American Association Of Blood Banks Research Articles

A new mixture ratio of heparin for the cell salvage device

Adequate cell salvage for extracorporeal circulation requires anticoagulants such as heparin. The guideline of the American Association of Blood Banks recommends that 1 L of 0.9% saline containing 30,000 units of heparin should be mixed with aspirated blood at a ratio of 15 ml per 100 ml of collected blood [1]. If we maintain the ratio of heparinized saline to blood at 15 : 100, we need 2 vials of the Korean heparin product because its maximum amount of heparin in a vial is 25,000 units [2]. Therefore, we developed an alternative method of anticoagulation using only 1 vial of heparin. For extracorporeal circulation, the dose of heparin, which maintains an ACT of longer than 400-450 seconds, is 300-400 U/kg body weight [3]. To simplify calculation, we assume blood volume to be 70 ml/kg because the average blood volume of men is 75 ml/kg and that of women is 65 ml/kg. Since 70 ml of blood requires 300 units of heparin, 100 ml of blood requires 428 units of heparin. According to the guideline, 15 ml of heparinized saline contains 450 units of heparin because 1 L of heparinzed saline contains 30,000 units of heparin. If we mix 25,000 units of heparin with 1 L of 0.9% saline, we need 18 ml of heparinized saline to maintain the same amount of heparin because the new concentration of heparin is 25 units/ml. If we apply this method to a continuous autotransfusion system (CATS®), we should set the infusion rate at 234 drops per minute because 13 drops make 1 ml in the CATS. In summary, we can use 1 vial of heparin (25,000 units) to prevent coagulation in the cell salvage device using our mixture ratio.

Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force

Search terms included: Transfusion-associated graft-versus-host disease, Transfusion-associated graft-versus-host, TA-GvHD. The last guideline covering this topic was published in 1996 (British Committee for Standards in Haematology (BCSH) Blood Transfusion Task Force, 1996. The writing group produced the new draft guideline, which was subsequently revised by consensus by members of the Haemato-oncology and Blood Transfusion Task Forces of the BCSH. The guideline was then reviewed by a sounding board of approximately 100 UK haematologists, the BCSH and the committee of the British Society for Haematology and amended, again by consensus. Criteria used to quote levels and grades of evidence are according to the GRADE system (Guyatt et al, 2006). Strong recommendations (grade 1, ‘recommended’) are made when there is confidence that the benefits either do or do not outweigh the harm and burden and costs of treatment. Where the magnitude of benefit or not is less certain a weaker grade 2 recommendation (‘suggested’) is made. Grade 1 recommendations can be applied uniformly to most patients whereas grade 2 recommendations require judicious application. The quality of evidence is graded as A (high quality randomized clinical trials), moderate (B) or low (C). This publication reports the key recommendations of the Writing Group. It is also accessible at http://www.bcshguide lines.com.

Evaluation of Plasmodium vivax ELISA for the blood screen

Plasmodium vivax malaria is the indigenous strain in the Republic of Korea (ROK). Plasmodium vivax can be transmitted through the transfusions of various blood components, which became a severe problem with the safety of blood transfusions and blood-related products in ROK. We evaluated a P.vivax-specific enzyme-linked immunosorbent assay (Genedia Malaria Ab ELISA 2.0, Green Cross, ROK) with blood samples from four groups: 251 samples from P.vivax-infected patients, 39 samples from post-treatment patients upon follow-up, 200 samples from healthy volunteers and 421 samples from domestic travellers to and from high endemic areas of ROK. The positive cases from the ELISA test were confirmed by both Giemsa microscopic and polymerase chain reaction methods. The clinical sensitivity and specificity of detecting P.vivax with ELISA test were 94.4% and 99.0%, respectively. Thirteen of 421 domestic travellers (3.0%) to endemic areas tested positive. The results indicate the effectiveness of detecting antibodies against P.vivax in blood with Genedia Malaria Ab ELISA 2.0 test in a large blood screen setting.

