Adverse Effects Of Transfusion Research Articles

The Impact of Pre-Heart Transplantation Blood Transfusion Varies Based on Recipient MELD-XI Score.

Prior studies reveal adverse effects of transfusion on cardiac surgery, but little is known of transfusion impact on heart transplantation. First-time, single-organ adult heart transplant recipients between January 1, 2010, and December 31, 2020, were included, stratified above or below a model for end-stage liver disease excluding international normalized ratio (MELD-XI) score of 9.4, and propensity score matched to their nearest neighbor. A 90 day landmark analysis within each cohort was also performed. Unadjusted analysis showed transfusion recipients, MELD-XI ≥9.4, were more likely to experience post-heart transplantation mortality (Hazard Ratio (HR), 1.352 [95% Confidence Interval (CI), 1.239-1.477], p < 0.001), persisting after adjustment for potential confounders (adjusted HR, 1.211 [95% CI, 1.100-1.335], p < 0.001) and after propensity-score matching (HR, 1.174 [95% CI, 1.045-1.319], p = 0.007). Post-transplant length of stay was longer (25.9 vs. 23.2 days, p < 0.001). Post-transplant dialysis was more common (18.7 vs. 15.9%, p = 0.009). There was no survival difference on 90 day landmarked analysis (p = 0.108). With MELD-XI <9.4, there was slight survival detriment among transfusion recipients on univariable analysis (HR, 1.111 [95% CI, 1.001-1.234], p = 0.049) but not on multivariable analysis (adjusted HR, 1.061 [95% CI, 0.952-1.181], p = 0.285). There was similar survival after propensity-score matching (HR, 1.032 [95% CI, 0.903-1.180], p = 0.642) and on landmark analysis (p = 0.581). Ultimately, transfusion was associated with worse post-heart transplantation outcomes among recipients with a MELD-XI ≥9.4.

5613475 ADVERSE REACTIONS TO RBC TRANSFUSION: A SINGLE THALASSEMIA AND SICKLE CELL DISEASE DEPARTMENT’S EXPERIENCE

Background: Thalassemia and Sickle Cell Disease patients require regular blood transfusions and iron chelation treatment for the entirety of their lives. Several patients had transfusion-related side effects as a result of frequent and chronic transfusions. Methods: In this study, we analysed the frequency of transfusion reactions and the methods used to address them by reviewing the medical records of 95 patients who received multiple transfusions on a regular basis during a 20-year period. All demographics and charactiristics are in TABLE 1. Table 1: - The Demographics and Characteristics Compared TYPE OF HEMOGLOBINOPATHY β-Thalassemia (51.3%) α-Thalassemia (2.6%) Sickle Cell Disease (12.8%) β-thal/SCD (15.4%) AGE AT THE ONSET OF TRANSFUSIONS < 2 years old (45.7%) > 20 years old (11.4%) > 30 years old (34.3%) occasionally (8.6%) TRANSFUSION FREQUENCY weekly (2.7%) every 15-20 days (54.1%) monthly (34.3%) exchange transfusions (2.7%) Results: Over a 20-year period, 42 percent (42,1%) of the 95 patients who received repeated transfusions reported at least one adverse event during the transfusion (about two per year reported). Our unit’s usual clinical practice is to transfuse patients with Leukoreduced RBC to prevent HLA alloimmunization, CMV transmission, and fever nonhemolytic transfusion reactions.Fever (48.1%), chills (18.5%), anaphylaxis/urticaria (11.2%), swelling (3.7%), hemolysis (11.2%), yersinia enterocolitica (3.7%), and alloimmunization (3.7%) were the most common side effects reported by patients experiencing a transfusion reaction (image 1).In each case, the transfusion was discontinued and the reaction was treated according to local clinical practice. Antibiotic therapy was used to manage infectious complications. Extended blood type matching (ABO, CcDEe, Kell, Duffy, Kidd, MNS,Lewis, Lutheran, etc) has been used in clinical practice as a prophylactic intervention in the case of hemolysis or alloimmunization. Before receiving washed red blood cells in future transfusions, some patients with fever or allergic responses were administered premedication with antihistamines or antipyretics. Nine patients (22.5%) of patients those who had experienced a previously adverse reaction reported a second episode with the following symptoms: allergic reaction/urticaria (44.5%), fever (33.5%), and alloimmunization (22.5%). Patients who developed alloimmunization during the second adverse transfusion event had no history of alloimmunization previously. Conclusions: In the studied population, there was no high prevalence of serious or fatal transfusion adverse effects. Every transfusion requires constant vigilance for the occurrence of transfusion reactions, especially in patients who have received multiple transfusions.

