Transfusion Of Blood Components Research Articles

Immuno-Hematologic Complexity of ABO-Incompatible Allogeneic HSC Transplantation

ABO incompatibility is not considered a contraindication for hematopoietic stem cell transplantation (HSCT). Approximately 30% of transplants from related donors and up to 50% of transplants from unrelated donors are ABO incompatible. Immuno-hematologic investigations allow to estimate donor/recipient ABO mismatch and anti-A/B isohemagglutinin (IHA) titration in the pre-HSCT phase. Immediate hemolysis or delayed complications (passenger lymphocyte syndrome and pure red cell aplasia) can occur post HSCT. Some preventive measures take into consideration either decision-making algorithms based on the recipient’s IHA titration or clinical protocols for the removal/reduction of IHAs through plasma exchange or immunoadsorption procedures. Product manipulation through red blood cell (RBC) and/or plasma depletion can also be taken into account. Currently, the best approach in the management of ABO-incompatible transplant is not defined in expert consensus documents or with solid evidence. In addition, the methods for IHA titration are not standardized. A transfusion strategy must consider both the donor’s and recipient’s blood group systems until the RBC engraftment catches on and ABO conversion (forward and reverse typing) is confirmed on two consecutive and independent samples. Therefore, ABO incompatibility in HSCT represents a demanding immuno-hematologic challenge and requires all necessary preventive measures, including the appropriate selection of ABO blood components for transfusion.

Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association with Mortality.

Evaluate the interaction between whole blood (WB) and blood component resuscitation in relation to mortality following trauma. WB is increasingly available in civilian trauma resuscitation, and it is typically transfused concomitantly with blood components. The interaction between WB and blood component transfusions is unclear. Adult trauma patients with a shock index >1 who received ≥4 combined units of red blood cells (RBC) or WB within 4 hours across 501 United States trauma centers were included using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database. The associations between 1)WB resuscitation and mortality, 2)WB to total transfusion volume ratio (WB:TTV) and mortality, 3)balanced blood component transfusion in the setting of combined WB and component resuscitation and mortality were evaluated with multivariable analysis. A total of 12,275 patients were included (WB: 2,884 vs. component-only: 9,391). WB resuscitation was associated with lower odds of 4-hour (adjusted odds ratio [aOR]: 0.81 [0.68-0.97]), 24-hour, and 30-day mortality compared to component-only. Higher WB:TTV ratios were significantly associated with lower 4-hour, 24-hour, and 30-day mortality, with a 13% decrease in odds of 4-hour mortality for each 10% increase in the WB:TTV ratio (0.87 [95%CI:0.80 - 0.94]). Balanced blood component transfusion was associated with significantly lower odds of 4-hour (aOR: 0.45 [95%CI: 0.29 - 0.68]), 24-hour, and 30-day mortality in the setting of combined WB and blood component resuscitation. WB resuscitation, higher WB:TTV ratios, and balanced blood component transfusion in conjunction with WB were associated with lower mortality in trauma patients presenting in shock requiring 4 units of RBC and/or WB transfusion within 4 hours of arrival.

Transfusion reaction - Signs and symptoms and hemovigilance interventions

The aim of this study was to review the literature on transfusion reactions - signs and symptoms and hemovigilance interventions. This is a bibliographical review of the literature. Scientific materials were used from the databases - Latin American and Caribbean Literature in Health Sciences - Lilacs, and Scientific Electronic Library Online - Scielo, and articles related to "Blood component transfusion" were selected. Despite the regulations and the efforts of the National Health Surveillance Agency (ANVISA), together with the sentinel networks, there is still under-reporting of transfusion reactions in Brazil. This makes it more difficult to control and recognize occurrences. Transfusion reactions cause varying degrees of damage to the patient and can be immediate: when signs and symptoms appear during the blood transfusion or up to 24 hours after the start of infusion therapy. As an integral part of the health system, all health professionals must achieve an optimum standard of patient care, prioritizing quality care and good practices in the management of patients who need to be transfused.

