Blood Inventory Research Articles

HLA Haplotype Frequency Analysis Within India: Pre-Requisite For Bone Marrow Donor Registry and Cord Blood Bank Planning

To better plan recruitment of volunteer adult unrelated donors for a registry and umbilical cord blood donations for cord banks to supply grafts for hematopoietic cell transplantation to serve Indian transplant candidate patients, we analyzed existing HLA typing data to estimate Indian national and regional populations' HLA haplotype frequencies.Indian BMT centers, renal transplant centers, adult donor registries and cord blood banks collaborated to collect HLA typing and demographic data. We have produced a catalogue of the frequency, and regional diversity, of HLA haplotypes in the Indian population. Haplotype frequency analysis was performed on the registry datasets (N=26,239) using a maximum-likelihood method capable of providing high-resolution estimates from typing data with ambiguities. These frequencies were generated for 20 regional subgroups into cohorts defined by either geographic state or by native language; and the 14 largest groups were used to develop a computational model of match rates. Patient family typing data was used to set phase for a group of N=485 patients that was used to run searches against the NMDP registry.The match rates for Indian patients searching the NMDP USA database (over 11 million donors including DKMS) were 39.7% at the 8/8 allele level (A, B, C, DRB1 high-resolution) and 92.2% at the 7/8 level. Matching models for patients (averaged across the 14 regional subgroups) showed a match rate within India at the current registry sizes of 13.7% at the 8/8 level and 38.2% at the 7/8 level. Increasing the registry to 1,000,000 would raise this to 55.0% for 8/8 and 84.1% for 7/8. A cord blood inventory of 50,000 units would provide a match rate of 22.2% at the 6/6 level and 78.9% at the 5/6 level. Increasing to a cord blood inventory of 250,000 units would increase these match rates to 42.5% at the 6/6 level and 90.3% at the 5/6 level.These data will define the needs and serve as critical planning data to define and direct donor recruitment goals to establish an effective Donor Registry and cord blood banking facilities able to serve the needs of Indian patients who could benefit from the curative potential of transplantation. Developed data will be shared with the broader scientific community to facilitate future studies of HLA in areas such as disease association, anthropology and transplantation. Disclosures:Joshi:Manipal Hospital, Bangalore: Employment. Damodar:NARAYAN HRUDAYALAYA: Employment. Cereb:Histogenetics: Employment. Young Yang:Histogenetics: Employment. Dedhia:Marrow Donor Registry (India): Employment.

Optimizing donor selection for public cord blood banking: influence of maternal, infant, and collection characteristics on cord blood unit quality

Banked unrelated donor umbilical cord blood (CB) has improved access to hematopoietic stem cell transplantation for patients without a suitably matched donor. In a resource-limited environment, ensuring that the public inventory is enriched with high-quality cord blood units (CBUs) addressing the needs of a diverse group of patients is a priority. Identification of donor characteristics correlating with higher CBU quality could guide operational strategies to increase the yield of banked high-quality CBUs. Characteristics of 5267 CBUs donated to the Carolinas Cord Blood Bank, a public bank participating in the National Cord Blood Inventory, were retrospectively analyzed. Eligible CBUs, collected by trained personnel, were processed using standard procedures. Routine quality and potency metrics (postprocessing total nucleated cell count [post-TNCC], CD34+, colony-forming units [CFUs]) were correlated with maternal, infant, and collection characteristics. High-quality CBUs were defined as those with higher post-TNCC (>1.25 × 10(9)) with CD34+ and CFUs in the upper quartile. Factors associated with higher CD34+ or CFU content included a shorter interval from collection to processing (<10 hr), younger gestational age (34-37 weeks; CD34+ and CFUs), Caucasian race, higher birthweight (>3500 g), and larger collection volumes (>80 mL). We describe characteristics identifying high-quality CBUs, which can be used to inform strategies for CBU collection for public banks. Efforts should be made to prioritize collections from larger babies born before 38 weeks of gestation. CBUs should be rapidly transported to the processing laboratory. The lower quality of CBUs from non-Caucasian donors highlights the challenges of building a racially diverse public CB inventory.