Fresh autologous blood transfusion reverses erythrocytes damage by reducing oxidative stress via promoting mitochondrial metabolism and M2 macrophages polarization

IntroductionSystemic inflammatory and immune suppressive incidents constitute a significant hallmark of red blood cell transfusion's adverse effects. These adverse side effects are seemingly associated with old blood transfusion; therefore, we aim to investigate the underlying mechanism of fresh autologous blood transfusion (fABT) and its subsequent effect in diabetic mice.Material and methodsIn the present study, we utilized 60 Swiss male mice aged 6-8 weeks, categorized into normal, diabetic, and freshly transfused with autologous blood. After treating the mice accordingly, further experimentations took place as we assessed the M1/M2 macrophage polarization concerning CD16/CD32/CD206 cells by flow cytometry, determined the mitochondrial metabolism using Lowry's analysis, measured hepatic oxidative stress using MDA and SOD assays, and examined the erythrocytic oxygen-carrying capacity (Q value) and oxygen consumption rate (OCR) and osmotic fragility.ResultsResults showed that fresh autologous blood transfusion markedly reduced M2 macrophage polarization, enhanced hepatic mitochondrial metabolism, reduced hepatic oxidative stress, and promoted red blood cells' oxygen-carrying capacity while reducing its osmotic fragility and oxygen consumption. Moreover, we found that fABT promoted the IGF2/PI3K signaling pathway, These results indicate the vital necessity of providing fresh autologous blood transfusion during therapy or surgeries.ConclusionsIn conclusion, our results are the first to highlight the underlying mechanism in which how fABT modulates physiological patterns in diabetic animals model, proposing a sound basis for utilizing fABT in clinical applications.

Haemoglobin value and red blood cell transfusions in prolonged weaning from mechanical ventilation: a retrospective observational study

IntroductionThe role of haemoglobin (Hb) value and red blood cell (RBC) transfusions in prolonged weaning from mechanical ventilation (MV) is still controversial. Pathophysiological considerations recommend a not too restrictive transfusion...

Red cell transfusion and alloimmunization in sickle cell disease.

Red cell transfusion remains a critical component of care for acute and chronic complications of sickle cell disease. Randomized clinical trials demonstrated the benefits of transfusion therapy for prevention of primary and secondary strokes and postoperative acute chest syndrome. Transfusion for splenic sequestration, acute chest syndrome, and acute stroke are guided by expert consensus recommendations. Despite overall improvements in blood inventory safety, adverse effects of transfusion are prevalent among patients with sickle cell disease and include alloimmunization, acute and delayed hemolytic transfusion reactions, and iron overload. Judicious use of red cell transfusions, optimization of red cell antigen matching, and the use of erythrocytapheresis and iron chelation can minimize adverse effects. Early recognition and management of hemolytic transfusion reactions can avert poor clinical outcomes. In this review, we discuss transfusion methods, indications, and complications in sickle cell disease with an emphasis on alloimmunization.