Tibor Jack Greenwalt: Father of Transfusion Medicine

Tibor J. Greenwalt (1914-2005) was, as much as anyone, the Father of Transfusion Medicine. He was founder of the Blood Center of Wisconsin, the first member of the American Association of Blood Banks, founding editor of Transfusion, chair of the National Research Council's Committee on Blood and Transfusion, national medical director of the American Red Cross Blood Services, and president of the International Society of Blood Transfusion. He wrote 200 papers and 25 books, describing erythroblastosis fetalis as an immune hemolytic anemia, new blood groups and antigens, the effects of hepatitis testing on blood safety, better ways to store red cell, and much more. He worked until days before his death at age 91, ending a 63-year career with 5 papers in press.

Donor hemovigilance: safety as the first priority of blood donor management

Background The American Red Cross instituted a donor hemovigilance program (HVP) in its 35 regional blood centres in 2003 to document adverse events occurring at the time of donation or reported later. The aims are to describe and quantitate rare events using standard definitions, define risk factors, design specific interventions and to assess outcomes. In the 1990s, most US blood centres converted to 500 ml whole blood (WB) collection bags to maximize blood collection. The AABB (formerly known as the American Association of Blood Banks) instituted a standard (#5.4.1.A) to permit a maximum blood loss of 10·5 ml/kg and minimum donor weight of 50 kg (110 lb), allowing 525 ml of blood to be removed from the smallest donors. In the last decade, the majority of States have enacted legislation to allow 16‐year‐old donors to donate with parental consent.Methods Standardized adverse event definitions and reporting were instituted in 2003, and adverse event data were collated and analysed at the National Medical Office. Standard database and statistical analytical methods were utilized. Estimated blood volume was calculated based on height, weight and gender, using the method of Nadler et al. Surgery 1962; 51:224–231.Results Analysis of HVP data from 2002 to 2006 highlighted that young, first time, female donors were at risk for vasovagal reactions, injuries related to falls and the need for outside medical care. Multivariate analysis revealed young age, low estimated blood volume (<3·5 l) (EBV) and first‐time donation status as major independent risk factors. Calculation of EBV revealed that current AABB standards allow, and CFR limits do not prevent, 15–20% blood loss of EBV from short, low‐weight female donors.Interventions to reduce vasovagal reactions were piloted, starting in 2008, including: (i) a controlled environment through standardized work guidance, physical setup and staffing matrices; (ii) improved donor and parent educational material prior to donation; (iii) enhanced donor monitoring post donation; (iv) fluid intake encouraged within 30 minutes of donation; (v) distraction and muscle tension techniques; (vi) use of apheresis double red cell collection in eligible donors; (vii) enhanced post donation instructions to donors and patients; (viii) implementation of selective height and weight restrictions in donors <19 years old to avoid collection from donors with EBV <3·5 l.Conclusions A national HVP has highlighted the issue of vasovagal syncope‐like reactions in young first‐time donors with low EBV leading to multiple interventions designed to reduce risk. Outcomes are being assessed and monitored. Current AABB standards do not adequately protect young donors with low height/weight from excess blood loss in the United States.

Estimating Blood Transfusion Requirements in Preparation for a Major Earthquake: The Tehran, Iran Study

Tehran, Iran, with a population of approximately seven million people, is at a very high risk for a devastating earthquake. This study aims to estimate the number of units of blood required at the time of such an earthquake. To assume the damage of an earthquake in Tehran, the researchers applied the Centre for Earthquake and Environmental Studies of Tehran/Japan International Cooperation Agency (CEST/JICA) fault-activation scenarios, and accordingly estimated the injury-to-death ratio (IDR), hospital admission rate (HAR), and blood transfusion rate (BTR). The data were based on Iran's major earthquakes during last two decades. The following values were considered for the analysis: (1) IDR = 1, 2, and 3; (2) HAR = 0.25 and 0.35; and (3) BTR = 0.05, 0.07, and 0.10. The American Association of Blood Banks' formula was adapted to calculate total required numbers of Type- O red blood cell (RBC) units. Calculations relied on the following assumptions: (1) no change in Tehran's vulnerability from CEST/JICA study time; (2) no functional damage to Tehran Blood Transfusion Post; and (3) standards of blood safety are secure during the disaster responses. Surge capacity was estimated based on the Bam earthquake experience. The maximum, optimum, and minimum blood deficits were calculated accordingly. No deficit was estimated in case of the Mosha fault activation and the optimum scenario of North Tehran fault. The maximum blood deficit was estimated from the activation of the Ray fault, requiring up to 107,293 and 95,127 units for the 0-24 hour and the 24-72 hour periods after the earthquake, respectively. The optimum deficit was estimated up to 46,824 and 16,528 units for 0-24 hour and 24-72 hour period after the earthquake, respectively. In most Tehran earthquake scenarios, a shortage of blood was estimated to surge the capacity of all blood transfusion posts around the country within first three days, as it might ask for a 2-8 times more than what the system had produced following the Bam earthquake.

