Transfused Patients Research Articles

The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study.

Packed red blood cell (pRBC) transfusions in patients undergoing surgery for cancer are given to treat anemia or acute hemorrhage. Evidence indicates that pRBC transfusions are associated with poor perioperative and oncological outcomes. The ARCA-1 (Perioperative Care in the Cancer Patient-1) study was designed to test the association between perioperative pRBC transfusions and postoperative morbidity and mortality in patients undergoing cancer surgery. The primary hypothesis of our study was that perioperative pRBC transfusions have a negative impact on postoperative morbidity and 1-year mortality. ARCA-1 was an international multicenter prospective observational cohort study. Participating centers enrolled a minimum of 30 consecutive adult patients with cancer who underwent surgery with curative intent. The primary end point was all-cause mortality 1 year after major cancer surgery. Secondary end points were rates of perioperative blood product use, 1-year cancer-specific mortality, overall survival, and 30-day morbidity and mortality. We performed a propensity score matching analysis to adjust for selection bias. A multivariable logistic regression model was fitted to estimate the effects of significant covariates on 1-year mortality, cancer-related mortality, and overall survival. A total of 1079 patients were included in the study. The rate of perioperative pRBC transfusions was 21.1%. Preoperative comorbidities, including anemia, American Society of Anesthesiologists (ASA) score of III to IV, a history of coronavirus disease 2019 (COVID-19), myocardial infarction, stroke, need for dialysis, history of blood transfusions, and metastatic disease were statistically significantly more frequent in transfused patients compared to nontransfused patients. The 1-year mortality rate was higher in transfused patients before (19.7% vs 6.5%; P < .0001) and after (17.4% vs 13.2%; P = .29) propensity score matching. 1-year mortality was 1.97 times higher in transfused than in no-transfused patients (odd ratio [OR], 1.97; 95% confidence interval [CI], 1.13-3.41). The odds of 1-year cancer mortality for patients who had perioperative pRBCs was 1.82 times higher (OR, 1.82; 95% CI, 0.97-3.43) compared to those who did not receive perioperative pRBC transfusion. The effect of perioperative pRBC transfusion on overall survival was also significant (hazard ratio [HR], 1.85; 95% CI, 1.15-2.99). Transfused patients also had a higher rate of 30-day postoperative mortality before (3.5% vs 0.7%; P = .0009) and after propensity score matching (4.2% vs 1.8%; P = .34). This international, multicenter observational study showed that perioperative pRBC transfusion was associated with an increased mortality risk.

Red Blood Cell (RBC) Antigen Confirmation Workflow – A Positive Impact at an Academic Medical Center

Abstract Introduction/Objective Introduction: Blood group antigens, present on the surface of red blood cells (RBCs), play a crucial role in transfusion medicine. These antigens are recognized serologically and form the basis of RBC phenotyping. Understanding the significance of antigen-negative RBCs is essential for mitigating the risk of hemolytic transfusion reactions and hemolytic disease of the fetus and newborn (HDFN). This study aims to assess the impact of implementing a new RBC antigen confirmation workflow on transfusion service efficiency and patient outcomes. Methods/Case Report Method: The study involved collaboration between our Transfusion Services Department (TS), the Blood Center supplier, and the Apheresis department. A comprehensive review of historical practices and FDA recommendations regarding RBC antigen labeling was conducted. Changes were implemented to streamline antigen confirmation testing and labeling processes. The impact on TS workload, turnaround time, and patient care metrics was evaluated. Results (if a Case Study enter NA) Results: Implementation of the new RBC antigen confirmation workflow led to a significant reduction in antigen confirmation tests performed by TS, with a 607% decrease observed from 2020 to 2023. Concurrently, the workload for reference lab workups increased by 337% over the same period. This shift in workload distribution allowed TS staff to focus more on patient reference workup cases and case review. The improved workflow efficiency resulted in enhanced turnaround times for providing patients with antigen-negative RBCs, ultimately improving the patient experience. Conclusion Conclusion: The adoption of the new RBC antigen confirmation workflow has resulted in compliance with FDA labeling requirements, efficient utilization of TS staff resources, and decreased turnaround times for blood delivery. These improvements have positively impacted patient care by ensuring timely access to compatible blood products. Future steps include developing reports to track turnaround time for patients with special blood product needs and continuing collaboration with the blood supplier and the Apheresis department to optimize inventory management and transfusion processes.

