Irish Blood Transfusion Service Research Articles

The expanding role of blood and tissue establishments in the development of advanced therapy medicinal products

Background aimsThe relationship between blood establishments and advanced cellular therapies is evident in several European countries, with some involved in research and development and/or in manufacturing. The aim of the present study was to understand the advanced therapy medicinal product (ATMP) infrastructural, regulatory and logistic requirements needed for the Irish Blood Transfusion Service to support advanced therapeutics in Ireland. MethodsAn online survey consisting of 13 questions was distributed in a targeted manner to the identified ATMP stakeholders in Ireland, namely those working in industry, health care, regulatory agencies or education. Subject matter experts in the field were approached and interviewed to gain further insight into the relationship between blood and tissue establishments (BTEs) and ATMPs, to explore the advantages these institutions have in development and to highlight potential challenges for implementation. ResultsIn total, 84.9% of survey respondents stated that BTEs have a role in the development of advanced therapeutics. Key BTE services identified as applicable to the ATMP sector from both surveys and interviews include the provision of starting materials for research and manufacturing, donor management, use of existing quality and traceability frameworks, product logistic strategies and Good Manufacturing Practice. Challenges for BTE expansion into the sector currently include high costs associated with ATMPs, lack of expertise in these therapies, limited therapeutic populations and no national ATMP strategic plan for Ireland. ConclusionsBlood establishments have services and expertise that can be extended into the advanced therapy sector. The existing knowledge and skill base of BTEs in Ireland should be leveraged to accelerate the development of ATMP strategies for industry and healthcare.

Changing Strategies for the Detection of Bacteria in Platelet Components in Ireland: From Primary and Secondary Culture (2010-2020) to Large Volume Delayed Sampling (2020-2023).

Bacterial contamination of platelet components (PC) poses the greatest microbial risk to recipients, as bacteria can multiply over the course of PC storage at room temperature. Between 2010 and 2020, the Irish Blood Transfusion Service (IBTS) screened over 170,000 buffy coat-derived pooled (BCDP) and single-donor apheresis platelets (SDAPs) with the BACT/ALERT 3D microbial detection system (Biomerieux, L'Etoile, France), using a two-step screening protocol which incorporated primary and secondary cultures. Although the protocol was successful in averting septic transfusion reactions (STRs), testing large sample volumes at later time points was reported to improve detection of bacterial contamination. A modified large-volume delayed sampling (LVDS)-type protocol was adopted in 2020, which in the case of SDAP was applied to collections rather than individual splits (2020-2023, 44,642 PC screened). Rates of bacterial contamination for BCDP were 0.125% on Day-2, 0.043% on Day-4 vs. 0.191% in the post-LVDS period. SDAP contamination rates in the pre-LVDS period were 0.065% on Day-1, 0.017% on Day-4 vs. 0.072% in the post-LVDS period. Confirmed STRs were absent, and the interdiction rate for possibly contaminated SDAP was over 70%. In the post-LVDS period, BCDPs had a higher total positivity rate than SDAPs, 0.191% (1:525) versus 0.072% (1:1385), respectively, (chi-squared 12.124, 1 df, p = 0.0005). The majority of organisms detected were skin-flora-type, low pathogenicity organisms, including coagulase-negative staphylococci and Cutibacterium acnes, with little change in the frequency of clinically significant organisms identified over time. Both protocols prevented the issue of potentially harmful components contaminated (rarely) with a range of pathogenic bacteria, including Escherichia coli, Serratia marcesens, Staphylococcus aureus, and streptococci. Culture positivity of outdates post-LVDS whereby 100% of expired platelets are retested provides a residual risk estimate of 0.06% (95% CI 0.016-0.150). However, bacterial contamination rates in expired platelets did not demonstrate a statistically significant difference between the pre-LVDS 0.100% (CI 0.033-0.234) and post-LVDS 0.059% (0.016-0.150) periods (chi-squared = 0.651, 1 df, p = 0.42).

