Allogeneic Red Blood Cell Units Research Articles

Blood banking in solid organ transplantation

: Over 150,000 organ transplants are performed annually worldwide, and transfusion medicine support is crucial for each patient. Liver transplants have posed the greatest challenge for transfusion support, including 4–9% rates of preoperative red blood cell (RBC) alloimmunization, and higher-end blood use is associated with adverse outcomes. However, with effective patient blood management, means/medians of 4–9 allogeneic RBC units per case and 75th percentiles of 7–12 units or lower are reported. Heart or lung transplant RBC transfusions averaged around 3 units, but COVID-19 lung transplants needed a median 8 units (75th percentile 15) due to dense adhesions. Passenger lymphocyte syndrome due to donor anti-A/B induce hemolysis after 6% of ABO-unmatched kidneys, 19% of livers and 29% of intestinal transplants. ABO-incompatible transplants are achieved by desensitization, A subgroup organs, or tolerance in infants. However, interlaboratory reproducibility of anti-A/B titers in these patients remains problematic. ABH structures are predominantly type 2 in RBCs and hearts, type 4 in kidneys and secretor-dependent type 1 in liver bile ducts and arteries. These anatomic differences suggest that anti-A/B assessments and therapeutic adsorptions might be improved by using organ-tailored ABH glycans. Therapeutic plasma exchange (TPE) and extracorporeal photopheresis (ECP) are widely employed for antibody removal and rejection treatment. As organ transplantation expands globally, transfusion medicine will continue to be integral to patient care.

Effect of acute normovolemic hemodilution on coronary artery bypass grafting: A systematic review and meta-analysis of 22 randomized trials.

Efficacy of minimal acute normovolemic hemodilution (ANH) in avoiding homologous blood transfusion during cardiovascular surgery remains controversial. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. To better understand the role of acute normovolemic hemodilution (ANH) in coronary artery bypass grafting (CABG), we compared ANH with standard intraoperative care in a systematic review including a standard pairwise meta-analysis of randomized controlled trials (RCTs). We searched the Cochrane Library, PubMed, EMBASE, Web of Science and Chinese National Knowledge Infrastructure (CNKI) up to April 1, 2020. The primary outcome was to assess the incidence of ANH-related number of allogeneic red blood cell units (ARBCu) transfused. Secondary outcomes included the rate of allogeneic blood transfusion and estimated total blood loss. A total of 22 RCTs including 1688 patients were identified for the present meta-analysis. Of these studies, 19 were about CABG with on-pump and three with off-pump. Our pooled result indicated that patients received ANH experienced fewer ARBCu transfusions, with a standardized mean difference (SMD) of -0.60 (95%CI -0.96 to -0.24; P=0.001). The rate of allogeneic blood transfusion in ANH group was significant reduced when compared with controls, with a relative risk (RR) of 0.65 (95%CI 0.52 to 0.82; P=0.0002). In addition, less postoperative estimated total blood loss was present, with a SMD of -0.53 (95%CI -0.88 to -0.17; P=0.004). The present meta-analysis indicated that ANH could reduce the number of ARBCu transfused in the CABG surgery setting. In addition, ANH could also reduce the rate of ARBCu transfusion and estimated total blood loss for CABG patients.

Risk of massive blood product requirement in cardiac surgery: A large retrospective study from 2 heart centers.

Cardiac surgery under cardiopulmonary bypass (CPB) accounts for most consumption of red blood cells (RBCs). Identifying risk factors for massive red blood cell transfusion (MRT) in cardiac surgery may help to reduce this consumption.We retrospectively analyzed 8238 patients who underwent valve surgery and/or coronary artery bypass grafting (CABG) under CPB at 2 major heart centers in China. Uni- and multivariate logistic regression was carried out to assess whether risk factors for MRT (defined as receiving at least 4 units RBCs) varied with type of cardiac surgery.A total of 1691 patients (21%) received at least 4 units RBCs (6.77 ± 4.78 units per person). This MRT group consumed 70% of the total units of allogeneic RBCs in the study. MRT incidence was 2-fold higher among patients undergoing CABG with or without valve surgery than among patients undergoing valve surgery alone. Multivariate logistic analysis identified the following MRT risk factors common to valve surgery alone, CABG alone, and their combination: female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin, and longer CPB. Several independent MRT risk factors were also identified specific to valve surgery: active endocarditis, nonatrial fibrillation, smaller left atrium diameter, abnormal international normalized ratio, and repeat surgery.Different types of cardiac surgery share several, but not all, MRT risk factors. This study may help guide the prediction and management of patients at higher MRT risk.