CDC Launches Surveillance System to Improve Blood Transfusion Safety

A SYSTEM LAUNCHED IN FEBRUary by the US Centers for Disease Control and Prevention (CDC) will help track adverse events associated with blood transfusion and give hospitals and public health officials tools they can use to help prevent such events in the future. The Hemovigilance Module is the newest component of the CDC’s National Healthcare Safety Network, a confidential and voluntary online surveillance system that the agency uses to track infections associated with health care. The module was created by the CDC in collaboration with AABB (formerly the American Association of Blood Banks), an organization that represents institutions and professionals involved in blood transfusion and transplantation. “Clinicians need to understand that although blood transfusion is very safe, there are adverse events,” said Matthew J. Kuehnert, MD, director of the CDC’s Office of Blood, Organ, and Other Tissue Safety. Kuehnert explained that the system will track events in which patients develop adverse reactions to transfusions—for example, if a patient receives the wrong blood type, has an allergic reaction, or contracts an infection. Moreover, the system will also track incidents in which procedures intended to ensure patient safety do not work properly and lead to patient harm or near misses. For example, if a physician orders one blood type, but the wrong blood type is delivered to the patient’s room, that would be considered such an incident. Often such a mix-up would be caught by redundant safety protocols before the patient receives the wrong type of blood; however, such problems increase the risk of poor outcomes. The system will for the first time provide national data on transfusion safety in the United States. Previously, surveillance of adverse events has been fragmented. Barbee Whitaker, PhD, director

Platelet Contamination in Plasma: a Possible Source of Biologic Mediators Linked to Transfusion-Related Acute Lung Injury.

Abstract 2109Poster Board II-86Introduction: Transfusion of plasma is associated with the highest risk of transfusion related acute lung injury (TRALI)-related death. We hypothesize that the current preparation regimen of plasma derived from whole blood has led to significant platelet contamination of plasma, and these platelets contribute to the high rates of TRALI in recipients of plasma. Materials and Methods: Ten units of whole blood were drawn from volunteer donors (5 females and 5 males). All units were centrifuged at 5,316g for 6 minutes to achieve acellular centrifugal effect (ACE) of 4.61×107 in accordance with the blood center's operating procedure for the primary separation of red cells from plasma. We divided each unit into 4 equal aliquots and compared 4 preparation regimens to evaluate the effect of freezing and cell depletion centrifugation (CDC) on platelets and associated factors: not frozen/no CDC, frozen/no CDC, not frozen/CDC, and frozen/CDC. CDC samples were centrifuged at an additional 12,500g for 7 minutes at 4°C to achieve cell depletion prior to freezing, and frozen samples were prepared according to the American Association of Blood Banks (AABB) standard for the preparation of frozen plasma. For each of the four preparation regimens we measured platelet levels using a Beckman Coulter Counter (model: AcT 5Diff AL). We also measured levels of four biologic mediators associated with platelets using commercially available ELISA kits: adenosine diphosphate (ADP), which is found in dense bodies; soluble CD40 ligand (sCD40L), which is found on the surface of platelets; vascular endothelial growth factor (VEGF) and platelet factor 4 (PF4), both found in the alpha granules. Results: We found significant platelet contamination (p<0.05) in the samples that did not undergo CDC with a mean platelet count of 38.8×103/μL (SEM ± 3.0, n=20) versus CDC samples which had a mean platelet count of 1.8×103/μL (SEM ± 0.9, n=20). Samples which had undergone both freezing and CDC had significantly lower levels of VEGF, sCD40L, and PF4 (p<0.05) than samples that had not undergone either process (Table 1). Conclusions: In our study, there was a direct correlation between the concentration of platelet-derived factors and platelet counts in plasma samples. Freezing plasma did not result in a significant decrease in platelet count, but was associated with a decrease in sCD40L. Performing the cell depletion centrifugation resulted in significant decreases in platelet count as well as sCD40L, VEGF, and PF4 levels. Finding a mechanism to reduce platelet contamination of frozen plasma may mitigate TRALI risk by decreasing the levels of biologic mediators, such as sCD40L, implicated in some cases of TRALI.PreparationsCD40L (ng/mL)VEGF (pg/mL)PF4 (ng/mL)ADP (nmol/μL)Not Frozen, No CDC0.930 ± 0.138 †0.087 ± 0.00651.160 ± 2.9420.065 ± 0.006Not Frozen, CDC0.230 ± 0.106 *†0.072 ± 0.00828.820 ± 3.810 *†0.064 ± 0.006Frozen, No CDC0.388 ± 0.104 *0.083 ± 0.00647.310 ± 1.7190.069 ± 0.007Frozen, CDC0.127 ± 0.108 *†0.059 ± 0.006 *†34.260 ± 3.561 *†0.069 ± 0.009Table 1. The data is expressed as the mean ± SEM in pg/ml or ng/ml of the measured biologic mediators from 10 units of plasma each prepared in 4 different ways;*= p<0.05 significance when compared to the not frozen, not CDC sample;†= p<0.05 significance when compared to the frozen, not CDC sample. Disclosures:No relevant conflicts of interest to declare.