Serological Detection of Human Parvovirus B19 in Thalassemia Patients of Wasit Province

Human ParvovirusB19 is nonenvelope single-strand DNA virussfrom a family of Parvoviridae that cause infections in human, it is related strongly to thalassemia. This case control (cross sectional) aged between (5-40) study was carried out in Al-Kut teaching hospital in Al-Iraq. The populations of our study included 120 patients samples with thalassemia infected by Human Parvovirus B19 in blood transfusion patients 64 male and 56 female and ELISA test was done. The positive cases was recorded according to enzyme linked immunosorbent assay test(ELISA) as apercentage of cases related to the main characterstics of patients, current study data has been indicated as following: in a total of 120 patients sample with thalassemia were included in this study, ELISA positive cases were 13 (10.8%), 6 (5%), 2 (1.7%) and 0 (0%) in the age groups (5-15), (16-25), (26-35) and (36-45) respectively. Male was more prevalent (14 (11.7%), than female (7 (5.8%), So as to records of major type in comparision to intermediate 15 (12.5%) and 6 (5%).

Molecular Detection of Human parvovirus B19 in Patients with Thalassemia in Wasit Province, Iraq

Background: Human B19 (PVB19) isssmall, non-envelope single strand DNA viruses from family of "Parvoviridae" it cause infections in human. In thalassemia are a heterogeneous grouping of genetic disorders that result from a decreased synthesis of alpha or beta chains of hemoglobin (Hb). Numerous factors contribute to functional abnormality found in βeta thalassemia patient like decrease red cells life span, rapidsiron turnover, and tissue deposition of excess iron B19 targets the erythroid progenitors in the bone marrow by binding to the glycosphingolipid. Materials and Methods: This case cross sectional study and the patients aged between (5-40) years , study has been carried outsin Al-Kut teaching hospitals in Al-Iraq-Wasit in a period between September 2023 and March 2024. This study followed the cross-sectional design. The populations of our study included 120 patients’ samples with thalassemia infected by Human Parvovirus B19 in blood transfusion patients 64 male and 56 female. Nested-PCR used to detect of B19V by using primers. PCR reaction was done by using special sets of primers mentioned previously and special components and specific program and procedure according to components of PCR reaction. Result: Human parvovirus 19 Positive case percentage using polymerase chain reaction indicated that the positive cases was reported according to polymerase chain reaction (PCR) as a percentage of case related to the main characteristic of patients, current study data has been indicated as following: in total of 120 patient sample with thalassemia has been included in this study, PCR positive case was 17 (14.2%), 6 (5%), 2 (1.7%) and 0 (0%) in the age groups (5-15), (16-25), (26-35) and (36-45) respectively. Male was more prevalent 17 (14.2%), than female 8 (6.7%), So as to records of major type in comparision to intermediate 19 (15.8%) and 6 (5%). All positive cases were 25 cases. Conclusion: Current data showed prevalence of Human parvovirus 19 in Iraqi patients. This prevalence should be alarming public health.

Red blood cell transfusion in a tertiary Haitian hospital’s emergency department: patient characteristics and availability challenges

BackgroundRed blood cell (RBC) transfusions are essential for many patients admitted to emergency departments (ED). However, accessibility to red cell transfusions is often limited, especially in low-income countries such as Haiti. This article aims to determine the proportion of patients requiring emergency transfusion, transfused patients’ characteristics, as well as the response rate and timeliness of blood product delivery for requests made.MethodsA retrospective study was conducted among all patients with RBC transfusion indications from January to June 2022 at the ED of Mirebalais Teaching Hospital. The parameters studied included transfusion indications, pre-transfusion hemoglobin levels, and delay from prescription to transfusion.ResultsDuring the study period, 3993 patients received treatment in the ED. The proportion of patients requiring RBCs was 7.69%, including 145 males and 117 females, with a median age of 43 [30–56] years. Only 21.7% of these patients received a transfusion. The average pre-transfusion hemoglobin level was 4.75 ± 1.68 g/dL. The most common transfusion’s indications were infection/sepsis (36.74%), trauma (23.48%), and cancer (21.57%). The median time delay from prescription to transfusion was 2.37 [0.97–4.93] days. The study identified significant associations between RBC transfusion probability and patient factors like hemoglobin levels, patient disposition, urgency of RBC request, and length of stay.ConclusionRBC transfusion requests are frequent in the ED of Mirebalais Teaching Hospital, with a relatively high transfusion delay. Further studies on the relevance of RBC requests and ways to reduce delay from prescription to transfusion would be beneficial to improve this situation.