Cost analysis of care and blood transfusions in patients with Major Obstetric Haemorrhage in Ireland.

Obstetric haemorrhage is the leading cause of maternal morbidity and mortality worldwide. We aimed to estimate the economic cost of Major Obstetric Haemorrhage (MOH) and the cost of therapeutic blood components used in the management of MOH in Ireland. We performed a nationwide cross-sectional study utilising top-down and bottom-up costing methods on women who experienced MOH during the years 2011-2013. Women with MOH were allocated to Diagnostic Related Groups (DRGs) based on the approach to MOH management (MOH group). The total number of blood components used for MOH treatment and the corresponding costs were recorded. A control group representative of a MOH-free maternity population was designed with predicted costs. All costs were expressed in Euro (€) using 2022 prices and the incremental cost of MOH to maternity costs was calculated. Cost contributions are expressed as percentages from the estimated total cost. A total of 447 MOH cases were suitable for sorting into DRGs. The estimated total cost of managing women who experienced MOH is approximately €3.2 million. The incremental cost of MOH is estimated as €1.87 million. The estimated total cost of blood components used in MOH management was €1.08 million and was based on an estimated total of 3997 products transfused. Red blood cell transfusions accounted for the highest contribution (20.22%) to MOH total cost estimates compared to other blood components. The total cost of caring for women with MOH in Ireland was approximately €3.2 million with blood component transfusions accounting for between one third and one half of the cost.

Selective IgA Deficiency and Blood Component Transfusion: In Search of the Lost Evidence

Background: Selective IgA deficiency (IgA-D) has been historically considered a high-risk entity for developing allergic/anaphylactic reactions after blood transfusion (AATRs). However, it has been suggested that the IgA-D-related anaphylactic transfusion reaction is not evidence-based. Methods: We conducted three different approaches to collect evidence about epidemiology, AATRs, and transfusion management of patients with IgA-D at La Fe University Hospital. Firstly, we analysed the prevalence of IgA-D in a population of patients diagnosed with acute leukaemia, The second approach consisted of collecting transfusion data from IgA-D patients. Finally, we reviewed the IgA levels of patients recorded in the hemovigilance system suffering an AATR. Results: IgA-D prevalence was 1 in 334 patients. At least one blood component was transfused to 23 patients diagnosed with IgA-D. Plasma was transfused to eight IgA-D patients, while six patients received red blood cells, platelets, and plasma. No adverse reactions were reported in any patient. AATRs occurred in 325 men and 264 women with a median age of 52 years. Severe reactions occurred in 56 patients (1/14,520 components). Mean IgA levels were 215 mg/dL (4–5570) for mild reactions and 214 mg/dL (14–824) for severe reactions (p = ns). Washed platelets were administered to two patients who developed severe and repeated AATRs. Both had normal IgA levels. Conclusions: Since the AATRs related to IgA-D are extremely low, as reported in current hemovigilance systems, IgA-D should not be considered a high-risk entity to develop AATRs. On the contrary, our findings support standard transfusion management of IgA-D patients.

Impacts of COVID-19 pandemic on the collection and use of blood and blood components in Taiwan

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the supply and transfusion of blood components. This study aims to evaluate changes in blood collection and transfusions during the period following the nationwide Level 3 alert (May–July 2021). MethodsWe retrieved usage data for red blood cells (RBC) from the Taiwan National Health Insurance (NHI) database 2019–2021. ResultsDuring the Level 3 alert period, approximately 85% of COVID-19 cases (11,455/13,624) were in Taipei. In Taipei, blood collection declined by 26.34% and RBC transfusions decreased by 17.14% compared to pre-pandemic levels. RBC usage decreased across all service types, with a significant decrease observed in hematology/oncology by 15.62% (-483 patients, -2,425 units). In non-Taipei regions, blood collection declined by 12.54%, rebounding around one month earlier than in Taipei. The decline in RBC transfusions occurred one month later than in Taipei, with a much lower magnitude (4.57%). Strain on the blood supply occurred in May and June in both Taipei and non-Taipei regions. Among 7,532 hospitalized COVID-19 patients, approximately 6.9% patients required a total of 1,873 RBC transfusions. The rapid increase in COVID-19 inpatients did not significantly increase the burden of blood demands. SummaryDuring the Level 3 alert, the most significant decline in both RBC collection and transfusions was observed in Taipei. In non-Taipei regions, the decrease in RBC use was only marginal. Notably, there was a significant decrease in RBC use in hematology/oncology in Taipei. This study supports transfusion specialists in seeking efficient ways to address similar future challenges.

Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.

Prevalence and pattern of blood and blood component utilization at the Kenyatta National Hospital maternity unit in 2022-2023: A cross-sectional study

Background: Blood and blood component transfusion plays a pivotal lifesaving role. Adequate amounts significantly reduce maternal morbidity and mortality. This study aimed to assess the prevalence and pattern of blood and blood component utilization among women managed at the Kenyatta National Hospital (KNH) maternity unit in 2022-2023. Methods: This was a cross-sectional study targeting women admitted to the KNH maternity unit. Participants were recruited through consecutive sampling. A data abstraction chart was used for data collection. The study variables included proportions of patients who required blood or blood components, indications for transfusion, number of units availed against those requested, and outcomes of the participants. To determine the prevalence of transfusion, the proportion of participants who received blood or blood components was calculated over the admissions. To determine the percentage per indication for transfusion, a particular indication was calculated over the total number of indications and expressed in percentages, and the need was calculated as the total need per blood request generated. Continuous data were analyzed for mean and standard deviation. Frequencies and percentages were calculated for variables with categorical data. Results: Among 5567 admissions, 344 participants who needed blood and blood components were sampled over 7 months from October 2022. This represented a prevalence of 6.2%. Of this prevalence, cesarean deliveries made up 3%, SVD 1.4%, and miscarriages accounted for 0.5% among others. Postpartum hemorrhage was the most common indication (34.5%), with 65.4% of participants having their need for blood/blood components met. The deficit in blood units ordered was 12.4%. The majority (98%) were discharged home. While mortality was recorded at 2%. Conclusion: The prevalence of blood/blood components transfusion was 6.2%. Postpartum hemorrhage remains the most common indication for blood transfusion. The need for blood and its components remains unmet both for the number of units and the type of component.

Timing and volume of transfusion for adult major trauma patients with hemorrhagic shock: a registry-based cohort study

IntroductionTransfusion of blood components is vital for the resuscitation of injured patients in hemorrhagic shock. Delays in initiating transfusion have been associated with harm, as has excess transfusion. The aim...

Nurses' self-efficiency levels in safe blood and blood component transfusion: The case of Turkey

ObjectiveThe study aimed to determine nurses' self-efficacy levels for safe transfusion of blood and blood components. MethodThe design of this study is descriptive and cross-sectional. Before starting the study, ethics committee approval and institution approval was obtained. The participants were informed about the purpose of the study, and their written consent was obtained. The research was conducted between the dates 01 March 2022 and 01 May 2022, a private hospital in Turkey. The study sample consisted of 482 nurses. Data were collected using descriptive characteristics form and the Safe Blood and Blood Products Transfusion Self-Efficacy Scale (SBT-SES). ResultsThe total SBT-SES scores of the nurses were high (202.7 ± 50.1), and the behavioral sub-factor self-efficacy scores were moderate (48.2 ± 19.5). When the SBT-SES scores were analyzed based on demographic characteristics, it was found that those who had received previous safe blood transfusion training scored higher than those who had not, and women scored higher than men (p < 0.05). In addition, no relationship was found between age, working time, number of weekly blood transfusions, and self-efficacy levels. DiscussionAs a result, nurses' self-efficacy levels towards blood transfusion are high. However, the behavioral sub-factor self-efficacy level is not sufficient. ConclusionBased on these results, in order to increase the behavioral self-efficacy levels of nurses, our recommendations are as follows: investigating appropriate training methods, considering the sex factor when choosing training methods and techniques, investigating the barriers to safe transfusion behaviors, and measuring self-efficacy levels at regular intervals.