Effects of gamma irradiation on red blood cells at different storage period: A comparative study

Objectives: The objective of this study was to explore the effect of gamma irradiation on the haematological and biochemical parameters of the allogeneic red blood cells units at different storage duration.Methods: A prospective comparative study was conducted at the Blood Bank unit, Department of Diagnostic Laboratory Services of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in year 2013. Total 36 allogeneic red blood cell units were selected by simple random sampling method and divided into two groups, 18 units in each group based on the storage period into i) up to 14 days and ii) >14 days to expiry. Pre and post irradiation samples were taken immediately before and after irradiation of the units to analyse for the haematological parameters such as plasma Hb level, percent red cell haemolysis, haemoglobin per unit blood (Hb/unit), haematocrit (HCT), red cell indices such as mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and biochemical parameters such as plasma sodium (Na+), potassium (K+) and LDH levels. Data was collected and statistical analysis was done.Results: Statistically significant changes were observed between red cell units of up to 14 days and > 14 days old and pre irradiated samples in terms of plasma haemoglobin level, percent red cell haemolysis and plasma Na+, K+ and LDH levels. However, pre and post irradiation samples in each group of 14 days and >14 days showed significant changes in the plasma Hb and % haemolysis, Hb/unit, HCT, MCV and MCH in 14 days group while only in plasma Hb, MCV and MCH in >14 days group without any effect on plasma Na+, K+ and LDH levels in both group.Conclusion: Comparison at two different red cells storage groups i.e. period of up to 14 days and >14 days, showed significant changes in haematological and biochemical parameters. In the pre irradiation group this reflects the gradual storage changes over time even without going through the irradiation process. On the other hand, the changes between pre and post–irradiation for both the groups of storage showed significant haematological changes indicating irradiation itself also causes significant changes. In view of all these findings, we recommend to irradiate the allogeneic red cell units within 14 days of collection to reduce the adverse effects resulted from irradiation on the cellular products.Bangladesh Journal of Medical Science Vol.17(1) 2018 p.30-35

Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Trials.

To better understand the role of acute normovolemic hemodilution (ANH) in a surgical setting with high risk of bleeding, we analyzed all randomized controlled trials (RCTs) in the setting of cardiac surgery that compared ANH with standard intraoperative care. The aim was to assess the incidence of ANH-related number of allogeneic red blood cell units (RBCu) transfused. Secondary outcomes included the rate of allogeneic blood transfusion and estimated total blood loss. Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH group and 1187 in the control group) were included in our meta-analysis using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE. Patients in the ANH group received fewer allogeneic RBCu transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25 to -0.34; P = .001; I = 95.1%). Patients in the ANH group were overall transfused less with allogeneic blood when compared with controls (356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk ratio = 0.74; 95% CI, 0.62 to 0.87; P < .0001; I = 72.5%), and they experienced less postoperative blood loss (388 mL in ANH versus 450 mL in control; mean difference = -0.64; 95% CI, -0.97 to -0.31; P < .0001; I = 91.8%). ANH reduces the number of allogeneic RBCu transfused in the cardiac surgery setting together with a reduction in the rate of patients transfused with allogeneic blood and with a reduction of bleeding.

Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection — Puerto Rico, 2016

Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus. Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic, the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pathogen reduction technology (PRT) for treatment of blood components can be implemented. To inform efforts to maintain the safety and availability of the blood supply in Puerto Rico, CDC, in collaboration with the Puerto Rico Department of Health, conducted a rapid assessment of blood collection and use on the island. A total of 139,369 allogeneic red blood cell (RBC) units, 45,243 platelet units, and 56,466 plasma units were collected in or imported to Puerto Rico during 2015, and 135,966 allogeneic RBC units, 13,526 therapeutic platelet units, and 25,775 plasma units were transfused. Because of the potential for local Zika virus transmission in areas with a competent mosquito vector, other areas of the United States should develop plans to ensure local blood safety and adequacy. Blood collection organizations and public health agencies should collaborate to maintain the safety and availability of local blood supplies in accordance with FDA guidance.

Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection--Puerto Rico, 2016.

Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus. Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic, the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pathogen reduction technology (PRT) for treatment of blood components can be implemented. To inform efforts to maintain the safety and availability of the blood supply in Puerto Rico, CDC, in collaboration with the Puerto Rico Department of Health, conducted a rapid assessment of blood collection and use on the island. A total of 139,369 allogeneic red blood cell (RBC) units, 45,243 platelet units, and 56,466 plasma units were collected in or imported to Puerto Rico during 2015, and 135,966 allogeneic RBC units, 13,526 therapeutic platelet units, and 25,775 plasma units were transfused. Because of the potential for local Zika virus transmission in areas with a competent mosquito vector, other areas of the United States should develop plans to ensure local blood safety and adequacy. Blood collection organizations and public health agencies should collaborate to maintain the safety and availability of local blood supplies in accordance with FDA guidance.

