Units Of Red Cell Concentrates Research Articles

Abstract A11: The international prognostic score and HIV status predict red cell concentrate transfusion need in Hodgkin Lymphoma

Abstract Background There is a significant burden of anaemia in advanced Hodgkin Lymphoma (HL) in an HIV burdened setting, however there is a paucity of data evaluating red cell concentrate (RCC) transfusion in newly diagnosed HL receiving treatment. We performed a retrospective study to determine predictors of transfusion. Methods Patients 13 years and older consecutively diagnosed with and treated for HL from 2010 to 2019 in Groote Schuur Hospital, University of Cape Town, were retrospectively studied. Patients were staged according to the Lugano classification, with clinical staging according to the National Cancer Comprehensive Network and categorized with both the HL International Prognostic Score (IPS)-7 and the HL IPS-3. Results Two hundred and eighty-five patients received first-line treatment for HL from 2010 to 2019. Patients had a median age of 34.5 years and were predominantly male (62.9%). The HIV prevalence was 39.5% and majority of patients (74.2%) had advanced disease. Bone marrow involvement was confirmed in 41% of cases by trephine examination or PET-imaging; the majority (35%) of these cases the bone marrow appeared to be the primary site with no lymphadenopathy peripherally or on imaging. Primary bone marrow HL was strongly associated with HIV infection. RCC transfusion was observed in 24.6% patients, with significantly more HIV-positive patients (40.4%) transfused than HIV-negative patients (14.1%) (P<0.001). The median number of transfusions for the total cohort was 2 (IQR 1-5). HIV-positive patients received significantly more RCC units (median 3, IQR 2-5) than HIV-negative patients (median 2, IQR 1-3); P=0.035. In univariable logistic regression, each one-point increase in HL IPS-7 was associated with a two-fold increase in the odds of transfusion, while each one-point increase in HL IPS-3 was associated with a two-and-a-half-fold increase in the odds of transfusion. In multivariable analyses, HL IPS-7 and HIV positivity were significantly associated with transfusion after adjusting for B symptoms and ECOG. Similar results were observed after replacing the HL IPS-7 with HL IPS-3. Conclusion The HL IPS-7 as well as HIV status proved to be strong predictors of RCC transfusion need in a newly diagnosed HL cohort in the developing world. The HL IPS-3 consisting of only age, haemoglobin and Lugano stage IV, is equally predictive of transfusion need and simple in use. Lugano stage IV was a surrogate marker for the high (41%) HL bone marrow involvement. Citation Format: Estelle R Verburgh, Kudakwashe Simba, Zainab Mohamed, Jessica J Opie, Karryn Brown, Jenna Oosthuizen, Katherine R Antel, Lillian Andera, Cecile du Toit, Vernon J Louw. The international prognostic score and HIV status predict red cell concentrate transfusion need in Hodgkin Lymphoma [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A11.

The effect of clinician education on blood transfusion practice in obstetrics: completing the audit cycle.

With blood products being alimited and expensive resource within the healthcare system, there is an ever-increasing emphasis on judicial and appropriate use. To evaluate whether implementing contemporary society recommendations on restrictive transfusion policies would reduce inappropriate use of red blood cell transfusions, by evaluating the effect of a staff educational campaign. An audit of peri-partum red cell concentrate (RCC) transfusion practice within a tertiary obstetric unit was undertaken, covering a 1-year period (2015), examining data related to transfusion prescribing practices. Subsequently, an educational programme was held for clinical and laboratory staff which aimed to bring practice in line with society guidelines. A repeat audit covering another 1-year period (2018) was undertaken. The number of RCC units of transfused reduced by 49% between 2015 and 2018 (426 to 218). The number of patients receiving transfusion dropped from 166 in 2018 (1.8% of births) to 119 in 2015 (1.5% of births). Among stable patients who were transfused, the proportion receiving a single unit increased from 6.9 to 53.9%. (p < 0.001). Haematological reassessment between units rose from 13.8 to 80.4% (p < 0.001). Written consent documentation improved (68% in 2018 vs. 38% in 2015) (p < 0.001). The implementation of guidelines has resulted in substantial reduction in RCC transfusions between 2015 and 2018. Fewer women received a blood transfusion, and those who did received fewer units. There is a higher proportion of patients being reassessed between units and receiving single unit transfusions. Recording of consent has improved.

A comparison of the effect of X and gamma irradiation on red cell storage quality.

