Transfusion Of Components Research Articles

Blood use and alloimmunization in myelodysplastic syndrome patients: A study of a hospital transfusion experience.

Patients with myelodysplastic syndrome (MDS) are characterized by chronic anemia and most of them require transfusion making them prone to developing transfusion dependence (TD) and inducing red blood cell (RBC) alloimmunization. Little information is available regarding the status of transfusions of MDS patients in China. Clinical history and transfusion information of MDS transfusion patients from 2004 to 2023 were collected from electronic medical and laboratory records. TD patients were divided into increased blasts (IB) and non-IB group. Blood component transfusion was evaluated and compared in different groups using Mann-Whitney and chi-square tests. A total of 893 MDS patients received a median of 13 (range, 0 - 436) RBC units and 10 (range, 0 - 216) platelets (PLT) units. Seventy-one (8%) patients formed 106 RBC specific antibodies of which Rh system was the most (82/106= 77%). Twelve patients (17%) had 14 antibodies (13%) evanescence whereas 7 patients had former antibodies reemerge. Alloimmunization was more common in female, older patients and patients with larger RBC transfusions. Among 222 TD patients, RBC transfusion and alloimmunization rate in IB group were lower than those in non-IB group whilst PLT was the opposite. Prophylactic Rh system compatible transfusion can reduce the risk of RBC alloimmunization in MDS patients' especially in TD and non-IB patients and can prevent reinduction of antibody evanescence. To our knowledge this is the first study we reveal RBC antibody induction and evanescence which may related to different disease stages and classifications of MDS patients.

Resuscitation of adult shocked trauma patients using major haemorrhage protocol guided by viscoelastic haemostatic assays versus formulaic approach.

The resuscitation of trauma patients with critical bleeding may follow a formulaic approach using high ratios of blood components or a viscoelastic haemostatic assay (VHA) guided approach. The aim of this study was to compare the two strategies for resuscitation of shocked trauma patients. This was a registry-based cohort study including shocked trauma patients from two trauma centres-one practising a formulaic approach, with VHA unavailable during trauma resuscitation and the other practicing a VHA-guided resuscitation strategy. The primary outcome was the total units of blood components transfused in 24 h after adjusting for differences in baseline characteristics and time to death. Between 01 Jan 2020 and 31 Dec 2022, 152 eligible patients were categorised to the formulaic group and 40 to the VHA group. Prehospital times were longer in the formulaic group (2.0 vs. 1.4 h), and more patients in the VHA group (38% vs. 17%) were transfused prehospital blood components. Formulaic resuscitation was associated with significantly more blood components transfused (adjusted incidence rate ratio 1.5; 95%CI: 1.4-1.7, p < 0.001). Using a formulaic approach, patients were administered more red blood cells, plasma and platelets, but fewer cryoprecipitate. There was no significant association of the formulaic approach with in-hospital mortality (adjusted odds ratio 2.4; 95%CI: 0.7-8.0, p = 0.17). Given the cost and potential adverse effects of blood component transfusions, VHA-guided transfusion strategies present an attractive option, particularly among centres managing high volumes of shocked patients. Further trials, enrolling the population most likely to benefit from precision transfusion strategies, are indicated.

PIRCHE-II: a new tool to predict rejection in cardiac transplantation?

