Transfusion Practice Research Articles

Knowledge and practices in transfusion regarding bedside compatibility test: Insights from a monocentric observational study.

The bedside compatibility test (BCT) is the final barrier to transfusion safety, aiming to prevent ABO-incompatible incidents. This study evaluated the knowledge and practices of BCT and assessed the impact of a training session introducing a new technique of BCT based on Serafol ABO card. This is an observational study targeting transfusion-qualified staff working at the MTM hospital in Nabeul. It involved an initial knowledge assessment, a training session on BCT principles, and post-assessment using an anonymous questionnaire that included the interpretation of Serafol ABO card examples. Among 93 participants, 18% frequently performed transfusions, and 31% had prior training. Incorrect BCT practices, including unsafe serum methods, were noted in 46%. Only 7.5% completed necessary pre-transfusion checks. The frequency of overall scores (≥50/100) increased significantly from 43% to 90% (p = 0.000) after the training session. Correct interpretation of the Serafol ABO card was achieved by 86% and 81% of participants in isogroup and non-isogroup compatible situations, respectively. However, 20.5% of participants would have transfused an incompatible unit. A significant difference was observed between doctors and paramedics in interpreting non-isogroup compatible and incompatible situations (p = 0.03). The overall mean interpretation score was 7.7/9, with a 77% compatibility accuracy rate. Professional profile parameters did not significantly influence correct responses. This study revealed gaps in BCT practices, significantly improved through training and the introduction of the Serafol ABO card. Continuous training, medical assessments, and procedure monitoring are vital to enhance transfusion safety.

A Two-Year Study of The Frequency of Rhesus Phenotype and Probable Genotype in a tertiary Care Hospital at Dhaka, Bangladesh

Background: The Rhesus system is a major blood group system like the ABO system. Despite proper blood grouping and cross-matching, recipients can develop Rhesus antibodies, leading to Hemolytic Disease of the Newborn (HDN) or Delayed Hemolytic Transfusion Reactions (DHTR). Rhesus-negative individuals are particularly at risk if exposed to Rhesus-positive red cells through transfusion or pregnancy. Identifying Rh phenotypes and potential genotypes can significantly help in preventing alloimmunization and adverse reactions in patients receiving multiple transfusions. Objective: To assess the frequency of Rh antigens phenotype and most probable genotype in the Bangladeshi population. Method: This cross-sectional study was conducted with 325 randomized samples from both patients and donors at the Transfusion Medicine Department of BIRDEM General Hospital from January 2020 to December 2021. Samples were tested for Rh antigens phenotype and most probable genotype by using the tube agglutination method. The Anti-Human Globulin Test (AHGT) was performed as needed or in specific situations. Results: Out of the 325 blood samples, 167 (51.2%) were from males and 158 (48.8%) were from females. Incidence of Rh D positive were 94.12% (306 samples) and 5.88% (19 samples) belong to Rh D negative. The most common genotypes among Rh D positive samples were DCe/DCe (R1R1)- 41.84%, DCe/dce (R1r) -28.61%, DCe/DcE (R1R2)- 19.07%, and dce/dce (rr)- 3.38%. Rare genotypes of Rh D positive individuals detected in our study included DcE/dce (R2r)-1.84%, DCe/DCE (R1Rz) -1.23%, Dce/dce (R0r)- 0.92%, and DcE/DcE (R2R2) - 0.61%. Among Rh D negative samples, the detected rare genotypes were dCe/dce (r’r) - 1.89% and dcE/dce (r”r) - 0.61%. Conclusion: There is significant racial and geographical variation in the frequency of Rh phenotypes and genotypes. The Rh blood group system is essential for developing strategies to prevent Rh sensitization in clinical transfusion practices. Additionally, it can be valuable for addressing medico-legal issues and conducting genetic studies in Bangladesh. Bangladesh Crit Care J March 2025; 13 (1): 30-34

Rethinking platelet and plasma transfusion strategies for neonates: Evidence, Guidelines, and Unanswered Questions.

