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Madkaiker D, Iyer K, Jagriti, Chenna D, Mohan G, Shastry S. S.O.S. - Save our supplies: Understanding reasons to tackle the challenge of wasted returned blood products. Transfus Clin Biol 2024; 31:76-80. [PMID: 38211935 DOI: 10.1016/j.tracli.2024.01.003] [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: 10/19/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate the return of blood components across different hospital areas, reasons for the same and suggest preventive strategies which might reduce out of controlled temperature storage (CTS) blood logistics and wastage. MATERIAL AND METHODS A retrospective audit was carried out in the department of Transfusion Medicine from January 2019 to December 2022. Data related to returned blood components was compiled using departmental records and blood centre software entries. RESULTS A total of 218 instances of returned components were noted and the total number of components returned were 442 (0.4% of all issued components) (38.4% (170) packed red blood cells, 16.2% (72) single donor cryoprecipitate concentrate, 19.6% (87) platelet concentrate and 25.5% (113) fresh frozen plasma). Components were returned back within 30 mins in only 27% (59/218) of all instances . Wards followed by high dependency units/intensive care units were noted to have the highest number of instances (86 (39.4%) and 69 (31.6%) respectively) with emergency department having the least,comprising 19 instances (8.7%). 77.9% (170/218) instances were observed for routine transfusion requests and 44.5% (97/218) of all instances could have been prevented by an appropriate clinical status assessment of the patient. CONCLUSION Stakeholders such as clinicians, transfusion laboratory professional and nursing staff must take consolidated efforts to eliminate wastage of blood components. Instances of returned blood components can be targeted by the hospital quality team as a quality improvement project.
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Affiliation(s)
- Deep Madkaiker
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kartik Iyer
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jagriti
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepika Chenna
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Mohan
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Cheng JY, Samudram H, Lee Lai Ling C, Nadarajan VS. Deviations in red cell blood component temperature during laboratory processing and at blood return monitored by a time-temperature indicator device. Transfus Med 2022; 32:484-491. [PMID: 36239101 DOI: 10.1111/tme.12924] [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: 07/07/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the performance and utility of a time-temperature indicator (TTI) to determine the cumulative exposure time (CET) of red cell components (RCC) to temperatures above 10°C occurring within and outside the transfusion laboratory. BACKGROUND AND OBJECTIVES Blood centres often use the '30 or 60-min rule' for accepting RCC exposed to room temperature (RT) back into inventory. Effective monitoring of these temperature deviations is however lacking. MATERIALS AND METHODS A Timestrip PLUS® TP153 10°C (TS + 10) TTI was attached to RCC units after preparation of the unit in the blood bank or on issue to the ward, to track the CET > 10°C during laboratory processing and outside the transfusion laboratory. RESULTS The mean CET of 153 RCC tracked within the laboratory was 56 min. Sixty-four (41.8%) and 34 (22.2%) of RCC had core temperature (CT) >10°C for more than 30 and 60 min, respectively. Among the 69 RCC that were returned unused, 27 (39.1%), 17 (24.6%) and 5 (7.2%) RCC units had CT >10°C for more than 30, 60 and 120 min respectively. CONCLUSION A large proportion of RCC have CT >10°C exceeding 30 min during handling within the transfusion laboratory, as well as when RCC are returned unused from transfusion locations. Corrective measures should be implemented to better manage the cold chain to avoid undesirable consequences to blood transfusion. A temperature sensitive device that can also indicate CET can be employed to objectively monitor the period that RCC remained at a CT that exceeds 10°C.
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Affiliation(s)
- Jian Yuan Cheng
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Hemalatha Samudram
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Christina Lee Lai Ling
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Veera Sekaran Nadarajan
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia.,Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
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Park M, Hur M, Kim H, Oh K, Kim H, Song YH, Ko DH, Chung Y. Questionnaire Survey on Current Red Blood Cell Transport and Storage in Korea for Reducing Wastage. Ann Lab Med 2022; 42:342-351. [PMID: 34907104 PMCID: PMC8677485 DOI: 10.3343/alm.2022.42.3.342] [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: 08/10/2021] [Revised: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background To ensure safe red blood cell (RBC) transfusion practice, it is important to comply with storage and transport requirements of RBC units. We conducted a comprehensive survey on the practice of RBC transport and storage to explore the awareness of and compliance with the 30-minute rule, the current status of RBC unit transport, and possible utility of temperature indicators (TIs) to reduce RBC wastage. Methods From June to August of 2019, 64 blood bank physicians (14 questions) in 64 secondary- and tertiary-care hospitals and 673 nurses (13 questions) in 42 tertiary-care hospitals replied to a questionnaire survey. The results of the survey were analyzed with descriptive statistics. Results Among the physicians surveyed, 97.0% (N=62) of hospitals had transfusion guidelines in place. The RBC wastage in 2018 ranged from less than five units to more than 200 units. Among the nurses surveyed, 99.4% (N=669) were aware of and complied with the 30-minute rule; 13.5% (N=91) of the nurses had experience of RBC wastage due to violation of the 30-minute rule. Both physicians (67%, N=43) and nurses (83.1%, N=559) responded that TIs would help reduce RBC wastage. Conclusions This is the first survey on the practices related to RBC transport and storage in Korea. This study provides fundamental data on current practice for the blood cold chain, insights into RBC wastage, and highlights the utility of TIs.