Factors affecting red blood cell storage age at the time of transfusion

Clinical trials are investigating the potential benefit resulting from a reduced maximum storage interval for red blood cells (RBCs). The key drivers that determine RBC age at the time of issue vary among individual hospitals. Although progressive reduction in the maximum storage period of RBCs would be expected to result in smaller hospital inventories and reduced blood availability, the magnitude of the effect is unknown. Data on current hospital blood inventories were collected from 11 hospitals and three blood centers in five nations. A general predictive model for the age of RBCs at the time of issue was developed based on considerations of demand for RBCs in the hospital. Age of RBCs at issue is sensitive to the following factors: ABO group, storage age at the time of receipt by the hospital, the restock interval, inventory reserve, mean demand, and variation in demand. A simple model, based on hospital demand, may serve as the basis for examining factors affecting the storage age of RBCs in hospital inventories. The model suggests that the age of RBCs at the time of their issue to the patient depends on factors external to the hospital transfusion service. Any substantial change in the expiration date of stored RBCs will need to address the broad variation in demand for RBCs while attempting to balance considerations of availability and blood wastage.

Immunophenotypic, Proteomic and Genomic Characterization of Human Cord Blood (CB) vs Peripheral Blood (PB) CD56+dim NK Cells: A More Pro NK Phenotype in CB

The Umbilical Cord Blood Collection Program (UCBCP), administered by UC Davis Health System, is a new statewide public program designed to capture the genetic diversity of Californians through collection of cord blood units (CBUs) for unrelated transplantation. This program is funded with revenue from California state birth certificate fees. The vision for the implementation of the mission by UCBCP is to expand access to cord blood stem cells by targeting current inventory deficiencies to provide greater probabilities that people of any race or ethnicity will find an appropriately matched CBU in the National Cord Blood Inventory (NCBI). In support of these goals, the UCBCP plans to promote targeted education programs for health professionals and to utilize best practices for cord blood collections. Through this process UCBCP will facilitate the provision of high quality CBUs for transplantation, as well as promote research and development of effective treatments utilizing cord blood stem cells by making the CBUs collected that do not meet the criteria for banking available to researchers. Much progress has been made toward developing a sustainable cord blood collection program for the state over the first year. The UCBCP leadership team has been developed andwe have identified cord blood banks through an RFP bidding process that will be partnered with hospitals in various parts of the state. The UCBCP is in varying stages of contract negotiations with three of the public banks who responded to the RFP. To date negotiations are in place for California collections in Southern California to occur at five Scripps hospitals, funded in part by the UCBCP; and by collections set to begin at 13 Kaiser Hospitals, also with support from the UCBCP. In the Central Valley, a collection site is being developed in Fresno, at the Community Regional Medical Center. In the Bay area the UCBCP is in negotiations with several hospitals, including California Pacific Medical Center and Alta Bates. In the Sacramento area, the UCBCP has commitments from 2 hospitals and are seeking the same from two additional birthing centers. At UCDHS, we have received IRB approval for the program, and have now initiated cord blood collections for purposes of collector training and process validation.

The Armed Services Blood Program

The Armed Services Blood Program (ASBP) provides the farthest-reaching blood supply in the world. This article provides statistics and a review of blood operations in support of combat casualty care during the last 10 years. It also outlines changes in blood doctrine in support of combat casualty care. This is a descriptive overview and review of blood product use and transfusions used by ASBP personnel to support combat operations in Iraq and Afghanistan between October 2001 and November 2011. The ASBP initiated major changes in blood availability and age of blood in theater. In support of data published by physicians in theater, showing improved patient survival when a higher ratio of fresh frozen plasma and red blood cells (RBCs) is achieved, plus the use of platelets, the ASBP increased availability of plasma and established platelet collection facilities in theater. New capabilities included emergency collection of apheresis platelets in the battlefield, availability and transfusion of deglycerolized red cells, rapid diagnostic donor screening, and a new modular blood detachment. Forward surgical facilities that were at one time limited to a blood inventory consisting of RBCs now have a complete arsenal of products at their fingertips that may include fresher RBCs, fresh frozen plasma, cryoprecipitate, and platelets. A number of clinical practice guidelines are in place to address these processes. Changes in blood doctrine were made to support new combat casualty care and damage-control resuscitation initiatives. Despite the challenges of war in two theaters of operation, a number of improvements and changes to blood policy have been developed during the last 10 years to support combat casualty care. The nature of medical care in combat operations will continue to be dynamic and constantly evolving. The ASBP needs to be prepared to meet future challenges. Epidemiologic study, level IV.