Putting blood donors at the heart infectious disease surveillance

Abstract Issue The emergence of SARS-CoV-2 brought with it an urgent need to generate accurate and real-time surveillance data. The Irish Blood Transfusion Service (IBTS), along with many blood establishments worldwide undertook SARS-CoV-2 serosurveillance studies using residual blood donor serum. This response highlighted the role that blood donors can play in informing public health policy. Description In September 2020 the IBTS undertook a SARS-CoV-2 seroprevalence study using blood donor specimens to track the ‘first-wave’ of the COVID-19 pandemic in Ireland. We utilised our operational capacity for sample collection and screening to quickly generate seroprevalence data. In 2021, the newly established National Serosurveillance Program (NSP) in Ireland invited the IBTS to collaborate on a SARS-CoV-2 serosurveillance study in blood donors which has continued into 2023. Results This response has led to an enhanced relationship between the IBTS and public health in Ireland and has highlighted a possible future role for the IBTS in providing ‘real-time’ seroprevalence data to policy-makers. This data can be used to inform decision-making in relation to infection prevention and control strategies including vaccination policy. Lessons This practice highlights the role that blood establishments can play in informing public health policy and indicates that this role could be expanded in the future in the cases of both emerging infections and vaccine preventable diseases. Blood donor studies offer a unique opportunity to screen healthy populations for the presence of antibodies to infections on a national level and with the opportunity for longitudinal sampling of returning donors. Key messages • The relationship between blood establishments and public health should be further explored in the future to support infectious disease surveillance programmes. • Blood donor studies can provide vital baseline data of healthy populations.

Confirmed circulation of SARS-CoV-2 in Irish blood donors prior to first national notification of infection.

IntroductionBlood donor studies offer a unique opportunity to screen healthy populations for the presence of antibodies to emerging infections. We describe the use of blood donor specimens to track the ‘first-wave’ of the COVID-19 pandemic in Ireland.MethodologyA random selection of donor samples received by the Irish Blood Transfusion Service (IBTS) between February and September 2020 (n = 8,509) were screened by multiple commercial SARs-CoV-2 antibody assays. The antibody detection rate was adjusted to the population to determine the SARS-CoV-2 seroprevalence in Ireland.ResultsSARS-CoV-2 antibody detection rose significantly during the first peak of COVID-19 infection, increasing from 0.3% in March, to 2.9% in April (p < 0.0001, The first SARS-CoV-2 antibody positive donor samples were collected on the 17th February 2020, 2 weeks prior to the first official notification. This is the earliest serological evidence of SARS-CoV-2 circulating in the Irish population. Our results also show a significantly higher antibody prevalence in the Capital city and in donors less than 40 years of age.ConclusionsThe present study demonstrates evidence of SARS-CoV-2 antibody reactivity across all age groups and counties. The critical value of blood donor seroprevalence studies is apparent in this report which identified the earliest serological evidence of SARS-CoV-2 infection in Ireland, as well as documenting the evolution of COVID-19 pandemic in Ireland over time.

A snapshot of ABO, RH, and JK blood group systems in modern Ireland.

ObjectivesThis study aimed to capture a snapshot of the Irish population to determine if there had been any changes in the ABO and RH blood group system (BGS) distribution from previous Irish studies and to establish an Irish JK BGS frequency, providing real time donor information to the Irish Blood Transfusion Service (IBTS).BackgroundIreland's population is constantly increasing and becoming more diverse, this has potential implications for the IBTS to provide blood with extended phenotypes for certain cohorts of patients.Materials and methodsAll first time blood donors had relevant testing performed in the Automated Donor Grouping (ADG) laboratory using the Beckman Coulter PK7300 analyzer with appropriate antisera by validated methods. All pertinent information and test results were categorized and analyzed.ResultsThe number of donors tested was 3427. ABO phenotype: A: 29.82%, B: 12.02%, O: 54.95% and A,B: 3.21%. RHD: 82.26%. RHCE: R1R1: 17.62%, R2R2: 2.89%, R1R2: 13.95%, R1r: 33.35%, R2r: 13.07%, Ror: 1.25%, R1RZ: 0.06%, R2RZ: 0.06%, r′r: 0.55%, r″r: 0.53%, rr: 16.66%. Kidd phenotype: Jk(a + b+): 49.63%, Jk(a‐b+): 23.34%, Jk(a + b‐): 27.02%.ConclusionThe observed frequencies for the relevant BGSs remained relatively unchanged to the prevalence values expected; however, statistically significant differences between the 2015 study and some of the previous studies were found for ABO distribution. 14.24% of the first time donors were born outside Ireland and statistically significant differences (P‐value < 0.001) were noted for aspects of the ABO and Rh phenotype distribution for the Irish born donors (BiI) vs those born outside Ireland (BoI).