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Affiliation(s)
- Mikyoung Park
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hahah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Nursing, Kyungbok University, Namyangju, Korea
| | - Hyunmi Kim
- Department of Nursing, Konkuk University Medical Center, Seoul, Korea
| | - Young Hye Song
- Department of Nursing, Konkuk University Medical Center, Seoul, Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Yousun Chung
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
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Park M, Hur M, Kim H, Oh K, Ko DH, Chung Y. Time-temperature indicators versus temperature indicators for transfusion practice: Application in the real hospital setting. Vox Sang 2021; 117:354-360. [PMID: 34319591 DOI: 10.1111/vox.13182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Temperature indicators (TIs) are used to monitor the surface temperature of red blood cell (RBC) units. We compared the utility of a newly developed time-temperature indicator (TTI) prototype, Freshzone TTI (FZTTI) (Freshzone, Seoul, South Korea) and two US Food and Drug Administration-approved TIs, Safe-T-Vue 10 (STV10; Temptime Corporation, Morris Plains, NJ) and Blood Temp 10 (BT10; Timestrip UK Ltd, Cambridge, UK). MATERIALS AND METHODS FZTTI, STV10 and BT10 were attached to 91 RBC units after issue (including eight units that were stored in refrigerators in the ward before transfusion). The time for colour change (CC) was monitored based on the 30-min rule. The CC of FZTTI indicated the total time elapsed since the temperature of RBC units exceeded 10°C, and the CC of STV10 and BT10 indicated that the temperature of RBC units exceeded 10°C. RESULTS In 83 units, the median time for CC differed significantly between FZTTI and the TIs (51.4 min in FZTTI vs. 13.9 min in STV10 and 10.5 min in BT10, both at p < 0.001). In addition, 95.2% (n = 79) of FZTTI tags changed colour after 30 min of issue, whereas 96.4% (n = 80) of STV10 and 98.8% (n = 82) of BT10 changed colour within 30 min of issue. In the eight units stored in refrigerators, the time for CC between the TTI and TIs was significantly different. CONCLUSION FZTTI outperformed the TIs, indicating that it is a feasible option for use in transfusion practice.
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Affiliation(s)
- Mikyoung Park
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Nursing, Kyungbok University, Namyangju, South Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Yousun Chung
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
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Castrillo A, Arroyo JL, Romón Í, Rivera J. Compliance with temperature and time requirements during in-hospital distribution of blood components: A national survey among transfusion services. Transfus Apher Sci 2020; 59:102908. [PMID: 32921561 DOI: 10.1016/j.transci.2020.102908] [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: 05/12/2020] [Revised: 07/13/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Temperature and time conditions during storage and distribution of blood components (BC) and their permissible deviations are strictly regulated. The degree of compliance with these requirements in daily practice of transfusion services (TS) is not well known. MATERIALS AND METHODS We conducted a survey among Spanish hospital TS covering different aspects of BC management in their daily activity. RESULTS Eighty-three TS managing 56 % of total transfusions answered the survey. Monitoring of red blood concentrates (RBC) temperature during in-hospital distribution was routinely performed by only 12 % of the TS. The main criterion for BC re-entry into the stock was the total time spent outside controlled temperature. Up to 41 % of the TS apply the "30-minute rule" to distributed RBC, while most services use a 60-minute rule for PC. No adverse events were detected when RBC that had remained longer than 30 or 60 min outside the TS were transfused. Fresh frozen plasma is usually thawed 2 h preissue and stored at 4 °C up to 24 h. DISCUSSION AND CONCLUSIONS In the Spanish context, the 30- and 60-minute rules for re-entry of RBC and PC into the TS stock are loosely followed. Feedback for a large number of TS suggests that the extension of the 30-minute RBC rule to at least 60 min is feasible, if other safety requirements are met. Flexibility with some requirements could help reduce product loss without deleterious effect on BC safety.
