Geo-Mapping Using In-Hospital Massive Transfusion Data as a Method for Prehospital Blood Management for Trauma Patients.

Exchange transfusion remains the definitive treatment for severe neonatal hyperbilirubinaemia; yet its aetiology and outcomes in rural tropical settings are poorly characterised. This five-year retrospective analysis of 58 neonates at a North Indian rural tertiary centre reveals that Rh incompatibility accounted for 76% of cases - a striking divergence from high income-country patterns where ABO incompatibility predominates - indicating critical gaps in antenatal Rh immuno-prophylaxis. The procedure achieved a mean bilirubin reduction of 50% (424 ± 106 to 212 ± 70&mu/L, p < 0.001) with no procedure-related mortality, though clinically significant adverse events occurred in 19% of neonates. Notably, 10.2% presented with acute bilirubin encephalopathy at the time of intervention, representing potentially preventable neurological injury. These findings make a compelling case for urgent, systematic improvements in antenatal screening, Rh immuno-prophylaxis access, and early jaundice recognition in tropical resource-limited settings.

Methaemoglobin (MetHb) is an oxidised form of haemoglobin (Hb) unable to bind oxygen. Raised levels of MetHb reduce the blood's oxygen-carrying capacity, causing potentially severe hypoxaemia and possible death. The condition arises from three main pathologies: mutations in globin genes causing Haemoglobin-M, inherited deficiency of the enzyme cytochrome b5 reductase (CytB5R) responsible for reducing MetHb back into functional Hb, and exposure to some oxidising agents. Well-documented causative agents include dapsone and cocaine-derived anaesthetics, with emerging evidence highlighting an increasing contribution from recreational and non-prescribed exposures. As the concentration of MetHb level increases, the oxygen-carrying capacity of the blood decreases. MetHb levels are usually measured by co-oximetry. Patients are typically asymptomatic at MetHb concentrations <10% with symptoms developing as levels increase, including cyanosis, confusion, arrhythmias, coma and death. These features will present alongside misleadingly normal partial pressure of oxygen in arterial blood and arterial oxygen saturation values on arterial blood gas and will not improve with supplemental oxygen. Management depends on severity, with intravenous methylene blue remaining first-line treatment for symptomatic cases. Alternative therapies include high-dose vitamin C, exchange transfusion and potentially hyperbaric oxygen, although there is little evidence to suggest how these should be used. Due to the potentially confusing acute presentation of the condition, the diagnosis can easily be missed.

SCD is a prevalent genetic disorder marked by chronic complications that impact quality of life and survival. Affecting approximately 100 000 individuals in the United States and millions globally, SCD results from a mutation in the β-globin gene, leading to sickle-shaped red blood cells and subsequent vaso-occlusive episodes, hemolysis, and multiorgan damage. Despite advancements such as newborn screening and disease-modifying therapies, individuals with SCD continue to face significant long-term challenges. This review focuses on the major long-term complications of SCD, including chronic pain, mental health diagnoses, neurological deficits, infection, alloimmunization, cardiopulmonary complications, and reproductive health concerns. Pain, often a hallmark of SCD, significantly affects quality of life and requires an individualized approach to management. Depression and anxiety are prevalent and impact both psychosocial well-being and disease outcomes. Neurological complications, including stroke and cognitive deficits, pose substantial risks and require ongoing monitoring. Reproductive health concerns, such as fertility and pregnancy complications, demand careful management. Alloimmunization, a potential consequence of transfusion exposure transfusion exposure, complicates future transfusion therapy and increases the risk of delayed hemolytic transfusion reactions. Cardiopulmonary complications, including pulmonary hypertension and restrictive lung disease secondary to recurrent acute chest syndrome, are associated with increased morbidity and warrant early recognition and monitoring. This review aims to bridge the knowledge gap for general pediatricians by providing comprehensive insights into these long-term complications and offering strategies for effective management. Understanding these aspects is essential for improving patient outcomes and ensuring that pediatricians can provide informed, empathetic, and proactive care for children with SCD.