Abstract Aim This retrospective observational study aims to compare patients diagnosed with antibody-mediated or cell-mediated rejection with patients without episodes of rejection and study any predictors of rejection at follow-up with particular attention to PIRCHE-II scores. Materials and Methods We performed a retrospective evaluation of prospectively collected data of heart transplant patients from January 2022 to August 2023, at a single hospital. Preoperative, intraoperative and postoperative parameters are collected anonymously in our institutional database used for internal quality control. The primary endpoint was the incidence of rejection in one of three control endomyocardial biopsies. As pre-operative data, age, sex, BSA, blood group mismatch, risk such as dyslipidemia, hypertension, diabetes, peripheral vascular disease, COPD, previous cardiac surgery, PRA, ischemia time and post-operative infections. We evaluated patients at a mean follow-up of 106 (78 – 180) days. In patients who tested positive for cell-mediated or antibody-mediated rejection, the PIRCHE-II score was calculated. Results There were 45 patients with no diagnosis of rejection and they were aged 61 [50-65]; 22.2% were women, with a mean BSA of 1.87 ± 0.19. 22.2% had a blood type mismatch. They had a mean PIRCHE-II of 111.88 ± 43.6. There were 15 patients diagnosed with rejection and they were 63 years old [52 – 66]; 20.0% were women, with a mean BSA of 1.84 ± 0.23. 13.3% had a blood type mismatch. They had a mean PIRCHE-II of 113.70 ± 33.90. In multivariable analysis, the main predictors of rejection were plasma transfusions [OR 0.053, 95% CI, p=0.02], post-operative infections [OR 0.076, 95% CI, p=&amp;lt;0, 02] and the PIRCHE – II [OR 3.284, 95% CI, p=0.04]. The mean PIRCHE-II of patients who presented antibody-mediated or cell-mediated rejection was 113.70 ± 33.90 and that of patients who did not present any rejection was 111.88 ± 33.90; Conclusion According to the results obtained, the PIRCHE-II algorithm could be a tool in immunological risk stratification in patients undergoing cardiac transplantation. It is necessary, however, to apply PIRCHE-II to a larger number of patients and should also be considered in light of other factors such as the immunological status of the recipients, the immediate post-operative course (infections, CMV reactivation, blood component transfusions), which could constitute an immunological trigger and patient compliance in immunosuppressive therapy.Patients' featuresResuts

MODERN PARAMETERS OF LABORATORY EXPRESS DIAGNOSTICS IN INTENSIVE NEUROLOGY AND NEUROSURGICAL PRACTICE IN PATIENTS WITH CRANIOCEREBRAL INJURIES

The parameters listed in the article show the huge path that laboratory express diagnosis of emergency conditions in neurology has taken over the past 50 years. And this is not the limit - new unique technologies appear. The range of measured and calculated parameters continues to expand, which makes it possible to more fully and adequately assess the condition of a critically ill patient. Thus, a timely and qualitative study of the gaseous composition of blood is important for carrying out differential diagnosis, prescribing adequate treatment and monitoring the therapy effectiveness. The aim of the study was to highlight the current parameters of laboratory rapid diagnostics in intensive neurology and neurosurgical practice in patients with traumatic brain injury. There are two situations that necessitate the development of rapid methods for monitoring hemostasis in the neurological intensive care unit and neurosurgical operating room: the need to immediately determine the concentration or biological effect of anticoagulants. Some areas of surgical intervention are associated with increased blood loss due to coagulopathy, which requires timely replacement therapy. A long process of determining hemostatic parameters by routine methods in a general laboratory leads to a delay in diagnosis and, as a result, untimely treatment. Quite a few express methods designed to obtain specific information about the hemostasis process are currently available in the operating room. If these monitoring methods are used correctly, the research results are reliable, so some researchers use them to develop algorithms for determining the need for transfusion of blood components. However, the development of new monitoring methods requires close collaboration with scientists specialized in hemostasis, plus quality control must be established. It is necessary to prove the positive effect of rapid diagnostic methods on the result to ensure the possibility of their wide application in various operations.

Perioperative selection of blood and components for substitution: Immunohaematological assessment of immunization risk and methods for selection of optimally compatible blood