Enhancing clinical insight: Implementing validated questionnaires for comprehensive assessment of clinician expertise in transfusion medicine practices

BackgroundBlood transfusion is a cornerstone of modern healthcare, pivotal in saving countless lives annually. However, inadequate knowledge among healthcare providers can lead to serious complications. Despite the availability of assessment tools like the Biomedical Excellence for Safer Transfusion (BEST) test, there is a need for indigenous-validated questionnaires to address knowledge gaps effectively. This study aimed to evaluate bedside transfusion medicine knowledge among clinical residents using a validated questionnaire, focusing on knowledge gaps. Study design and methodsA cross-sectional study was conducted at a tertiary care referral center in Northern India. The questionnaire, developed based on national and international transfusion guidelines, was validated by an expert panel, and administered to 245 clinical residents. The questionnaire covered six domains related to transfusion medicine: blood component storage, blood bank procedures, transfusion-transmitted infections, administration of blood components, transfusion reactions, and transfusion practices. ResultsThe study revealed varying levels of knowledge across specialties and residency years. Overall, residents scored 61 % in transfusion medicine knowledge, with Pediatrics residents demonstrating the highest scores. The incremental increase in knowledge from first to third-year residents underscores the value of continuous, experience-based learning throughout the residency period. DiscussionStudy highlights significant knowledge gaps in bedside transfusion practices among clinical residents, emphasizing the need for structured educational interventions. Tailored programs, integrated into undergraduate and postgraduate curricula, are essential to improve transfusion safety and patient outcomes. Addressing these gaps can lead to better bedside transfusion practices, reducing risks and improving the quality of patient care.

The Effects of Calcium Gluconate Administration on Potassium Levels of Post Packed Red Cell (PRC) Transfusion Patients with More Than Three-Day-Stored Blood at RSUP Haji Adam Malik, Medan

Background: Blood transfusion is an important and routine medical treatment, especially in cases requiring surgeries such as trauma. One of the biochemical changes that occurs in PRC due to erythrocyte storage is an increase in potassium levels. Hyperkalemia is the most common complication of stored blood transfusion. Cardiac arrest has been widely reported in transfusion-associated hyperkalemia. Methods : This study used a pre-experimental study with a pretest-posttest group design to determine the effects of Ca gluconate administration on blood potassium levels in patients receiving packed red cell (PRC) transfusions with blood stored for &gt; 3 days at RSUP Haji Adam Malik Medan. Results : The distribution of sample characteristics in this study showed a mean age of 46 ± 13.63. There were 7 (22.6%) male and 24 (77.4%) female patients, with a mean BMI of 23.28 ± 6.44. Based on the hemodynamic profile, the mean systolic BP was 105.87 ± 20.59, diastolic BP 70.41 ± 11.94, RR 23.06 ± 2.39 and MAP 83.31 ± 14.48. The mean value of potassium levels before an administration of Ca gluconate was 5.84 ± 0.89, while the mean value after the administration was 5.43 ± 0.90. There were no statistically significant changes in the potassium levels after the administration of Ca gluconate in any samples. Conclusions : There are effects of Ca gluconate administration on the potassium levels of post Packed red cell (PRC) transfusion patients with blood stored for &gt; 3 days at RSUP Haji Adam Malik Medan.