Processing methods and storage duration impact extracellular vesicle counts in red blood cell units

AbstractExtracellular vesicles (EVs) are active components of red blood cell (RBC) concentrates and may be associated with beneficial and adverse effects of transfusion. Elucidating controllable factors associated with EV release in RBC products is thus important to better manage the quality and properties of RBC units. Erythrocyte-derived EVs (EEVs) and platelet-derived EVs (PEVs) were counted in 1226 RBC units (administered to 280 patients) using a standardized cytometry-based method. EV size and CD47 and annexin V expression were also measured. The effects of donor characteristics, processing methods, and storage duration on EV counts were analyzed by using standard comparison tests, and analysis of covariance was used to determine factors independently associated with EV counts. PEV as well as EEV counts were higher in whole-blood–filtered RBC units compared with RBC-filtered units; PEV counts were associated with filter type (higher with filters associated with higher residual platelets), and CD47 expression was higher on EEVs in RBC units stored longer. Multivariate analysis showed that EEV counts were strongly associated with filter type (P < .0001), preparation, and storage time (+25.4 EEV/µL per day [P = .01] and +42.4 EEV/µL per day [P < .0001], respectively). The only independent factor associated with PEV counts was the residual platelet count in the unit (+67.1 PEV/µL; P < .0001). Overall, processing methods have an impact on EV counts and characteristics, leading to large variations in EV quantities transfused into patients. RBC unit processing methods might be standardized to control the EV content of RBC units if any impacts on patient outcomes can be confirmed. The IMIB (Impact of Microparticles in Blood) study is ancillary to the French ABLE (Age of Transfused Blood in Critically Ill Adults) trial (ISRCTN44878718).

Soluble mediators in packed red blood cells augment lipopolysaccharide-induced monocyte interleukin-1β production.

Soluble mediators in packed red-blood-cell (PRBC) units have been hypothesized as a mechanism associated with transfusion-related immune modulation. Soluble mediators including damage-associated molecular patterns (DAMPs) are known to activate inflammasomes. Inflammasome complexes maturate caspase-1 and interleukin (IL)-1β. We assessed whether PRBC supernatants (SN) modulated IL-1β driven inflammation and whether macrophage migration inhibitory factor (MIF) was a contributing factor. Isolated monocytes were incubated with PRBC-SN in an in vitro transfusion model. Lipopolysaccharide (LPS) was added in parallel to model a bacterial infection. Separately, recombinant MIF was used in the model to assess its role in IL-1β driven inflammation. IL-1β and caspase-1 were quantified in the PRBC-SN and culture SN from the in vitro model. PRBC-SN alone did not induce IL-1β production from monocytes. However, PRBC-SN alone increased caspase-1 production. LPS alone induced both IL-1β and caspase-1 production. PRBC-SN augmented LPS-driven IL-1β and caspase-1 production. Recombinant MIF did not modulate IL-1β production in our model. Soluble mediators in PRBC modulate monocyte IL-1β inflammation, which may be a contributing factor to adverse effects of transfusion associated with poor patient outcomes. While MIF was present in PRBC-SN, we found no evidence that MIF was responsible for IL-1β associated immune modulation.

The Necessity of Clinical Rh Phenotypic Serological Detection and Homotypic Infusion in Patients with Repeated Blood Transfusion.

BackgroundThis study analyzed the distribution of Rh serological phenotype in people living in Hangzhou, China, and assessed the necessity of its routine clinical detection and homotypic infusion.Material/MethodsBlood donors and patients who might need blood transfusion were enrolled into the study, and ABO and 5 major Rh serological antigens (C, c, D, E, and e) were routinely detected. The consistent ABO and Rh serological phenotype blood was transfused between the blood donors and recipients. Irregular antibodies were screened and identified in patients before the blood transfusion. Then, the transfusion adverse effects were monitored and compared with the previous data in the hospital.ResultsThe phenotypic frequencies of Rh blood groups were D>C>E>c>e. The CCDee was the most common phenotype and CcdEe was the least common. The detection rate of unexpected antibodies gradually increased, while the unexpected antibodies slowly decreased in the Rh system. There was a correlation between the isotypic infusion of 5 Rh antigens and the detection rate of antibodies in the Rh system (R=0.845). The adverse effects of blood transfusion declined from 19.95% in 2011 with just homotypic ABO infusion to 3.098% in 2019 with the transfusion of homotypic ABO and the 5 major Rh serological antigens.ConclusionsThe consistency of the transfusion with ABO and 5 significant Rh serological antigens could prevent and decrease the high frequency production of isoantibodies, which is of vital importance in reducing the incidence rate of adverse effects in patients receiving transfusions.