Collection and Storage of Apheresis Platelets Results in a Significant Decline in the Percentage of Coated-Platelets.

Abstract 23 Introduction:Platelets initiate hemostasis by adhering to the site of vascular injury and providing a negatively charged surface for thrombin generation. A subset of platelets, referred to as coated-platelets, has an enhanced ability to generate thrombin. Coated-platelets, observed in vitro upon dual agonist stimulation with collagen and thrombin, retain several serotonin-derivatized proteins on their surface and express phosphotidylserine, creating a highly active prothrombinase complex. Experimental studies have concluded that dogs deficient in coated-platelets manifest with excessive nasal, intraocular and post-operative bleeding, suggesting a key role for coated-platelets in hemostasis. The fraction of coated-platelets made by normal individuals is approximately 30% with a range of 15% – 55%. Platelet concentrates are stored at room temperature to preserve their viability and must be transfused within five days of collection secondary to a high risk of contamination. We conducted a pilot study in healthy platelet donors to evaluate how the process of apheresis and in vitro storage affect the ability to generate coated-platelets. Secondarily, we aimed to evaluate the coated-platelet potential of apheresis platelet units transfused in clinical practice. Methods: Healthy voluntary platelet donors presenting at the Oklahoma Blood Institute were enrolled and demographic data such as age, sex, smoking status, donation history, past medical history and medications were noted. A Pre-donation blood sample was obtained. Thereafter, donors underwent apheresis using the Caridian BCT Trima system via continuous centrifugation in a closed system per guidelines outlined by the American Association of Blood Banks (AABB). A Post-donation sample was drawn from the platelet concentrate bag 30 minutes after apheresis. Units were packaged, processed and stored per routine procedures. A third platelet sample was obtained when the unit was released for transfusion. Platelet rich plasma was prepared and coated-platelets were assayed as previously described (J. Thromb. Haemostasis 6:609, 2008). Statistical analysis was performed using paired t-test to compare the change in percentage of coated-platelets between the three samples. Results: Nine donors were enrolled. The mean percentage of coated-platelets in the Pre-donation samples was 40.4% (20.7%–59.7%). Thirty minutes after the apheresis collection procedure, the mean percentage of coated-platelets in the concentrate was 34.3% (17.3%–49.0%) suggesting a 15% decline in percentage of coated-platelets with the process of apheresis (p<0.01). Eight units were transfused within one to four days of collection. The mean percentage of coated-platelets in the transfused product was 17.1 % (10.1%–28.4%); a 52% decline in the percentage of coated-platelets during the process of storage was noted (p<0.001). [Figure A and B]. [Display omitted] Conclusion:Coated-platelets are a recently recognized component of hemostasis, and the ability of stored platelets to retain coated-platelet potential is unknown. Our preliminary results indicate that the process of platelet apheresis and storage significantly decreases the ability to generate coated-platelets. Current quality control guidelines for platelet storage measure platelet viability with factors such as pH, pCO2, pO2, lactate and platelet morphology; however, there is no evaluation of the hemostatic function of stored platelets relative to coated-platelets. Our results reveal that during storage following current transfusion guidelines, the percentage of coated-platelets decreases. Part of this decline appears to be associated with the apheresis process itself and further progresses with storage. Our study provides the first evidence that retention of coated platelet levels during preparation and storage is problematic and may be an important factor in evaluating the hemostatic potential of infused platelets. Disclosures:No relevant conflicts of interest to declare.