Gendered Silence and Misdiagnosis in the Clinical Encounter: Celia de Fréine's Blood Debts and the Hepatitis C Scandal in Ireland

Gendered Silence and Misdiagnosis in the Clinical Encounter:Celia de Fréine's Blood Debts and the Hepatitis C Scandal in Ireland* Luz Mar González-Arias (bio) … a blood disorder is a whole body issue.Unanchored, migrant—blood is its own diaspora. sinÉad gleeson, constellations (37) The history of women's health care is characterized by silenced or heavily edited episodes that have contributed to the neglect of women's bodies and minds and accordingly prevented them from receiving the best possible treatments. As Hannah Devlin has contended, this prevailing attitude toward women's health has triggered "a string of health-care scandals over several decades" in which the voices of the patients have been consistently ignored. Ireland is no exception in this respect, and its history, both past and present, is punctuated by the silencing of women's voices and bodies in the clinical encounter. The death of Savita Halappanavar in October 2012 at Galway University Hospital—where, in spite of her physical distress and severe complications in the midst of a miscarriage, she was refused a termination of her pregnancy because there was still a fetal heartbeat—stands out among the recent failures of the Irish medical, religious, and political systems with respect to women, and it has left an indelible impact on the campaigns for reproductive justice in the [End Page 264] country (Holland). The CervicalCheck cancer controversy, which first emerged in 2018 and involved scores of women who received incorrect smear-test results; the brutal procedure of symphysiotomy, performed as an alternative to caesarean sections; and the hepatitis C scandal that will be the focus of this essay have also become paradigmatic examples of obstetric violence and gender imbalances in the medical history of Ireland. Celia de Fréine's collection Blood Debts, originally published in Irish as Fiacha Fola in 2004,1 and rendered into English by the author herself in 2014, is to date the only poetic articulation of the so-called hepatitis C scandal (also known as the Anti-D scandal) in Ireland. In the late 1970s about 1,600 Irish citizens, most of them women, were infected with a contaminated blood product: Anti-D immunoglobulin, also known as the Anti-D agent. The product was given to women with rhesus-negative blood who had given birth to rhesuspositive babies in order to prevent damage to the fetus in any subsequent pregnancies. This blood product was revolutionary in the prevention of rhesus disease, but it proved disastrous for the patients who received a batch manufactured in 1976 by the Irish Blood Transfusion Service Board (BTSB) from a donor who had infective hepatitis. A number of women were diagnosed with lupus, jaundice, fatigue, and a rash, but no connection between their illnesses and the toxic agent was initially established. The scandal, which has been referred to as "Ireland's greatest medical disaster" (Keane), was made public only in 1994 when evidence was provided that the BTSB had been alerted to the possibility of contamination yet had ignored the warning.2 De Fréine is "an inhabitant of liminal spaces" (Palacios-González and González-Arias 103), and her "creative force is to be found in the rich terrain between languages, genres, geographies, and literary [End Page 265] traditions" (González-Arias, "Afterword" 102). Although mainly known as a poet, she has also published numerous essays, worked successfully in opera and filmmaking, and published and produced numerous plays. Originally from Northern Ireland, she now divides her time between Dublin and Connemara; she has been inspired and influenced by English, Irish, French, and Eastern European literary traditions; she translates her own work from Irish into English, and most of her collections have appeared in dual-language format. De Fréine is a poet who upsets traditional boundaries, a characteristic that not only flavors the formal aspects of her work but also leaves its mark on the varied themes she has worked on, the volatile relationship between health and gender featuring prominently among them. In several of her collections, for instance, de Fréine has explored posttraumatic stress disorder and the demonstrations of extreme violence against women on the part of soldiers that...

HLAMatchmaker is effective for selecting appropriate platelet units for alloimmunised thrombocytopaenic patients who are refractory to random donor platelets.

HLAMatchmaker has been used in the Irish Blood Transfusion Service (IBTS) to select platelets for HLA-alloimmunised, platelet refractory thrombocytopaenic patients since 2006. Although available since 2002, only three studies have been published supporting the programme's effectiveness for this indication. We sought to examine increments to HLA-matched platelets (HMPs) at various matchmaker scores and to examine the impact of transfusing older platelets and ABO-mismatched platelets to this patient group. A total of 20 consecutive HLA-alloimmunised thrombocytopaenic patients were retrospectively studied. Data collected included: pre- and post-transfusion platelet count, indication for transfusion, HLAMatchmaker score, age of unit and degree of ABO mismatch. Data were also collected on the last 3 U of (RDPs). The Mann-Whitney U-test was used to compare increments between transfusion episodes of random donor platelets (RDPs) vs HMPs with matchmaker scores <3, 4-7 or >8. Increments at <2 h were available for 63 transfusion episodes. Increments at 2-24 h were available for 93 transfusion episodes. Increments were higher when transfusing HMPs than when transfusing RDPs. Increments for HMPs that were ABO mismatched were no different than for ABO-identical units, with the exception of late increments post-transfusing HMPs with a major ABO mismatch. Age of platelets did not influence increments. The use of HLAMatchmaker to select platelet units for thrombocytopaenic HLA-alloimmunised patients produced satisfactory platelet increments. When providing HLAMatchmaker-selected HMPs, ABO mismatch and the use of platelet units that are up to 7 days old should be permissible.