Establishing a comprehensive apheresis medicine program in a resource-constrained setting presents significant structural, financial, and logistical challenges. Despite the growing clinical importance of apheresis services globally, published experience from sub-Saharan Africa remains sparse. This study describes the 5-year operational experience of building and sustaining an Apheresis Medicine program at Next Hematology Medicare, a private hematology center in Lagos, Nigeria, including the challenges encountered, solutions implemented, and clinical outcomes achieved. A retrospective review of all apheresis procedures performed between May 2020 and December 2025 was conducted. Therapeutic apheresis procedures included automated red cell exchange transfusion (RCE), therapeutic plasma exchange (TPE) and leukocytapheresis. Donor apheresis procedures comprised single-donor apheresis platelet collections for transfusion and stem cell collection (SCC) by donors. Data on patient demographics, clinical indications, procedural outcomes, and geographic distribution of platelet delivery were collected and analyzed. A total of 2405 apheresis procedures were performed over the 5-year period. Donor apheresis platelet (AP) collection was the most frequently performed procedure (n = 1772; 73.7%), followed by RCE (n = 617; 25.7%) as the most common therapeutic apheresis modality. TPE accounted for 12 procedures (n = 12; 0.5%), while leukocytapheresis (n = 2; < 0.1%) and SCC (n = 1; < 0.1%) were performed infrequently. For AP, Sepsis/DIC was the leading transfusion indication (n = 968; 54.6%). RCE was performed predominantly for patients with sickle cell anemia (SCA), with intractable recurrent vaso-occlusive crises (VOC) being the most common indication (n = 382; 61.9%). RCE significantly reduced hemoglobin S (HbS%) from 93.13% ± 12.4% to 18.74% ± 4.2% (p < 0.001) and improved hematocrit from 16.34% ± 3.5% to 26.01% ± 4.2% (p < 0.001). TPE was primarily indicated for neurological and transplant-related conditions. Apheresis platelets were distributed nationally across all six geopolitical zones and internationally. A fully functional Apheresis Medicine program can be successfully established and sustained in a resource-constrained low- and middle-income country (LMIC) setting, delivering outcomes comparable to high-income country benchmarks. RCE showed significant hematological benefits for patients with SCA, and donor apheresis platelet delivery extended care across all Nigerian geopolitical zones. The operational framework described here, addressing funding, infrastructure, staffing, licensing, and blood safety, provides a possibly replicable model for Apheresis Medicine program development across sub-Saharan Africa.

The convergence of Advanced Maternal Age (AMA ≥ 35), In Vitro Fertilization (IVF) conception, and Placenta Accreta Spectrum (PAS) represents a clinical nexus of potentially elevated obstetric risk, hypothetically associated with a high probability of massive peripartum hemorrhage (MPH). Based on limited observational evidence, this case-based narrative review hypothesizes that this risk profile warrants protocol-driven management considerations, which are presented as hypothesis-generating rather than definitive. A 54-year-old gravida 4, para 2 (2 living children) with an IVF-conceived twin pregnancy and two prior cesarean deliveries presented at 34 1/7 weeks with catastrophic hemorrhage. Prenatal MRI confirmed placenta percreta. During a planned, coordinated admission for delivery, the patient experienced acute hemorrhage, prompting an emergency classical cesarean hysterectomy with partial cystectomy. This was performed by a multidisciplinary team employing a comprehensive hemostatic strategy including prophylactic arterial balloon occlusion, tranexamic acid, intraoperative cell salvage, and a massive transfusion protocol. Estimated blood loss was 4,500 mL. Both neonates required NICU admission but were discharged in stable condition. Based on this single case and the available observational literature (summarized in Supplementary Tables S1-S7), we hypothesize that this case exemplifies a potential the compounded pathophysiology that may amplify morbidity in the AMA/IVF/prior uterine scar risk profile. While the management principles discussed are derived from limited evidence and should be considered hypothesis-generating, they may inform care for similar high-risk patients. We suggest that effective management may include: 1)Aggressive prenatal diagnosis with early MRI where available; 2) Consideration of delivery at a Level IV center with a multidisciplinary team; and 3) Implementation of a proactive Patient Blood Management plan. These suggestions derive from limited evidence and require prospective validation.