Acetaminophen and Chlorpheniramine Maleate Premedication among Patients with Chronic Transfusion: a Prospective, Randomized Controlled Trial

Introduction: Patients with chronic transfusion, especially those with transfusion-dependent thalassemia, are susceptible to transfusion reactions. Acetaminophen and/or chlorpheniramine maleate (CPM) are commonly used as premedication in Thailand, although their efficacy in preventing transfusion reactions remains unclear. This study aims to evaluate the efficacy of acetaminophen and CPM in preventing febrile nonhemolytic transfusion reaction (FNHTR) and allergic transfusion reaction (ATR) before leukocyte-poor packed red cells (LPRC) transfusion.Methods: This study is a prospective, randomized controlled trial involving patients with chronic transfusionaged 18 years. Patients were randomly assigned to either receive oral acetaminophen and intravenous CPM or placebo (calcium carbonate and normal saline) before LPRC transfusion. The primary endpoint was the combined incidence of FNHTR and ATR amongpatients receiving premedication compared with those receiving placebo. This study was registered at Thai Clinical Trial Registry Study ( TCTR20221011002).Results: Ninety-four patients were recruited, with 46 in the premedication arm and 48 in the placebo arm. The incidence of FNHTR and allergic transfusion reaction in the premedication arm and the placebo arm was 0% and 2.1%, respectively (P = 0.33). FNHTR occurred in one patient in the placebo arm, and no patients presented ATR. No adverse events were reported with any medication.Conclusions: Among patients with chronic transfusion receiving LPRC, the incidence of FNHTR or ATR is low. Premedication with oral acetaminophen and intravenous CPM did not have benefits in preventing transfusion reactions. Therefore, acetaminophen and CPM could be safely omitted in chronic transfused patients without a history of transfusion reactions

Risk factors associated with blood transfusion in liver transplantation

To explore preoperative and operative risk factors for red blood cell (RBC) transfusion requirements during liver transplantation (LT) and up to 24 h afterwards. We evaluated the associations between risk factors and units of RBC transfused in 176 LT patients using a log-binomial regression model. Relative risk was adjusted for age, sex, and the model for end-stage liver disease score (MELD) (adjustment 1) and baseline hemoglobin concentration (adjustment 2). Forty-six patients (26.14%) did not receive transfusion. Grafts from cardiac-death donors were used in 32.61% and 31.54% of non-transfused and transfused patients, respectively. The transfused group required more reoperation for bleeding (P = 0.035), longer mechanical ventilation after LT (P < 0.001), and longer ICU length of stay (P < 0.001). MELD and hemoglobin concentrations determined RBC requirements. For each unit of increase in the MELD score, 2% more RBC units were transfused, and non-transfusion was 0.83-fold less likely. For each 10-g/L higher hemoglobin concentration at baseline, 16% less RBC transfused, and non-transfusion was 1.95-fold more likely. Ascites was associated with 26% more RBC transfusions. With an increase of 2 mm from the baseline in the A10Fibtem measurement of maximum clot firmness, non-transfusion was 1.14-fold more likely. A 10-min longer cold ischemia time was associated with 1% more RBC units transfused, and the presence of post-reperfusion syndrome with 45% more RBC units. We conclude that preoperative correction of anemia should be included in LT. An intervention to prevent severe hypotension and fibrinolysis during graft reperfusion should be explored.Trial register: European Clinical Trials Database (EudraCT 2018–002,510-13) and ClinicalTrials.gov (NCT01539057).

The prevalence of erythrocyte alloimmunization in clinical practice: A hospital-based study

Abstract BACKGROUND: One of the complications of blood transfusion is the development of red cell alloimmunization. Little published literature on the prevalence and actual significance of red cell alloantibodies among nonregularly transfused patients and the general population. OBJECTIVES: This study aimed to estimate red cell alloantibodies’ prevalence, specificity, and clinical significance in obstetric and medical practice in Iraq. MATERIALS AND METHODS: A cross-sectional hospital-based study involving internal medicine patients and ladies in obstetric wards of Baghdad Teaching Hospital in Baghdad/Iraq, from January 2022 to May 2022. Demographic data were collected along with detailed medical, obstetric, and transfusion history. Alloantibody screening was performed, and samples with positive results were subjected to antibody titration and identification. RESULTS: A total of 200 patients were enrolled. Indirect antiglobulin test was positive in 15% of patients in internal medicine wards and 23% of ladies in obstetric wards, with most of the identified alloantibodies being clinically significant, against Kidd and Duffy antigen groups. Blood transfusion of more than four units to patients at internal medical wards showed a significant association as a risk for developing red cell alloantibodies (P = 0.025). For ladies in obstetric wards, there was a significant association between pregnancy loss at the time of screening and alloimmunization (P = 0.0164). CONCLUSION: High prevalence of red cell alloantibodies in comparison to what is published worldwide. Transfusion of more than four units of blood and pregnancy loss at the time of screening were statistically significant risks for alloimmunization of the medical and obstetric populations, respectively.