Extensive haplotype diversity in African American mothers and their cord blood units

HLA-A, -B, -C, -DRB1, -DQB1 assignments were obtained for 374 pairs of African American mothers and their umbilical cord blood units (CBU) by DNA sequencing. An algorithm developed by the National Marrow Donor Program was used to assign 1122 haplotypes by segregation. Seventy percent of the haplotypes carried assignments at all five loci. In the remainder, alleles at various loci, most often DQB1 in 48% of the haplotypes with a missing assignment, could not be assigned due to sharing of both alleles by mother and CBU. There were 652 haplotypes carrying a unique combination of alleles at the five loci; the majority (74%) were singletons. Novel B∼C and DRB1~DQB1 associations were observed. The results show the genetic diversity in this population and provide validation for a publically available tool for pedigree analysis. Our observations underscore the need for procurement of increased numbers of units in the national cord blood inventory in order to identify matching donors for all patients requiring hematopoietic stem cell transplantation.

103-P

Aim The aims of this study were to explore haplotypic diversity within the U.S. population and to develop and validate a tool to assign haplotypes by segregation. Methods HLA-A,B,C,DRB1,DQB1 high resolution assignments were obtained for 531 pairs of mothers and their umbilical cord blood units (CBU) by DNA sequencing. An algorithm developed by the National Marrow Donor Program was used to assign 1593 haplotypes by segregation. Results 70% of the haplotypes carried assignments at all 5 loci. In the remainder, alleles at various loci, most often DQB1 in 46% of the haplotypes with a missing assignment, could not be assigned due to sharing of both alleles by mother and CBU. Of the 1120 haplotypes with all loci defined, there were 747 haplotypes observed only once in the study accounting for 66.7% of the haplotypes identified. 78 haplotypes were observed twice; one, A ∗ 01:01:01G, B ∗ 08:01:01G, C ∗ 07:01:01G,DRB1 ∗ 03:01:01, DQB1 ∗ 02:01:01G, was observed 22 times. Novel B∼C and DRB1∼DQB1 associations were observed. 320 haplotypes carried HLA-A∗02 alleles; in contrast, only single haplotypes were found carrying A ∗ 43 and A ∗ 69. Conclusions These results demonstrate the genetic diversity in this U.S. population. Our observations underscore the need for procurement of increased numbers of donors in the national cord blood inventory in order to identify matching donors for all patients requiring hematopoietic stem cell transplantation.

93-P

The HLA match rates for the populations served by the Canadian OneMatch registry have not yet been well ascertained. We aimed to use population haplotype frequencies to project HLA match rates for this registry of over 300,000 adult donors and estimate the impact of developing a new cord blood bank. We calculated high-resolution HLA A∼C∼B∼DRB1 haplotype frequencies from 141,405 OneMatch donors typed by DNA methods, resolving both allelic and phase ambiguity using the EM algorithm. Because of population substructure in Aboriginals, we divided the Aboriginal peoples of Western provinces from Eastern provinces. Using frequencies from 13 Canadian sub-populations, we estimated HLA match rates for five years of increasing adult donor registry size and for the establishment and growth of a nascent cord inventory. Matching models considered availability for adult donors and cell dose requirements for cord of 2.5 × 10 7 TNC/kg. Allele-level 8/8 HLA match rates for patients searching for adult donors ranged from 2% for Blacks to 46% for Caucasians. Estimated 7/8 match rates ranged from 12% for Blacks to 86% for Caucasians. We expect that 8/8 and 7/8 match rates will improve by 1-2% per population per year through 2019. Estimated 4/6 match rates for pediatric patients who also search the cord inventory after accrual of 20,000 units ranged from 88% for Blacks to 99% for Caucasians, a substantial marginal benefit. Continued recruitment of adult donors will improve HLA match rates at a steady pace, while development of a cord blood inventory has the potential to close current gaps in stem cell availability, especially for minorities. When analyzing indigenous populations, it is important to consider dividing populations into geographical regions to avoid error in matching models due to population substructure. Recruitment strategy must also be considered in the global context, and we encourage application of similar matching models to all stem cell registries worldwide.