Transfüzyon İmmünolojisi

Transfusion as a transplantation of blood cells is a complex process with many immunological consequences which are variably related to the features of donors, recipients and blood components. In all allogeneic blood transfusions immune responses are stimulated by effecting innate and adaptive immunities. Red blood cell antigens, platelet antigens, neutrophil antigens and major histocompatibility complex antigens have important roles in blood transfusion. The interactions of the stimulated antibodies with these antigens have significant consequences that result in various clinical manifestations, some of them may be life-threating. More improved understanding of the immunological processes associated with transfusion will make obtaining more effective results possible in the management of the adverse effects of transfusion as for safety of the patient and transfusion applications.

P.393 Changes in peripheral blood extracellular vesicles in psychotic patients determined by vesicle characterization and proteomics

Red blood cells (RBCs) are stored up to 35–42 days at 2–6 °C in blood banks. During storage, the RBC membrane is challenged by energy depletion, decreasing pH, altered cation homeostasis, and oxidative stress, leading to several biochemical and morphological changes in RBCs and to shedding of extracellular vesicles (EVs) into the storage medium. These changes are collectively known as RBC storage lesions. EVs accumulate in stored RBC concentrates and are, thus, transfused into patients. The potency of EVs as bioactive effectors is largely acknowledged, and EVs in RBC concentrates are suspected to mediate some adverse effects of transfusion. Several studies have shown accumulation of lipid raft–associated proteins in RBC EVs during storage, whereas a comprehensive phospholipidomic study on RBCs and corresponding EVs during the clinical storage period is lacking. Our mass spectrometric and chromatographic study shows that RBCs maintain their major phospholipid (PL) content well during storage despite abundant vesiculation. The phospholipidomes were largely similar between RBCs and EVs. No accumulation of raft lipids in EVs was seen, suggesting that the primary mechanism of RBC vesiculation during storage might not be raft -based. Nonetheless, a slight tendency of EV PLs for shorter acyl chains was observed.

Non-electrical powered continuous cell concentration for enumeration of residual white blood cells in WBC-depleted blood using a viscoelastic fluid

White blood cells (WBCs) are one of the critical components whose number has to be reduced before blood transfusion, failing which adverse transfusion effects may occur in patients. However, due to the extremely low concentration of residual WBCs (r-WBCs) in WBC-depleted blood, it is difficult to quantify r-WBCs accurately without using expensive and voluminous instruments. Therefore, the development of a continuous cell concentration technique is required to produce a countable number of cells from rare cells, which cannot normally be detected. In this paper, we present a viscoelastic microfluidic device for sheathless, continuous concentration of WBCs. The device performance was evaluated using polystyrene particles with different sizes at various flow rate conditions in a non-Newtonian fluid compared to a Newtonian fluid. Large particles with a blockage ratio higher than 0.1 were tightly focused at the center and collected at the center outlet with a 98% collection ratio. Meanwhile, the viscosity effect of lysed blood samples with various hematocrits was considered. Finally, diluted WBCs with various dilution ratios were concentrated by ~18-fold and continuous concentration of WBCs in lysed blood samples was performed using a non-electrical powered hand pump sprayer. Without using an external power source, center-focused WBCs were collected at the center outlet at approximately 150 μl/min and the final number of WBCs was increased to 1.8 × 104 cells/ml from undetectable levels.

The practice of transfusion and fluid bolus therapy in neonates

There is increasing uncertainty over the potential benefits and harms of volume expansion in paediatric and adult critical care settings. In addition, there are increasing numbers of reports of adverse effects and association with RBC transfusions in neonates, including transfusion‐associated necrotizing enterocolitis. Preterm infants &lt;28 weeks’ gestation in particular are likely more vulnerable to volume shifts and changes in blood pressure due to their unique physiology. This review paper will provide an overview of the current evidence base supporting the use of RBC transfusion thresholds and the use of fluid bolus therapy in neonates. We will argue that enhanced data collection and collaborations through neonatal networks, development of international consensus definitions of transfusion adverse effects and associations, as well as haemodynamic compromise in neonates, are needed to further advance research in these areas.