The aim of this study is to assess the risk for immune and hematologic adverse events in perioperative transfusion of blood components. Our second goal is to propose methods for the selection of an optimally compatible donor in order to limit the negative impact of complications following blood component transfusion on the hospital outcome of patients admitted to clinics of general, gastrointestinal, thoracic, and vascular surgery. The largest group of patients included in this study were patients with gastrointestinal disorders (614 patients; 31%) and patients with diseases of the organs of the blood and lymphatic system (589 patients; 30%). This was followed by patients with diseases of the skin and subcutaneous tissue (368 patients; 18%) and patients with benign and malignant neoplasms (365 patients; 18%). The remaining 65 patients (3%) were diagnosed with diseases of the endocrine system, trauma patients, and patients with genitourinary disorders. The methods used for optimal selection of compatible blood components in this study are enzyme tests, Coombs tests, and tests in agglutinating medium. The study shows that clinically significant antibodies, which could provoke a post-transfusion hemolytic reaction, were detected in 4.3% of the screened patients. In the majority of patients, the specificity of antierythrocyte antibodies cannot be established. For those patients where the specificity of anti-erythrocyte antibodies could be established, the type of antibody and the antigen system to which it belonged were as follows (in descending order): 1. Anti-erythrocyte antibodies belonging to the Rh system: 37% (n = 17) of all screened patients (1.6% of all patients), including anti-E type (5 patients), anti-D (8 patients), anti-C-1, anti-C (2 patients), and anti-Cw (1 patient). 2. In 3 (6% or anti-erythrocyte antibodies belonging to other erythrocyte antigen systems—Kidd-1 patients, Lewis-2 patients—6% of the screened patients (0.3% of all patients). 3. In 57% (n = 26) of those screened (2.4% of all patients), alloantibodies without any known specificity were identified. The largest number of identified antibodies were directed against the D antigen belonging to the Rh system. Most of the anti-D alloantibodies found in Rhesus D (-) negative patients with no history of prior transfusion of D (+) positive red blood cell (RBC) concentrate possibly have resulted from prior Rh isoimmunization during pregnancy, provided that anti-D antibodies persist for a long time after birth—in some of the studied patients, 15–20 or more years. A greater number of alloimmunizations were found in women—28 (61%), compared to men—18 (39%), due to previous sensitization with different blood group antigens during pregnancy. This study shows that timely diagnosis is essential for the selection of appropriate RBC concentrate, for the avoidance of adverse reactions, and for the improvement of hematological parameters after transfusion of blood components. Graphical abstract:

Research Progress on Prognostic Factors in Patients with Lower-Risk Myelodysplastic Syndrome--Review

Myelodysplastic syndrome (MDS) is a group of heterogeneous clonal disorders originating from hematopoietic stem cells, characterized by hemocytopenia and a high risk of transformation to acute myeloid leukemia (AML). The expected survival time of MDS patients varies widely, and accurate prognostic assessment is particularly important. Currently, patients with MDS are usually classified into a higher-risk group (HR-MDS) and a lower-risk group (LR-MDS) based on clinical prognostic scoring systems, but these scoring systems have certain limitations. Patients with LR-MDS account for 2/3 of MDS patients, with a lower risk of disease progression and a better prognosis, and their treatment mainly relies on erythropoiesis-stimulating agents, immunosuppressants and component transfusion. However, some LR-MDS patients still have poor prognosis, and the existing prognostic scoring systems cannot accurately evaluate their prognosis. In this review, the potential factors that may influence the prognosis of MDS patients beyond the existing assessment criteria were briefly summarized, with the aim of providing reference for the prognosis evaluation and treatment of LR-MDS patients.

Assessment of Blood Products Transfusion in Tertiary Neonatal Intensive Care Units Ain Shams University

Abstract Background Preterm Neonates, especially very low birth weight infants, remain a category of patients with high transfusion needs. Appropriate transfusion of neonates is vital when the potential clinical benefit outweighs the risk. However, the association between transfusion and adverse outcomes remains inconclusive. Aim Of The Work To evaluate transfusion practices in Tertiary Neonatal Intensive Care Units at Ain Shams University. Patients and Methods A cross sectional observational study was conducted on patients selected from Tertiary Neonatal Intensive Care Units at Ain Shams University- Children’s hospital. There were 703 neonates (29.64%) who received at least one type of blood products (packed red blood cells, platelets, fresh frozen plasma or cryoprecipitate) transfusion or underwent exchange transfusion during their hospital stay. All neonates receiving blood products transfusions were assessed for full history taking, clinical parameters i.e. gestational age, birth weight and general examination, indications for admission whether medical or surgical indications. Co-morbid illness such as bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, sepsis and patent ductus arteriosus were also noted. In addition, the indications for each of blood products transfusion i.e. anemia, exchange transfusion, thrombocytopenia, sepsis or other indications. Then, the requisition was assessed for pre- and post-transfusion laboratory parameters. Results Packed red blood cell was the most frequent blood component transfused (82.4%) and the main indication was anemia of prematurity (34.8%). There was a highly statistically significant increase in each of hemoglobin and hematocrit (HCT) post transfusion (with P value &amp;lt;0.0001) and a highly statistically decrease in the required median fraction of inspired oxygen (FiO2) (with P value &amp;lt;0.0001). 681 neonates (96.9%) presented with comorbidities; the most common comorbidity was neonatal sepsis in 81.2%. Packed red blood cells (PRBCs) transfusions were highly statistically significant related to comorbidity development. Conclusion Majority of blood transfusions occur during the first 2 weeks of life. Gestational age, birth weight, underlying disease of neonates, the need for oxygen support and blood collection within first two weeks of birth influence their transfusion needs. Sepsis remains the foremost etiological factor for blood component transfusion.