Patient Blood Management: Moving Above and Beyond the Optimal Use of Blood!

Transfusion of blood components or products is among the most common procedures performed during a patient’s stay in the hospital. However, apart from being life-saving in exsanguination, blood transfusion is also associated with adverse events such as transfusion-transmitted infections, allergic reactions, transfusion-associated circulatory overload, transfusion-related acute lung injury, and transfusion-related immunomodulation with nosocomial infections and cancer recurrence. These potentially fatal complications have raised perennial concerns among healthcare professionals with regard to blood transfusion and patient outcomes. Thus, in the last few decades, the safety of the blood product has remained the key focus area for almost every stakeholder, whether end user or policy maker. Optimal use of blood is a globally recognized and recommended policy that ensures that the right amount and type of blood component is transfused to the right patient at the right time. Essentially, it focuses on improving the safety and effectiveness of the clinical transfusion process. However, with the evolving knowledge around transfusion science, increasing involvement of surgeons, anesthesiologists, and other specialists in transfusion offerings and proceedings, and the accumulating evidence on the fact that blood transfusion can, often, be more detrimental to a patient’s clinical status rather than benefiting it, has led to the endorsement and establishment of policy(ies) for optimal use of blood. Patient blood management (PBM), a concept coined and introduced almost two decades ago, encompasses, rather comprehensively, not just the policies and procedures of optimal use of blood and restricting transfusion to as minimum as possible but has a scope that spans much beyond that. PBM is driven and implemented through the three-pillar and nine-field matrix that incorporates the objectives of optimizing hematopoiesis, minimizing bleeding and blood loss, and harnessing and optimizing the physiological tolerance of anemia within the preoperative, intraoperative, and postoperative settings. PBM focuses on patient safety rather than product safety and, thus, ensures adopting a customized approach toward judicious and clinical use of the precious resource, blood. The principles and practices of PBM gained significant relevance and acceptability in the past few years, especially after the pandemic of COVID-19 when the World Health Organization issued a policy brief on its urgent implementation. Through this review article, we intend to establish not just the impact of PBM implementation towards improvement in patient outcomes but also the fact that the relevance and means of PBM extend far above and beyond just the optimal use of blood.

Perioperative Factors and Radiographic Severity Scores for Predicting the Duration of Mechanical Ventilation After Arterial Switch Surgery

ObjectivesCardiac surgery on cardiopulmonary bypass (CPB) during the neonatal period can cause perioperative organ injuries. The primary aim of this study was to determine the incidence and risk factors associated with postoperative mechanical ventilation duration and acute lung injury following arterial switch operation (ASO). The secondary aim was to examine the utility of the Brixia score for characterizing postoperative acute lung injury (ALI).Design: A retrospective study. SettingA single-center university hospital. ParticipantsA total of 93 neonates with transposition of great arteries with intact ventricular septum (dTGA/IVS) underwent ASO. InterventionsNone Measurements and Main ResultsFrom January 2015 to December 2022, 93 neonates with dTGA/IVS were included in the study. The cohort had a median age of 4.0 (3.0-5.0) days and a mean weight of 3.3 ± 0.5 kg. About 63% of patients had ≥ 48 hours postoperative mechanical ventilation after ASO. Risk factors included prematurity, post-CPB transfusion of salvaged red cells, platelets and cryoprecipitate, and postoperative fluid balance by univariate analysis. The larger transfused platelet volume was associated with the risk of ALI by multivariate analysis. The median baseline Brixia scores were 11.0 (9.0-12.0) and increased significantly in the postoperative day 1 in patients who developed moderate ALI 24 hours after admission to the intensive care unit (15.0 (13.0-16.0) vs. 12.0 (10.0-14.0), p = 0.046). ConclusionsArterial switch operation results in a high incidence of ≥ 48-hour postoperative mechanical ventilation. Blood component transfusion is a potentially modifiable risk factor. The Brixia scores may also be used to characterize postoperative acute lung injury.

