Unnecessary Donor Research Articles

Duragen: A dermal substitute for the management of suboptimal wounds.

Using a flap in a large wound with a very small area of exposed vital structures may be an excessive intrusion and cause unnecessary donor site morbidity. Dermal matrix (DuraGen) was applied onto critical areas where bone or tendons were exposed and a split skin graft was placed thereon. All patients had satisfactory wound closure without the need for a flap. DuraGen appears to be a safe, single-stage alternative, to a flap for the healing of complex wounds.

Ultrasensitive PCR system for HBV DNA detection: Risk stratification for occult hepatitis B virus infection in English blood donors.

Occult hepatitis B (HBV) infection (OBI), characterized by low viral loads, accounts for much of the risk of HBV transfusion-transmitted infection. With anticore antibodies (anti-HBc) screening introduced in England, the imperative to identify OBI donors has increased. We aimed to develop an ultra-sensitive PCR system and investigate risk factors for HBV DNA presence in blood donations. Seven extraction methods and three PCR assays were compared. The optimal system was sought to determine HBV DNA presence in anti-HBc-positive donations. Predictors of DNA positivity were subsequently investigated. Extraction from 5 mL of plasma increased sample representation and resulted in HBV DNA detection in low viral load samples (~0.5 IU/mL). Screening of 487 763 donations in 2022 identified two OBI donors and 2042 anti-HBc-positive donors, 412 of the latter with anti-HBs < 100 mIU/mL. Testing of 134 anti-HBc-positive donations utilizing the 5 mL extraction method identified two further HBV DNA-positive donations. Higher anti-HBc titer and anti-HBs negativity were significant predictors of DNA detectability in anti-HBc-positive donations. An ultrasensitive PCR assay identified potentially infectious donations increasing HBV DNA detection in anti-HBc-positive donors from 0.5% to 1.9%. Anti-HBc titers may further complement the risk stratification for DNA positivity in anti-HBc screening and minimize unnecessary donor deferral.

Re-Entry Evaluation of Chinese Blood Donors with Unconfirmed Hepatitis B Screening Results.

The hepatitis B virus (HBV) remains a high priority for Chinese blood banks due to the high prevalence of infection. HBV blood safety has been significantly improved by the implementation of highly sensitive and specific serological and molecular HBV screening assays. The multiplication of viral markers tested and the ever-increasing analytical sensitivity of the tests can make the interpretation of the results difficult. False-positive or indeterminate results may lead to permanent donor deferrals and conflicts between donors and blood banks. To avoid blood shortages, blood services aim to limit unnecessary donor losses by developing procedures for the re-entry of donors temporarily deferred due to an unconfirmed HBV reactivity. The development of such procedures based on donor follow-up and HBV confirmation remains limited. A review of the scarce data available revealed considerable heterogeneity in testing methods and re-entry algorithms, limited validation studies, and a lack of accurate assessment of the residual infectious risk potentially associated with donor re-entry. In conclusion, systematic and widely validated confirmatory testing and prolonged follow-up are essential for safe re-entry of temporary deferred donors. Standardization of HBV testing methods and the establishment of dedicated expert laboratories are needed because of the complexity of HBV infection in blood donors.

Hematological Parameters from the Feline Blood Donor to the Blood Unit: What Changes Are to Be Expected?