Irradiation of red cell components is indicated for recipients at risk of transfusion-associated graft vs. host disease. Current technologies available comprise of a gamma (γ) or an x source of radiation. The benefits of x vs. γ include non-radioactivity and hence no decay of the source. We aimed to compare the effect of the two technologies on red cell component storage quality post-irradiation. Paired units of red cell concentrates (RCC), neonatal red cell splits (RCS), red cells for intra-uterine transfusion (IUT) or neonatal exchange transfusion (ExTx) were either γ- or x-irradiated. Units were sampled and tested for five storage parameters until the end of shelf life. Equivalence analysis of storage quality parameters was performed for pairs of the same components (RCC, RCS, IUT or ExTx) that were either γ- or x-irradiated. Nearly all component comparisons studied showed equivalence between γ and x irradiation for haemolysis, ATP, 2,3-DPG, potassium release and lactate production. The exceptions found that were deemed non-equivalent were higher haemolysis with x irradiation for ExTx, lower 2,3-DPG with x irradiation for RCS irradiated early and higher ATP with x irradiation for IUT. However, these differences were considered not clinically significant. This study has demonstrated that a range of red cell components for use in different age groups are of acceptable quality following x irradiation, with only small differences deemed clinically insignificant in a few of the measured parameters.

Non-invasive monitoring of red blood cells during cold storage using handheld Raman spectroscopy.

The current best practices allow for the red blood cells (RBCs) to be stored for prolonged periods in blood banks worldwide. However, due to the individual-related variability in donated blood and RBCs continual degradation within transfusion bags, the quality of stored blood varies considerably. There is currently no method for assessing the blood product quality without compromising the sterility of the unit. This study demonstrates the feasibility of monitoring storage lesion of RBCs in situ while maintaining sterility using an optical approach. A handheld spatially offset Raman spectroscopy (RS) device was employed to non-invasively monitor hemolysis and metabolic changes in 12 red cell concentrate (RCC) units within standard sealed transfusion bags over 7 weeks of cold storage. The donated blood was analyzed in parallel by biochemical (chemical analysis, spectrophotometry, hematology analysis) and RS measurements, which were then correlated through multisource correlation analysis. Raman bands of lactate (857 cm-1 ), glucose (787 cm-1 ), and hemolysis (1003 cm-1 ) were found to correlate strongly with bioanalytical data over the length of storage, with correlation values 0.98 (95% confidence interval [CI]: 0.86-1.00; p=.0001), 0.95 (95% CI: 0.71-0.99; p=.0008) and 0.97 (95% CI: 0.79-1.00; p=.0004) respectively. This study demonstrates the potential of collecting information on the clinical quality of blood units without breaching the sterility using Raman technology. This could significantly benefit quality control of RCC units, patient safety and inventory management in blood banks and hospitals.

Not all red cell concentrate units are equivalent: international survey of processing and in vitro quality data.

In vitro qualitative differences exist in red cell concentrates (RCCs) units processed from whole blood (WB) depending on the method of processing. Minimal literature exists on differences in processing and variability in quality data. Therefore, we collected information from blood manufacturers worldwide regarding (1) details of WB collection and processing used to produce RCCs and (2) quality parameters and testing as part of routine quality programmes. A secure web-based survey was developed, refined after pilot data collection and distributed to blood centres. Descriptive analyses were performed. Data from ten blood centres in nine countries were collected. Six blood centres (60%) processed RCCs using the top-and-top (TAT) method which produces RCCs and plasma, and eight centres (80%) used the bottom-and-top (BAT) which additionally produces buffy coat platelets. Five of the centres used both processing methods; however, four favoured BAT processing. One centre utilized the Reveos automated system exclusively. All centres performed pre-storage leucoreduction. Other parameters demonstrated variability, including active cooling at collection, length of hold before processing, donor haemoglobin limits, acceptable collection weights, collection sets, time to leucoreduction, centrifugation speeds, extraction devices and maximum RCC shelf life. Quality marker testing also differed amongst blood centres. Trends towards higher RCC unit volume, haemolysis and residual leucoctyes were seen in the TAT compared with BAT processing across centres. Methods and parameters of WB processing and quality testing of RCCs differ amongst surveyed blood manufacturers. Further studies are needed to assess variations and to potentially improve methods and product quality.