Epidemiology of chronic red-cell transfusion recipients in Sweden and Denmark-a 10 year follow-up study.

Chronic red-cell transfusions may be an indispensable part of patient treatment and may require early intervention to avoid adverse transfusion effects. The population of chronic transfusion recipients including common diagnoses and survival remains poorly characterised. Thus, the objective was to examine the complete range of chronic transfusion recipients, including demographic and patient characteristics and survival. All patients who received their first transfusion in Sweden or Denmark from January 1, 2002 to December 31, 2010 were followed up for subsequent transfusion episodes until December 31, 2012. Data on patient characteristics at time of the first and subsequent transfusions were retrieved from the national registers. We estimated the proportion of transfused patients who experienced 20 or more red-cell transfusion episodes (with an episode defined as all transfusions received 4 days or less apart) and characterised this patient population with respect to diagnoses, demographics and survival. Among 893 117 first time red-cell transfusion recipients, 6157 (0·7%) experienced 20 or more episodes in total. The most common diagnoses among these patients were haematologic malignancies followed by non-haematologic malignancies and non-malignant blood and immune system related diseases. On average, chronically transfused patients had a median survival of less than 1 year following their 20th transfusion episode. This study provides an overview of patient characteristics related to repeat red-cell transfusions and of the amount of red-cell transfusion episodes administered during a 10-year period in two countries. Patients who become chronically transfused suffer from diseases with poor prognosis.

Phospholipid composition of packed red blood cells and that of extracellular vesicles show a high resemblance and stability during storage

Red blood cells (RBCs) are stored up to 35–42days at 2–6°C in blood banks. During storage, the RBC membrane is challenged by energy depletion, decreasing pH, altered cation homeostasis, and oxidative stress, leading to several biochemical and morphological changes in RBCs and to shedding of extracellular vesicles (EVs) into the storage medium. These changes are collectively known as RBC storage lesions. EVs accumulate in stored RBC concentrates and are, thus, transfused into patients. The potency of EVs as bioactive effectors is largely acknowledged, and EVs in RBC concentrates are suspected to mediate some adverse effects of transfusion. Several studies have shown accumulation of lipid raft–associated proteins in RBC EVs during storage, whereas a comprehensive phospholipidomic study on RBCs and corresponding EVs during the clinical storage period is lacking. Our mass spectrometric and chromatographic study shows that RBCs maintain their major phospholipid (PL) content well during storage despite abundant vesiculation. The phospholipidomes were largely similar between RBCs and EVs. No accumulation of raft lipids in EVs was seen, suggesting that the primary mechanism of RBC vesiculation during storage might not be raft -based. Nonetheless, a slight tendency of EV PLs for shorter acyl chains was observed.

Audit of Red Cell Transfusions in the Neonatal Intensive Care Unit, Rotunda Hospital 2011-2015