What is the appropriate size of the worldwide cord blood inventory?

In spite HLA polymorphism distribution has some variations between major ethnic groups, in a US study by Beatty et al. (Human Immunology, 2000), 10 000 donors provided a 4/6 HLA‐match for patient in every group using the conventional CB match criteria (low resolution for HLA‐A,‐B and high resolution for HLA‐DRB1). This was also shown in our UK study where 10 000 randomly selected donors allowed finding a match for almost all patients (Querol, Haematologica, 2009). For better match level (5/6) a bigger inventory was required but enlarging size showed a progressive decrease on its efficiency. Thus, only 5000 units were required to find a donor for 50% of patients; but to achieve 65%, we then need to triplicate size (15 000), and growth up to 50 000, to match 80%. Further increase has only marginal benefit. We can then speculate that an optimal world size inventory be the addition of fractions of 5–15 000 donors for each major ethnic group considered, depending on their anticipated diversity, to at least provide options of finding a 5/6 donor for more than half of the patients but assuring a 4/6 match donor for almost any of them. In addition, inter‐ethnic cross matching and other HLA favorable interactions like use of HLA homozygous for mixed ethnicities, and consideration of Non‐Inherited Maternal Antigen (NIMA) match effect, if confirmed, would further increase donor availability. If we consider 23 major ethnic groups as proposed by the allele frequency net database (Gonzalez‐Galarza, Nucleic Acid Research 2011), a worldwide CB inventory would be in the region of 300 000 units. This would suffice to provide an optimal compatible donor for any patient in need. To be effective, all units within the inventory should be larger than 1·5E9 total nucleated cells (20% of those collected) to serve patients up to 100 kg using the double CBT strategy (threshold 1·5E7 TNC/kg). A central world cord blood bank may achieve this equalitarian goal with €300 million budget and a proper world distribution and size of regional collection programmes.

Red blood cell storage lesion and adverse clinical outcomes: post hoc ergo propter hoc?

Red blood cell storage lesion and adverse clinical outcomes: post hoc ergo propter hoc?

The present and the future of stem cell therapies

StemCyte is a leading Umbilical Cord Blood Stem Cell Therapy Company with one of the largest and most racially diverse Public Cord blood inventories in the world. We have been providing a life saving cellular therapy product since 2001 and have delivered high quality, HLA matched umbilical cord blood stem cells for more than 1600 transplants to 240+ of the world's leading Transplant Centers in over 30 countries. StemCyte has operations in the US, Taiwan and India and has embarked on a very deliberate strategy over the past 8 years to enhance our base business by consistently growing our revenue, year over year, while supporting research and being engaged in new clinical indications for stem cells sourced from umbilical cord blood. This presentation “The Present and Future of Stem Cell Therapies from the perspective of a Public Umbilical Cord Blood Bank CEO”; .chronicles the advances in UCB Clinical life saving applications, the current indications being explored by StemCyte and others and what we believe to be the potential uses of this rich source of adult stem cells while understanding the regulatory environment as well as the need to remain focused and sustain our ongoing business objectives.

Blood donation: survey results.