Balancing agendas in donor testing

Balancing agendas in donor testing

Managing change

In the 1980s, the Administrative Section Coordinating Committee (ASCC) published a series of administrative manuals to assist the American Association of Blood Banks (AABB) membership in developing processes for administrative activities conducted in a hospital or blood center. These manuals covered topics such as finance, inventory, information systems, and other areas that provide the infrastructure to support operations. In 2004, the ASCC adopted a plan to create a new set of documents addressing the AABB Quality System Essentials (QSEs) from an administrative viewpoint. In the past 30 years, blood banking has made significant strides in donor and patient safety with the addition of tests for infectious diseases, increased regulations, and the introduction of new technologies, as well as a focus on quality. The demands of managing and documenting all of these important advances and the frequency with which these changes have occurred have challenged our industry. While many articles and books are available for managing change in general, this article applies several aspects of the QSEs as a practical foundation for managing change in donor centers, hospital blood banks, and transfusion services. Utilizing this systematic guide to manage change can not only facilitate the change process but help to guard against unforeseen consequences.

Abstracts of Papers to be Presented at American Association of Blood Banks. 45 Annual Meeting November 7-12, 1992

Abstracts of Papers to be Presented at American Association of Blood Banks. 45 Annual Meeting November 7-12, 1992

Canine platelet transfusions

To review potential platelet storage options, guidelines for administration of platelets, and adverse events associated with platelet transfusions. Data sources included original research publications and scientific reviews. Transfusion of platelet concentrates (PCs) plays a key role in the management of patients with severe thrombocytopenia. Currently PCs are stored at 22 degrees C under continuous gentle agitation for up to 5 days. Chilling of platelets is associated with rapid clearance of transfused platelets, and galactosylation of platelets has proven unsuccessful in prolonging platelet survival. Although approved by the American Association of Blood Banks, cryopreservation of human platelets in 6% DMSO largely remains a research technique. Pre-storage leukoreduction of PCs has reduced but not eliminated acute inflammatory transfusion reactions, with platelet inflammatory mediators contributing to such reactions. Canine plateletpheresis allows collection of a concentrate with a high platelet yield, typically 3-4.5 x 10(11) versus <1 x 10(11) for whole blood-derived platelets, improving the ability to provide sufficient platelets to meet the recipient's transfusion needs. Cryopreservation of canine platelets in 6% DMSO offers immediate availability of platelets, with an acceptable posttransfusion in vivo platelet recovery and half-life of 50% and 2 days, respectively. While data on administration of rehydrated lyophilized platelets in bleeding animal models are encouraging, due to a short lifespan (min) posttransfusion, their use will be limited to control of active bleeding, without a sustained increase in platelet count. Fresh PC remains the product of choice for control of bleeding due to severe thrombocytopenia or thrombopathia. While cryopreservation and lyophilization of canine platelets offer the benefits of immediate availability and long-term storage, the compromise is decreased in vivo recovery and survival of platelets and some degree of impaired function, though such products could still be life saving.

