented no ATR. Conclusion In our study, combining both BAT and skin tests was associated with a good negative predictive value since we were able to safely transfuse our patient. Further studies are still necessary to confirm this result but this pilot study indicates that skin tests and BAT might help prevent ATR. When BAT is not available, skin tests may also be useful in preventing ATR.
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Affiliation(s)
- Philippe Akiki
- Blood Bank Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Dedeken
- Department of Pediatric Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Alina Ferster
- Department of Pediatric Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Virginie Doyen
- Department of Immuno-Allergology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gwendy Dupire
- Department of Immuno-Allergology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Carole Nagant
- Laboratory of Immunology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Smet
- Laboratory of Immunology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nathalie Ghorra
- Laboratory of Immunology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Ruth
- Blood Bank Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maïlis Lauwers
- Blood Bank Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Valery Daubie
- Blood Bank Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francis Corazza
- Laboratory of Immunology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Hanane El Kenz
- Blood Bank Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Wang Q, Jermyn S, Quashie D, Gatti SE, Katuri J, Ali J. Magnetically actuated swimming and rolling erythrocyte-based biohybrid micromotors. RSC Adv 2023; 13:30951-30958. [PMID: 37876656 PMCID: PMC10591291 DOI: 10.1039/d3ra05844a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
Erythrocytes are natural multifunctional biomaterials that can be engineered for use as micro robotic vectors for therapeutic applications. Erythrocyte based micromotors offer several advantages over existing bio-hybrid micromotors, but current control mechanisms are often complex, utilizing multiple external signals, such as tandem magnetic and acoustic fields to achieve both actuation and directional control. Further, existing actuation methods rely on proximity to a substrate to achieve effective propulsion through symmetry breaking. Alternatively, control mechanisms only requiring the use of a single control input may aid in the translational use of these devices. Here, we report a simple scalable technique for fabricating erythrocyte-based magnetic biohybrid micromotors and demonstrate the ability to control two modes of motion, surface rolling and bulk swimming, using a single uniform rotating magnetic field. While rolling exploits symmetry breaking from the proximity of a surface, bulk swimming relies on naturally occurring shape asymmetry of erythrocytes. We characterize swimming and rolling kinematics, including step-out frequencies, propulsion velocity, and steerability in aqueous solutions using open-loop control. The observed dynamics may enable the development of future erythrocyte micromotor designs and control strategies for therapeutic applications.
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Affiliation(s)
- Qi Wang
- Department of Chemical and Biomedical Engineering, FAMU-FSU Collee of Engineering Tallahassee Florida 32310 USA
- National High Magnetic Field Laboratory Tallahassee Florida 32310 USA
| | - Sophie Jermyn
- Department of Chemical and Biomedical Engineering, FAMU-FSU Collee of Engineering Tallahassee Florida 32310 USA
- National High Magnetic Field Laboratory Tallahassee Florida 32310 USA
| | - David Quashie
- Department of Chemical and Biomedical Engineering, FAMU-FSU Collee of Engineering Tallahassee Florida 32310 USA
- National High Magnetic Field Laboratory Tallahassee Florida 32310 USA
| | - Sarah Elizabeth Gatti
- National High Magnetic Field Laboratory Tallahassee Florida 32310 USA
- Department of Biomedical Engineering, Vanderbilt University College of Engineering Nashville Tennessee 37235 USA
| | - Jaideep Katuri
- Department of Chemical and Biomedical Engineering, FAMU-FSU Collee of Engineering Tallahassee Florida 32310 USA
- National High Magnetic Field Laboratory Tallahassee Florida 32310 USA
| | - Jamel Ali
- Department of Chemical and Biomedical Engineering, FAMU-FSU Collee of Engineering Tallahassee Florida 32310 USA
- National High Magnetic Field Laboratory Tallahassee Florida 32310 USA