Immunoglobulin A (IgA) deficiency is common and typically defined as <5-7 mg/dL. Individuals with absolute IgA deficiency (aIgA def) have extremely low levels, can produce allo-anti-IgA and may be at risk for anaphylactic transfusion reactions. There is no globally-accepted definition of aIgA def. We sought to determine how rare donor programmes define IgA deficiency (IgA def), how they test for it and how they manage requests for aIgA def blood products. We queried rare blood donor programmes that participate in the International Society of Blood Transfusion Working Party on Rare Donors using an email survey sent to 39 members representing 35 programmes in 28 countries. Responses were obtained from 23 programmes in 16 countries. Seventeen included IgA def as a rare phenotype, with nine classifying IgA def as levels <0.05 mg/dL. Eight of the 14 programmes indicated that fulfilment of requests for IgA-deficient products requires clinical consultation and 8 programmes require patients to have detectable anti-IgA. Programmes reported provision of a small number of IgA-deficient products in the past 5 years. While respondents from rare donor programmes in 17 countries include aIgA def as a rare blood phenotype, programmes in 5 countries do not. The level of IgA used to define IgA def varies among programmes and, in some cases, across programmes within the same country. Further study is needed to better understand IgA-mediated anaphylactic transfusion reactions. A recommendation is provided for managing transfusion support of patients considered at risk.

Trauma remains a major cause of mortality worldwide, particularly in low- and middle-income countries. Organized trauma systems and dedicated trauma services have been associated with improved outcomes; however, data from Southeast Asia remain limited. This study evaluated the impact of establishing a dedicated Trauma Surgery Unit (TSU) at a Malaysian tertiary referral center. A single-center observational study was conducted at Hospital Tuanku Ja'afar Seremban, Malaysia, comparing trauma patients managed before TSU establishment (April-June 2024) and after implementation (July 2024-December 2025). Outcomes included epidemiology, operative workload, solid organ injury management, and mortality. Trauma system interventions introduced during the study included a trauma registry, structured Trauma Team Activation (TTA) criteria, institutional trauma protocols, and a Massive Transfusion Protocol (MTP). Statistical analyses were performed using Chi-square, Fisher's exact, and Student's t-tests. A total of 1038 trauma patients were included (128 pre-unit; 910 post-unit). Blunt trauma accounted for 97.0% of injuries, with road traffic crashes comprising 90.7%. Major trauma (ISS > 15) represented 53.7% of admissions. Following TSU establishment, overall mortality decreased from 17.2% to 7.6% (p<0.001), while mortality among major trauma patients decreased from 24.4% to 13.8% (p<0.001). A total of 114 operative procedures were performed, including 67 laparotomies, with a non-therapeutic laparotomy rate of 4.5%. Among 197 blunt solid organ injuries, non-operative management was successful in 94.3% of cases. Lower overall and major trauma mortality rates were observed following the establishment of a dedicated Trauma Surgery Unit and implementation of structured trauma system initiatives. While causality cannot be inferred from this observational study, the findings support continued development and evaluation of organized trauma services in Malaysia and other middle-income healthcare settings.