Comparative Study between Incidence and Risk Factors of Major and Minor Infections in Early Post-Operative Course of Pediatric Cardiac Surgery: A Single Center Study

Abstract Background Nosocomial infections (NI) also termed as healthcare-associated infections (HCAIs) include infections that are acquired from a hospital or other health care centers, which appear for the first time within 48 hours of hospital admission, 3 days of discharge or 30 days of operation. However, in some cases, the NIs occur within 30 days after discharge, such as surgical site infections. Aim of the Work Primary aim: Identifying the frequency and risk factors of major and minor infection in the early postoperative course of pediatric cardiac surgery. Secondary Aim Identifying the most prevalent isolated microorganisms and the antimicrobial susceptibility pattern. Tertiary Aim Highlighting the points of improvement to reduce the incidence of post- operative infection in the center of study. Patients and Methods This study is a prospective cohort observational study conducted on patients who were admitted at post-operative Cardiac Pediatric Intensive Care Unit at Ain Shams University Hospitals over 6 months from May 2022 to November 2022. Results The study included 60 pediatric patients (32 males and 28 females) who underwent cardiac surgical intervention for congenital heart disease with ages ranging from 1 to 168 months and a median age of 30 months (IQR between 12 and 108 months). Out of 60 patients, 15% had postoperative major infections, 13.3% had minor infections and the rest (71.7%) developed neither major nor minor infection during the early post-operative period. The most common risk factors of infection (either major or minor) were the long duration on mechanical ventilation, central venous catheterization and postoperative need for blood transfusion (packed RBCs, plasma, PLT transfusion). Of the 350 collected culture samples;23 were positive (incidence 6.5%). The most common isolated gram positive organisms were staph aureus (incidence 1.1%), the most common isolated gram negative organisms were Klebsiella ssp (incidence 2.2%) followed by acintobater cepacia (incidence 1.4%) then E. coli (incidence 1.1%). No isolation of fungal infection was found. Regarding antimicrobial susceptibility pattern of these microorganisms, we found that they were sensitive to different spectrum of antibiotics. Factors assessing in decreasing the risk factors of major and minor infections during post-operative period included: early diagnosis of the type of organism responsible for nosocomial infection and early treatment with suitable antibiotics. Conclusion Major postoperative infections caused adverse outcomes in pediatric cardiac surgery and were associated with longer hospital stay. Blood components transfusions, duration of mechanical ventilation and central venous catheterization were associated with higher rates of nosocomial infections.

Trial Of Pathogen-reduced Cryoprecipitate vs. Cryoprecipitated AHF to Lower Operative Transfusions (TOP-CLOT): study protocol for a single center, prospective, cluster randomized trial

BackgroundIntraoperative hemorrhage in cardiac surgery increases risk of morbidity and mortality. Low pre-operative and perioperative levels of fibrinogen, a key clotting factor, are associated with severity of hemorrhage and increased transfusion of blood components. The ability to supplement fibrinogen during hemorrhagic resuscitation is delayed 45–60 min because cryoprecipitated antihemophilic factor (cryo AHF) is stored frozen, due to a short post-thaw shelf life. Pathogen Reduced Cryoprecipitated Fibrinogen Complex (INTERCEPT Fibrinogen Complex, IFC) can be kept thawed, at room temperature, for up to 5 days, making it possible to be immediately available for hemorrhaging patients. This trial will investigate if earlier correction of acquired hypofibrinogenemia with IFC in hemorrhaging cardiac surgery patients reduces the total number of perioperatively transfused allogeneic blood products (red blood cells, plasma, and platelets) as compared to cryo AHF.MethodsThis is a single center, prospective, cluster randomized trial with an adaptive design. Acquired hypofibrinogenemia will be assessed by rotational thromboelastometry (ROTEM) and the threshold for cryo AHF/IFC transfusion defined as FIBTEM A10 ≤ 10 mm in bleeding patients. IFC/cryo AHF will be randomized by 1-month blocks. Cardiac surgery patients will be enrolled in the study if they have an eligible procedure and at least one dose of a cryo AHF/IFC product (approximately 2 g fibrinogen) is transfused. Data from the electronic health record, including the blood bank and lab information systems, will be prospectively collected from the health system’s data warehouse.DiscussionThis trial aims to provide evidence of the clinical efficacy of utilizing readily available thawed IFC during acute bleeding in the cardiac surgery setting compared to traditional cryo AHF.Trial registrationClinicalTrials.gov NCT05711524. Feb 3, 2023.