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Affiliation(s)
- Azucena Castrillo
- Axencia Galega de Sangue, Órganos e Tecidos. Rúa Xoaquín Díaz de Rábago 2-6, 15705, Santiago de Compostela, A Coruña, Spain; Grupo de Trabajo de Procesamiento y Producción de Componentes Sanguíneos de la Sociedad Española de Transfusión Sanguínea y Terapia Celular (SETS).
| | - José L Arroyo
- Banco de Sangre y Tejidos de Cantabria. Hospital Santa Cruz de Liencres. Barrio las Mazas, 39120, Liencres, Cantabria, Spain; Grupo de Trabajo de Procesamiento y Producción de Componentes Sanguíneos de la Sociedad Española de Transfusión Sanguínea y Terapia Celular (SETS)
| | - Íñigo Romón
- Servicio de Trasfusión. Hospital Universitario Marqués de Valdecilla - IDIVAL. Avenida Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - José Rivera
- Servicio de Hematología y Oncología Médica. Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB, Arrixaca, CIBERER-U765. Paseo de Garay, 2, 30003, Murcia, Spain; Grupo de Trabajo de Procesamiento y Producción de Componentes Sanguíneos de la Sociedad Española de Transfusión Sanguínea y Terapia Celular (SETS)
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Park M, Hur M, Yi A, Kim H, Lee HK, Jeon EY, Oh K, Lee MH. Utility of temperature‐sensitive indicators for temperature monitoring of red‐blood‐cell units. Vox Sang 2019; 114:487-494. [DOI: 10.1111/vox.12784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/19/2019] [Accepted: 04/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Mikyoung Park
- Department of Laboratory Medicine Konkuk University School of Medicine Seoul Korea
| | - Mina Hur
- Department of Laboratory Medicine Konkuk University School of Medicine Seoul Korea
| | - Ahram Yi
- Department of Laboratory Medicine Green Cross Laboratories Yongin Gyeonggi Korea
| | - Hanah Kim
- Department of Laboratory Medicine Konkuk University School of Medicine Seoul Korea
| | - Hyun Kyung Lee
- Department of Laboratory Medicine Konkuk University School of Medicine Seoul Korea
| | - Eun Young Jeon
- Department of Nursing Konkuk University Medical Center Seoul Korea
| | - Kyung‐Mi Oh
- Department of Nursing Konkuk University Medical Center Seoul Korea
| | - Mark Hong Lee
- Department of Internal Medicine Konkuk University School of Medicine Seoul Korea
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Ramirez‐Arcos S, Kou Y, Cayer M, De Grandmont M, Girard M, Cloutier M. The impact of red blood cell manufacturing variables on bacterial growth dynamics: a pilot study. Vox Sang 2019; 114:478-486. [DOI: 10.1111/vox.12782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/26/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Sandra Ramirez‐Arcos
- Canadian Blood Services Centre for Innovation Ottawa ON Canada
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa ON Canada
| | - Yuntong Kou
- Canadian Blood Services Centre for Innovation Ottawa ON Canada
| | - Marie‐Pierre Cayer
- Héma‐Québec Applied Research Medical Affairs and Innovation Québec QC Canada
| | | | - Mélissa Girard
- Héma‐Québec Applied Research Medical Affairs and Innovation Québec QC Canada
| | - Marc Cloutier
- Héma‐Québec Applied Research Medical Affairs and Innovation Québec QC Canada
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Aplin K, Pitt T, Allen J, Roy A, Tidey K, Ball J, McDonald CP. Extending the 30‐minute rule for red cell units – investigation of the bacterial risk of 60‐minute exposures to ambient temperature. Vox Sang 2019; 114:189-197. [DOI: 10.1111/vox.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/22/2018] [Accepted: 12/13/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Kate Aplin
- National Bacteriology Laboratory NHS Blood and Transplant London UK
| | - Tyrone Pitt
- National Bacteriology Laboratory NHS Blood and Transplant London UK
| | - Jennifer Allen
- National Bacteriology Laboratory NHS Blood and Transplant London UK
| | - Anjana Roy
- National Bacteriology Laboratory NHS Blood and Transplant London UK
| | - Katrina Tidey
- National Bacteriology Laboratory NHS Blood and Transplant London UK
| | - Joanne Ball
- National Bacteriology Laboratory NHS Blood and Transplant London UK