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Sugier HR, Bellebon L, Aider JL, Larghero J, Peltzer J, Martinaud C. Feasibility of an acoustophoresis-based system for a high-throughput cell washing: application to bioproduction. Cytotherapy 2023; 25:891-899. [PMID: 37269272 DOI: 10.1016/j.jcyt.2023.05.003] [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: 10/28/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AIMS These last decades have seen the emergence and development of cell-based therapies, notably those based on mesenchymal stromal cells (MSCs). The advancement of these promising treatments requires increasing the throughput of processed cell for industrialization in order to reduce production costs. Among the various bioproduction challenges, downstream processing, including medium exchange, cell washing, cell harvesting and volume reduction, remains a critical step for which improvements are needed. Typically, these processes are performed by centrifugation. However, this approach limits the automation, especially in small batch productions where it is performed manually in open system. METHODS An acoustophoresis-based system was developed for cell washing. The cells were transferred from one stream to another via the acoustic forces and were collected in a different medium. The optimal flow rates of the different streams were assessed using red blood cells suspended in an albumin solution. Finally, the impact of acoustic washing on adipose tissue-derived MSCs (AD-MSCs) transcriptome was investigated by RNA-sequencing. RESULTS With a single passage through the acoustic device at input flow rate of 45 mL/h, the albumin removal was up to 90% while recovering 99% of RBCs. To further increase the protein removal, a loop washing in two steps was performed and has allowed an albumin removal ≥99% and a red blood cell/AD-MSCs recovery of 99%. After loop washing of AD-MSCs, only two genes, HES4 and MIR-3648-1, were differently expressed compared with the input. CONCLUSIONS In this study, we developed a continuous cell-washing system based on acoustophoresis. The process allows a theoretically high cell throughput while inducing little gene expression changes. These results indicate that cell washing based on acoustophoresis is a relevant and promising solution for numerous applications in cell manufacturing.
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Affiliation(s)
- Hugo R Sugier
- Aenitis Technologies, Paris, France; Institut André Lwoff, INSERM UMR-MD 1197, Villejuif, France.
| | - Ludovic Bellebon
- Laboratoire PMMH, UMR7636 CNRS, ESPCI Paris - PSL, Paris Sciences Lettres, Sorbonne Université, Paris, France
| | - Jean-Luc Aider
- Laboratoire PMMH, UMR7636 CNRS, ESPCI Paris - PSL, Paris Sciences Lettres, Sorbonne Université, Paris, France
| | - Jérôme Larghero
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France; Unité de Thérapie Cellulaire, INSERM U976, Centre d'investigation clinique de Biothérapies CBT501, Paris, France
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Kim Y, Kim B, Kang M, Nam H, Ko DH, Park Y. Associations of Perioperative Red Blood Cell Transfusion With Outcomes of Kidney Transplantation in Korea Over a 16-Year Period. J Korean Med Sci 2023; 38:e212. [PMID: 37463685 DOI: 10.3346/jkms.2023.38.e212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/22/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study investigated the associations between transfusion of different types of red blood cell (RBC) preparations and kidney allograft outcomes after kidney transplantation (KT) over a 16-year period in Korea using a nationwide population-based cohort. METHODS We investigated the reported use of RBCs during hospitalization for KT surgery, rejection, and graft failure status using nationwide data from the National Health Information Database (2002-2017). The associations between the type of perioperative RBC product and transplant outcomes were evaluated among four predefined groups: no RBC transfusion, filtered RBCs, washed RBCs, and packed RBCs (pRBCs). RESULTS A total of 17,754 KT patients was included, among which 8,530 (48.0%) received some type of RBC transfusion. Of the patients who received RBC transfusion, 74.9%, 19.7%, and 5.4% received filtered RBCs, pRBCs, or washed RBCs, respectively. Regardless of the type of RBC products, the proportions of acute rejection and graft failure was significantly greater in patients receiving transfusion (P < 0.001). Cox proportional hazards regression analyses showed that the filtered RBC and pRBC groups were significantly associated with both rejection and graft failure. The washed RBC group also had hazard ratios greater than 1.0 for rejection and graft failure, but the association was not significant. Rejection-free survival of the pRBC group was significantly lower than that of the other groups (P < 0.001, log-rank test), and graft survival for the no RBC transfusion group was significantly greater than in the other groups (P < 0.001, log-rank test). CONCLUSION Perioperative RBC transfusion was associated with poor graft outcomes. Notably, transfusion of pRBCs significantly increased transplant rejection. Therefore, careful consideration of indications for RBC transfusion and selection of the appropriate type of RBCs is necessary, especially for patients at high risk of rejection or graft failure.