Reduction of allogeneic red blood cell usage during cardiac surgery by an integrated intra‐ and postoperative blood salvage strategy: results of a randomized comparison

The amount of allogeneic blood transfusion may relate to worse outcome in cardiac surgery. The reinfusion of red blood cells (RBCs) lost by patients, including those of chest drains, is a promising strategy to minimize allogeneic transfusions. To verify this hypotheis, 1047 cardiac surgery patients were randomly assigned to either traditional intraoperative blood salvage followed by chest drain insertion or intra- and postoperative strategy with the Haemonetics cardioPAT system. Allogeneic RBC transfusion rate (primary endpoint) and postoperative complications (secondary endpoint) were recorded at the time of discharge from the hospital and at first month follow-up visit, respectively. The cardioPAT arm received 1.20 units of allogeneic RBCs per patient, whereas the control group required 2.11 units per patient, and this difference proved to be highly significant (p=0.02). We observed a comparable 45-day mortality rate but a lower rate of deep vein thrombosis (p=0.04) and atrial fibrillation (p=0.04) in the cardioPAT arm. A significant reduction in patient exposure to allogeneic RBCs was observed in the cardioPAT system arm. Complications were slightly less frequent in the cardioPAT group. The use of the cardioPAT is a safe and effective strategy to reduce allogeneic RBC transfusions in cardiac surgery.

Oxygen Carriers in Cardiac Surgery

SUMMARYArtificial oxygen carriers – the hemoglobin‐based oxygen carriers (HBOCs) and the perfluorocarbon (PFC) emulsions – have been developed with the aim of avoiding the risks associated with allogeneic blood transfusions. H BOCs are solutions of free human or bovine hemoglobin, modified by internal crosslinking and by polymerization so as to avoid renal toxicity and to increase the intravascular lifetime. Last‐generation PFC emulsions are formed by lipid particles enclosing a synthetic hyperfluorinated, chemically inert hydrocarbon, perflubron, which dissolves gases without binding them. In order to be efficient, the emulsions must be used with 100% oxygen.HBOCs and PFC emulsions were found to be safe and to reduce allogeneic blood transfusions in preclinical and clinical phase I/II studies. One PFC emulsion (Oxygent®) and three H BOCs (DCLHb, Hemolink® and Hemopure®) were used in phase II and III clinical trials in cardiac surgery with cardiopulmonary bypass (CPB). HBOCs were well tolerated but increased the number of adverse events, mainly hypertension, jaundice‐like syndrome and elevation of the blood levels of hepatic and pancreatic enzymes. The effects of HBOCs on transfusion avoidance were modest, limited to the first postoperative days, without decreasing the total number of transfused red blood cell (RBC) units. Oxygent® was used in combination with acute normovolemic hemodilution in phase II studies. It was safe, had modest effects on transfusion avoidance in the post‐CPB period (until 5 days for the highest administered dose), but did not decrease the number of allogeneic red blood cell units transfused per patient. A phase III clinical trial was voluntarily stopped before completion because of an increased incidence of adverse events (stroke). More evidence is warranted before oxygen carriers can be recommended for routine use in cardiac surgery.

Predictors of blood transfusions in spinal instrumentation and fusion surgery.

A retrospective review of 244 adult spine instrumentation and fusion surgery cases (1994-1995) from one institution. To ascertain the predictors of blood transfusions for adult patients undergoing different types of multilevel spine surgery. Blood loss and transfusion requirements during and after multilevel spine surgeries have always been perceived as great. Identifying the predictors of blood transfusion with this type of surgery may aid in reducing the amount of blood loss and the transfusion requirements. The charts of 244 adult patients who underwent multilevel spine surgery from January 1994 to July 1995 were retrospectively reviewed. A large percentage of patients required blood transfusion. The significant determinants for increased amounts of allogeneic red blood cell units transfused on the day of surgery using linear multiple regression modeling were low preoperative hemoglobin concentration, tumor surgery, increased number of posterior levels surgically fused, history of pulmonary disease, decreased amount of autologous blood available, and no use of the Jackson table (R2 = 0. 63). The significant determinants for an increased amount of autologous red blood cell units transfused on the day of surgery using linear multiple regression modeling were increased autologous red blood cells available, low preoperative hemoglobin concentration, and increased number of posterior levels surgically fused (R2 = 0. 60). The need for transfusion is associated with multiple factors, suggesting that a multifaceted, integrated approach may be necessary to reduce this risk.