Hepatitis E virus infection in the Irish blood donor population.

Hepatitis E virus (HEV) Genotype 3 (G3) infection is a zoonosis that may be transmitted during the acute phase by transfusion. The aim of this study was to determine the incidence of HEV and seroprevalence among Irish blood donors. Anonymized samples from 1076 donations collected in 2012 were tested for HEV immunoglobulin (Ig)G using the Wantai enzyme-linked immunosorbent assay. A total of 24,985 anonymized donations collected between December 2013 and June 2014 were individually tested for HEV RNA using the Procleix HEV assay; reactive donations were confirmed by an in-house real-time polymerase chain reaction (PCR) test. Seroprevalence for anti-IgG was 5.3% (95% confidence interval [CI], 4.0%-6.8%), ranging from 1.1% in the 18- to 29-years age group to 33.3% in males over 60 years. HEV RNA screening of 24,985 samples yielded five PCR-confirmed donations (1:4997, 0.02%; 95% CI, 0.0065%-0.0467%), only one of which was serologically reactive (HEV IgM reactive only). Viral loads ranged from 10 to 44,550 IU/mL. Genotype analysis on three samples identified HEV G3 virus. Four of the five viremic donations were from donors in the 18- to 29-years age group (p=0.01). Seroprevalence for anti-HEV IgG was low compared to some European countries, but 1 in 5000 donations was viremic. Viremia was predominantly in younger Irish donors. After Department of Health approval the Irish Blood Transfusion Service implemented individual blood donation HEV RNA screening initially for a 3-year period from January 2016.

Transfusion-associated circulatory overload in Ireland: a review of cases reported to the National Haemovigilance Office 2000 to 2010.

Transfusion-associated circulatory overload (TACO) is an increasingly reported condition but symptoms and signs are still unrecognized. We present a review of the incidence and clinical features of TACO reported to the National Haemovigilance Office at the Irish Blood Transfusion Service. Between 2000 and 2010, a total of 1071 cases of serious transfusion-related reactions were reported, of which 221 (21%) cases were TACO. A total of 2,000,684 blood components were issued, with a TACO incidence of one in 9177. The TACO incidence per red blood cells, plasma, and platelet components issued was one in 8000, one in 16,000, and one in 57,884, respectively. The majority of cases (68%, n = 151) were elderly patients, while no sex difference was seen. Twenty-eight (13%) patients experienced severe morbidity; 31 (14%) deaths were reported, of which five (2%) were considered due to TACO and the other deaths considered due to and underlying conditions, which in most cases were cardiovascular (76%). An increased risk of mortality was found in patients on diuretics either before transfusion as part of their routine therapy or given as pretransfusion medication (odds ratio, 2.49; 95% confidence interval, 1.06-6.01). In 19 (21%) cases, TACO reaction was due to human error. The strong association between TACO and human errors supports the role of hemovigilance and of adequate transfusion medicine teaching for preventing morbidity and mortality associated with TACO.

Homozygous expression of fetal red cell antigen in donor oocyte pregnancy complicated by allo‐immunisation: are current antibody thresholds to trigger increased monitoring relevant?