Introduction/BackgroundNeonates are an intensively transfused group of vulnerable patients. Neonatal transfusion practice and general care has evolved over recent years, including the introduction of pedi-packs to limit donor exposure, and it remains important to audit practice. Inappropriate transfusions expose babies to potential adverse effects of transfusion. A national audit performed in the UK in 2010 concluded that there is a lack of evidence to back many of the existing recommendations for neonatal transfusion.We undertook a prospective audit in order to review 5 years of transfusion practice in a tertiary NICU. Our current neonatal transfusion guidelines are based upon internationally published guidelines.Aims & Objectives:To determine the number of babies transfused, whether transfusions were adherent to local guidelines, to identify areas requiring improvement and to determine whether continuous auditing and feedback to clinicians improves practiceMethodology/Interventions This was a prospective audit conducted over a 5 year period. Data were prospectively and retrospectively retrieved from patient charts and electronic databases. Data were stored in a password-protected excel spreadsheet created on a secure hospital network.Results and Discussion A total of 557 babies were transfused with red cells during the period 2011 -2015, representing 7-12% of babies admitted to NICU. The median number of transfusions decreased in babies of all birth weight categories between 2011-2015. The biggest change was in babies <750g, where median donor exposure was reduced from 2 to 1 during this time. The overall percentage of babies admitted to NICU requiring a blood transfusion reduced from 12% to 7%. The most significant reduction was seen in babies ≥1500g with a reduction from 4% in 2011 to 2% in 2015.Conclusions Auditing of neonatal transfusion especially in the area of pedi-pack top up transfusions highlighted specific areas where improvements could be made. This includes adherence to guidelines, consultant-led decision to transfuse (when time permits), and on-going audit and feedback to clinicians. These measures along with a multi-disciplinary approach to blood management have seen an overall reduction in percentage of babies being transfused without compromising the well-being of the baby. This has led to a reduction of donor exposure to the baby and a reduction in the cost and workload across all disciplines of staff associated with blood transfusion leading to an overall improvement to patient safety and quality of care. Despite this, the transfusion rate in babies of < 1000g remains the highest however this would be expected given the overall clinical needs of babies in this birth weight category. [Display omitted] [Display omitted] DisclosuresNí Áinle:Actelion UK: Research Funding.

Haptoglobin or Hemopexin Therapy Prevents Acute Adverse Effects of Resuscitation After Prolonged Storage of Red Cells.

Extracellular hemoglobin and cell-free heme are toxic breakdown products of hemolyzed erythrocytes. Mammals synthesize the scavenger proteins haptoglobin and hemopexin, which bind extracellular hemoglobin and heme, respectively. Transfusion of packed red blood cells is a lifesaving therapy for patients with hemorrhagic shock. Because erythrocytes undergo progressive deleterious morphological and biochemical changes during storage, transfusion of packed red blood cells that have been stored for prolonged intervals (SRBCs; stored for 35-40 days in humans or 14 days in mice) increases plasma levels of cell-free hemoglobin and heme. Therefore, in patients with hemorrhagic shock, perfusion-sensitive organs such as the kidneys are challenged not only by hypoperfusion but also by the high concentrations of plasma hemoglobin and heme that are associated with the transfusion of SRBCs. To test whether treatment with exogenous human haptoglobin or hemopexin can ameliorate adverse effects of resuscitation with SRBCs after 2 hours of hemorrhagic shock, mice that received SRBCs were given a coinfusion of haptoglobin, hemopexin, or albumin. Treatment with haptoglobin or hemopexin but not albumin improved the survival rate and attenuated SRBC-induced inflammation. Treatment with haptoglobin retained free hemoglobin in the plasma and prevented SRBC-induced hemoglobinuria and kidney injury. In mice resuscitated with fresh packed red blood cells, treatment with haptoglobin, hemopexin, or albumin did not cause harmful effects. In mice, the adverse effects of transfusion with SRBCs after hemorrhagic shock are ameliorated by treatment with either haptoglobin or hemopexin. Haptoglobin infusion prevents kidney injury associated with high plasma hemoglobin concentrations after resuscitation with SRBCs. Treatment with the naturally occurring human plasma proteins haptoglobin or hemopexin may have beneficial effects in conditions of severe hemolysis after prolonged hypotension.

Optimizing transfusion therapy in the chronically transfused patient

Patients may require regular transfusion due to congenital or acquired conditions resulting in haemolysis, ineffective blood cell production, bone marrow failure or a combination of these. In South‐East Asia, the most common congenital cause is thalassaemia while acquired causes include haematological malignancies such as myelodysplastic syndrome (MDS) and acute leukaemia. The major goal of transfusion in these patients is to minimize complications from their conditions. Due to the frequent transfusions, their cumulative risks from transfusion are higher than other patients. The transfusion‐associated adverse events which may affect these patients include mild adverse reactions such as febrile non‐haemolytic transfusion reactions and urticaria, as well as severe complications such as haemolytic transfusion reactions, anaphylaxis, transfusion‐transmitted infections, transfusion‐associated circulatory overload and transfusion‐related acute lung injury (TRALI). In addition, patients who need regular red cell transfusion are at risk of transfusional haemosiderosis. Therefore, measures should be taken to maximize the efficacy of transfusion and minimize the adverse effects of transfusion in these patients.