A survey of 1735 blood centers (131) and hospitals (1604) in the US showed that blood collection rate per thousand US population of donor age between 18 and 65 years decreased from 85.6 (total number of collections, 13.890) in 2004 compared to 88.0 (total number of collections, 14.259) in 2001 (2.7 % decrease). As blood utilization increases with the advent of more complex therapeutic interventions, blood collection centers are finding it difficult to maintain an adequate blood inventory because the availability of blood for transfusion is dependent on volunteer donors [1]. In the US approximately 40% of the adult population is eligible to donate blood, but just 5% about 5% do so [2]. moreover, only 3.5% of the age-eligible population donates blood in Australia. Donation anxiety due to a previous blood donation experience might be a major predictor of a donor’s future intention not to donate blood. Providing easy access to donation sites, overcoming time demands (such as scheduling appoinments for donation hours) and feeling confident for the procedure, more flexible donation hours, and increasing the number of sites where donation take place have positively influenced blood donation intentions [3]. The present study aimed to determine blood donors’ perceptions of the blood donation experience, behavioural and affective attitudes toward donation, and demographic characteristics that may influence their intention to donate blood in the future.

What Clinical Characteristics of Mothers and Babies Favorably Influence Cord Blood Potency? Defining Parameters That Can Guide Public Cord Blood Collection

Abstract 484 Background:Cord blood (CB) is a rich source of hematopoietic stem cells and provides access to transplantation for many patients who otherwise would not have a suitably matched donor. Numerous international public CB banks are actively accruing units to the public inventory. While public banking is an activity that benefits many patients by increasing access to hematopoietic stem cell transplantation, it is financially challenging to maintain operations of a public bank which must front all costs of inventory building and overall operations. It is well recognized that total nucleated cell (TNC) content as well as numbers of CD34+ and colony forming unit (CFU) cells define a superior cord blood unit (CBU). In the US, criteria defining a higher quality CBU have been established through the C.W. Bill Young Cell Transplantation Program’s National Cord Blood Inventory. Applying current criteria, only ∼40% of collected CBUs meet criteria for banking. To improve the yield of “bankable” CBUs and allow for better focus of resources, we hypothesized that certain maternal/donor characteristics may be predictive of TNC (also, CD34+ or CFU) and, therefore, be more likely to meet banking criteria. Methods:Between 9/07–7/09, CBUs donated to the Carolinas Cord Blood Bank (n=5282) and meeting criteria for public banking (n=5268) or identified for directed donation (n=14) were analyzed. Standard criteria for donor eligibility were followed, including gestational age >34 weeks, uncomplicated pregnancy and delivery, singleton birth, and maternal age ≥18 years. Technical characteristics were obtained as part of routine banking procedures (including post-processing TNC, CD34+ and CFU) and were correlated with clinical features of the mother and baby including maternal age, delivery type, baby gender, birth weight (BW), gestational age, race/ethnicity and collected CB volume. Univariate and multivariate logistic regression models were created dichotomizing for TNC, CD34+ and CFU content. Univariate and adjusted odds ratios are provided. Results:In this study cohort, the infant donors had a median gestational age and BW of 39.0 weeks (range, 34–42 weeks) and 3580g (range, 1800–5724g), respectively. Both genders were evenly represented although there were more Caucasian infants (58.9%) followed by African American (20.2%) and Hispanic (12.9%). Slightly more infants were born via vaginal delivery (59.8%) to mothers with a median age of 29 years (range, 18–53 years). The median TNC count was 11.7×108 (range, 2.9–55.5), CD34+ cells were 3.36×106 (range, 0.017–98.2) and CFU content was 34.0×105 (range, 0.6–193.3). In univariate analysis, maternal/donor characteristics that were associated with high TNC (defined as a TNC of >10×108) included Caucasian race [OR 1.29 (95%CI 1.14–1.46) p<0.0001], Caesarian delivery [OR 1.23 (95%CI 1.09–1.39) p<0.0001], higher gestational age [OR 1.16 (95%CI 1.10–1.22) p<0.0001] and BW>3500g [OR 1.86 (1.64–2.09) p<0.0001]. Conversely, African American race was a negative predictor of high TNC [OR 0.76 (95%CI 0.66–0.88) p=0.0002] while gender and Hispanic race were not significant. In multivariate modeling of TNC including maternal/donor characteristics, BW [>3500g; OR 1.75(95%CI 1.54–1.98) p<0.0001] was the best predictor of a high TNC followed by Caucasian race [OR 1.20(95%CI 1.06–1.36) p=0.004] and Caesarian delivery [OR 1.20 (95%CI 1.05–1.36) p=0.006). We also examined clinical variables predictive of a high CD34+ content (defined as >3×106). In univariate analysis, male gender [OR 1.31 (95%CI 1.19–1.49) p<0.0001], BW>4000g [OR 1.93 (95%CI 1.66–2.25) p<0.0001], older gestational age [(OR 1.19 (95% CI 1.14–1.25) p<0.0001] and Caucasian race [OR 1.18 (95%CI 1.06–1.32) p=0.003] were predictive of high CD34+ content. Interestingly, neither maternal nor donor characteristics were associated with high CFU growth in univariate or multivariate analysis. Conclusions:Maternal/donor characteristics are predictive of TNC and CD34+ in collected CBUs. However, no clinical characteristic predicted graft CFU content, the primary determinant of CBU potency. These associations could be used to prioritize donations, optimizing resource utilization and financial modeling. Of note, African American race was associated with lower TNC indicating that increased numbers of African American CBUs will need to be collected to achieve a robust inventory of higher quality units. Disclosures:No relevant conflicts of interest to declare.