Impact of Type and Screen Method on Turnaround Time and Man-Hour Utilization Compared to Conventional Coomb's Crossmatch: A Cross-Sectional Analytical Study.

Background Blood component transfusion is vital for various medical conditions, requiring thorough pretransfusion testing to ensure safety and compatibility. The Type and Screen (T and S) method allows for efficient detection of clinically significant antibodies while reducing unnecessary crossmatching. This study evaluates T and S's impact on turnaround time and man-hour utilization compared to conventional crossmatching. Methodology The study included 835 elective crossmatch requests. Blood grouping, antibody screening, and antihuman globulin (AHG) crossmatching were performed using column agglutination technology, while immediate saline crossmatching was done by tube technique. Turnaround time (TAT), man-hour utilization, and saved rates were calculated for both the T and S protocol and routine AHG crossmatch. Results In this study, 835 elective blood samples underwent antibody screening and immediate saline phase crossmatching, with validation by AHG phase crossmatch. The T and S protocol significantly reduced TAT for both first (51.24 vs. 71.56 minutes) and subsequent transfusions (17.47 vs. 39.67 minutes) compared to AHG crossmatching, with reductions being statistically significant (p < 0.0001). T and S also saved 279.28 man-hours (11.6 man-days), equating to 0.33 man-hours saved per sample. Conclusion Our study shows that the T and S protocol significantly enhances blood bank efficiency by reducing TAT and man-hour utilization compared to conventional AHG crossmatching. This improvement not only optimizes manpower but also makes the process more cost-effective.

Retrospective Analysis of Transfusion-Related Adverse Reactions: A 15-Month Study of a Single Center’s Experience

The aim of this study was to evaluate transfusion-related adverse reactions (TRARs). In this study, all adverse reactions (ARs) related to blood/blood product transfusions conducted between 01.01.2022 and 31.03.2023 at the Health Sciences University Türkiye, Adana City Training and Research Hospital were evaluated. In total, 97,926 records of blood and blood component transfusions were evaluated during the study period. The distribution of blood components used was as follows: 57,066 (58.2%) red blood cell concentrates, 27,345 (28%) fresh frozen plasma, 12,282 (12.5%) pooled platelet concentrates, 564 (0.6%) apheresis platelet concentrates, and 669 (0.7%) cryoprecipitates. In total, 40 AR reports were associated with transfusions. The probability levels of the relationship degrees of reactions for these 40 cases were as follows: 2 cases; not likely (5%); 32 cases; likely (80%); 2 cases; highly likely (5%); and 4 cases, unassessable (10%). All unwanted reactions were acute, and there were no delayed reactions. No transfusion reaction (TR) leading to death occurred. Of the patients who developed reactions, 60% (n=24) were female, and 40% (n=16) were male. The ages of patients with unwanted reactions ranged from 2 to 86 years, with a median age of 33. Among the cases with unwanted reactions, 8 were children (20%) and 32 were adults (80%). In our study, the frequency of allergic TR was 8.1 per 100,000 children and 32.6 per 100,000 adults. A statistically significant difference in the distribution of blood component types among cases based on the types of unwanted reaction was observed (p=0.003). In this retrospective evaluation of 15 months of data from a single center, 97,926 blood component transfusions were performed, and the prevalence of TRAR was 40.8 per 100,000 blood components.