Mitochondrial damage-associated molecular patterns as potential proinflammatory mediators in post-platelet transfusion adverse effects.

Platelet concentrates (PCs) are the most common blood components eliciting nonhemolytic transfusion reactions (NHTRs), such as allergic transfusion reactions and febrile reactions. However, the precise mechanisms of NHTRs in PC transfusion remain largely unknown. Previous studies reported that mitochondria-derived damage-associated molecular patterns (DAMPs) could be important mediators of innate cell inflammation. Platelets (PLTs) represent a major reservoir of mitochondria in the blood circulation. The aim of this study was to determine the possible involvement of mitochondrial DAMPs in NHTRs. The amount of mitochondrial DAMPs was determined as an index of total copy numbers of mitochondrial DNA (mtDNA), including mtDNA itself and free mitochondria, using quantitative real-time polymerase chain reaction. To examine whether neutrophils, monocytes, and basophils were activated by mitochondrial DAMPs in vitro, an in vitro whole blood cell culture assay was performed. In blood components associated with NHTRs, the mean total mtDNA concentration was highest in PCs followed in order by fresh-frozen plasma and red blood cells. The amount of mtDNA in NHTR PCs was higher than that in control PCs without NHTRs. The mitochondrial DAMPs present in NHTR PCs was high enough to activate neutrophils, monocytes, and basophils, when costimulated with N-formyl-l-methionyl-l-leucyl-l-phenylalanine or HLA antibodies. PLT-derived mitochondrial DAMPs are candidate risk factors for the onset of NHTRs.

Evaluation of two methods for counting residual leukocytes in leuko-reduced platelets: Nageotte's method and flow cytometry

Introduction: Leukoreduced (LR) blood components are used for the prevention of several transfusion adverse effects. Advancement in technology has led to newer methods to count residual leukocytes (rWBC) which miss detection on most standard automated hematology analyzers. Materials and Methods: Samples from thirty eight platelet concentrates (prepared by Buffy-coat method) were randomly taken on the day of preparation for rWBC count using Nageotte's chamber and flowcytometer. Results: The rWBC count on Nageotte's ranged from 2.5 WBC/μL to a maximum of 600 WBC/μL where as the flowcytometric count had a lowest of 1.97 WBC/μL to a highest of 740 WBC/μL. We found that the WBC counts using the Nageotte's method and flowcytometeric method are highly correlated. The concordance correlation coefficient or intraclass correlation coefficient which is a measure of reliability was 0.78 Conclusion: In view of the high concordance in correlation coefficient between the two methods, Nageotte's method could be skillfully performed for assessing leukoreduction in LR platelet concentrates of resource constrained blood banks of developing nations.

Single Unit Transfusions in a Community Medical Center

Academic medical centers have implemented comprehensive patient blood management programs to reduce potential adverse transfusion effects. A retrospective study of single unit transfusions was conducted at a 319 bed community medical center to determine single unit transfusion practice patterns. Patient records of 535 single unit recipients were examined for gender, age and change in hemoglobin and hematocrit. Females (mean age 67) accounted for 64 % of recipients, with a mean increase in hemoglobin of 1.3 g/dL. Males (mean age 67) had a mean increase of 0.9 g/dL. An incidental finding was that laboratory assessment of hemoglobin was unavailable for 6% (pre transfusion) and 15% (post transfusion) of recipients. The proportion of single units transfused on a monthly basis ranged from 0.02% to 0.05%. No change toward increased use of single unit transfusion was identified. A formal patient blood management program is recommended as a next step in providing appropriate transfusion therapy.