IntroductionSickle cell disease (SCD) confers a three-to fivefold increase in the prevalence of intracranial aneurysms (IA). Flow diversion (FD) requires mandatory dual antiplatelet therapy (DAPT), yet perioperative transfusion to reduce hemoglobin S (HbS) risks delayed hemolytic transfusion reaction (DHTR). No guidelines address this conflict between DHTR-associated coagulopathy and mandatory DAPT. We report the largest FD series in SCD.MethodsRetrospective single-center case series of SCD patients undergoing FD for IA (2017 to 2026). Of 12 SCD patients treated for aneurysms, seven received FD and comprised the analytic cohort.ResultsSeven patients (5 HbSS, 2 HbS/β0-thalassemia; median age 38; 71% female) harbored 29 aneurysms; 12 were treated with FD across 8 procedures using 15 devices. HbS <30% was achieved in 3 of 7 (43%); one patient underwent FD at HbS 78.5% due to alloimmunization. Clopidogrel hyporesponsiveness was identified in 2 of 4 TEG-tested patients (50%). Procedure-related mortality was 14% (1/7): fatal DHTR with DIC on postoperative day 8, the first reported DHTR-DAPT collision. Procedure-related morbidity included one intraoperative thrombus and one vasospasm episode, both resolved without sequelae (2/8 procedures, 25%). Additional events included asymptomatic in-stent stenosis and delayed stroke from SCD vasculopathy. At last follow-up, 5 of 6 survivors maintained mRS 0 to 1.Discussion and ConclusionFD is technically feasible in SCD, but the 14% procedure-related mortality from a fatal DHTR exposes the unresolved conflict between transfusion-associated hyperhemolysis and mandatory DAPT. CYP2C19-mediated clopidogrel resistance and alloimmunization pose additional challenges that require predefined protocols and prospective multicenter registries.

Many mitigation processes have been introduced to reduce septic transfusion reactions (STRs) caused by the transfusion of bacterially contaminated PLTs. The efficacy of primary culture and pathogen reduction is assessed in this review using data from long-term hemovigilance programs in the US, Canada, UK, France, Switzerland, and Australia. These surveillance programs are passive, with under-reporting of cases and differences in diagnostic criteria and reporting requirements between countries and institutions, but changes in rates over time reflect changes in the incidence of reported STRs. Prior to the introduction of these mitigation methods, reported STR rates ranged from 10 to 100 per million PLT units transfused. Reported STR rates were lowered following the introduction of primary culture using aerobic culture of 8-20 mL samples of PLT pools and apheresis collections around 24 h after collection, ranging from 2 to 24 per million PLT units. Use of large volume, delayed sampling (LVDS) primary culture of 16-20 mL, using both aerobic and anaerobic culture bottles, of pools and apheresis split units performed 36-48 h after collection was associated with a further decrease in reported STR rates, ranging from 0.56 to 4 per million PLT units transfused. Pathogen reduction of apheresis and whole-blood derived PLTs using amotosalen/UVA was associated with a low incidence of reported STR rates, ranging from 0 to 1.1 per million PLT units transfused. Reported STR rates using LVDS primary culture were lower than rates using other primary culture methods, with even lower rates using the amotosalen/UVA for pathogen reduction.

Severe allergic transfusion reactions to group B/AB plasma or platelets in group O recipients are linked to α-Gal sensitization.

To compare Twin Anemia Polycythemia Sequence (TAPS) cases by treatment modality. Single-center, retrospective review of TAPS without Twin to Twin Transfusion Syndrome undergoing expectant management (EM), intrauterine transfusion +/- partial exchange transfusion (IUT/pET), fetoscopic laser surgery (FLS), or selective fetal reduction (SFR). In 52 TAPS cases, 36 (69%) were spontaneous and 16 (31%) postlaser. 15 (29%) underwent EM, 9 (17%) IUT/pET, 22 (42%) FLS, and 6 (12%) SFR. FLS and SFR groups had higher median middle cerebral artery (MCA) discordance (p=0.007). IUT/pET had later median gestational age (GA) at diagnosis (weeks): 20.9 for FLS, 18.0 for SFR, 21.4 for EM, and 25.6 for IUT/pET (p=0.001). FLS was associated with isolated polyhydramnios (p=0.027), and SFR with isolated oligohydramnios (p=0.005). Treatment to delivery interval (weeks) was 5.4 for IUT/pET, 11.0 for FLS, and 20.6 for SFR (p<0.001). Median GA at delivery was latest in SFR (p=0.003). Perinatal survival for EM, IUT/pET, FLS and SFR was 93.3%, 94.4%, 87.5%, and 50%, respectively. Gestational age, fluid abnormalities, and MCA discordance differed across treatment groups. Placentation, TAPS etiology, and coexisting sFGR were more evenly distributed across management strategies indicating they were less influential factors in management decisions. Outcomes were overall favorable and did not differ across management groups.