HLA type and risk of alloimmunization in sickle cell disease

Red blood cell (RBC) transfusions are frequently required to treat patients with sickle cell disease (SCD) [1]. One of the most serious complications of repeat transfusion is alloimmunization to RBC antigens [2]. Because human leukocyte antigen (HLA) genes mediate the response to foreign antigens, particular HLA alleles may predispose to the development of alloimmunization in patients with SCD who receive multiple transfusions. We conducted a case-control study to determine if particular HLA alleles are associated with alloimmunization and whether HLA homozygosity influences the risk of developing RBC alloantibodies. High-resolution HLA genotyping was performed on DNA samples from 159 multiply transfused patients with SCD. HLA allele frequencies were compared between alloantibody-positive and alloantibody-negative groups. The HLA-DRB1 * 1503 allele was associated with an increased risk (P = 0.039), while HLA-DRB1 * 0901 conferred protection from alloimmunization (P = 0.008). HLA Class II locus homozygosity was more frequently observed in the alloantibody-negative group (P = 0.01). These preliminary findings suggest that particular HLA-DR81 alleles and overall homozygosity at HLA class II loci are associated with alloimmunization risk in SCD. If confirmed, HLA type may serve as a useful genetic predictor of alloimmunization risk, and permit a targeted approach to the use of phenotypically matched blood.

Lab Equipment Requirements: When Manufacturer and Joint Commission Guidelines Differ

What should you do when a manufacturer’s maintenance guidelines for equipment differ from compliance requirements published by the Joint Commission (JC)? While some assert that JC standards should be followed, others contend that manufacturers’ or other accreditation agencies’ recommendations—such as those of the AABB (formerly the American Association of Blood Banks)—are more important. Take, for example, blood warmers and the proper intervals at which their calibration and alarm activation checks should be performed. Navigating the maze of regulations and agencies can be a challenge. Paul Kelley, CBET, manager of biomedical engineering at Washington Hospital in Fremont, CA, says that his facility conducts quarterly calibration checks for blood warmers even though manufacturer instructions stipulate such checks need only be performed annually. “At the time—six years ago—we had a very hard time getting clarification on the AABB requirement, so we went with the most conservative recommendation we had,” says Kelley. Arif Subhan, CCE, senior clinical engineer at Masterplan, cites the 2009 Joint Commission Laboratory Accreditation Standard EC.6.20 EP12 and the Clinical Lab Improvement Act (CLIA) regulations, specifically 42 CFR 493.1254. Subhan says it is his understanding that both Joint Commission and CLIA affirm that maintenance checks be conducted on laboratory equipment, instruments, or test systems according to manufacturer recommendations. A JC lab accreditation program must meet CLIA regulations, which stipulate that lab equipment must at least be tested according to manufacturers’ recommendations. However, the JC has given the flexibility under the hospital accreditation program to the hospitals to come up with their own testing intervals based on criteria such as risk, organizational experience, and manufacturers’ recommendations (EC.02.04.01 EP 4). Subhan refers to subtle differences in the accreditation standards for laboratories and hospitals. While most biomedical equipment technicians (BMETs) know that when working in a hospital they must follow that hospital’s accreditation program, Subhan adds, “The lab has to follow JC laboratory standards. They’re almost the same as the hospital standards, but there are subtle differences.” Megan Sawchuk, associate director of the JC’s Standards Interpretation Group, says lab workers must consider the following three sources for compliance when establishing their equipment maintenance practices, particularly for blood transfusion equipment: 1) the CLIA regulations, which are reflected in the JC standards 2) the AABB standards, which are included in the JC’s lab accreditation process 3) the manufacturer’s stated recommendations Like Subhan, Sawchuk also cites CLIA’s CFR 493.1254 as the “go-to” reference for maintenance and function checks for lab equipment and notes that section 493.1252 also has requirements pertaining to protecting equipment from electrical fluctuations. During a JC survey, Sawchuk says a hospital should provide a copy of the manufacturer’s instructions and, if they plan to do something different from those, they should explain why. And when there’s a difference in requirements among the manufacturer, JC laboratory or Lab Equipment Requirements: When Manufacturer and Joint Commission Guidelines Differ

What’s happening – Probing of HPA-1a antigen–antibody interaction by surface plasmon resonance technology

This brief report summarizes the use of surface plasmon resonance technology (SPRT) in probing HPA-1a antigen–antibody interactions, based on a poster presented at the 60th meeting of the American Association of Blood Banks. It was concluded that the GP purification method could affect the performance of antigen in SPRT. It also highlighted that chips immobilised with Monoclonal antibody (Mab)-purified GP-IIb/IIIa work satisfactorily with both monoclonal and recombinant Abs with the appropriate concentration and binding affinity, while determination of the avidity and concentration of maternal polyclonal antibodies in respect to clinical severity on NAIT warrants further development.