The transfusion of platelets and Fresh Frozen Plasma (FFP) to critically ill neonates in neonatal intensive care units (NICU) are both common interventions, yet they are still widely performed without adhering to international guidelines. The guidance itself on the therapeutic management of neonatal coagulation disorders is generally limited due to the absence of strong indications for treatment and is mainly aimed at the prevention of major hemorrhagic events such as intraventricular hemorrhage (IVH) in premature neonates. Historically, the underrepresentation of neonates in clinical studies related to transfusion medicine had led to significant gaps in our knowledge regarding the best transfusion practices in this vulnerable group and to a wide variability in policies between different neonatal units, often based on local experience or guidance designed for older children or adults, and possibly increasing the risk of inappropriate or ineffective interventions. Platelet transfusion and, particularly FFP administration have been linked to potentially fatal complications in neonates and thus any decision needs to be carefully balanced and requires a thorough consideration of multiple factors to the neonatal population. Despite recent advances towards more restrictive practices, platelet and Fresh Frozen Plasma (FFP) transfusions, are still subject to wide variability in practices This review examines the existing literature on platelet and FFP transfusions and on the management of massive hemorrhage in neonates; provides a summary of evidence-based guidelines on these topics; and highlights current developments and areas for ongoing and future research with the aim of improving clinical practices.

Investigating discrepancies and false positives in immunohematology tests using gel cards: insights from a case study on antibodies targeting the gel card matrix.

Discrepancies in gel card immunohematologic testing can result in false-positive reactions, making detecting antibodies and performing crossmatching difficult. Such unexpected reactivity may result from interactions with test system components, including the column matrix, chemicals, or reagents, rather than true antigen-antibody binding. Accurate identification and resolution of these discrepancies are crucial to prevent delays in transfusion and ensure patient safety. This case involved a 24-year-old patient with sickle cell disease who required a blood transfusion, highlighting the diagnostic challenges posed by variability in gel card platforms. Blood grouping was performed using Tulip gel cards (Tulip Diagnostics, Pvt Ltd). The forward grouping was AB positive, but the reverse grouping showed pan-positive results. Repeat grouping by the gold standard-the conventional tube technique-resolved the discrepancy, and the blood group was identified as AB positive. Antibody screening (ABS) and autoantibody testing using Tulip gel cards showed pan-positive reactions, although the direct antiglobulin test was negative. However, conventional tube techniques for ABS and thermal amplitude tests for autoantibodies were negative. Crossmatching of phenotype-matched packed red blood cell units showed incompatibility on Tulip gel cards but compatibility using the conventional tube technique. The possibility of antibodies against enhancement media, such as low-ionic-strength solution, was ruled out after repeat testing with normal saline and phosphate-buffered saline, which showed negative reactions in different immunohematology tests. Due to suspected interference from the gel card components, crossmatching, ABS, and autoantibody testing were repeated using Bio-Rad gel cards, which showed compatible results. The false-positive reactions were attributed to antibodies against materials in Tulip gel cards, including silica-based microbeads, polyvinyl alcohol, and other stabilizers that are absent in Bio-Rad gel cards. This case underscores the importance of multiplatform validation, reagent standardization, and conventional tube testing in resolving immunohematologic discrepancies and ensuring safe transfusion practices.

A wake-up call: from low prevalence to paediatric HIV crisis in Larkana, Pakistan