Transfusion MedicineVolume 24, Issue 3 p. 182-183 LETTER TO THE EDITOR Homozygous expression of fetal red cell antigen in donor oocyte pregnancy complicated by allo-immunisation: are current antibody thresholds to trigger increased monitoring relevant? B. Doyle, Corresponding Author B. Doyle Red Cell Immunohaematology Laboratory, Irish Blood Transfusion Service, Dublin, Ireland Correspondence: Barry Doyle MSc, Red Cell Immunohaematology, Irish Blood Transfusion Service, National Blood Centre, James Street, Dublin, Ireland. Tel.: +0035314322994; fax: +0035314322709; e-mail: [email protected]Search for more papers by this authorJ. Quigley, J. Quigley Department of Transfusion Medicine, National Maternity Hospital, Dublin, IrelandSearch for more papers by this authorC. Allen, C. Allen Merrion Fertility Clinic, Dublin, Ireland Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, IrelandSearch for more papers by this authorJ. Fitzgerald, J. Fitzgerald Red Cell Immunohaematology Laboratory, Irish Blood Transfusion Service, Dublin, IrelandSearch for more papers by this author B. Doyle, Corresponding Author B. Doyle Red Cell Immunohaematology Laboratory, Irish Blood Transfusion Service, Dublin, Ireland Correspondence: Barry Doyle MSc, Red Cell Immunohaematology, Irish Blood Transfusion Service, National Blood Centre, James Street, Dublin, Ireland. Tel.: +0035314322994; fax: +0035314322709; e-mail: [email protected]Search for more papers by this authorJ. Quigley, J. Quigley Department of Transfusion Medicine, National Maternity Hospital, Dublin, IrelandSearch for more papers by this authorC. Allen, C. Allen Merrion Fertility Clinic, Dublin, Ireland Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, IrelandSearch for more papers by this authorJ. Fitzgerald, J. Fitzgerald Red Cell Immunohaematology Laboratory, Irish Blood Transfusion Service, Dublin, IrelandSearch for more papers by this author First published: 26 March 2014 https://doi.org/10.1111/tme.12117Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume24, Issue3June 2014Pages 182-183 RelatedInformation

The efficacy of fibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage – an observational study

Fibrinogen replacement is critical in major obstetric haemorrhage (MOH). Purified, pasteurised fibrinogen concentrate appears to have benefit over cryoprecipitate in ease of administration and safety but is unlicensed in pregnancy. In July 2009, the Irish Blood Transfusion Service replaced cryoprecipitate with fibrinogen. To examine the impact of this externally imposed change on blood product use and clinical outcomes in MOH. Women with MOH requiring fibrinogen between 1 January 2009 and 30 June 2011 were identified from an MOH database. Aetiology of MOH, medical treatments, blood product use and clinical outcomes were compared between the cryoprecipitate and fibrinogen groups. Of 21 614 deliveries, 77 cases of MOH were identified. Of the 77 cases, 34 (44%) received cryoprecipitate (n = 14) or fibrinogen concentrate (n = 20). The mean (± SEM) dose utilised was 2.21 ± 0.35 pools of cryoprecipitate and 4 ± 0.8 g of fibrinogen. There was a stronger correlation between the increase in fibrinogen level and dose of fibrinogen (Pearson co-efficient 0.5; P = 0.03) than dose of cryoprecipitate (Pearson co-efficient 0.32; P = 0.3). Mean (± SEM) estimated blood loss (EBL), red cell concentrate (RCC) and Octaplas transfused were greater (but not significantly) in the cryoprecipitate group compared with the fibrinogen group; EBL = 5.2 ± 1.1 vs 3.3 ± 0.5 L (P = 0.1); RCC = 7.2 ± 1.2 vs 5.9 ± 1.0 U (P = 0.4); Octaplas = 4.1 ± 0.7 vs 3.2 ± 0.7 U (P = 0.36), respectively. Haemostasis was secured, and there were no adverse reactions or thrombotic complications. Purified virally inactivated fibrinogen concentrate is as efficacious as cryoprecipitate in correcting hypofibrinogenaemia in MOH.

Pathogen reduction: State of reflection in Ireland

The Irish Blood Transfusion Service is currently assessing the feasibility and affordability of implementing pathogen reduction for platelets in Ireland. Since 2002, almost all plasma transfused in the country has been subjected to a pathogen reduction process in the form of Octaplas™ (or Uniplas™ for group AB recipients), manufactured from plasma from donors at the South Texas Blood and Tissue Center, San Antonio, TX, USA. Pathogen reduction of platelets for Ireland is driven by two major concerns: by the need for robust systems to prevent the transmission of any emerging transfusion transmissible infections or of diseases for which we do not currently test, and by the poor sensitivity and efficacy of even the most sensitive available approaches to bacterial contamination of platelets. While the safety of blood transfusion is a matter of public safety rather than health economics, it is currently the case that money spent in Ireland on pathogen reduction of platelets will result in fewer resources available for public use elsewhere, so that detailed cost balancing is required in deciding whether or not to implement pathogen reduction. Considerations that influence the costs of implementation in our hands include the ability to discontinue platelet irradiation, the ability to maintain a single inventory from the point of view of CMV, extending storage to day 7 of shelf-life as a routine, and avoidance of travel deferrals for platelet donors.