Feasibility of photoacoustic imaging for the non‐invasive quality management of stored blood bags

During the in vitro storage of red blood cells (RBCs), unfavourable changes (storage lesions) cause a rapid consumption of intracellular diphosphoglycerate. The latter deregulates the oxygen-haemoglobin binding potential, subsequently increasing oxygen saturation (SO2 ) and membrane degradation, transforming RBCs from biconcave discs to rigid spherical bodies (spheroechinocytes). Current laboratory techniques invasively extract RBC samples to assess the quality of red cell concentrate (RCC) units. Optical technologies could provide a means of assessing quality non-invasively. A photoacoustic (PA) imaging technique was developed for acquiring the SO2 of blood bags non-invasively. Seven RCC units were monitored every 3-5days until expiry (6weeks). Measurements were validated against a conventional blood gas analyzer (BGA). Using an image flow cytometry assay, morphological profile trends were compared against the SO2 trends during blood bag storage. A strong correlation (r2 ≥0·95) was found when comparing temporal data between PA and BGA SO2 measurements. Inter-sample PA variability was found to be similar to that produced by BGA (±0·8%). A strong correlation was found to exist between the temporal changes in SO2 and relative spheroechinocyte population (0·79≤r2 ≤0·97). This study suggests that PA imaging can non-invasively track the SO2 of stored RBCs non-invasively. By longitudinally monitoring the change in SO2 , it is possible to infer the effects of the storage lesion on RBC morphology. This non-invasive monitoring technique allows for the assessment of blood bags, without compromising sterility pre-transfusion.

The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011.

External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn.

Audit of pediatric transfusion practices in a tertiary care hospital.

To perform a retrospective audit of transfusion practices, in order to study the appropriate and inappropriate usage of different blood components in pediatric population. The present study, conducted over a period of 3 mo analyzed all the episodes of transfusions and divided them into appropriate and inappropriate according to the type of blood components, the requesting departments and the clinical indication of transfusion. Data was reviewed according to the British Committee for Standards in Hematology and American Association of Blood Bank guidelines. A total of 2,145 units of hemocomponents were transfused to children, including 1,181 units of red cell concentrates, 566 units of platelet concentrates/platelet rich plasma, 118 units of whole blood and 280 units of fresh frozen plasma in 1,819 episodes. Appropriate usage of blood components was 59.65%. Whole blood was most appropriately transfused (82.9%). Appropriate indications outnumbered inappropriate requisitions in Department of Pediatric Medicine (70.38 %), Nursery (82.54 %) and Thalassemia day care centre (55.63%). Red cell concentrate was most appropriately indicated in anemias (73.14%) and inappropriately in cases of surgeries (53.6%). Platelets were used more appropriately in all clinical indications. Whole blood was transfused most appropriately (100%) in double venous exchange therapy. Most appropriate indication of fresh frozen plasma usage was coagulopathy (42.57%). As the appropriate usage (59.65%) of blood components was low in the present study, regular auditing of transfusion practices from time to time is indicated. This not only helps guide their judicious use but also serves to evaluate and decrease their inappropriate usage.

Intra-operative cell salvage in South Africa: Feasible, beneficial and economical

Healthcare services in KwaZulu-Natal (KZN) frequently experience shortages of blood products. Alternatives to traditional blood sources are needed. One possibility is cell salvage and autologous blood transfusion. Few data exist relating to their use in the South African context. To ascertain whether cell salvage (CS) is beneficial, feasible and economical in our setting, with the anticipation that results would excite further studies and potentially change current practice and improve existing protocols. Methods. This study reviewed current intraoperative Cell Saver use at Grey's and Edendale hospitals in Pietermaritzburg, KZN. Current practices were observed and compared with the costs of the equivalent amount of red cell concentrate (RCC) purchased from the South African National Blood Service (SANBS). All cases of Cell Saver usage over a 1-year period from July 2012 to June 2013 were analysed. The total volume of blood transfused from CS was 55 735 ml, approximately equivalent to 186 RCC units. The comparative cost of equivalent units of RCC from SANBS was R258 445. The total cost of Cell Saver disposables during the study period was R206 047, or R263 478 when Cell Saver machine depreciation costs were included. More than one CS blood unit was available for transfusion in 66% of cases. No additional staff were required to operate the Cell Saver, which was successfully used by medical officers. This study showed that intraoperative CS use is feasible, has potential patient benefit by reducing blood bank blood transfusion, and is financially comparable to purchasing the equivalent number of SANBS RCC.