Dear Madam, Human Immunodeficiency Virus (HIV) is a retrovirus that attacks and damages the immune system, particularly the CD4+ T cells, resulting in acquired immunodeficiency syndrome (AIDS). It is a major public health issue, with having claimed of 40.4 million lives to date. In 2022, 630 000 people died globally from HIV-related causes. There were approximately 39.0 million people living with HIV by the end of 2022 with 1.3 million people becoming newly infected with HIV in 2022 globally.1 The prevalence of HIV in Pakistan is 0.1%, which is categorized as a low epidemic. Of the people living with HIV in the Eastern Mediterranean Region, 70% reside in three countries, including Pakistan. In 2016, 17,000 individuals lost their lives to AIDS, compared to 15,000 in 2014. This indicates a concerning rise in incidences and mortality in the general population, making it a significant issue that requires revaluation.2 HIV transmission occurs through the body fluids of an infected individual, including blood, breast milk, semen and vaginal fluids. Additionally, it can also spread from a mother to her baby.1 While the general prevalence of HIV in Pakistan remains relatively low, a worrying trend has emerged. In 2019, 30,191 individuals were tested for HIV in Larkana District, and 876 of them tested positive. Of those who tested positive, an alarming 719 (82%) were children under the age of 15. This issue was brought to the attention of the World Health Organization (WHO), who dispatched a team of health professionals to conduct a preliminary survey. The initial findings suggested that unsafe injection practices and poor infection control may be contributing to the high number of HIV infections among children. However, official results have yet to be confirmed. As of February 2021, Hermez et al reported that the outbreak in Larkana District is ongoing, with 1,492 cases diagnosed. Their study concluded that unsafe health practices were the primary cause of the outbreak of HIV among children. This conclusion was based on the finding that 99% of infected children had received injections in the past year, indicating the reuse of medical equipment and potentially contaminated blood transfusions as the primary cause of the outbreak.3 The situation in Larkana District, Pakistan, has raised serious concerns about the effectiveness of infection control measures in healthcare facilities and blood transfusion practices in the country. ---Continue

Blood group antigens and antibodies in East Asia and their impact on transfusion practice.

Blood group antigens and antibodies in East Asia and their impact on transfusion practice.

Association between red blood cell transfusion and subsequent cardiovascular events in patients admitted to the cardiovascular intensive care unit: a single-center retrospective study.

Anemia can worsen the prognosis of patients with acute cardiovascular (CV) disease; however, the effect of red blood cell (RBC) transfusion on mid-term outcomes in such patients requiring intensive care remains unclear. Therefore, this study investigated the association between RBC transfusions during hospitalization and subsequent CV events (all-cause mortality, non-fatal myocardial infarction or stroke, admission for acute heart failure [AHF], unstable angina, and other CV events) after hospital discharge in patients admitted to the cardiovascular intensive care unit (CICU). We retrospectively enrolled 517 patients with emergent admission to the CICU for suspected acute CV disease between January and December 2018. After excluding 41 patients who died or developed CV events during hospitalization, the remaining 476 patients (44.3% with acute coronary syndrome, 22.1% with heart failure, 6.7% with acute aortic dissection, 16.0% with other cardiac diseases, and 10.9% with non-cardiac diseases) were included in the analysis and divided into transfusion (n = 111) and non-transfusion (n = 365) groups based on RBC transfusion requirements during hospitalization. All patients were followed up for subsequent CV events over a period of 180 days after hospital discharge. Compared with the non-transfusion group, the transfusion group showed a higher incidence of chronic kidney disease (73.9% vs. 48.2%, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (18.0 ± 7.2 vs. 13.9 ± 5.6, p < 0.001), frequency of use of invasive mechanical support devices (52.3% vs. 13.7%, p < 0.001), and surgery rate (35.1% vs. 3.3%, p < 0.001), as well as a lower nadir hemoglobin level (8.9 ± 2.3 g/dL vs. 11.7 ± 1.9 g/dL, p < 0.001). The cumulative incidence of CV events was higher in the transfusion group than in the non-transfusion group (32.9% vs. 9.1%, log-rank p < 0.001), with a similar trend observed even after propensity score matching (29.2% vs. 12.3%, log-rank p = 0.049). RBC transfusion remained independently associated with subsequent CV events after adjusting for age, sex, nadir hemoglobin level, bleeding complications, and CV risk factors (adjusted hazard ratio, 2.46; 95% confidence interval, 1.11-5.46; p = 0.027). These findings suggest that RBC transfusion during hospitalization is independently associated with subsequent CV events in patients admitted to the CICU, indicating the need for cautious evaluation of transfusion practices based on potential long-term adverse effects.