Does fibrinogen concentrate reduce blood products use in major obstetric haemorrhage?

In July 2009, the Irish Blood Transfusion Service replaced cryoprecipitate with fibrinogen concentrate to reduce the potential risk of pathogen transmission. Fibrinogen concentrate appears to have similar efficacy in treatment...

Quality control in homograft valve processing: when to screen for microbiological contamination?

Human donor heart valves remain essential for many reconstructive heart procedures. Heart valve donations are a scarce resource which must be used efficiently and safely. Infection transmission remains a potential risk with homograft valve use. Early experience with homograft valves identified high rates of microbial contamination at collection and initiated the practise of immersion in an antibiotic cocktail. Many centres rely on the microbiology screening after exposure to the antibiotic cocktail. We in our centre accept or reject valves on the basis of the microbiology screening at the time of collection prior to immersion in antibiotic solution. We wanted to compare our rate of valve discard and the rate of microbial contamination at implant with other centres. Valves are collected for the Irish Heart Valve Tissue Bank through partnership between the National Centre for Cardiothoracic Surgery and the Irish Blood Transfusion Service. Valves are collected in a surgical theatre setting and processed in dedicated section of the Irish Blood Transfusion Board. Tissues are screening for microbiology at collection and also at implantation. A total of 564 human heart valves and valve conduits were processed through the service during the study period. 167 (29.6%) were discarded during the processing and storage stages. The major reason for this in 117 cases was unsatisfactory microbiology on initial tissue screening. Repeat screening of accepted valves at the time of implantation identified positive cultures in only 0.9%. Optimal use of these limited resources is clearly important. However recipient safety remains paramount. One-fifth of collected valves are discarded at the processing stage due to positive microbiology screening. This is a higher rate of discard then other centres which reject 5.6-10% due to positive microbiology. However our rate of contamination at time of implant is lower then the 3% rate reported elsewhere. We are satisfied that our current discard rate, although significant, reflects rigorous quality control and the optimal balance between valve availability and patient safety.

Transfusion Associated Circulatory Overload (TACO) Incidence and Risk Factors.

Abstract 3157Poster Board III-94 IntroductionTransfusion circulatory overload (TACO) is a complication of transfusion, often confused with transfusion acute lung injury (TRALI), and is probably under-reported. The pathophysiology is believed to be caused by increased hydrostatic blood pressure leading to fluid leakage in the alveolar space, emulating congestive cardiac failure. We report on a large cohort of TACO cases in Ireland. MethodsAll consecutive TACO cases reported to the National Haemovigilance Office of Ireland between 2000-2008 were retrospectively reviewed. The incidence of TACO was calculated on units issued from the Irish Blood Transfusion Service (IBTS). Comparative analysis of patient demographic and clinical data was made using Fisher's exact test. Results179 TACO cases were reviewed. 149 (83%) involved red cell concentrate (RCC), platelets (PLT) n=4 (2%); fresh frozen plasma (FFP) /solvent detergent plasma (SDP) n=16 (8%); multiple components n=10 (6%). During the study period, a total 1,614,973 blood components (RCC, FFP, SDP and PLT) were issued corresponding to a TACO incidence of 1/10.000 of all components issued. TACO incidence per RCC, platelets and plasma issued was 1/8000, 1/48000 and 1/15000 respectively, excluding the cases where multiple components were transfused. While the majority of patients developing TACO were elderly (> 70years)(n= 120, 67%), up to eight cases (4%) were reported in young patients (<30 years). There was no difference in gender. An underlying cardiovascular condition was reported in 73% (131) cases. Patient outcome was specified in 178 cases. One hundred and fifty three (85%) patients recovered post reaction. However, 15 (8%) patients experienced morbidity ranging from prolonged resolution of symptoms, to myocardial infarction (n=2), cancellation of surgery (n=1), and admission to intensive care (n=4). 25 (14%) deaths were reported, and TACO was identified as possible cause of death in n=5 (2%) cases. Four of these patients were male and one patient was female. A total of 158 (88%) patients received diuretics before (n=36), during (n=26) or post (n=124). Nineteen patients (11%) did not receive diuretics; four of these patients died, one of which was possibly attributed to transfusion. Information was unavailable in two cases. Patients treated with diuretics post transfusion were more likely to survive (80% vs. 40%); however statistical significance was not reached (p=0.07). The median transfused volume was 275 mls (range 80-9500 mls). There was no statistical significance between actual time of transfusion and time over which transfusion were prescribed. Approximately 10 % (18) cases involved large volume transfusion most likely in an emergency situation. While only three of these transfusion events met the clinical definition of a massive transfusion (150mls per minute), patients in this cohort received between 300 and 8200 mls per hour. The median volume transfused was 1500mls (range 1000mls – 9500mls). Eleven (61%) patients had underlying cardiovascular conditions. Seven patients were > 70 years, all of whom had underlying cardio–vascular conditions. Four (22%) patients died, one death which was possibly attributed to transfusion, and a further three patients (17%) required admission to intensive care. Four (22%) cases involved young female patients (age < 30 years) who had no underlying cardiovascular condition, but one patient had asthma. These patients were being treated for obstetric bleeding, and all recovered. ConclusionThis study reports a TACO incidence of 1 /10 000 units issued from the IBTS. Although this incidence is based on units issued rather than transfused, it probably reflects significant underreporting, and perhaps even under-recognition. This study identified TACO has significant impact on patient outcome with approximately 8% (15) of patients suffering significant morbidity and a further 2% (5) of patients dying following onset of TACO. Finally, patients receiving large volume transfusion in emergency situations even young patients are at risk of developing TACO. DisclosuresNo relevant conflicts of interest to declare.