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Spindler-Raffel E, Benjamin RJ, McDonald CP, Ramirez-Arcos S, Aplin K, Bekeredjian-Ding I, de Korte D, Gabriel C, Gathof B, Hanschmann KM, Hourfar K, Ingram C, Jacobs MR, Keil SD, Kou Y, Lambrecht B, Marcelis J, Mukhtar Z, Nagumo H, Niekerk T, Rojo J, Marschner S, Satake M, Seltsam A, Seifried E, Sharafat S, Störmer M, Süßner S, Wagner SJ, Yomtovian R. Enlargement of the WHO international repository for platelet transfusion-relevant bacteria reference strains. Vox Sang 2017; 112:713-722. [PMID: 28960367 DOI: 10.1111/vox.12548] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Interventions to prevent and detect bacterial contamination of platelet concentrates (PCs) have reduced, but not eliminated the sepsis risk. Standardized bacterial strains are needed to validate detection and pathogen reduction technologies in PCs. Following the establishment of the First International Reference Repository of Platelet Transfusion-Relevant Bacterial Reference Strains (the 'repository'), the World Health Organization (WHO) Expert Committee on Biological Standardisation (ECBS) endorsed further repository expansion. MATERIALS AND METHODS Sixteen bacterial strains, including the four repository strains, were distributed from the Paul-Ehrlich-Institut (PEI) to 14 laboratories in 10 countries for enumeration, identification and growth measurement on days 2, 4 and 7 after low spiking levels [10-25 colony-forming units (CFU)/PC bag]. Spore-forming (Bacillus cereusPEI-B-P-07-S, Bacillus thuringiensisPEI-B-P-57-S), Gram-negative (Enterobacter cloacaePEI-B-P-43, Morganella morganiiPEI-B-P-74, PEI-B-P-91, Proteus mirabilisPEI-B-P-55, Pseudomonas fluorescensPEI-B-P-77, Salmonella choleraesuisPEI-B-P-78, Serratia marcescensPEI-B-P-56) and Gram-positive (Staphylococcus aureusPEI-B-P-63, Streptococcus dysgalactiaePEI-B-P-71, Streptococcus bovisPEI-B-P-61) strains were evaluated. RESULTS Bacterial viability was conserved after transport to the participating laboratories with one exception (M. morganiiPEI-B-P-74). All other strains showed moderate-to-excellent growth. Bacillus cereus, B. thuringiensis, E. coli, K. pneumoniae, P. fluorescens, S. marcescens, S. aureus and S. dysgalactiae grew to >106 CFU/ml by day 2. Enterobacter cloacae, P. mirabilis, S. epidermidis, S. bovis and S. pyogenes achieved >106 CFU/ml at day 4. Growth of S. choleraesuis was lower and highly variable. CONCLUSION The WHO ECBS approved all bacterial strains (except M. morganiiPEI-B-P-74 and S. choleraesuisPEI-B-P-78) for repository enlargement. The strains were stable, suitable for spiking with low CFU numbers, and proliferation was independent of the PC donor.
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Affiliation(s)
| | | | - C P McDonald
- National Health Service Blood and Transplant, London, UK
| | | | - K Aplin
- National Health Service Blood and Transplant, London, UK
| | | | - D de Korte
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - C Gabriel
- Blood Centre Linz, Austrian Red Cross, Linz, Austria
| | - B Gathof
- Institute of Transfusion Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - K Hourfar
- German Red Cross, Frankfurt/Main, Germany
| | - C Ingram
- Constantia Kloof, South African National Blood Service, Johannesburg, South Africa
| | - M R Jacobs
- Case Western Reserve University, Cleveland, OH, USA
| | - S D Keil
- Terumo BCT Biotechnologies, Lakewood, CO, USA
| | - Y Kou
- Canadian Blood Service, Ottawa, ON, Canada
| | - B Lambrecht
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - J Marcelis
- Elisabeth Hospital, Tilburg, The Netherlands
| | - Z Mukhtar
- Dow Safe Blood Transfusion Services, DUHS, Khi, Pakistan
| | - H Nagumo
- Japanese Red Cross, Tokyo, Japan
| | - T Niekerk
- Constantia Kloof, South African National Blood Service, Johannesburg, South Africa
| | - J Rojo
- Centro Nacional de la Transfusión Sanguínea, Mexico, Mexico
| | - S Marschner
- Terumo BCT Biotechnologies, Lakewood, CO, USA
| | - M Satake
- Japanese Red Cross, Tokyo, Japan
| | - A Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - E Seifried
- German Red Cross, Frankfurt/Main, Germany
| | - S Sharafat
- Dow University of Health Sciences, Khi, Pakistan
| | - M Störmer
- Institute of Transfusion Medicine, University Hospital of Cologne, Cologne, Germany
| | - S Süßner
- Blood Centre Linz, Austrian Red Cross, Linz, Austria
| | - S J Wagner
- Holland Laboratory, Transfusion Innovation Department, American Red Cross, Rockville, MD, USA
| | - R Yomtovian
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
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