Transfusion and clinical outcomes after percutaneous coronary intervention

We investigated the long-term patterns and effects of transfusion on the clinical outcome of patients undergoing percutaneous coronary intervention (PCI) using a nationwide registry. Five-year clinical outcome of all Koreans undergoing PCI using stent in year 2011 (n = 48,786) was investigated. Primary outcome was the incidence density of transfusion. The association of transfusion with major adverse clinical event (MACE) consisting all-cause death, revascularization, critically ill cardiovascular status, or stroke was assessed after adjusting the propensity of each patient for transfusion. The 5-year incidence density of transfusion was 4.74 (95% confidence interval [CI] 4.70–4.79) per 100 person-year. Patients who received transfusion were older and had higher frequency of clinical risk factors (p < 0.001, all). Transfusion was associated with MACE (hazard ratio [HR] 3.2, 95% CI 3.2–3.3, p < 0.001) and all other clinical events (HR 1.5–6.9, p < 0.001, all). The period of transfusion coincided with the period of highest MACE incidence density. Subgroup analyses showed consistent results. Within 5 years after PCI, a total of 22.9% of patients received transfusion and had a 3.2-fold higher risk of MACE compared to patients without transfusion.

A clinical audit of red blood cell transfusion practices at a district hospital in South Africa.

Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines. A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria. Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n= 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n= 52) of the cases, the guidelines were applied appropriately. The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution:The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

Standard Compared With Extended Red Blood Cell Antigen Matching for Prevention of Subsequent Hemolytic Disease of the Fetus and Newborn: A Systematic Review.

To systematically review and meta-analyze alloimmunization among recipients of red blood cells (RBCs) matched for ABO blood type and Rhesus D (ABO+D) antigen compared with those also matched for c, E, and Kell (cEK). Four online databases (Medline, Scopus, EMBASE, ClinicalTrials.gov) were searched from March 28, 2023, to April 1, 2024. The search protocol was peer reviewed and published on PROSPERO (CRD42023411620). Studies reporting alloimmunization as the primary outcome among recipients of RBCs matched for ABO+D or additional cEK matching were included. Patients transfused with unmatched RBCs or a mixture of matching regimens were excluded. Risk of bias was assessed with Cochrane Tool to Assess Risk of Bias in Cohort Studies and Tool for Risk of Bias. Random-effects meta-analysis was used to combine effect estimates. Ten studies met criteria. Risk of bias was low. Overall, 91,221 patients were transfused, of whom 40,220 (44.1%) received additional cEK-matched RBCs. The overall rate of alloimmunization was 6.2% (95% CI, 2.5-14.9%) for ABO+D-only matching and 1.9% (95% CI, 0.7-5.1%) when cEK was added. Time of follow-up antibody testing ranged from 6 to 18 months after transfusion. Additional cEK match was associated with significantly less alloimmunization compared with standard ABO+D match (odds ratio [OR] 0.37, 95% CI, 0.20-0.69). This association remained when chronically transfused patients were excluded (OR 0.65, 95% CI, 0.54-0.79) and for alloimmunization to c, E, or K antigens only (OR 0.29, 95% CI, 0.18-0.47). Additional cEK RBC matching protocols were associated with lower odds of recipient alloimmunization. Given severe sequelae of alloimmunization in pregnancy, routine cEK matching for transfusion in people with pregnancy potential younger than age 50 years in the United States merits consideration. PROSPERO, CRD42023411620.

Cemented Versus Uncemented Reverse Shoulder Arthroplasty Treatment of Proximal Humerus Fractures: National Shoulder Arthroplasty Data from Türkiye.