Contingency planning for natural disasters

Contingency planning for natural disasters

Age of blood as a limitation for transfusion: potential impact on blood inventory and availability

Age of blood as a limitation for transfusion: potential impact on blood inventory and availability

An Empiric Model for Defining A Suitable Cord Blood Inventory Size in Brazil Using an HLA Matching Computer Program.

AbstractAbstract 3834 Introduction:Umbilical cord blood represents an alternative for patients who need Hematopoietic Cell Transplants and cannot rely on identical HLA donors. The Brazilian public cord blood consortium has been operating since 2002 with six centers to date, including the Cord Blood Bank at Albert Einstein Hospital, Sao Paulo, Brazil. However, currently there are no studies concerning the optimal size of a cord blood inventory in our country. It is difficult to define the inventory size due to the different possible levels of HLA compatibility and the minimum cellularity required for transplantation. Objective:To estimate the minimum number of cord blood units that should be stored in Brazil in order to adequately provide 4/6, 5/6 and 6/6 HLA-A, -B, -DRB1 matches for a significant percentage of patients who need stem cell transplantation. Methods:A computer program was developed to match HLA compatibilities between a group of 904 patients searching for unrelated stem cell transplantation and a database of over 10,500 Volunteer Unrelated Donors (VUD) and 1,018 cord blood units stored in the Albert Einstein Hospital Cord Bank. In sequence, the number of units necessary for different levels of matches was estimated. This database consisted of HLA-A, -B and -DRB1 typed with low resolution for class I and high resolution for class II. The sequence of individual units in the DATABASE was randomized in order to avoid any bias in the analyses caused by data clustering. Both groups of donors and patients came from varied ethnical backgrounds and live in the state of Sao Paulo, Brazil. The program compared each patient phenotype with the phenotypes of database subgroups of increasing size (500 to 11,500 at 1,000 intervals). The results were then analyzed according to: a) Likelihood of finding 4/6, 5/6, 6/6 matches using at least one cord blood unit for each patient; b) Likelihood of finding at least four compatible cord units (ie, multiple) per match for each patient. Results:For a minimum 4/6 match using at least one cord blood unit, over 82% of patients were able to find suitable units within an inventory size of 1,500 cords. That percentage raised to over 95% by increasing the inventory size to 5,500 cords. The curve grew asymptotically from that point onwards. When at least four cord units were required at the same compatibility level (4/6), over 90% of patients were able to find suitable units within an inventory size of 11,500 cords With more restrictive (5/6 or 6/6) matching requirements using at least one cord blood unit, 61,3% of patients were able to find suitable unit within an inventory size of 11,500 cords. When at least four cord units with a minimum of 5/6 match were required, only 22,8% of patients will find these amount of units in a bank with 11.500 stored units. An estimate of the need of stored cord blood units based on these analyses suggests that, considering the same genetic distribution of donors, and taking into account that only 21% of the inventory of our bank would provide > 3,0×10E7 TCN for an adult or multiple cord units for an adequate cell dosage, more than 58.000 units would be necessary to find a suitable unit with 5/6 match for 61,3% of patients. Conclusions:Despite the high degree of variability of the HLA phenotype in the studied population, it was possible to find a suitable matched cord blood unit within a relatively small inventory. That finding is true only for a low HLA compatibility level. Indeed, with only 2,600 stored units, Albert Einstein's Blood Bank has already sent 70 units for transplantation, mostly for children. However, when a higher degree of compatibility and/or a higher cellularity are necessary, the number of units in the database increases drastically. This study suggests that a minimum inventory of 58,000 cord blood units would be necessary to find a suitable match for almost two thirds of the Brazilian population. Finally, it's important to mention that this study is based on a relatively small sample and should be tested in larger studies including rare phenotypes and ethnic minorities. Disclosures:No relevant conflicts of interest to declare.