Therapeutic Plasma Exchange: Core Curriculum 2008

Therapeutic Plasma Exchange: Core Curriculum 2008

Promoting Recognition and Prevention of Transfusion-Related Acute Lung Injury

CRITICALCARENURSE Vol 27, No. 4, AUGUST 2007 49 transfusion-related death in the United States, surpassing deaths caused by ABO incompatibility and bacterial contamination. The actual incidence of TRALI remains unknown in the United States; however, with improved recognition, the number of cases of TRALI reported in the literature has increased significantly since the initial case series was reported in 1985. Nevertheless, much about this clinical syndrome that may complicate blood transfusions remains poorly understood, and TRALI remains an important topic of research in transfusion medicine. In 2006, the AABB (formerly the American Association of Blood Banks) assembled a TRALI task force to develop recommendations for the prevention of TRALI. This article is a summary of AABB actions on TRALI and includes a summary of the recommendations made by the AABB task force.

Transfusion from male-only versus female donors in critically ill recipients of high plasma volume components*

To reduce the incidence of transfusion-related acute lung injury (ALI), the American Association of Blood Banks recently recommended rapid implementation of strategies to minimize transfusion of high plasma volume components, fresh frozen plasma and apheresis platelets, from potentially alloimmunized donors, especially females. The objective of this study was to evaluate the effect of transfusing components from male-only vs. female donors on development of ALI, gas exchange, and outcome in critically ill patients. In this retrospective case-control study, we identified patients who received high plasma volume components from male-only donors and compared them with patients matched by severity of illness, postoperative state, and number of transfusions but who received high plasma volume components from female donors. Four intensive care units at a tertiary medical center. Critically ill patients who received >2 units of fresh frozen plasma or apheresis platelets. None. From a database of 3,567 patients who received a total of 46,101 units of fresh frozen plasma and 6,251 units of apheresis platelets, we identified 112 patients who received three or more male-only donor components and 112 matched controls. Baseline characteristics, ALI risk factors, and development of ALI were similar between the two groups. Arterial oxygenation (PaO2/FIO2) worsened after the female (mean difference -52, 95% confidence interval -14 to -91, p = .008) but not after male-only donor product transfusion (mean difference 22, 95% confidence interval -23 to 67, p = .325). Male-only component recipients had more ventilator-free days (median 28 vs. 27, p = .006) and a trend toward lower hospital mortality rates (14% vs. 24%, p = .054). In critically ill recipients of high plasma volume components, gas exchange worsened significantly after transfusion of female but not male donor components. Prospective studies are needed to evaluate the effect of recommendations by the American Association of Blood Banks on outcome of transfused critically ill patients.

A Question of Clarity: Redesigning the American Association of Blood Banks Blood Donor History Questionnaire—A Chronology and Model for Donor Screening

A new donor history questionnaire, introduced by the American Association of Blood Banks in 2004 and approved by Food and Drug Administration in 2006, is now in widespread use in the United States. The development of this questionnaire involved an in-depth look at the entire system of donor screening questions, and is notable for its use of survey design experts as well as blood banking experts, government agencies, and an ethicist who represented the public interest in developing the actual questions. The end result is a questionnaire that uses capture questions in a time bounded format, donor educational materials, and a medication deferral list. Detailed instructions for donor screeners include follow-up questions in easy-to-follow flow-charts. Most importantly, for the first time in the history of developing donor history questions, all materials were tested for donor comprehension using cognitive interview evaluation. This article discusses the development of the questionnaire, explains the methodology, and describes the thinking and rationale for decisions made during redesign of the questionnaire.