Explanation and interpretation of blood transfusion provisions for critically ill and severely bleeding pediatric patients in the national health standard "Guideline for pediatric transfusion"

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Critically ill children often present with anemia and have a higher demand for transfusions compared to other pediatric patients. This guideline provides guidance and recommendations for blood transfusions in cases of general critical illness, septic shock, acute brain injury, extracorporeal membrane oxygenation, non-life-threatening bleeding, and hemorrhagic shock. This article interprets the background and evidence of the blood transfusion provisions for critically ill and severely bleeding children in the "Guideline for pediatric transfusion", aiming to enhance understanding and implementation of this aspect of the guidelines. Citation:Chinese Journal of Contemporary Pediatrics, 2025, 27(4): 395-403.

Massive transfusion policy in the Netherlands, a nationwide survey.

Massive transfusion protocols (MTPs) guide the physician in optimizing transfusion strategies. Although international guidelines on massive transfusion exist, it is unknown whether all Dutch hospitals adhere to these guidelines. The main objective of this study was to create an overview of the massive transfusion strategies of Dutch hospitals and to evaluate if logistical factors, for example, the unavailability of thawed plasma, influence transfusion practices. Furthermore, this study was initiated to evaluate the interest in a ready-to-use plasma product. A questionnaire on transfusion strategy, available resources, and yearly usage/wastage of transfusion products was distributed to all hospitals in the Netherlands. Sixty-nine hospitals were approached, of which 58 responded (response rate 84%). The majority of hospitals (67%) strived for a 1:1 erythrocyte/plasma ratio. Five percent of the hospitals used an erythrocyte/plasma ratio >2:1, which did not meet (inter)national guidelines. No relation was found between the clinical strategy described in the MTP and available resources; moreover, direct plasma availability did not increase plasma wastage. Hospitals for which it takes longer to have plasma available for transfusion generally are more interested in a ready-to-use plasma product (n = 55, 75.0% vs. 57%). This was the first nationwide survey on massive transfusion practices in the Netherlands. There is clear uniformity when it comes to using an MTP. Logistics surrounding plasma availability or plasma thawing capacity did not influence MTPs. Nevertheless, there seems to be substantial interest in a ready-to-use plasma product, especially in hospitals with limited plasma use.

Hospitalizations with blood transfusions and transfusion-related adverse events in US acute care hospitals, 2016-2020.

National data on transfusion-related adverse events (TAEs) in the United States are limited. Administrative and payment-related data may augment hemovigilance systems to assess transfusion safety. A nationwide administrative database was analyzed to characterize transfusion-related hospitalizations and TAEs by trends, patient/hospital characteristics, and outcomes. Transfusions and TAEs were identified using medical codes and charges. Generalized estimating equations (GEE) modeled transfusion trends, while logistic regression assessed transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) risk factors. During 2016-2020, 8.4% of hospitalizations involved transfusions, with red blood cell (RBC) transfusion being most common (5.2%). In 2020, compared to 2016, hospitalizations with RBC transfusion decreased by 2% (Rate Ratio (RR) 0.98; 95% CI: 0.97-0.99), while plasma transfusion hospitalizations increased by 13% (RR 1.13; 95% CI: 1.08-1.19). TAEs occurred in 0.35% of hospitalizations (3.5/1000 transfusion hospitalizations). Among the TAEs included in the study, TACO, febrile nonhemolytic reactions, and TRALI were most common. In 27% of cases, the specific TAE was unidentified. TAEs were associated with higher inpatient mortality and longer lengths of stay. Variability in TAE rates was observed by patient and hospital characteristics. Risk factors for TACO included age >64, female sex, teaching hospitals, rural location, and Northeast region. TRALI risk was higher in teaching hospitals and those with >200 beds. Administrative data provide insights into transfusion practices and associated morbidity and mortality but have limitations. Linking administrative, electronic health record, and blood bank data may enhance TAE identification.

Transfusion probability as an alternative measure of lab-guided medical decision-making.