Effectiveness of Structured teaching program on Knowledge and Practice of Blood and Blood components Transfusion among Staff Nurses

Background: Blood is a collection of cells that have been specialized to perform a set oftasks within an organism. It is described as the fluid connective tissue that carriesoxygen and nutrients to the body. It is straw in colour, the average volume of blood inthe human body is 5 litres generally, the PH of blood is 7.4, which is slightly alkaline. The blood comprises 8% of our total body weight. It is composed of plasma, about 55% and 45% cells, respectively. Blood transfusion is when apatient receives a blood product through an intravenous line or the introduction of newmatching blood into the bloodstream or/and of any specific blood components. Objectives: The study aimed to assess the knowledge and practice of a structured teaching programme on blood and blood components among staff nurses. Methods: 50 Staff nurses were selected by a non-probabilityconvenient sampling technique. Quasi-experimental design with one grouppre-test and post-test design was used. The tools used to collect the data consisted of a structuredknowledge questionnaireand structured practice scale on blood and blood component transfusion. The reliability was checked using test-retest method showed that the tools were highly reliable. Results: The good knowledge score was increased from pretest (12%) to posttest (32%). Moderate practice score was increased from pretest (50%) to posttest (78%). There was a significant difference (p&lt;0.05) between mean pretest knowledge and practice scores with mean post test knowledge and practice scores. So, the structured teaching program was effective in improving the knowledge and practice of staff nurses regarding blood and blood components. The Chi-square test showed that there was a significant association with knowledge and gender, practice and marital status, education. The other variables are not showing association. Conclusion: The findings revealed thatstaff nurses’ knowledge and practice regarding bloodand blood components transfusion wasimproved after the teaching program.

Assessing the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease: a European perspective.

Several countries have recently reassessed the international risk of variant Creutzfeldt-Jakob disease (vCJD) transmission through transfusion of blood and blood components (red blood cells, platelets and plasma) and relaxed donor deferrals based on geographic and transfusion exposure in countries formerly considered to be high risk, such as the UK. In this regard, the European Blood Alliance organised a consensus meeting of experts and involved professionals to discuss current knowledge, epidemiological data, prevention and various methods for assessing the risk of transfusion-transmitted vCJD, as well as to develop an appropriate position on possible approaches to address these challenges in Europe. Participants reached a consensus that the current risk of transfusion-transmitted vCJD associated with blood donors who either travelled to or received transfusions in the UK during the vCJD outbreak is minimal. In addressing such risks, it would be pragmatic that assessments and guidelines are developed by European expert bodies, rather than individual assessments by Member States. Regardless of the approach used, European or national, a qualitative risk assessment based on a review and analysis of available data, considering all the uncertainties and experiences of other countries, would provide crucial information to reassess blood donation strategies regarding the transfusion-associated vCJD risk.

Whole Blood Program: Implementation in a Rural Trauma Center

BACKGROUND: The balanced transfusion of blood components plays a leading role in traumatic hemostatic resuscitation. Yet, previous whole blood studies have only focused on urban trauma center settings. OBJECTIVE: To compare component vs whole blood therapy on wastage rates and mortality in the rural setting. METHODS: This study was a nonrandomized, retrospective, observational, single-center study on a cold-stored whole blood program implementation for adult massive transfusions from 2020 to 2022 at a Level II trauma center. Trauma registry data determined the facility’s whole blood needs and facilitated sustainable blood supplies. Whole blood use protocols were established, and utilization and laboratory compliance for incompatible ABO antibody hemolysis was monitored and reviewed monthly at stakeholder and trauma services meetings. RESULTS: From 2018 to 2019, the facility initiated component therapy massive transfusions every 9 days (n = 41). Therefore, four units of low-titer, O-positive whole blood delivered fortnightly was determined to provide patient coverage and minimize wastage. Across the study time frame (2020–2022), there were n = 68 hemodynamically unstable patients, consisting of those receiving whole blood, n = 37, and patients receiving component therapy, n = 31. Mortality rates were significantly lower (p = .030) in the whole blood population (n = 3, 8%) compared to those solely receiving component therapy (n = 9, 29%). Wastage rates were constantly evaluated; in 2021, 43.4% was not utilized, and in 2022, this was reduced to 38.7%. Anecdotally, nurses appreciated the ease of administration and documentation of transfusing whole blood, as it negated ratio compliance. CONCLUSION: This evidence-based whole blood program provides vital care to severely injured trauma patients in a vast, rural region.