Erythropoiesis stimulating agents, blood transfusion, and the practice of medicine

Erythropoiesis stimulating agents, blood transfusion, and the practice of medicine

Impact of cytomegalovirus (CMV) antibody reflex testing in the transfusion service on management of CMV‐seronegative blood inventory

Our goal is to minimize unnecessary cytomegalovirus (CMV)-seronegative blood transfusion to preserve the CMV-seronegative blood inventory for patients who are identified as CMV seronegative. We implemented a CMV antibody reflex testing protocol for patients who require CMV-compatible blood but in whom a CMV serostatus is unknown (coded as CMVT in our computer system). A solid-phase red blood cell (RBC) adherence antibody detection system was validated to detect CMV antibodies in plasma samples (received for ABO/Rh type and RBC antibody screen) with acceptable sensitivity and specificity. We evaluated the impact of this CMV antibody reflex testing on the management of RBC and platelet (PLT) inventory for patients requiring CMV-compatible blood. Over a 16-month period, implementation of CMV antibody reflex testing identified 361 (34%) of 1063 previously CMV-untested patients who required CMV-compatible blood and who were CMV seronegative. We observed a 75% decrease in the number of CMVT patients in our data base from 190 per month before implementation to 57 at 16 months postimplementation. Consequently we reevaluated the percentage in our blood inventory of CMV-seronegative units required while potentially saving 1234 CMV-seronegative blood products (835 RBCs and 399 PLTs) each month. A strategy of performing CMV antibody reflex testing in the transfusion service allows more effective blood inventory management and control in maintaining a CMV-seronegative blood inventory dedicated for patients who truly require it.

Age of blood as a limitation for transfusion: potential impact on blood inventory and availability

Evolving concerns about storage lesions for red blood cells (RBCs) have led to ongoing trials evaluating the benefits of transfusing fresher blood to acutely ill patients. We evaluated several RBC maximum shelf lives (MSLs) and their impact on RBC availability and outdate rate. First, we determined the mean age of the RBC units in our inventory by analyzing the data set of 18,987 nonirradiated RBC units transfused at our institution from April 2008 to March 2009. Second, we determined the feasibility of issuing RBC units of a designated age to patients using the same data set. We defined six scenarios where RBC units have different MSLs: Scenarios 1, 2, 3, 4, and 5 used a MSL of 7, 14, 21, 28, and 35 days, respectively. Scenario 6 used a combination of different MSLs depending on the category of patients. RBC units spent on average 8.6 days on the shelf with a mean age of 10.2 days at delivery and 18.8 days at issue for transfusion. Using the original 18,987 data points, we observed a shortfall in the availability of RBC units, decreased by 51, 20, 10, 4, 1, and 0% and an increase in the outdate rate to 3.2, 2.2, 1.0, 0.6, 0.4, and 4.5% for Scenarios 1, 2, 3, 4, 5, and 6, respectively, compared to baseline. Changing the MSL for RBC units would require novel approaches to RBC inventory management to meet hospital demands with acceptable outdate rates.

Management of a National Blood Inventory in Peace and Disasters: The Israeli Experience

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