The clinical decision to transfuse is strongly influenced by laboratory results. Analysis of transfusion decision-making through pre-transfusion laboratory results (e.g. pre-transfusion hemoglobin) is a common yet misleading approach to studying transfusion practice. We introduce "Transfusion Probability", an alternative method overcoming many limitations of pre-transfusion lab result analyses. Under this approach, we estimate the probability of transfusion after results at a specific value (e.g. hemoglobin 7.4 g/dL) or in a range of values (e.g. 7.0-7.9 g/dL) using the proportion of tests followed by transfusion. We provide a comprehensive methodology for causal inference on the effect of patient characteristics and other variables of interest. Analyses using pre-transfusion and transfusion probability were compared through a retrospective cohort study of hospitalized patients (N = 525,032). We found red blood cell transfusion probabilities of 76.2% in the 6.0-6.9 g/dL, 18.9% in the 7.0-7.9 g/dL, and 4.5% in the 8.0-8.9 g/dL hemoglobin ranges. After confounder adjustment, gastrointestinal bleeding patients were more likely to be transfused, with risk differences ranging from 6.6% in the 8.0-8.9 g/dL range to 13.8% in the 6.0-6.9 g/dL range. Pre-transfusion hemoglobin results showed minimal differences between gastrointestinal bleeding patients and other patients in unadjusted (0.00 g/dL) and adjusted analyses (-0.03 g/dL). In contrast to pre-transfusion result analysis, transfusion probability offers a nuanced account of transfusion practice and natural comparisons between patient groups. Wider use of our approach can provide actionable insights for clinical decision-making.

CRISPR-Cas9-driven antigen conversion of clinically relevant blood group systems.

The common practice of blood transfusion entirely relies on blood donations from the population. Ensuring blood group compatibility between a donor and a recipient is paramount to prevent critical adverse reactions. Finding compatible blood can be challenging given the high diversity of blood group antigens, especially for chronically transfused patients at higher risk of alloimmunization owing to repeated exposures to foreign RBCs. In addition, due to the immunogenicity of the ABO blood group and the highly polymorphic nature of the Rhesus (Rh) system, they both remain of prime importance in transfusion medicine. Cultured red blood cells (cRBCs) may eventually provide an alternative for blood donations-at least in some circumstances. Combining cRBCs with blood group gene editing could broaden transfusion accessibility by making antigen expression compatible with rare phenotypes, thus meeting the needs of more patients. Starting from mobilized, erythroid-primed hematopoietic stem and progenitor cells (HSPCs), we used virus- and selection-free, CRISPR-Cas9-mediated knockouts to produce erythroid cells devoid of AB and Rh antigen. The approach yielded almost complete conversion to O- and RhNull phenotypes, as determined by standard hemagglutination and flow cytometry analyses. Combined with robust cRBC protocols, these clinically relevant phenotypic changes could eventually expand the accessibility of blood transfusion for specific and unmet clinical needs.

Ultra-Restrictive Transfusion Thresholds in Critically Ill Adults: Are We Ready for the Next Step?

Anemia is almost universal in critically ill patients, with 25% receiving blood transfusions as clinicians aim to prevent insufficient oxygen delivery. The current 'restrictive' hemoglobin (Hb) threshold of 7 g/dL for the nonbleeding critically ill population is supported by several landmark transfusion trials. While some trials have investigated lower transfusion thresholds, these were not conducted in this specific population. Transfusion is associated with various risks including transfusion-associated circulatory overload, transfusion-related acute lung injury, and hemolytic reactions. Moreover, transfusion products are scarce and expensive as they are produced from voluntary blood donations. Therefore, it is essential to limit blood transfusion to when absolutely necessary. Research indicates that several patient categories tolerate lower Hb levels than 7 g/dL. For instance, studies on acute hemodilution in healthy volunteers have shown that lower Hb levels do not lead to organ ischemia. Similarly, studies involving patients who refuse transfusions, often report lower Hb levels down to 5g/dL or less. These lower Hb levels appear to have limited impact on mortality or morbidity related outcomes. In patients with severe burns or hematological disorders, Hb levels below 7 g/dL are not associated with significant adverse outcomes. These findings suggest that the transfusion threshold for critically ill patients could potentially be lowered, as Hb levels under 7 g/dL do not inherently lead to increased mortality or morbidity. An individualized approach to deciding whether to transfuse or not might be best. This shift in transfusion practice could help reduce costs and minimize the risks associated with blood transfusions.