This study evaluated national trends in cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humerus fractures using a comprehensive national surgical database. This study aimed to compare RSA used in the treatment of proximal humerus fractures with the literature and to determine the country's trend. A cross-sectional study was conducted using the health records of individuals aged ≥ 18 years who underwent RSA for proximal humerus fractures between 2016 and 2022. Patients were divided into cemented and uncemented groups, and demographic data (age, sex), duration of hospital stay, transfusions, revisions, mortality, and Charlson Comorbidity Index (CCI) scores were analyzed. A total of 618 cemented RSA and 1,364 uncemented RSA procedures were reviewed. Patients who underwent cemented RSA were significantly older than those who had uncemented RSA (p = 0.002). Transfusion rates were higher in the cemented RSA group (p = 0.006). The frequency of revision surgery was 6.1%. Younger age and male sex were associated with revision (p < 0.001). CCI scores were higher among transfused patients than non-transfused patients (p < 0.001). The incidence of cemented RSA was 11.7% and 49% in 2016 and 2022, respectively. Differences were found among hospital types and geographical regions. While cemented RSA has been gaining attention and increased application in recent years for proximal humerus fractures, uncemented RSA still predominates. The choice between these 2 methods is largely influenced by regional and hospital-level factors. The type of RSA and high CCI scores were found to have no significant impact on the risk of surgical revision.

Efficacy and Safety of Reduced Dose Azacitidine in the Treatment of Elderly Patients with Myelodysplastic Syndromes

To analyze the efficacy and safety of low-dose azacitidine in the treatment of senile myelodysplastic syndromes (MDS). A total of 92 elderly MDS patients who were initially diagnosed in the Huaibei Miners General Hospital and the Affiliated Hospital of Xuzhou Medical University from January 2018 to June 2022 were randomly divided into the observation group and the control group with 46 patients in each group. The observation group received a low dose of azacitidine 100 mg/d, d1-7, 28 days as a course of treatment, 6 courses in total, and the control group received a standard dose of azacitidine 75 mg(m2·d), d1-7, 28 days as a course of treatment, a total of 6 courses of treatment. The clinical efficacy, overall survival (OS) and adverse reactions of the two groups of patients were observed. There was no statistically significant difference in the clinical data between the two groups (P >0.05). After treatment, the hemoglobin and platelet levels of the two groups of patients were significantly higher than before treatment in each group (P < 0.05). There was no statistically significant difference in leukocyte, hemoglobin and platelet levels between patients in the observation group and control group (P >0.05). The number of cases with complete remission, partial remission, hematological remission, disease stabilization and disease progression in the observation group were 4, 10, 22, 6 and 4, respectively, with a total effective rate of 78.26%. The numbers of cases with complete remission, partial remission, hematological remission, disease stabilization and disease progression in control group were 8, 12, 18, 4 and 4, respectively, with a total effective rate of 82.61%. The total effective rate of patients in the observation group was slightly lower than that of the control group(χ2=0.457, P =0.254). There was no significant difference between the two treatment schemes in the treatment of patients with blood transfusion dependence and patients with low risk, medium risk and high risk (P >0.05). It takes 4 and 6 courses of treatment to achieve the best treatment response in the control group and observation group respectively. There was no significant difference in OS between the two groups (P >0.05). In the observation group, there were 4, 6 and 2 cases of infection, III-IV degree myelosuppression and gastrointestinal reaction, respectively, with the incidence rate of adverse events being 26.09%. In the control group, there were 6, 16 and 6 cases of infection, III-IV degree myelosuppression and gastrointestinal reaction, respectively, with the adverse event rate was 60.87%. The incidence of adverse events in the control group was significantly higher than that in the observation group (χ2=7.095, P =0.036). Elderly patients with MDS have poor tolerance to chemotherapy. Reducing azacitidine in the treatment of elderly MDS patients shows good efficacy and safety.

Investigation of Delayed Transfusion Reactions in Sickle Cell Disease Patients Polytransfused in the Brazilian Amazon.