Surgical Safety Checklist as an optimal organizational model in ensuring the maximum degree of preparedness for intraoperative incidents (case report)

Objective. The use of checklists for quality and safety control of medical care is an effective tool for reducing the frequency of errors, dangers and complications in any section of medical practice.The aim is to demonstrate the possibilities of minimizing and leveling the potential risks accompanying surgical intervention using the example of routine application of the surgical safety checklist.Object and methods. Patient A., 55 years old, was admitted to the emergency department of Samara City Clinical Hospital №1 named after N.I. Pirogov on 24.04.2023. with complaints of pain in the right upper abdomen, nausea, vomiting, general weakness. The diagnosis was Cholelithiasis, acute calculous cholecystitis with the formation of a perivesical abscess. It required laparoscopic cholecystectomy operation. While filling in the surgical safety checklist (SSC) and analyzing possible intraoperative incidents, the attending physician executed an informed voluntary consent for transfusion of donor blood components. The corresponding components were ordered. Having weighted up the potential intraoperative risks specified in the part "Before anesthesia" of SSC, the anesthesiologist installed a catheter into one of the central veins and performed the urine bladder catheterization. Surgical intervention was complicated by bleeding, which required conversion of surgical approach. Upper median laparotomy, cholecystectomy, surgical hemostasis were performed. Total blood loss was 1000 ml, plasma and red blood cell were donated to the patient. The operation was completed by drainage of the subhepatic space and suturing of surgical wounds.Results. The clinical case describes the importance of a team approach at the stage before the operation, as well as the role of all specialists provided life support and medical care for the patient. It results from attentive work with the checklist which shows a clear liability for each member of the operating team at different stages of preparation and treatment of a surgical patient.Conclusions. The development of a culture of surgical safety is an important way to minimize the risks associated with surgical intervention for each individual patient and for the institution by optimizing the work of operating units.

Frequency and causes of blood chimera in combat trauma victims

The frequency and causes of blood chimeras in victims of combat trauma who arrived from special military operations were analyzed. Data from immunohematological studies of patients admitted to the clinics of the Military Medical Academy named after S. M. Kirov in the period from February to December 2022 were analyzed. All patients were assessed for blood group membership by AV0 systems and Rh factor with phenotyping of erythrocytes and the presence of antierythrocyte antibodies. Chimerism was found in 21% of the patients. According to the AB0 system, general chimerism was detected in 3. 1% of cases, whereas blood chimerisms for antigens A and B were found in 81. 8% and 36. 4% of the cases, respectively. Moreover, blood chimerism for antigens C, c, E, and e was detected in 100% of the cases, and for antigen D, the rate of chimerism was 7. 6%. The identified chimerism in the patients was caused by the use of “universal” doses of erythrocyte blood components by advanced medical service units. In general, the frequency of blood chimerism in victims of combat trauma in the clinics of the Military Medical Academy named after S. M. Kirov was 21%. Blood chimerism in combat trauma victims did not lead to significant immunization. Despite the absence of detected immunization, blood chimerism was a favorable background for possible hemolytic posttransfusion complications during treatment. Possible options for the prevention of blood chimerism include the introduction into practice of advanced use of artificial oxygen carriers, active use of hardware support for reinfusion of blood spilled into the cavity, and preparation of autokrovi for certain patients. These measures are aimed at reducing the number of transfusions of donor blood components, thereby preventing the formation of antierythrocyte antibodies and blood chimeras.