Cell Salvaging Reduces the Severity of Dilutional Coagulopathy (as Evaluated Through the Consumption of Blood Products) in Liver Transplantation.

Abstract 2290 Background:Intra-operative autologous red blood cell (RBC) salvaging (SRBC) reduces requirements for allogeneic RBC transfusion during surgery, and should be considered in surgeries with anticipated blood losses over 1 L. However, the auto-transfusion of large volumes of SRBC can lead to dilutional coagulopathy, due to the loss of clotting factors and platelets during cell processing, worsening the outcome of surgery.Orthotopic liver transplantation (OLT) has historically been associated with major blood loss and massive blood transfusion due to the aggressiveness of surgery, the anhepatic phase and the pre-existing underlying disease. While transfusion requirements have been greatly reduced over the past decade, large volumes correlate with worsened prognosis and can also lead to dilutional coagulopathy.Most published series on cell salvaging focus on orthopedic, cardiac or oncologic patients, and data on its use in liver transplantation remains insufficient and contradictory, with the suggestion that salvage is associated with a higher degree of dilutional coagulopathy than allogeneic transfusion. Methods:We performed a retrospective analysis of a 5-year series of OLT patients undergoing surgery (including for fulminant liver failure) in our Centre, comparing the number of units of Red Cell Concentrate (RCC) transfused during each procedure and the volume of autologous SRBC obtained intra-operatively and reinfused before the conclusion of surgery, with the number of units of fresh frozen plasma (Plasma) and Platelet Concentrate (PC) consumed, as a clinical marker of the depth of coagulopathy, both through univariate and multivariate analysis. Results:A total of 218 OLTs were analyzed; an average of 13.6±17.5 units (U) of RCC, 7.4±12.4 U of Plasma and 5.0±7.9 U of PC were used. In one third of patients (30.7%) no allogeneic RCC was transfused, and in a further third (34.4%) less than 5 U were consumed, resulting in a median of 2 U of RCC per patient. A mean of 1003.4±1061.3 mL of SRBC were reinfused in the 70 patients (32.1%) who underwent salvage.There was no correlation between the number of RCC units and the volume of SRCB infused (−0.04, p=NS), and the mean volume of SRBC was not different between patients who were transfused with RCC (315.3±845.4) and those who were not (337.7±527.0, p=NS); on the other hand, patients who underwent cell salvage used significantly less units of RCC (3.3±6.1) than those who did not (9.4±14.1, p<0.001).We found a strong correlation between the number of Plasma and PC units administered (0.73, p<0.001), and between the number of RCC and Plasma (0.91, p<0.001) and PC units (0.68, p<0.001) used; patients who were transfused with at least 1 U of RCC consumed significantly more Plasma (18.7±18.7 U) and PC (7.1±8.6 U) than patients who did not receive any allo-RCC (1.9±4.0, p<0.001 and 0.3±1.8, p<0.001, respectively). Likewise, there was a significant correlation between the volume of SRBC and the number of Plasma (0.63, p<0.001) and PC units used (0.31, p=0.009); however, patients who underwent cell salvage used significantly less Plasma (7.4±11.7 U) and PC (2.8±6.1 U) than patients who did not (16.1±19.1, p<0,001 and 6.1±8.4, p=0.002, respectively), and patients who received only autologous SRBC were transfused with significantly less Plasma (2.0±4.4 U) and PC (0.0±0.0 U) than patients who received only allogeneic RCC units (20.6±19.8, p<0.001 and 7.6±8.9, p<0.001, respectively). Discussion:The choice to use SRBC was introduced a priori, as reflected in the absence of correlation between the volume of RCC and SRBC used. However, the use of salvaging resulted in a significantly lower need for allogeneic RCC.The volume of allo or auto-RBC needed during surgery correlated with the severity of coagulopathy, and the number of Plasma and PC units administered to revert it were strongly correlated, as expected. However, the choice to use SRBC was associated with a decrease in the volume of Plasma and PC needed, when compared to surgeries without salvaging. Likewise, the exclusive use of SRBC resulted in a significantly lower use of Plasma and PC during surgery than the exclusive use of allo-RCC. Conclusion:In our series, intraoperative salvaging not only reduced the consumption of RCC, but was also associated with a lower severity of surgical coagulopathy, as evaluated clinically through the number of units of Plasma and PC needed to stabilize the patient. Disclosures:No relevant conflicts of interest to declare.