Fluid resuscitation in trauma: What you need to know.

There have been numerous changes in resuscitation strategies for severely injured patients over the last several decades. Certain strategies, such as aggressive crystalloid resuscitation, have largely been abandoned because of the high incidence of complications and worsening of trauma-induced coagulopathy. Significant emphasis has been placed on restoring a normal coagulation profile with plasma or whole blood transfusion. In addition, the importance of the lethal consequences of trauma-induced coagulopathy, such as hyperfibrinolysis, has been easily recognized by the use of viscoelastic testing, and its treatment with tranexamic acid has been extensively studied. Furthermore, the critical role of early intravenous calcium administration, even before blood transfusion administration, has been emphasized. Other adjuncts, such as fibrinogen supplementation with fibrinogen concentrate or cryoprecipitate and prothrombin complex concentrate, are being studied and incorporated in some of the institutional massive transfusion protocols. Finally, balanced blood component transfusion (1:1:1 or 1:1:2) and whole blood have become commonplace in trauma centers in North America. This review provides a description of recent developments in resuscitation and a discussion of recent innovations and areas for future investigation.

Ways to Ensure Safety in the Preparation, Storage and Transfusion of Blood Components in Blood System Diseases

Ways to Ensure Safety in the Preparation, Storage and Transfusion of Blood Components in Blood System Diseases

Perioperative use of erythrocyte-containing blood components in children during the first months of life

BACKGROUND: Anemia can be diagnosed before surgery, occur during surgical treatment, and develop and worsen in the postoperative period in children with surgical diseases. Anemia is associated with increased morbidity, severe complications, and even death after surgical treatment. AIM: This study aimed to determine the frequency and indications for transfusion of red blood cell-containing components in the perioperative period in children in the first months of life. MATERIALS AND METHODS: This cohort study included 187 children from the G.N. Speransky Children’s Hospital No. 9. The hemoglobin, hematocrit, and red blood cell levels were studied as well as the volume of intraoperative blood loss, hemodynamic parameters, the presence of hemorrhagic syndrome, and the use of adrenomimetics in the perioperative period. The stage of the perioperative (pre, intra, or post) period at which the transfusion of erythrocyte-containing components was conducted was recorded. Statistical data analysis was performed using the statistical computing environment R 4.3.0. RESULTS: The average age of the children at the time of surgery was 41 (16.5–63) days [5.9 (2.4–9) weeks]. Sixty-four (34.2%) children were in their first month of life, 72 (38.5%) in their second month, and 51 (27.3%) in their third month, and 76 (40.6%) children were premature. The surgeries were emergent and urgent in 102 (54.5%) children and planned in 85 (45.5). The hemoglobin, hematocrit, and erythrocyte levels at which erythrocyte-containing components were transfused were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively. The volume of erythrocyte-containing components was 54.0 (32.9–74.4) ml (10–30 ml/kg/child’s body weight). The need for and duration of artificial pulmonary ventilation in the postoperative period were 31 (72.1%) cases and 48.5 (22.5–190) hours, respectively, in contrast to children who did not receive transfusions of red blood cell-containing components—57 (39.6%) cases and 40 (22–96) hours. The indication for transfusion was anemia of varying degrees; however, 74.4% of children received adrenergic agonists simultaneously with transfusion to stabilize hemodynamics: dopamine monotherapy in 23 (74.2%) and combinations of dopamine and norepinephrine in 8 (25.8%) at 10 (8–12) mcg/kg/min and 0.2 (0.15–0.4) mcg/kg/min, respectively. CONCLUSION: The frequency of use of red blood cell-containing components was 23%. Threshold values for transfusion of erythrocyte-containing components Hb, Ht, and erythrocytes were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively.