Congenital thrombotic thrombocytopenic purpura in children

Introduction. Congenital thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening genetic disorder characterized by recurrent episodes of microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction due to the defi ciency or dysfunction of the ADAMTS13 enzyme. Despite the availability of clinical and laboratory diagnostic criteria the diagnosis remains challenging due to a wide range of diseases with similar appearance.Aim: to analyze the clinical manifestations and treatment results of identifi ed cases of congenital TTP at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology.Methods. This article reviews 11 clinical cases with congenital TTP genetically confi rmed or with typical clinical and laboratory signs.Results. Clinical and laboratory signs of TTP are highly variable and nonspecifi c, which was observed in the described cohort of patients. One of the trigger factors is often an acute respiratory viral infection, and stabilization of the disease can occur after transfusions of blood components. A delay of diagnosis can often lead not only to a delay of correct therapy, but also to the prescription of wrong therapy. The main diagnosis confi rmatory method was a molecular genetic test, which was carried out in 8 cases. All patients diagnosed with congenital TTP were successfully treated with FFP therapy.Conclusion. Early diagnosis of TTP is diffi cult due to the lack of specifi c clinical manifestations and easily accessible laboratory tests

A comprehensive study of rare Rhesus phenotype case

Introduction. The RH system includes major antigens D, C/c and E/e encoded by two closely related RHD and RHCE genes. Correct identifi cation of Rh antigens in both donors and recipients is the key to proper transfusion practice. However, there are cases when Rh antigens cannot be detected by standard serological typing. For example, –D– phenotype has no expression of C, c, E, and e antigens on the surface of erythrocytes due to various genetic rearrangements in the RHCE gene.Aim: to present a study of a family where two siblings have a defi cient -D-phenotype with a normal rhesus phenotype in the parentsMaterials and methods. A comprehensive study of family N., including parents and two sons was conducted. Initially, an unusual phenotype -D- was identifi ed in the siblings, who are currently donors. All family members identifi ed themselves as Tatars. Serology tests were performed using gel cards. Genomic DNA of family members, as well as cDNA of siblings, was examined by allele-specifi c PCR, exon-scanning assay, and Sanger sequencing. In addition, copy number analysis was performed to identify rearrangements in the RHD and RHCE genes.Results. During serological typing of siblings, only the D antigen was revealed, while the C/c and E/e antigens were absent. Molecular genetic analysis suggested that the cause of the phenotype –D– in the brothers was a hybrid allele RHCE-D(3-8)- CE in homozygous status, forming a haplotype inherited from each parent with the normal RHD allele. The sequence of the fi rst two exons in the hybrid allele corresponded to RHCE*C allele. The parents were heterozygous for the identifi ed allele, so the expression of C/c and E/e antigens was not altered.Conclusion. Two donors with the –D– phenotype were assessed by comprehensive study. Identifi cation of the genetic causes of such variants in recipients is necessary to ensure safety during transfusion of erythrocyte-containing blood components. Genotyping of donors with Rh-defi cient phenotypes is also highly recommended in order to predict the molecular structure of Rh antigens.

Septic Transfusion Reactions Involving Burkholderia cepacia Complex: A Review.

This review was conducted to assess the global incidence of transfusion-transmitted infections (TTIs) caused by contamination of blood components with the Burkholderia cepacia complex (Bcc). Our search encompassed various specialized databases such as Medline/PubMed, Web of Science, Scopus, Scielo, ScienceDirect, and ClinicalKey. An analysis of the literature revealed a total of eleven reported cases where blood components contaminated with Bcc had been transfused, resulting in sepsis among the affected patients. Of these cases, eight were documented in the literature, while the remaining three occurred within the institution involving the authors of this review. A comparative examination was conducted, considering factors such as primary diagnosis, transfused blood component, time elapsed between transfusion and manifestation of symptoms, administration of antibiotics, and final outcome. Interestingly, regardless of the storage temperature, all blood components were found to be susceptible to Bcc contamination. Furthermore, the cases investigated revealed diverse sources of contamination, and it was observed that all the affected patients had compromised immune systems due to underlying illnesses. Based on these findings, a series of preventive strategies were derived to mitigate and decrease the occurrence of similar cases.

Clinical outcomes in hospitalized plasma and platelet transfusion recipients prior to and following widespread blood donor SARS-CoV-2 infection and vaccination.