Consultant presence during major obstetric haemorrhage

BackgroundConsultant presence on labour ward can improve patient outcomes, with recommendations for on-site cover of 60 hours/week in units with ≥5,000 births/year. The study aims to assess the potential impact...

Inadvertent bleeding in an infant after inguinal hernioplasty leads to diagnosis of hemophilia B

To the Editor: A seven-month-old male infant who was diagnosed with inguinal hernia at routine medical checkup was admitted to our hospital for surgical repair. Past history and family history were negative for bleeding tendencies, purpura, and hemophilia. Preoperative physical examination and laboratory tests indicated no abnormalities. Coagulation tests were not performed. Hernioplasty was performed with no oozing or complications. The patient was discharged from the operating room at 4 p.m. At 7 a.m. on postoperative day (POD) 1, HR had increased to 132 bpm and BP decreased to 90/40 mmHg. The mother noticed blood contamination of the gauze covering the wound at night, but she did not inform the medical staff. At 9 a.m. on POD1, the attending surgeon noticed the patient to be extremely pale and that the gauze covering the wound was soaked with blood. Blood tests confirmed severe anemia (hemoglobin (Hb) 4.8 g/dl). Emergency hemostasis was performed immediately under general anesthesia. After failure to secure another peripheral venous access, we inserted a central venous catheter in the right internal jugular vein. Preparation of red cell concentrate (RCC) took a long time because blood type screening had not been conducted preoperatively. The coagulation tests showed long APTT (125 s), and thus fresh frozen plasma was transfused. Oozing was observed throughout the surgical field. The blood loss measured intraoperatively was 50 g and laboratory tests at the end of surgery showed Hb 8.9 g/dl, and Ht 26.4% after transfusion of two units of RCC. On POD2, the scrotum began to swell because of oozing which required removal of the stitches to reduce the pressure. On POD6, plasma clotting factor IX was reduced to 8% of the normal value, and he was diagnosed as hemophilia B. Therefore, clotting factor IX was transfused which resulted in complete cessation of oozing on POD11. The patient was discharged on POD26. Routine preoperative management does not include coagulation tests, especially before minor pediatric surgery, for example hernioplasty, for children with no family history of bleeding disorders. Routine use of coagulation tests have been discussed by otorhinolaryngologists who perform elective tonsillectomy and adenoidectomy. Houry et al. [1] and the American Academy of Otolaryngology Head Neck Surgery [2] recommended performing preoperative hemostatic screening tests only for patients with abnormal bleeding history. The reported negative predictive value of normal APTT in the absence of symptoms and M. Sumie (&) T. Yokoo-Matsuoka K. Yamaura Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Maidasi 3-1-1, Higasi-ku, Fukuoka 812-8582, Japan e-mail: sumimako@chorus.ocn.ne.jp

Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage

Objectives The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD). Study design This prospective study from 2004 to 2007 was carried out in three Dublin maternity hospitals. Women were identified as having MOH if they received ≥5 units of red cell concentrate (RCC) acutely. Risk factors for hysterectomy or end organ dysfunction were calculated using logistic regression. Results One hundred and seventeen cases of MOH in 93,291 deliveries were identified (1.25/1000). The predominant cause was uterine atony. Haemostasis was achieved with medical therapy alone in 15% of cases. The hydrostatic balloon and the B-Lynch suture arrested bleeding in 75% and 40% of cases utilised respectively. Hysterectomy was required to arrest bleeding in 24% of women and 16% of women developed end organ dysfunction (11 had both). There was one maternal death. Independent risk factors for hysterectomy included the number of previous caesarean sections (OR 3.28, 95% CI 1.95–5.5), placenta praevia (OR 13.5, 95% CI 7.7–184), placenta accreta (OR 37.7, 95% CI 7.7–184), uterine rupture (OR 7.25, 95% CI 1.25–42) and the number of units of RCC transfused (OR 1.31, 95% CI 1.13–1.5). Independent risk factors for end organ dysfunction (EOD) were placenta accreta (OR 5, 95% CI 1.5–16.5), uterine rupture (OR 13.86, 95% CI 2.32–82), the number of RCC transfused (OR 1.31, 95% CI 1.13–1.5) and the minimum haematocrit recorded (OR 5.53, 95% CI 1.7–18). Conclusions MOH is complicated by hysterectomy in 24% and end organ dysfunction in 16% of cases. The risk of peripartum hysterectomy is increased with the number of previous caesarean sections, the aetiology of the bleed, namely placenta praevia/accreta or uterine rupture and the volume of blood transfused. Critically, failure to maintain optimal haematocrit during the acute event was associated with end organ dysfunction.