Persistent circulating unmetabolised folic acid in a setting of liberal voluntary folic acid fortification. Implications for further mandatory fortification?

BackgroundIreland is an example of a country that has extensive voluntary fortification with folic acid. After a public consultation process, in 2006, the Food Safety Authority in Ireland FSAI [1] recommended mandatory fortification. However due to safety considerations this decision is now on hold. Before mandatory fortification goes ahead, existing levels of unmetabolised folic acid and their anticipated increase after fortification needs investigation because of the potential of folic acid to mask pernicious anaemia and possibly accelerate the growth of existing cancers. The aim of this study was to examine the levels of circulatory unmetabolised folic acid in Irish adults (both fasted and un-fasted) and new-born infants (fasted) before the proposed implementation of mandatory folic acid fortification. A secondary aim was to predict the increase in circulatory unmetabolised folic acid levels after fortification.MethodsStudy 1. Setting: Irish Blood Transfusion Service (IBTS). Whole blood samples were collected from blood donors (n = 50) attending for routine blood donation sessions (representing the general population). Subjects were not fasted prior to sampling. Study 2. Setting: Coombe Women's and Infant's University Hospital, Dublin. Whole blood samples were collected by venipuncture from mothers (n = 20), and from their infant's umbilical-cords (n = 20) immediately after caesarean section. All women had been fasted for at least 8 hours prior to the surgery. A questionnaire on habitual and recent dietary intakes of folic acid was administered by an interviewer to all subjects. The data collection period was February to April 2006. Serum samples were analysed for plasma folate, plasma folic acid and red cell folate.ResultsBlood Donor Group: Circulatory unmetabolised folic acid was present in 18 out of 20 mothers (fasted) (CI: 68.3%–99.8%) comprising 1.31% of total plasma folate, 17 out of 20 babies (fasted) (CI: 62.1%–96.8%), and 49 out of 50 blood donors (unfasted) (CI: 88.0%–99.9%), comprising 2.25% of total plasma folate,ConclusionWhile the levels of circulatory unmetabolised folic acid reported are low, it is persistently present in women immediately after caesarean section who were fasting indicating that there would be a constant/habitual exposure of existing tumours to folic acid, with the potential for accelerated growth. Mandatory fortification might exacerbate this. This has implications for those with responsibility for drafting legislating in this area.

Severe gastrointestinal haemorrhage, first manifestation of neonatal haemophilia A

HaemophiliaVolume 15, Issue 3 p. 817-819 Severe gastrointestinal haemorrhage, first manifestation of neonatal haemophilia A A. PICCIN, A. PICCIN National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's Hospital Irish Blood Transfusion Service Trinity College University, Dublin, IrelandSearch for more papers by this authorA. O’MARCAIGH, A. O’MARCAIGH National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's HospitalSearch for more papers by this authorS. DEIRATANY, S. DEIRATANY National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's HospitalSearch for more papers by this authorC. MC MAHON, C. MC MAHON National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's HospitalSearch for more papers by this authorO. P. SMITH, O. P. SMITH National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's Hospital Trinity College University, Dublin, IrelandSearch for more papers by this author A. PICCIN, A. PICCIN National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's Hospital Irish Blood Transfusion Service Trinity College University, Dublin, IrelandSearch for more papers by this authorA. O’MARCAIGH, A. O’MARCAIGH National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's HospitalSearch for more papers by this authorS. DEIRATANY, S. DEIRATANY National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's HospitalSearch for more papers by this authorC. MC MAHON, C. MC MAHON National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's HospitalSearch for more papers by this authorO. P. SMITH, O. P. SMITH National Paediatric Centre for Coagulation and Haemostasis, Our Lady’s Children's Hospital Trinity College University, Dublin, IrelandSearch for more papers by this author First published: 21 April 2009 https://doi.org/10.1111/j.1365-2516.2009.01988.xCitations: 1 Dr Andrea Piccin, Irish Blood Transfusion Service, James’s Street, Dublin 8, Ireland.Tel: +353 (0) 1 432 2812; fax: +39 049 875 0693;e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume15, Issue3May 2009Pages 817-819 RelatedInformation