Simple SummaryFeline blood donation requires sedation to allow for good blood collection, avoiding venous damage and unnecessary donor stress. In the present study, we describe the variation of hematological parameters in a population of healthy blood-donor cats that underwent the same sedation protocol, including medetomidine, alfaxalone, and butorphanol. Significant differences in hematological parameters were observed between unsedated and sedated cats; particularly, the mean red blood cell count, hemoglobin concentration, hematocrit value, mean corpuscular volume, and red blood cells distribution width were significantly lower in sedated cats than in conscious ones, thus confirming that sedation is a critical procedure in cats. No significant differences for the main hematological parameters were observed between sedated cats and feline blood units, suggesting that the dilution with the conservative–anticoagulant solution (ratio 1:7) exerts negligible effects on these parameters with respect to samples of sedated animals.Feline blood donation requires sedation to allow for good blood collection, avoiding venous damage and unnecessary donor stress. In the present study, we describe the variation of hematological parameters in a population of 74 healthy blood-donor cats that underwent the same sedation protocol, including medetomidine, alfaxalone, and butorphanol. Changes in hematological parameters were evaluated in blood samples collected from conscious cats (group A), sedated cats (group B), and feline whole-blood units (FBUs) (group C). Significant differences were observed between unsedated and sedated cats: the mean RBC count, HGB, HCT, and RDW were significantly lower in sedated cats than in conscious ones, with a difference of 17.95%, 18.42%, 28.21%, and 10.00%, respectively. In accordance with previously reported data, our results confirm that sedation is a critical procedure in cats that can affect most of the hematological parameters. The second finding of our study is that no significant differences for the main hematological parameters were observed between sedated cats and FBUs, thus suggesting that the dilution with the conservative–anticoagulant solution exert negligible effects on these parameters with respect to samples of sedated animals. This hematological change must be taken into consideration since such parameters are important to define the quality of FBUs.

Blood donor screening in the Netherlands: Universal anti-HBc screening in combination with HBV nucleic acid amplification testing may allow discontinuation of hepatitis B virus antigen testing.

In the Netherlands, blood donor screening for hepatitis B virus (HBV) consists of HBsAg screening since the 1970s, HBV DNA minipool testing (MP-NAT) since 2008, and anti-HBc screening since 2011. Anti-HBc reactivity causes deferral only if anti-HBs titers are <200 IU/mL, or when anti-HBc was acquired during follow-up. Over 5.5 million donations from 582,459 Dutch donors were screened for HBV DNA, HBsAg, anti-HBc, and, if anti-HBc positive, also for anti-HBs. The added value, expressed as the yield of (potentially) infectious and/or recent HBV infections versus unnecessary donor loss, was evaluated for each of the three HBV screening tests. HBV donor screening identified 89 HBV-infected donors with at least two reactive HBV markers (MP-NAT, HBsAg and/or anti-HBc). Single HBV-marker yield was: 5 MP-NAT-only, 0 HBsAg-only, and 20 anti-HBc-only donors. In addition, anti-HBc screening yielded 1,067 potentially infectious donors at risk for occult HBV infection (OBI). In total, 4,126 (0.71%) donors were anti-HBc-reactive at first-time screening, and 1,098 (0.19%) seroconverted during follow-up. Anti-HBc-related donor loss was limited to 2,627 (0.45%) donors using anti-HBs titers and two-strike programs. Donor loss due to MP-NAT and HBsAg screening was extremely low: 0 and 128 donors, respectively. HBV donor screening could be limited to MP-NAT and anti-HBc screening. MP-NAT and anti-HBc improved blood safety by intercepting infectious donations from donors with recent infection or OBI, while HBsAg did not. Unnecessary donor loss related to anti-HBc screening is substantial but does not endanger the continuity of the blood supply.

Hepatitis C virus prevalence and incidence estimates among Chinese blood donors.

Hepatitis C virus (HCV) is an important transfusion-transmitted virus with global significance. The objective of this study was to evaluate the HCV prevalence and incidence among Chinese blood donors from 2013 to 2016. Whole blood and apheresis platelet donations collected from five Chinese blood centers from June 1, 2013, to December 31, 2016, were screened in parallel by two different enzyme-linked immunosorbent assays for anti-HIV 1/2, hepatitis B surface antigen, anti-HCV, and syphilis. Screening-reactive samples were further confirmed by western blot. Confirmatory positive rates among first-time and repeat donors were used to estimate the prevalence and incidence rates. Multivariable logistic regression modeling was used to examine factors associated with HCV infection. A total of 1,276,544 donations were collected from five Chinese blood centers, of which an estimated 1203 were confirmed HCV positive. The overall HCV prevalence among first-time donors was 166.56 per 100,000 donors (95% confidence interval, 156.04-177.08). The HCV incidence rate was estimated to be 15.21 (95% confidence interval, 11.83-19.56) per 100,000 person-years among repeat donors. Multivariable logistic regression results showed that increased age, lower educational levels, ethnicity, and occupation were all important factors associated with HCV confirmatory status among first-time donors (p < 0.01). HCV infection is still an important concern for transfusion safety in China. Our findings indicate that continued strong efforts are needed to monitor and control the risk of transfusion-transmitted HCV infection in China. Moreover, to reduce unnecessary donor loss, HCV donor screening procedures should be improved by incorporating confirmatory testing into routine blood center operations.