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Affiliation(s)
- Yoonjung Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Banseok Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Minjin Kang
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - HyunJun Nam
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yongjung Park
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Chand S, Rudrappan RB, Gupta D. Leukoreduced red cell concentrates: Are they meeting the quality standards? Asian J Transfus Sci 2023; 17:151-156. [PMID: 38274957 PMCID: PMC10807532 DOI: 10.4103/ajts.ajts_126_21] [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: 09/02/2021] [Revised: 10/07/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Leukocytes are responsible for producing both immune and nonimmune adverse reactions, and therefore, various methods have been developed to remove them from the blood components before transfusion. AIM The aim of this study was to analyze the quality parameters in leukoreduced red cell concentrates (RCCs) and investigate the efficiency of leukocyte removal and red cell recovery in the leukoreduction methods followed in our center. MATERIALS AND METHODS The study evaluated the quality parameters in 112 RCCs prepared using buffy-coat reduction by the Terumo automatic component extractor II+ system, manual saline washing, and leukofiltration using the Leucolab filter system. RESULTS With analysis, leukofiltration was found to be the most efficient in reducing leukocyte content in RCCs, achieving a mean leukoreduction of 99.99%. Buffy-coat reduction and saline washing achieved a leukoreduction of 78.54% and 82.67%, respectively. While filtration showed the least red cell recovery of 81.93% compared to 90.57% in buffy-coat reduction and 91.87% in saline washing methods. An analysis of hemoglobin content showed that none of the buffy-coat removed RCCs processed from 350-ml collections and underwent poststorage leukofiltration could meet the European Standards for minimum hemoglobin content. CONCLUSION Filtration is found to be the better method for leukoreduction of RCCs. It is suggested to perform a single method of leukoreduction preferably leukofiltration for maximum red cell recovery.
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Affiliation(s)
- Sreethu Chand
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Raj Bharath Rudrappan
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Debasish Gupta
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Baker SA, Wong LK, Wieland R, Bulterys P, Allard L, Nguyen L, Quach T, Nguyen A, Chaesuh E, Cheng P, Bowen R, Virk M. Validated transport conditions maintain the quality of washed red blood cells. Transfusion 2022; 62:1860-1870. [DOI: 10.1111/trf.17062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Steven Andrew Baker
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
- Transfusion Medicine Section, Department of Pathology University of Utah Salt Lake City Utah USA
| | - Lisa Kanata Wong
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - Rebekah Wieland
- Department of Pathology Stanford University Stanford California USA
| | - Philip Bulterys
- Department of Pathology Stanford University Stanford California USA
| | - Libby Allard
- Department of Pathology Stanford University Stanford California USA
| | - Lang Nguyen
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - Thinh Quach
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - AnhThu Nguyen
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - Eunkyong Chaesuh
- Division of Clinical Chemistry, Department of Pathology Stanford University Stanford California USA
| | - Phil Cheng
- Division of Clinical Chemistry, Department of Pathology Stanford University Stanford California USA
| | - Raffick Bowen
- Division of Clinical Chemistry, Department of Pathology Stanford University Stanford California USA
| | - Mrigender Virk
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