Phase 1 Clinical Trial of Prion-Filtered Red Cell Concentrates (pfRCC) in Patients Requiring Allogeneic Blood Transfusion.

Background; Transmission of vCJD by blood transfusion from pre-symptomatic blood donors has occurred in 4 reported cases to date. Screening blood donors for infectivity is unlikely to be feasible for several years. Removing infectivity from blood using selective filtration may provide a useful degree of protection from transfusion transmission of the disease. A filter that may remove infectivity from red cell concentrates has been developed and trialed in volunteers receiving autologous blood. No studies have been carried out to date of pfRCC in allogeneic transfusions in the clinical setting.Aims; To establish safety and tolerability of transfusion of prion filtered red cell concentrates.Methods; Twenty patients scheduled to receive transfusion were recruited following ethical approval and with informed consent. Prion filtered units were prepared by the Irish Blood Transfusion Service. A mean loss of 9 gm of haemoglobin per unit of RCC occurred during the filtration process. Each patient received one unit of pfRCC, and a median of 2 units overall (range 1 to 4 units) per transfusion episode. A cross-match sample, full blood count (FBC), renal and liver profile was taken from each patient prior to transfusion. Patients were observed for adverse reactions. After 24 hours, FBC, renal and liver profile were repeated. Six weeks after the transfusion a further sample was tested for red cell antibodies. Six of these patients have consented to undergo re-transfusion with pfRCC. Two re-infusions have taken place uneventfully six months after the first exposure to pfRCC and 4 more are planned. Results No serious adverse events were encountered during the study, or at 24 hour and 6 week follow up after the initial transfusion episode. Mean haemoglobin increment per unit transfused was 0.68g (SD 0.45g; range −0.5 to 1.35g ). Recruitment and follow-up is ongoing in patients exposed to repeat transfusion challenge. Summary The first clinical transfusions of pfRCC were well tolerated. Two patients were rechallenged with transfusions of pfRCC without adverse effect. Further studies with transfusions of prion filtered red cells are now warranted to extend the safety data and to determine whether efficacy is comparable to standard transfusions in adult and paediatric populations.

An investigation of the impact of prolonged waiting times on blood donors in Ireland

The aim of this study was to investigate the impact of prolonged queuing times on blood donors, by measuring their satisfaction levels, and positive and negative affects. As donation times have increased over the past number of years within the Irish Blood Transfusion Service, this is an important issue to examine in a climate where voluntary donors are becoming scarce and demands on people's time are increasing. Eighty-five blood donors were sampled from one urban and one rural blood donor clinic. The respondents conducted a questionnaire by means of face-to-face interview, while waiting in the clinic. The questionnaire contained the Positive and Negative Affect Scale (PANAS), and a waiting satisfaction scale. Both actual and perceived waiting times of the donors were noted. Waiting time was found to be negatively related to satisfaction. Inexperienced donors expressed higher levels of negative affect than experienced donors. Urban donors were significantly more satisfied than rural donors. There was a significant difference in perceived waiting time between lone donors and those queuing in a group, with those waiting alone perceiving their wait as shorter. While all respondents stated that they intended to donate again, over one-third stated that prolonged waiting times would be their most likely deterrent. However, only 15% stated that long queuing times might actually prevent them from donating in the future, and almost all respondents said that they would recommend donation to a friend, despite long queuing times. Although our results show that the respondents were not satisfied with current waiting times, it did not seem to affect their future intentions to donate. These findings provide some optimism for the future of blood donation in Ireland, as they suggest a strong sense of commitment to donation within the population sampled. Future research could explore the application of 'the service industry' approach to waiting times to blood donation clinics.