A local and fast interpolation method for mesh deformation

In this study, a local interpolation approach is developed to deal with the deformation of a mesh containing structured and stretched viscous elements. A new strategy is proposed to compute the local influence distance at each movable mesh point. This strategy not only helps to exclude unnecessary donor points from the computation of the new position of the mesh point, but also gets those viscous elements stiffened appropriately such that they are no longer inverted easily. Further improvements on the efficiency of the proposed algorithm are achieved by parallelising the algorithm and developing a bounding box technique to speed up the procedure of searching donor points. Meanwhile, the robustness of the proposed algorithm in the case of large boundary movement is enhanced by incorporating a state-of-the-art multi-step technique. Various numerical experiments are conducted and the results show that the proposed algorithm could treat cases involving complex boundary movements at a low level of computing consumptions.

P033 Cryopreserved donor cell crossmatches: Can we believe the results?

Aim In order to facilitate rapid turnaround, exchange programs such as the NKR require preliminary flow cytometric crossmatching (FCXM) using frozen cells. However, we’ve found that questionable FCXM results occur more often with frozen cells compared to results obtained with fresh donor lymphocytes. In this study, we investigated the frequency of such discrepant results. We compared 17 donor/recipient pairs who were crossmatched using both frozen and fresh donor cells. Methods Fresh lymphocytes were isolated using EasySep™ (StemCell Technologies). Frozen cells were thawed following a validated protocol (ASHI Laboratory Manual). All cells were treated with pronase. FCXM were performed using a rapid protocol (Liwski, et al., H.I. 72, 2011). In all cases, a screening FCXM was performed with frozen cells and a final FCXM was performed with fresh donor cells. For final FCXM, one specimen tested in the initial screening FCXM was included. Donor specific antibodies (DSA) were analyzed using multiple solid phase platforms. Results Six out of the 17 FCXM comparisons were discrepant. Among the discrepant FCXM, 4/6 were T & B cell positive using frozen cells and negative using fresh cells; 1/6 had elevated, but within negative range, MCS using frozen cells and clearly negative MCS ( Conclusions The problem with unreliable frozen cell crossmatches is that false positive results can lead to unnecessary donor denial and false negative results can bring about last minute exchange failure. When a recipient clearly has no DSA, a positive FCXM using frozen cells is not typically problematic and most often a repeat FCXM using fresh cells is negative. On the other hand, for patients with DSA, the intent of an exploratory FCXM with frozen cells is to rapidly evaluate whether or not DSA strength is at an acceptable level. However, in order to be clinically informative, it is important that FCXM results using frozen cells correlate with fresh cells. Download : Download high-res image (279KB) Download : Download full-size image

Repair of Craniomaxillofacial Traumatic Soft Tissue Defects With Tissue Expansion in the Early Stage.

Craniomaxillofacial traumatic soft tissue defects severely affect the function and appearance of the patients. The traditional skin grafting or free flap transplantation can only close the defects in the early stage of operation but cannot ensure similar color, texture, and relative aesthetic contour. In the present study, the authors have explored a novel strategy to repair craniomaxillofacial traumatic soft tissue defects by tissue expansion in the early stage and have obtained satisfactory results. Eighteen patients suffering large craniomaxillofacial traumatic soft tissue defects were treated by thorough debridement leaving the wounds unclosed or simply closed with thin split-thickness scalp grafts, adjacent expander implantation in the first stage, and expanded flap transposition in the second stage. There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years (mean, 19.4 ± 12.2 years), with average 15 months follow-up (range, 3-67 months). The average expansion time was 74.3 days (range, 53-96 days). The 18 patients with a total of 22 expanders were treated with satisfactory results. All the flaps survived and the skin color, texture, and contour well matched those of the peripheral tissue. Only 1 complication of infection happened in the 18 cases (5.56%) and the 22 expanders (4.55%), which was similar to the rate reported in the literature. No other complications related to the expanders occurred. Debridement and tissue expansion in the early stage has been proved to be a more effective strategy to repair craniomaxillofacial traumatic soft tissue defects. This strategy can not only achieve satisfactory color, unbulky and well-matched texture similar to normal, but also avoid unnecessary donor site injuries.