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Hosgood SA, Elliott TR, Jordan NP, Nicholson ML. The Effects of Free Heme on Functional and Molecular Changes During Ex Vivo Normothermic Machine Perfusion of Human Kidneys. Front Immunol 2022; 13:849742. [PMID: 35585981 PMCID: PMC9108696 DOI: 10.3389/fimmu.2022.849742] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Normothermic machine perfusion (NMP) is a technique of kidney preservation designed to restore cellular metabolism after cold ischemia. Kidneys are perfused with an oxygenated banked red blood cell (RBC) based solution for 1h at 36°C. During NMP, RBCs can become damaged, releasing free heme into the perfusate. This can act as a damage-associated molecular pattern (DAMP) activating inflammatory signalling pathways. The aim of this study was to measure the levels of free heme during NMP, assess the effect on kidney function and determine any association with inflammatory and stress related gene expression. Levels of free heme were measured in perfusate samples from a series of donation after circulatory death (DCD) kidneys undergoing NMP as part of a randomised controlled trial (RCT). The age of RBCs and levels of free heme were correlated with perfusion parameters. Changes in gene expression were analysed in a series of kidneys declined for transplantation using the NanoString nCounter Organ Transplant Panel and qRT-PCR. Older units of RBCs were associated with higher levels of free heme and levels increased significantly during NMP (Pre 8.56 ± 7.19µM vs 26.29 ± 15.18µM, P<0.0001). There was no association with levels of free heme and perfusion parameters during NMP (P > 0.05). Transcriptional and qPCR analysis demonstrated the upregulation of differentially expressed genes associated with apoptosis (FOS and JUN), inflammatory cytokines (IL-6, SOCS3, ATF3), chemokines (CXCL8, CXCL2, CC3/L1) and oxidative stress (KLF4) after NMP. However, these did not correlate with levels of free heme (P >0.05). A significant amount of free heme can be detected in the perfusate before and after NMP particularly when older units of red cells are used. Although transcriptional analysis demonstrated significant upregulation of genes involved with apoptotic, inflammatory and oxidative pathways these were not associated with high levels of free heme.
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Wolf J, Geneen LJ, Meli A, Doree C, Cardigan R, New HV. Hyperkalaemia Following Blood Transfusion–a Systematic Review Assessing Evidence and Risks. Transfus Med Rev 2022; 36:133-142. [DOI: 10.1016/j.tmrv.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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12
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Crawford TM, Andersen CC, Hodyl NA, Robertson SA, Stark MJ. Effect of washed versus unwashed red blood cells on transfusion-related immune responses in preterm newborns. Clin Transl Immunology 2022; 11:e1377. [PMID: 35284073 PMCID: PMC8907378 DOI: 10.1002/cti2.1377] [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: 09/23/2021] [Revised: 01/04/2022] [Accepted: 02/04/2022] [Indexed: 12/22/2022] Open
Abstract
Objectives Transfusion with washed packed red blood cells (PRBCs) may be associated with reduced transfusion‐related pro‐inflammatory cytokine production. This may be because of alterations in recipient immune responses. Methods This randomised trial evaluated the effect of transfusion with washed compared with unwashed PRBCs on pro‐inflammatory cytokines and endothelial activation in 154 preterm newborns born before 29 weeks’ gestation. Changes in plasma cytokines and measures of endothelial activation in recipient blood were analysed after each of the first three transfusions. Results By the third transfusion, infants receiving unwashed blood had an increase in IL‐17A (P = 0.04) and TNF (P = 0.007), whereas infants receiving washed blood had reductions in IL‐17A (P = 0.013), TNF (P = 0.048), IL‐6 (P = 0.001), IL‐8 (P = 0.037), IL‐12 (P = 0.001) and IFN‐γ (P = 0.001). The magnitude of the post‐transfusion increase in cytokines did not change between the first and third transfusions in the unwashed group but decreased in the washed group for IL‐12 (P = 0.001), IL‐17A (P = 0.01) and TNF (P = 0.03), with the difference between the groups reaching significance by the third transfusion (P < 0.001 for each cytokine). Conclusion The pro‐inflammatory immune response to transfusion in preterm infants can be modified when PRBCs are washed prior to transfusion. Further studies are required to determine whether the use of washed PRBCs for neonatal transfusion translates into reduced morbidity and mortality.