A pilot study of the possibility and the feasibility of haemoglobin dosing with red blood cells transfusion

Red blood cell concentrates (RBCs) are the major blood component transfused. Although the haemoglobin content is variable, the transfusion dose is prescribed as units of red cell concentrates. Thus, by chance, large volume patients may receive a low haemoglobin dose and low volume patients may be transfused with haemoglobin-rich RBCs. The aim of this study was to evaluate whether the haemoglobin increment (grams per litre) in the patient can be predicted from the haemoglobin dose (in grams) transfused, with and without correction for estimated blood volume. If this is true, it may be possible to achieve the predicted transfusion outcome by selecting RBCs for each patient. Haemodynamically stable patients scheduled for day treatment with transfusion of RBCs were recorded. A total of 52 transfusions episodes, 27 for women and 25 for men, were recorded. Blood volumes were estimated, haemoglobin content in the RBCs was measured before transfusion, and pre- and post-transfusion haemoglobin concentrations were obtained. The haemoglobin content of the RBCs prepared for transfusion showed a wide range, varying from 38.7 g/unit to 69.0 g/unit. There were statistically significant correlations between haemoglobin concentration in the RBCs and haemoglobin increment in patients. Post-transfusion increment in circulating haemoglobin can be predicted from the haemoglobin content of transfused cells, but knowledge of the patient's blood volume improves the accuracy of prediction. It may be feasible to select the high haemoglobin content RBC for patients with largest blood volume and vice versa.

Transfusion de concentrés de globules rouges à Yaoundé, Cameroun : quelle qualité ?

As part of a quality assurance process in the transfusion service of a hospital blood bank of Yaoundé, Cameroon, a selection of units of red cell concentrates (RCC) were evaluated for volume, haemoglobin, and haematocrit levels as well as blood cell content. Blood samples were all collected into standard double blood bags containing an anticoagulant, citrate-phosphate-dextrose and adenine. During a three-month period, 35 bags intended for the preparation of the RCC were analysed. After relevant screening for transfusion transmissible infections ,and ABO and rhesus (RH1) blood grouping, the bags were centrifuged to obtain RCC. The resultant red cell bags were weighed and the volumes estimated. Full blood counts were performed on samples of the RCC using an electronic particle counter (DIANA 5, HYCEL Diagnostics, Reims, France). The results obtained showed that, based on ISO 9001: 2000 norms, there were 57, 66 and 80% of RCC respectively with volumes, hemoglobin levels as well as hematocrit that were in conformity with the norms. When the data was analysed based on the Algerian norms, 83, 66 and 95% respectively conformed. The significance of these findings and the need for establishing local norms for quality assurance in our community are discussed.

A study of blood product use in patients with major trauma in Scotland: analysis of a major trauma database

Objectives: (1) To define blood product requirements in patients with trauma whose underlying injuries are consistent with major blood loss; (2) to use these data to estimate the annual number...

Automated collection of blood components: their storage and transfusion.

The performance of an automated device, the Gambro TRIMA, was evaluated for component production, and an in vivo assessment of the platelets was carried out. Red cell concentrates (RCCs), platelets and plasma were collected and stored according to standard blood bank procedures and evaluated for quality by in vitro measurements. Additionally, single-donor platelets (n=10) were transfused to thrombocytopenic patients after 5 days of storage. Platelet counts were measured after 1 h and the corrected count increment (CCI) was calculated. No significant changes were seen before or after procedure in donor haemoglobin, haematocrit, coagulation factors or platelet count. Return-line samples showed no increase in the level of plasma haemoglobin. Plasma haemoglobin and potassium increased following RBC storage, but there was no change in the red cell number. Platelet aggregation decreased from 52 to 11% (adenosine diphosphate) and the Kunicki morphology score dropped from 379 to 174. Little change was seen in the hypotonic shock response (69-63%) or in the percentage of CD62 expression (4.8-19.8) over time. The CCI averaged 28+/-26 x 10(3) microL(-1) in 10 patients 1 h after transfusion. The TRIMA machine collects RCCs, platelets and plasma in a variety of combinations in one session. For autologous collection, two units of RCC plus platelets can be collected at one time, reducing administrative and testing costs. The platelets have good in vivo recovery, as shown by the CCI values. An added advantage is that the TRIMA machine can be used in hospitals to generate components in times of shortage without the need for a component's laboratory.