Early application of tissue expansion in repair of traumatic soft tissue defects in the head and face

Objective To explore a novel strategy to repair traumatic soft tissue defects in the head and face by tissue expansion in the early stage. Methods Eighteen patients with traumatic soft tissue defects were treated with thorough debridement leaving the wound unclosed or simply closed with thin split-thickness scalp skin grafting, and adjacent expander implantation in the early stage and expanded flap transposition in the second stage. Results There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years [mean, (19.4±12.2) years], with average 15 months follow-up (range, 3-67 months). The average expansion time was 74.3 days (range, 53-96 days). The total of 18 patients with 22 expanders were treated with satisfactory results. All the flaps survived and the skin color, texture and contour well matched to those of the peripheral tissue. Only one complication of infection happened in the 18 cases (5.56%) and total 22 expanders (4.55%), which was similar to the rate reported in the literature. There were no any other complications related to the expander. Conclusions Debridement and tissue expansion in the early stage have been proved a more effective strategy to repair traumatic soft tissue defects in the head and face, which can not only achieve satisfactory color, unbulky and well matched texture similar to normal, but also can avoid unnecessary donor site injuries and does not increase the infection rate of tissue expansion. Key words: Soft tissue defects; Tissue expansion; Head and face; Trauma

A Comparative Study of Solubility Based Sickle Cell Screening Versus Genomic Method in Blood Donors

Background:Sickle cell trait (SCT) is more common in minority African-Americans (AA) and Hispanic blood donors. Screening donors for Sickle Hemoglobin (HbS) carrier status (SCT) can be useful, especially in managing the transfusion needs of neonates and patients with sickle cell disease. Currently, the Sickledex test, based on the principle of relative insolubility of HbS in phosphate buffers, is routinely used for HbS donor screening. However, there are several limitations including the inability to perform high-throughput testing by automation as donor centers target larger numbers of minority blood donors. False positives results due to hyperlipidemia, dysglobulinemia and higher peripheral blood hematologic counts have also been reported. Hence alternative methods to identify SCT donors are highly desirable in blood centers. The purpose of this study was to validate testing, and to identify rates of False Positive (FP) and False Negative (FN) sickledex screening in blood donors by verifying the presence or absence of the most common mutation seen with HbS production using molecular methods. The comparison could offer evidence to use molecular methods as a test of record to manage HbS carriers at blood centers.Methods and ResultsBetween Jan 2012 till Dec 2014, 200 sickledex screening tests were done daily, totaling approximately 90,000 donors self-identifying as Caucasians and 60,000 donors identifying as African American or Hispanic tested during the study period. Amongst Caucasians tested, 154 had a positive sickledex screen result. Since the prevalence of SCT is less common in the Caucasian population, we hypothesized several of these Caucasian donors could have a false positive screening test. All 154 sickledex positive Caucasian donor samples were prospectively tested for the HbS mutation detection with molecular methods. BioArray Human Erythrocyte Antigen (HEA) Bead Chip DNA assay with PCR multiplex based technology was used to detect the HbS mutation (β-globin change -173 A>T, more commonly designated 20A>T). Of the 154 sickledex + Caucasians, 108 (70%) donors tested negative (FP Screen) and 46 (30%) tested positive for the HbS mutation. A retrospective review of sickledex results in our electronic database for minority donors (n-3431) who also had HEA BeadChip assay was performed to determine concordance. Of 3431 minority donors tested, only 2 (0.0006%) had a positive sickledex screening and were negative by HEA, with the remaining negative by both the sickledex screen and HEA tests. Among minority donors (n= 254) testing + for HbS by HEA, 3% (8/254) were negative by sickledex screening. To establish concordance of HEA assay with high performance liquid chromatographic (HPLC) assay, two separate cohorts were evaluated. Initially 12 sickle screen and HEA positive donors was subject to HPLC analysis, which confirmed SCT status in all 12 samples. Subsequently sickledex screen positive but HEA negative samples (n= 40), were subject to HPLC. All 40 showed absence of SCT by HPLC. Finally, 58 random sickledex + samples had gene sequencing and HEA performed in parallel. Out of 58 samples, 54 showed a positive HbS mutation by HEA with A>T (SCT) nucleotide change noted with gene sequencing. In the remaining 4 samples, HEA was negative with gene sequencing showing (3 T>T and in 1C>T) change at nucleotide 163 associated with Hemoglobin Okayama.Conclusion:The HEA bead chip assay testing for the HbS mutation showed 100% concordance with HPLC and gene sequencing in samples studied. Molecular methods can process multiple samples in a single setting to detect SCT. FP sickledex screening results in Caucasians needs confirmatory testing for the HbS mutation to avoid unnecessary donor notification and deferral. The association, if any, of false positive sickledex screening in Caucasian donors with the Hgb Okayama mutation is under further investigation. DisclosuresNo relevant conflicts of interest to declare.