This study aimed to investigate the evolving data trends of the Chinese Haemovigilance Network (CHN) and provide insights into its future development. Data were collected from the CHN covering the period of 2018-2023. The data were subdivided into three phases and analysed from several aspects. We also compared the percentage distribution of adverse transfusion reactions (ATRs) between the CHN and other national haemovigilance reports. Overall, the number of hospitals participating in reporting ATRs has increased, from a total of 188 in 2018-2019 to 206 in 2020-2021 and 222 in 2022-2023. The CHN received 6410 ATRs cases: 1915 in 2018-2019, 2265 in 2020-2021 and 2230 in 2022-2023. The reports for all three phases covered 11 types of ATRs that involved transfusion of nine blood components. The highest percentage of ATRs was caused by apheresis platelets (591/1915 in 2018-2019, 756/2265 in 2020-2021 and 760/2230 in 2022-2023). In terms of ATR severity, no severity was overwhelming (91.70% in 2018-2019, 95.74% in 2020-2021 and 93.34% in 2022-2023). The CHN report showed a higher proportion of allergic reactions compared to serious hazards of transfusion. Similarly, differences in the distribution of ATRs were also observed between the CHN system and both the Australian and transfusion and transplantation reactions in patients haemovigilance systems. Over the past 6 years, the CHN has established a relatively advanced haemovigilance system. Comparison of the CHN and other national haemovigilance reports revealed differences in the classification and percentage distribution of ATRs, underscoring the need for standardized reporting to enhance global transfusion safety.

ABSTRACTMassive transfusion protocols are essential in trauma resuscitation but may inadvertently increase the risk of acute hemolytic transfusion reactions (AHTRs), which are typically caused by ABO incompatibility. Recognition is difficult because signs of hemolysis can mimic trauma‐related hemorrhage or coagulopathy. Cognitive biases in emergency decision‐making may further delay diagnosis. Although ABO‐incompatible AHTR remains exceptionally rare in trauma, it is easily overlooked in the context of polytrauma. We describe three cases of ABO‐incompatible AHTR admitted to a tertiary trauma center. First, a 52‐year‐old man with multiple injuries received three mis‐issued AB+ units instead of group O blood. He developed hemoglobinuria, coagulopathy, and fatal multiorgan failure. The second case involved an 81‐year‐old man with multiple comorbidities who underwent hip fracture fixation; due to a mislabeled admission sample, he received A+ instead of B+ blood, resulting in persistent anemia, renal failure, and death. The third case was a 30‐year‐old woman with severe head and thoracic trauma who received incompatible blood under an emergency release protocol. She developed hemolysis, neurologic decline, and sepsis, and ultimately died of multiorgan failure. In all three patients, early post‐transfusion anemia and hemodynamic instability were attributed to trauma, delaying recognition of hemolysis. AHTR may therefore be overlooked in trauma settings, where its manifestations overlap with injury‐related complications and cognitive biases such as anchoring and premature closure may impair diagnostic reasoning. Strict transfusion safety protocols, heightened vigilance when hemoglobin levels fail to rise, and awareness of cognitive errors may improve early recognition and patient outcomes.