Sickle cell disease (SCD) affects approximately 100,000 people in the United States and millions worldwide, with the highest prevalence of 70% of SCD being found in individuals of African ethnicity. Delayed hemolytic, alloimmunization, and anamnestic transfusion reactions in multiple transfusion patients need to be investigated and managed to avoid a worsening of the patient's clinical status. This paper aims to investigate delayed transfusion reactions in SCD patients who were polytransfused in the Brazilian Amazon. The clinical and laboratory indicators of SCD patients with more than four transfusions were investigated. The patients were treated at the Fundação Hospitalar de Hematologia e Hemoterapia do Estado do Amazonas, Brazil. A total of 44 polytransfused patients with SCD were followed. Regarding Rh phenotype, it was possible to observe a frequency of 26.6% (12) patients with the RZRZ (DCE/DCE) phenotype, in addition to 4.5% (two) patients with RH and RHCE variants. It was also possible to observe 20.5% (nine) patients with an alloimmunization reaction, who presented the following alloantibodies: anti-RhD, anti-E, anti-K, anti-Jkb, anti-N, anti-S, and anti-Dia, two of which are unidentified. Of these, four (44.4%) patients also presented autoantibodies, anti-e, and three unidentified antibodies, and four (44.4%) patients presented an anamnestic reaction, with anti-RhD, K, and Jkb antibodies. Of the 44 patients monitored, 54.4% (24) had clinical and laboratory indicators of a delayed hemolytic reaction. Delayed transfusion reactions, often neglected, occur frequently. Therefore, transfusions need to be monitored for at least 28 days, with medical investigation of clinical and laboratory indicators to make greater use of this therapeutic resource.

Optimizing O red blood cell concentrate usage in the emergency department in the era of patient blood management

BackgroundEmergency transfusion may require the availability of O-negative red blood cell concentrates without pre-transfusion testing. At the Cliniques Universitaires Saint-Luc, the emergency department was used to having access to two decentralized O-negative red blood cell concentrates. This study aims to analyze the consumption of O-negative red blood cell concentrates in emergency situations both before and after the implementation of a novel strategy aiming at optimizing stocks. This strategy provides a combined allocation of one unit of O-positive red blood cell concentrate and one unit of O-negative red blood cell concentrate decentralized in the emergency department and reserve the transfusion of the negative unit only to under 45-year-old women and under 20-year-old men. Materials and MethodsA retrospective study was conducted of the transfusion and medical records of all patients who received immediate transfusions in the emergency department without pre-transfusion testing between 2008 and 2022. ResultsA total of 193 patients received O red blood cell concentrates without pre-transfusion testing in emergency situations between 2008 and 2022. During the first 24 h of hospitalization, 354 O-negative units were transfused. Mean ratios of number of O-negative bags between 2008 and 2020 was 1.98 unit/patient. After implementation of the new strategy, the ratio in 2021 was 1.46 unit/patient and drastically decreased in 2022 to 0.79 unit/patient. ConclusionIn situations of emergency, allocating O-negative units only for women younger than 45 years and men younger than 20 years could have saved 85% of O-negative red blood cell concentrates transfused (303/354) yet balancing the immunological risk. Limiting the number of delocalized units of O-negative red blood cell concentrates in the emergency department seems to lower O-negative consumption. With this strategy, the units spared could have been transfused to patients with greater needs (e.g., sickle cell patients or chronically transfused patients).

Red blood cell alloimmunization in transfused patients with myelodysplastic syndromes: a retrospective study from northern China.

Alloimmunization against red blood cell (RBC) antigen is an important concern in myelodysplastic syndromes (MDSs) patients with chronic transfusion, causing potential risk for hemolytic reaction and limited supply of compatible blood. However, there is little data addressing RBC alloimmunization in this patient cohort among the Chinese population. This study aims to evaluate the incidence, specificity of antibodies, and RBC units transfused before antibody formation and its significance in a population of patients consistently receiving RhD-matched RBC units. We retrospectively reviewed the transfusion and clinical information of all transfused patients with MDS enrolled in our hospital from 2012 to 2022. The cumulative incidence of alloimmunization was analyzed by a Kaplan-Meier plot. Alloimmunization incidence was compared based on different transfused RBC units using the log-rank test. A total of 103 patients with MDS were included in this study; alloantibody formed in 8 (7.8%) patients. Before reaching 32 RBC units, 87.5% of the alloimmunized patients had developed their alloantibodies. All but 1 of the alloantibodies developed were antibodies to Rh antigens. The RBC transfusion intensity and frequency were significantly higher following alloimmunization in the alloimmunized patients (P=.008, P=.008, respectively). The antibodies detected mostly involve the Rh system among MDS patients in China. The alloimmunization tended to occur early prior to reaching 32 RBC units in patients with MDS. Rh antigen matching should be considered early in the patient's transfusion history and completed before receiving 32 RBC units.