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Affiliation(s)
- Tara M Crawford
- The Women's and Children's Hospital Adelaide SA Australia.,The Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - Chad C Andersen
- The Women's and Children's Hospital Adelaide SA Australia.,The Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - Nicolette A Hodyl
- The Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - Sarah A Robertson
- The Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - Michael J Stark
- The Women's and Children's Hospital Adelaide SA Australia.,The Robinson Research Institute The University of Adelaide Adelaide SA Australia
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13
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Lu S, Allyn M, Weigand M, Chalmers JJ, Palmer AF. Tangential flow filtration facilitated washing of human red blood cells: A proof-of-concept study. Vox Sang 2022; 117:803-811. [PMID: 35262216 DOI: 10.1111/vox.13259] [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: 08/13/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Red blood cell (RBC) units in hypothermic storage degrade over time, commonly known as the RBC storage lesion. These older RBC units can cause adverse clinical effects when transfused, as older RBCs in the unit lyse and release cell-free haemoglobin (Hb), a potent vasodilator that can elicit vasoconstriction, systemic hypertension and oxidative tissue injury after transfusion. In this study, we examined a novel method of washing ex vivo stored single RBC units to remove accumulated cellular waste, specifically cell-free Hb, using tangential flow filtration (TFF) driven by a centrifugal pump. MATERIALS AND METHODS The TFF RBC washing system was run under hypothermic conditions at 4°C, at a constant system volume with 0.9 wt% saline as the wash solution. The RBC washing process was conducted on 10 separate RBC units. For this proof-of-concept study, RBC units were expired at the time of washing (60-70 days old). Cell-free Hb was quantified by UV-visible absorbance spectroscopy and analysed via the Winterbourn equations. Pre- and post-wash RBC samples were analysed by Hemox Analyser, Coulter counter and Brookfield rheometer. The RBC volume fraction in solution was measured throughout the wash process by standard haematocrit (HCT) analysis. RESULTS No substantial decrease in the HCT was observed during the TFF RBC washing process. However, there was a significant decrease in RBC concentration in the first half of the TFF RBC wash process, with no significant change in RBC concentration during the second half of the TFF cell wash process with an 87% overall cell recovery compared with the total number of cells before initiation of cell washing. Utilization of the extinction coefficients and characteristic peaks of each Hb species potentially present in solution was quantified by Winterbourn analysis on retentate and permeate samples for each diacycle to quantify Hb concentration during the washing process. Significant cell-free Hb reduction was observed within the first four diacycles with a starting cell-free Hb concentration in the RBC unit of 0.105 mM, which plateaus to a constant Hb concentration of 0.01 mM or a total extracellular Hb mass of 0.2 g in the resultant washed unit. The oxygen equilibrium curve showed a significant decrease in P50 between the initial and final RBC sample cell wash with an initial P50 of 15.6 ± 1.8 mm Hg and a final P50 of 14 ± 1.62 mm Hg. Cooperativity increased after washing from an initial Hill coefficient of 2.37 ± 0.19 compared with a final value of 2.52 ± 0.12. CONCLUSION Overall, this study investigated the proof-of-concept use of TFF for washing single RBC units with an emphasis on the removal of cell-free Hb from the unit. Compared with traditional cell washing procedures, the designed system was able to more efficiently remove extracellular Hb but resulted in longer wash times. For a more complete investigation of the TFF RBC washing process, further work should be done to investigate the effects of RBC unit storage after washing. The designed system is lightweight and transportable with the ability to maintain sterility between uses, providing a potential option for bedside ex vivo transfusion in clinical applications.