To determine the prevalence of portal vein thrombosis (PVT) in neonates following umbilical venous catheterization (UVC), and to identify risk factors associated with PVT development in this population. Systematic review conducted in accordance with PRISMA guidelines. Prospective cohort studies assessing PVT in catheterized patients were included. Meta-analyses were performed using random-effects models for prevalence estimates and odds ratios (OR), heterogeneity assessment with Cochran's Q test and Higgins' I², and publication bias with funnel plot and Egger's test. The search identified 344 studies, of which 11 met the inclusion criteria. The sample included 1086 neonates (1052 catheterized). Abdominal ultrasound confirmed 200 cases of PVT, yielding a prevalence of 19% (range: 0% to 49%), with six studies reporting prevalence rates above 5%. Meta-analysis showed an association between PVT and blood transfusion or exchange transfusion through the umbilical catheter (p = 0.0024). There was a trend toward increased risk of PVT in neonates with sepsis (p = 0.0705), whereas catheter tip location was not associated with increased PVT prevalence, although there is a risk of bias (p = 0.4636). A wide variation in PVT prevalence was observed across the included studies. Blood transfusion through the umbilical catheter was confirmed as a risk factor, while neonatal sepsis was associated with a trend toward this outcome. These findings support the implementation of systematic abdominal ultrasound screening protocols for PVT in all neonates undergoing UVC.

In 2012, the International Society of Blood Transfusion (ISBT) formalized the JR blood group system (ISBT 032), with Jra (ISBT 032001) as its only antigen. Jra is located on a multipass membrane glycoprotein named ABCG2. ABCG2, or ATP-binding cassette subfamily G member 2, is also known as breast cancer resistance protein (BCRP) or CD338. This glycoprotein participates in various physiological, biochemical and metabolic processes in the human body. It is encoded by the ABCG2 gene, located on chromosome 4. In recent years, the ABCG2 gene variants have been gradually unraveled through the deeper study of the JR blood group system. Meanwhile, the JR blood group system is clinically important, being associated with fetal and neonatal anemia, hydrops fetalis, neonatal jaundice, hemolytic disease of the fetus and newborn (HDFN), and hemolytic transfusion reaction (HTR). Furthermore, its carrier molecule, ABCG2, is associated with hyperuricemia/gout and mirror syndrome. In addition, ABCG2 plays an important regulatory role in a variety of physiological and pathological processes, such as the regulation of uric acid metabolism, the maintenance of folate and porphyrin homeostasis, the regulation of blood-brain barrier substance exchange, and the regulation of anti-tumor drug transport and drug resistance. This study reviews the distributional characteristics, molecular biological features, immunological features and clinical significance of the JR blood group system and ABCG2.

Neonatal hyperbilirubinemia is a significant public health concern in Ethiopia, contributing to approximately 10% of neonatal mortality. This study aimed to identify the clinical outcomes and determinants of jaundice among neonates admitted to the Neonatal Intensive Care Unit (NICU) at Asella Referral and Teaching Hospital (ARTH) in South East Ethiopia. The objective of this study was to assess the magnitude of neonatal hyperbilirubinemia, its clinical outcomes, and the maternal and neonatal determinants among neonates admitted to the ARTH NICU. An institution-based retrospective cross-sectional study was conducted using systematic random sampling (K = 7), 183 neonates were selected randomly from a source population of 1,350 admissions. Data were analyzed using multivariate logistic regression to identify independent predictors of hyperbilirubinemia, with statistical significance set at p < 0.05. The prevalence of hyperbilirubinemia was 16.4%( n = 30; 95% CI: 11-21.8). Among these jaundiced neonates, 46.7% (n = 14) presented with high admission total serum bilirubin levels ranging from 15 to 19mg/dL, and 26.7% (n = 8) required exchange transfusion. Inadequate breastfeeding (AOR 9.51, 95% CI: 1.24-72.67, p = 0.030) and neonatal sepsis (AOR 3.71, 95% CI: 1.34-10.28, p = 0.012) were the primary independent predictors. The high admission bilirubin levels and significant need for exchange transfusion highlight the urgent need for universal pre-discharge screening and robust lactation support.