A critical analysis of adult platelet product utilisation in South Africa, 2014 - 2021

Background. Platelet products are usually prescribed for the prevention and treatment of bleeding in patients with reduced platelet counts, or those with dysfunctional platelets. Between 2008 and 2017, platelet use across 12 multinational transfusion centres increased by 10.2%, and a further increase of 3.9% is predicted by 2032. The National Health Insurance (NHI) Bill has been signed into South African (SA) law, starting the transition from a two-tiered healthcare system to universal access to healthcare. Healthcare sector-specific platelet recipient and utilisation profiles for SA are largely unknown. Quantifying differences in utilisation patterns between the SA healthcare sectors is essential for long-term planning, and to provide valuable insights to inform policy. Objectives. To critically analyse platelet utilisation patterns at the South African National Blood Service (SANBS) according to SA healthcare sector. Methods. The SANBS provides blood products to eight out of the nine provinces in SA. We conducted a descriptive, cross-sectional, retrospective analysis of all platelet requisitions processed by the SANBS between 1 January 2014 and 31 December 2021. Healthcare sector- specific demographic and utilisation patterns were determined, and per capita utilisation calculated. Results. Of the 445 803 platelet units issued in the specified time period, 200 856 (45.1%) were issued to the public sector, compared with 244 922 (54.9%) to the private sector. The public sector recipients were mostly female (55.7%), with a median (interquartile range (IQR)) age of 29 (15 - 42) years, and in the private sector, mostly male (53.1%), with a median (IQR) age of 53 (36 - 65) years. The private sector issued more units of platelets per 1 000 population on average than the public sector, with 3.89 units per 1 000 private sector population v. 0.59 units per 1 000 public sector population. Conclusion. Platelet utilisation between SA’s healthcare sectors is distinctly different. The drivers underpinning these patterns are interdependent, including population and demographic characteristics, disease patterns, transfusion practices and healthcare demands. A greater understanding of socioeconomic and disease drivers is required to provide policy-relevant insights to predict utilisation and assist transfusion services with planning in light of the NHI rollout.

Trends and Incidence of Transfusion Reactions: a Single-Center 5-Year Retrospective Analysis.

Transfusion reactions, including allergic and febrile non-hemolytic responses, remain a safety concern despite advancements in donor screening and leukocyte reduction. Understanding the incidence and contributing factors of these reactions is essential for enhancing transfusion practices and patient safety. This study retrospectively analyzed transfusion reactions at our institution from January 2019 to August 2024. Data from hemovigilance records were reviewed to identify the incidence, types, and severity of reactions. An overall reaction rate of 0.28% was observed, with itching/urticaria, chills, and fever as the most common types. These findings align with global reports, indicating the effectiveness of the implemented preventive strategies in minimizing severe reactions. This study highlights the importance of individualized patient protocols and continuous monitoring to reduce transfusion risks. Preventive strategies, such as leukocyte reduction, premedication for high-risk patients, and vigilant observation during transfusions, have proven effective in limiting reaction severity. By providing insights into transfusion reaction patterns, this analysis supports efforts to enhance patient safety and optimize transfusion practices through targeted quality improvements.

Exploring the pattern of blood utilization in various obstetric scenarios unfolding within the wall of tertiary care centre: A Prospective study from Western India.

Exploring the pattern of blood utilization in various obstetric scenarios unfolding within the wall of tertiary care centre: A Prospective study from Western India.

Prediction of risk of blood transfusion in patients with cirrhosis.

Blood transfusion is usually required for cirrhotic patients with bleeding which is related to high risk of mortality. Identifying cirrhotic patients at high risk of bleeding and needing blood transfusions would benefit these patients, yet this remains an unmet need. This study aims to enhance blood transfusion management for patients with cirrhosis by developing a predictive model to assess the risk of transfusion. We enrolled a cohort of 711 patients diagnosed with cirrhosis at The First Affiliated Hospital of Nanjing Medical University and divided into training set ( n = 537) and validation set ( n = 174). Each participant underwent a comprehensive clinical assessment. Data on prothrombin time (PT), platelet counts, and inflammatory markers were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The nomogram was constructed. Model performance was evaluated through receiver operating characteristic curve analysis. The study successfully identified PT, platelet counts, and the mentioned inflammatory markers as significant predictors of the need for transfusion. The resulting nomogram demonstrated high predictive accuracy, with area under the curve values of 0.85 in the training set and 0.83 in the validation set. The developed nomogram for predicting the need for blood transfusion in patients with cirrhosis shows promising effectiveness for clinical application. This tool can significantly contribute to optimizing transfusion practices, potentially improving patient care and outcomes through more personalized and efficient transfusion strategies.