Correlation between Serum Ferritin and Thyroid Hormones Level in Children with Thalassemia

Background: Thalassemia is a group of hereditary blood disorder characterized by reduced or absent globin chain synthesis resulting in transfusion dependent anaemia and iron overload. Due to regular blood transfusion and inadequate chelation therapy patient develop multiorgan dysfunction. Objectives: To find any correlation between serum ferritin and thyroid hormones level in children with transfusion dependent thalassemia. Methods: This cross-sectional study was carried out in the department of Paediatrics and department of Medicine, Sylhet MAG Osmani Medical College Hospital between June, 2021 to May, 2022, on one hundred children with transfusion dependent thalassemia who were on more than 12 times blood transfusion but did not take any chelation therapy and whose serum ferritin level were &gt; 1000 ng/ml. Assessment of their thyroid hormones level and statistically its correlation with serum ferritin were done. Result: A total of 53 (53%) male and 47 (47%) female were included in this study. The mean age of the patients was 9.47 ±3.63 years. Mean serum ferritin was 1980±1126.19 ng/ml, mean serum TSH was 3.55±2.08 µIU/ml, mean serum free T4 was 1.10±0.18 ng/ml, mean serum free T3 was 3.64±0.37 pg/ml. Subclinical hypothyroidism and euthyroid were found in 20 patients (20%) and 80 patients (80%) respectively. No overt hypothyroidism or hyperthyroidism were found. Mean serum ferritin in subclinical hypothyroid and euthyroid were 2407±995.37 ng/ml and 1875.59±1131.18 ng/ml respectively which difference was statistically significant (P value &lt;0.05). Scattered diagram was done and it showed linear correlation between serum ferritin and serum TSH of subclinical hypothyroid group. No linear correlation was found between serum ferritin and F.T3 and F.T4 on scattered diagram. Positive (Pearson) correlation was found between serum ferritin and serum TSH of subclinical hypothyroid group and strong positive (Pearson) correlation (r=0.74, P=0.02) was found between them. Conclusion: This study showed that good percentages of children with transfusion dependent thalassemia are suffering from subclinical hypothyroidism. There is positive correlation between serum ferritin level and subclinical hypothyroidism.

Phase 3 randomized COMMODORE 1 trial: Crovalimab versus eculizumab in complement inhibitor-experienced patients with paroxysmal nocturnal hemoglobinuria.

Crovalimab, a novel C5 inhibitor, allows for low-volume, every-4- week, subcutaneous self-administration. COMMODORE 1 (NCT04432584) is a phase 3, global, randomized trial evaluating crovalimab versus eculizumab in C5 inhibitor-experienced patients with paroxysmal nocturnal hemoglobinuria (PNH). Adults with lactate dehydrogenase ≤1.5 × upper limit of normal and receiving approved eculizumab doses for ≥24 weeks were randomized 1:1 to receive crovalimab (weight-based tiered dosing) or continue eculizumab. The original primary study objective was efficacy; however, given the evolving treatment landscape, target recruitment was not met, and all efficacy endpoints became exploratory, with safety as the new primary objective. Exploratory efficacy endpoints included transfusion avoidance, hemolysis control, breakthrough hemolysis, hemoglobin stabilization, FACIT-Fatigue score, and patient preference (crovalimab vs. eculizumab). Eighty-nine patients were randomized (45 to crovalimab; 44 to eculizumab). During the 24-week primary treatment period, adverse events (AEs) occurred in 77% of patients receiving crovalimab and 67% receiving eculizumab. No AEs led to treatment withdrawal or death, and no meningococcal infections occurred. 16% of crovalimab-treated patients had transient immune complex reactions (also known as Type III hypersensitivity events), an expected risk when switching between C5 inhibitors that bind to different C5 epitopes; most were mild/moderate and all resolved without treatment modification. Crovalimab-treated patients had sustained terminal complement activity inhibition, maintained disease control, and 85% preferred crovalimab over eculizumab. Together with phase 3 COMMODORE 2 results in complement inhibitor-naive patients, these data support crovalimab's favorable benefit-risk profile. Crovalimab is a new C5 inhibitor for PNH that is potentially less burdensome than existing therapies for this lifelong disease.