Selective immunoglobulin A (IgA) deficiency is the most common human immunodeficiency, affecting approximately 1 in 500-800 individuals of European ancestry. It is defined by a serum IgA level below 7 mg/dL, with normal immunoglobulin G (IgG) and immunoglobulin M (IgM) levels. Since 1968, severe allergic transfusion reactions have been reported in IgA-deficient patients, often linked to anti-IgA antibodies. This led to recommendations for using IgA-deficient blood components in affected individuals. However, due to the rarity of such reactions, standardized and evidence-based guidelines are lacking, while blood services face logistical challenges maintaining registries of IgA-deficient donors and inventories of compatible products. An international survey was conducted to assess current practices in managing IgA deficiency. The survey explored the frequency of transfusion reactions involving IgA/anti-IgA, detection methods for IgA deficiency and anti-IgA antibodies, reasons for requesting IgA-deficient products, product availability and strategies to facilitate access to IgA-deficient products. Participants from 14 countries/regions across four continents reported a wide variability in defining IgA deficiency, criteria for recommending IgA-deficient products and anti-IgA testing practices. These findings highlight the need for international reference standards and harmonized recommendations to improve the management of IgA-deficient patients. Establishing harmonized best practices and evidence-based guidelines should enhance patient safety and support clinical decision making globally.

Transfusion-associated circulatory overload (TACO) prevention requires identification of susceptible patients and enactment of appropriate mitigation strategies. We implemented a clinical decision support (CDS) tool at our institution to reduce TACO occurrence by alerting transfusing clinicians to at-risk patients. A CDS tool was designed to screen patient charts for TACO risk factors (age > 60, renal/cardiac impairment and prior TACO) at the time of inpatient blood component ordering through the electronic health record (EHR). The presence of risk factors triggered a Best Practice Advisory (BPA) pop-up featuring mitigation strategies. TACO rates and frequencies were compared pre- and post-BPA implementation using a Z-test. TACO as a proportion of transfusion reactions decreased 40% from 9.6% (406/4208) to 5.8% (47/804) in the 941 days after BPA implementation (z = 3.44, p = 0.00056). TACO frequency decreased 44% from 1 of 11.2 days to 1/20.0 days post-BPA (z = 4.00, p < 0.00001), while overall reaction frequency decreased 8% from 1 of 1.08 days to 1 of 1.17 days (z = 7.31, p < 0.00001). Among 47 post-BPA TACO events, 38 were subjected to the CDS algorithm, with the BPA firing for 4 of 36 (11%) of cases with TACO risk factors. TACO rates decreased at our institution following BPA implementation, despite BPA under-firing. Ongoing monitoring for BPA sustained effects is needed.

Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis. Hyperleukocytosis in pertussis contributes to a drastically worsened prognosis by promoting pulmonary hypertension and multiorgan failure, leading to accelerated disease progression and elevated mortality. Exchange transfusion can improve the prognosis of in children with pertussis and increase the success rate of treatment. We retrospectively analyzed 2 infants with severe pertussis treated with modified exchange transfusion. Reconstituted whole blood was prepared using O-type leukoreduced concentrated red blood cells and AB-type leukocyte-reduced, virus-inactivated fresh frozen plasma, with a red blood cell to plasma ratio of 1:1 to 2:1 and a hematocrit of 40% to 50%. The total exchange volume was 150 to 180 mL/kg (approximately twice the blood volume). After exchange transfusion, both infants showed marked reduction in white blood cell count and clinically significant improvement in dyspnea. No severe adverse reactions occurred, and both children were discharged. Modified double-volume exchange transfusion is a safe and effective treatment for infants with severe pertussis and hyperleukocytosis.