Preoperative bleeding risk assessment in cardiac surgery patients

Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery.Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing components in cardiac surgery adults’. Duplicate articles were manually excluded. An additional search was performed among the reference lists of selected publications.Results. A total of 2,011 publications were found. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews, and regular reviews without language restrictions were considered based on the content of the abstract. In the second stage, for studies that passed the initial screening, decisions were made based on an assessment of the full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. Ultimately, 40 publications were included in the review.Conclusion. Preoperative bleeding risk assessment is a multimodal, interdisciplinary challenge that necessitates a patient-centered approach. It should commence at the preparatory stage and involve primary care physicians, cardiologists, surgeons, anesthesiologists, laboratory diagnostic specialists, and transfusiologists. The cornerstone of this process is the thorough collection of individual and family medical histories. Obtaining detailed information through patient involvement, utilizing bleeding risk rating scales, reviewing previous bleeding incidents, and supporting these findings with laboratory test data represent the most scientific approach to developing an individualized management plan for patients at risk of bleeding.

Identification of Babesia microti immunoreactive antigens by phage display cDNA screen.

Human babesiosis is a malaria-like illness caused by protozoan parasites of the genus Babesia. Babesia microti is responsible for most cases of human babesiosis in the United States, particularly in the Northeast and the Upper Midwest. Babesia microti is primarily transmitted to humans through the bite of infected deer ticks but also through the transfusion of blood components, particularly red blood cells. There is a high risk of severe and even fatal disease in immunocompromised patients. To date, serology testing relies on an indirect immunofluorescence assay that uses the whole Babesia microti antigen. Here, we report the construction of phage display cDNA libraries from Babesia microti-infected erythrocytes as well as human reticulocytes obtained from donors with hereditary hemochromatosis. Plasma samples were obtained from patients who were or had been infected with Babesia microti. The non-specific antibody reactivity of these plasma samples was minimized by pre-exposure to the human reticulocyte library. Using this novel experimental strategy, immunoreactive segments were identified in three Babesia microti antigens termed BmSA1 (also called BMN1-9; BmGPI12), BMN1-20 (BMN1-17; Bm32), and BM4.12 (N1-15). Moreover, our findings indicate that the major immunoreactive segment of BmSA1 does not overlap with the segment that mediates BmSA1 binding to mature erythrocytes. When used in combination, the three immunoreactive segments form the basis of a sensitive and comprehensive diagnostic immunoassay for human babesiosis, with implications for vaccine development.

Clinical benefits of parenteral iron carboxymaltose in patients with colorectal cancer: a retrospective observational study

Background. The high incidence of anemia in colorectal cancer and its severe consequences for patients determine the need for timely diagnosis and correction of this condition. At the same time, it is extremely important to choose a method for correcting anemia, allowing to achieve maximum efficiency and safety. Aim. To evaluate perioperative methods for correcting iron deficiency anemia in patients with colorectal cancer based on a comparative analysis of the clinical results of intravenous administration of iron carboxymaltose and transfusion of blood components. Materials and methods. The results of treatment of 594 patients with colorectal cancer operated on in 2022 at the department of surgical treatment methods No. 3 (abdominal oncology No. 1) of the Volgograd Regional Clinical Oncology Dispensary were studied. Stratification of patients into groups was carried out using the method of pseudo-randomization by sex and age to eliminate confounding errors. After pseudo-randomization in a 1:1 ratio, the sample of patients with anemia was divided into 2 groups (main group – 124 patients, in whose treatment blood-saving techniques and parenteral administration of iron carboxymaltose were used, and control group – 124 patients, for treatment of anemia in which transfusions of blood components were used). In 98 (39.5%) cases hemicolectomies were performed, in 88 (35.5%) – anterior resections of the rectum, in 36 (14.5%) – resections of the sigmoid colon, in 18 (7.3%) – extirpations of the rectum, in 8 (3.2%) – resection of the transverse colon, 217 (87.5%) operations were performed through laparotomy access, 31 (12.5%) using minimally invasive technologies. Results. The frequency of postoperative complications of grade III–V according to Clavien–Dindo score in the main group (4.8%, 6/124) was statistically significantly lower compared to the control group (14.5%, 18/124) [χ2=6.643; p=0.01]. Postoperative mortality in the main group was 0.8% (1/124), in the control group – 5.6% (7/124) [χ2=4.65; p=0.032]. Conclusion. The use of blood-saving technologies with parenteral administration of iron carboxymaltose in patients with colorectal cancer leads to a reduction in the number of postoperative complications and the level of postoperative mortality.