Identification des facteurs prédictifs de transfusion sanguine homologue en chirurgie cardiaque à partir d’une étude observationnelle

Objective. – To determine perioperative variables for predicting allogenic transfusion in adult cardiac surgery. Study design. – Prospective study. Patients. – We included 335 consecutive patients undergoing cardiac surgery between February and April 2001. Methods. – Perioperative variables were prospectively collected in a database. For each patient who received transfusion, hemoglobin threshold for transfusion and total number of units of red cell concentrates were collected. Univariate and multivariate analysis were performed. Results. – The two strategies for blood conservation which were predominantly used were aprotinin therapy (78%) and blood salvage from the extracorporeal circuit (68%). During perioperative period, 42% of patients [95% CI: 37–47%] received allogenic transfusion. The haemoglobin threshold for transfusion was 7.4 ± 1.1 and 8.0 ± 0.7 g dl –1 in operating room and in intensive care unit, respectively. On average, 3.4 ± 2.7 units of red cell concentrates were transfused perioperatively per patient. Using multivariate analysis, perioperative allogenic transfusion was significantly associated with the following variables: preoperative haemoglobin level < 12 g dl –1 (odds ratio 8.9; p = 0.001), emergency procedure (odds = 3.7, p = 0.01), reoperation (odds ratio = 3.3; p = 0.002), chronic obstructive pulmonary disease (odds ratio = 2.5; p = 0.03) and complex surgery (odds ratio = 2.4; p = 0.01). The age, the gender, and body mass index were only independent risk factors by univariate analysis. Conclusion. – In despite of techniques to limit requirement of allogenic transfusion, a large proportion of cardiac surgical patients remains transfused. Independent risk factors of perioperative transfusion are haemoglobin level < 12 g dl –1, emergency procedure, reoperation, chronic obstructive pulmonary disease and complex surgery.

Biocompatibility of leukocyte removal filters during bedside leukocyte filtration of red cell concentrates

The biocompatibility of leukocyte removal filters was evaluated in four different types of leukocyte filters made from different materials during bedside leukocyte filtration of red cell concentrates (RCC). Two units of banked RCC were filtrated through each leukocyte filter inserted into the transfusion line ( n = 20). The results indicate that there was no significant increase of granulocyte elastase nor the generation of the complement split product C3a during filtration of the first unit of RCC. However, activation of the complement system occurred during filtration of the second unit of RCC in particular by the filters made from cellulose acetate. There was no increase of either clotting or fibrinolytic activity during leukocyte filtration by all these leukocyte removal filters. Samples taken from patients revealed that no increase of these bioactive substances was found in patients who received the transfusion through leukocyte filters. Thus, the evaluated leukocyte removal filters do not compromise patients in terms of biocompatibility and are safe to be used during bedside filtration.

Etude multicentrique sur l'efficacité de la déleucocytation par filtration des globules rouges

To determine the actual efficacy of red cells filtration technique, the "Labile Blood Component Production" french study group, including 21 blood centers, realized a large study on more than 1,400 filtrations and 3,000 controls. 745 units of red cell concentrates (RCC) and 690 units of buffy-coat poor red blood cells (BC PRBC) were filtered through 6 commercialized leukocytes depleting filters: not less than 170 experiments per filter, tested by 3 different blood centers. Pre-filtration controls prove that buffy-coat removal, done manually or with automated equipment, involves a first leukocytes depletion about 63% and an hemoglobin loss equal to 4 g (7%). After filtration, residual leukocytes counts were performed manually in a Nageotte counting chamber. In this study, we evaluated the reliability of this simple method which accurately measures very low leukocytes counts. The variation coefficient was 25% for 2.5 leukocytes/microliter concentration (O.6 x 10(6) per filtered unit). The results, obtained from 1200 evaluated filtrations, confirm that buffy-coat removal obviously improves the filtration performances (residual leukocytes level is lower than 1 x 10(6) per unit for 78% filtered BC PRBC versus 43% filtered RCC). Furthermore, 90% of overall filtered units are containing less than 5 x 10(6) leukocytes.