Effects of change in transfusion practice, population mix and fertility on red blood cell alloantibody prevalence.

Factors affecting red blood cell (RBC) alloimmunization have changed in New Zealand (NZ). We aimed to investigate whether alloimmunization prevalence had changed as a result. We calculated the prevalence (%) of patients with RBC alloantibodies among those who had antibody screening/identification done in Canterbury, NZ, during three periods: 2006-2010 (P1), 2012-2016 (P2) and 2018-2022 (P3). During P1, P2 and P3, respectively, females and males numbered 58,817, 30,082; 48,775, 28,383 and 56,200, 31,443. Combining the periods, the overall alloantibody prevalence in females and males was 2.4 versus 0.9, p < 0.0001, and in those ≥60 and ≤40 years, it was 1.9 versus 1.5, p < 0.0001. Prevalence declined, especially after P2. Prevalence of the five most common alloantibodies during P1, P2 and P3, respectively, was as follows: anti-E, 0.39, 0.48, 0.37; anti-D, 0.38, 0.34, 0.27; anti-K, 0.34, 0.32, 0.22; anti-Fya, 0.18, 0.19, 0.14; anti-C, 0.17, 0.16, 0.12; all alloantibodies, 2.0, 2.1, 1.5. p-values by the chi-squared test comparing prevalence (P1 vs. P2, P1 vs. P3, P2 vs. P3, respectively) were anti-E, 0.005, 0.5, 0.0006; anti-D, 0.2, <0.0001, 0.001; anti-K, 0.5, <0.0001, 0.0001; anti-Fya, 0.6, 0.04, 0.01; anti-C, 0.6, 0.006, 0.03; all alloantibodies, 0.1, <0.0001, <0.0001. RBC alloantibody prevalence has declined. The chief reasons for this appear to be changes in transfusion management, NZ population mix and fertility. The decline is beneficial.

Assessing the use of Blood Transfusions in Anemia Management in Ugandan Hospitals

Anemia remains a significant public health challenge in Uganda, particularly affecting children, pregnant women, and individuals with chronic diseases. Blood transfusions play a critical role in managing severe anemia in hospital settings, yet their availability and accessibility face numerous challenges, including shortages in blood supply, inadequate infrastructure, and safety concerns. This review evaluates the effectiveness of blood transfusions in anemia management in Ugandan hospitals, examining clinical indications, supply constraints, and associated risks. Additionally, it explores alternative strategies to reduce reliance on transfusions, such as improving nutritional interventions, enhancing malaria control programs, and strengthening healthcare infrastructure. The findings highlight the need for sustainable approaches to anemia management and policy improvements to optimize blood transfusion practices. Addressing these challenges will be essential in reducing anemia-related morbidity and mortality and improving overall public health outcomes in Uganda. Keywords: Anemia, blood transfusion, Uganda, anemia management, blood supply, public health.

Patient Blood Management in Pediatric Cardiac Surgery

ABSTRACT Children undergoing open heart surgery are often exposed to allogeneic blood products due to developmental changes in their haemostatic system and inflammation, use of anticoagulants, haemodilution and coagulopathy due to CPB. The complexity of surgical procedures, complex cardiopulmonary interactions and the risk of inadequate oxygen delivery and postoperative bleeding increase the use of blood products. Patient blood management aimed at minimising blood product transfusion is associated with improved patient outcomes. Safe conservative blood management practices covering the pre-, intra- and postoperative periods result in reduced blood product transfusion. This review summarises the current evidence on anaemia management and blood transfusion practices in the perioperative care of children undergoing cardiac surgery.