The safety of transfusion of SARS-CoV-2 antibodies in high plasma volume blood components to recipients without COVID-19 is not established. We assessed whether transfusion of plasma or platelet products during periods of increasing prevalence of blood donor SARS-CoV-2 infection and vaccination was associated with changesin outcomes in hospitalized patients without COVID-19. We conducted a retrospective cohort study of hospitalized adults who received plasma or platelet transfusions at 21 hospitals during pre-COVID-19 (3/1/2018-2/29/2020), COVID-19 pre-vaccine (3/1/2020-2/28/2021), and COVID-19 post-vaccine (3/1/2021-8/31/2022) study periods. We used multivariable logistic regression with generalized estimating equations to adjust for demographics and comorbidities to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Among 21,750 hospitalizations of 18,584 transfusion recipients without COVID-19, there were 697 post-transfusion thrombotic events, and oxygen requirements were increased in 1751 hospitalizations. Intensive care unit length of stay (n = 11,683) was 3 days (interquartile range 1-5), hospital mortality occurred in 3223 (14.8%), and 30-day rehospitalization in 4144 (23.7%). Comparing the pre-COVID, pre-vaccine and post-vaccine study periods, there were no trends in thromboses (OR 0.9 [95% CI 0.8, 1.1]; p = .22) or oxygen requirements (OR 1.0 [95% CI 0.9, 1.1]; p = .41). In parallel, there were no trends across study periods for ICU length of stay (p = .83), adjusted hospital mortality (OR 1.0 [95% CI 0.9-1.0]; p = .36), or 30-day rehospitalization (p = .29). Transfusion of plasma and platelet blood components collected during the pre-vaccine and post-vaccine periods of the COVID-19 pandemic was not associated with increased adverse outcomes in transfusion recipients without COVID-19.

Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection - A single-arm, prospective, interventional trial (PORTAL trial).

The International Normalised Ratio (INR), which assesses the loss of procoagulant factors in the extrinsic pathway, fails to evaluate the coagulation abnormalities comprehensively after a major liver resection, which often leads to reduced synthesis of procoagulant and anticoagulant-factors. This study was conducted with an aim to study the trend and compare the results of routine coagulation tests and thromboelastography (TEG) during the perioperative period in patients undergoing major liver resections (≥3 segments). Twenty-five patients who underwent a major liver resection were enrolled. This prospective, single-arm, interventional study was performed with the primary objective of determining the serial changes in conventional coagulation tests and TEG during the perioperative period in patients undergoing major liver resections, at the preincision period, intraoperative period, postoperatively, at 48 h and on the fifth postoperative day. Transfusion requirements of blood components were also assessed with a TEG-guided replacement strategy. Spearman rank-order correlation was used to study the relationships of coagulation tests (both TEG and conventional tests) at each time point. The prothrombin time (PT)-INR was elevated in 14 patients (56%) at the intraoperative, immediate postoperative and 48-h time points in contrast to the TEG parameters, which remained normal in all patients. Blood component transfusion was avoided in 4, 11 and 10 patients at the intraoperative, immediate postoperative and 48-h time points, respectively. International Normalised Ratio overestimates the coagulopathy in patients undergoing major liver resection, and a thromboelastography-guided transfusion strategy reduces overall transfusion requirements.

Medico-legal and management issues in patient blood management era.

In recent decades, the approach to blood transfusion has changed radically around the world. In the past, transfusion represented the only solution for anemia, today the paradigm has changed: through the implementation of the Patient blood management (Pbm) program it is possible to manage the patient's own blood in order to reduce and, in many cases, eliminate the administration of blood components for transfusion. This approach increases patient safety by reducing clinical risks as well as costs. The implementation of the PBM program in Australia has demonstrated that the use of blood is not strictly necessary but, on the contrary, is largely avoidable. Through change management the traditional attitude of doctors and healthcare facilities can be modified. Law no. 24/2017 focuses on the safety of care by encouraging the necessary implementation of Pbm in hospital settings; the failure to adopt an organized Pbm program may constitute, in the event of an adverse transfusion event, a clear profile of health responsibility on the part of the management and clinicians.