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Affiliation(s)
- Shuwei Lu
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Megan Allyn
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Mitchell Weigand
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Jeffrey J Chalmers
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Andre F Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio, USA
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14
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Meli A, McAndrew M, Frary A, Rehnstrom K, Stevens-Hernandez CJ, Flatt JF, Griffiths A, Stefanucci L, Astle W, Anand R, New HV, Bruce LJ, Cardigan R. Familial pseudohyperkalemia induces significantly higher levels of extracellular potassium in early storage of red cell concentrates without affecting other standard measures of quality: A case control and allele frequency study. Transfusion 2021; 61:2439-2449. [PMID: 33960432 DOI: 10.1111/trf.16440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Familial pseudohyperkalemia (FP) is characterized by an increased rate of potassium leakage in refrigerated red cells and is associated with the minor allele of the single nucleotide polymorphism rs148211042 (R723Q) in the ABCB6 gene. The study aims were to obtain the minor allele frequencies of ABCB6 variants and to measure supernatant potassium accumulation, and other red cell storage parameters, in red cell concentrates (RCC) from carriers of variant rs148211042 under standard blood bank conditions. STUDY DESIGN Whole blood units were collected from 6 FP individuals and 11 controls and processed into RCC in additive solution. RCC were sampled and tested over cold storage for full blood count, extracellular potassium, glucose, lactate, microvesicle release, deformability, hemolysis, pH, adenosine triphosphate, and 2,3-diphosphoglycerate. RESULTS Screening of genotyped cohorts identified that variant rs148211042 is present in 1 in 394 British citizens of European ancestry. FP RCC had significantly higher supernatant potassium at all time points from day 3 onwards (p < .001) and higher mean cell volume (p = .032) than controls. The initial rate of potassium release was higher in FP RCC; supernatant potassium reached 46.0 (23.8-57.6) mmol/L (mean [range]) by day 5, increasing to 68.9 (58.8-73.7) mmol/L by day 35. Other quality parameters were not significantly different between FP RCC and controls. CONCLUSION These data suggest that if a blood donor has FP, reducing the RCC shelf-life to 5 days may be insufficient to reduce the risk of hyperkalemia in clinical scenarios such as neonatal large volume transfusion.
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Affiliation(s)
- Athinoula Meli
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Margaret McAndrew
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Amy Frary
- Department of Haematology, University of Cambridge, Cambridge, UK.,National Institute for Health Research BioResource-Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karola Rehnstrom
- Department of Haematology, University of Cambridge, Cambridge, UK.,National Institute for Health Research BioResource-Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christian J Stevens-Hernandez
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Bristol, UK.,School of Biochemistry, University of Bristol, Bristol, UK
| | - Joanna F Flatt
- Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Bristol, UK
| | | | - Luca Stefanucci
- Department of Haematology, University of Cambridge, Cambridge, UK.,British Heart Foundation Centre of Excellence, Cambridge, UK
| | - William Astle
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK.,MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rekha Anand
- Clinical Directorate, NHS Blood and Transplant, Birmingham, UK
| | - Helen V New
- Clinical Directorate, NHS Blood and Transplant, London, UK.,Centre for Haematology, Imperial College London, London, UK
| | - Lesley J Bruce
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Bristol, UK
| | - Rebecca Cardigan
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
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15
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Reece JT, Sesok-Pizzini D. Inventory Management and Product Selection in Pediatric Blood Banking. Clin Lab Med 2020; 41:69-81. [PMID: 33494886 DOI: 10.1016/j.cll.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood banks need to understand patterns of use and ordering practices to provide the blood donor centers with the best information with which to develop daily scheduled deliveries of blood products. Blood use is a large component of this process through maximizing physician education about appropriate ordering practices and use of appropriate tools. Simple measures can help provide guidance on the number of available components and the need to order more from the blood donor center. Special product requests in pediatrics, such as fresh blood, leukoreduction, irradiation, and antigen-negative units can also drive inventory practices and use patterns.
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Affiliation(s)
- Jenna T Reece
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Deborah Sesok-Pizzini
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, 5136 Main Hospital, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
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