Blood Use in a Large North Eastern Italian Academic Hospital During the Period 2009-2013: What Reasons for a Decrease?

Blood is a precious and scarce resource and its management needs continuous efforts in order to maintain a balance between supply and demand. Considering that blood components supply depends substantially on voluntary donors, population is getting older and new measures to reduce an unnecessary donor exposure to patients are expensive, the cost to maintain a sufficient provision is notably increased [1].

Haemostatic management of cardiac surgical haemorrhage.

Almost 30,000 cardiopulmonary bypass operations are performed in the UK every year, consuming a considerable portion of the UK blood supply. Each year, in cardiac surgery, 90% of blood products are used by only 10% of patients, and over the past 25 years, much innovation and research has gone into improving peri-operative diagnosis and therapy for these patients. Visco-elastic tests performed at the bedside, with modifications to allow direct quantification of fibrinogen levels, are probably the biggest advancement. There is no clear advantage of thromboelastometry over thromboelastography, and the published literature remains scarce. Visco-elastic testing has recently been coupled with the systematic replacement of clotting factors by means of factor concentrates, with objective improvement in terms of blood loss, red blood cell usage and surgical re-exploration. The National Institute for Health and Care Excellence has reviewed the available evidence and recommended visco-elastic tests as cost effective in cardiac surgery. Factor concentrates, however, carry significant risks, particularly unnecessary donor exposures, potential selective over-correction of partial deficiencies and the possibility that the postoperative risk of venous thromboembolism is increased; as yet there are no data on risk-benefit analysis. There are a number of promising drugs used in topical haemostasis, but the requirement to apply these before major bleeding is manifest limits their use considerably. Hyperfibrinolysis is less important than in the past due to the wide spread adoption of antifibrinolytic agents and close intra-operative monitoring of heparin effect.

Living donor liver transplantation.

Living donor liver transplantation (LDLT) continues to evolve, generating interesting issues on the applicability and safety of new techniques. Specific selection criteria and standardized surgical techniques with high ethical and medical standards are needed to minimize donor risk. In this aspect, minimally invasive donor hepatectomy has caused controversies. The reproducibility and safety of pure laparoscopic major hepatectomy in LDLT remains uncertain. Therefore, a stepwise approach is needed to avoid unnecessary donor risk. To expand the living donor pool, dual graft and ABO-incompatible LDLT have emerged as well tolerated and effective methods. The extended selection criteria for hepatocellular carcinoma in LDLT appear acceptable to balance donor risk and recipient outcome. However, these criteria should be validated based on the risk-benefit ratio. Despite technical advances, technical challenges persist such as Budd-Chiari syndrome and portal vein thrombosis. To address these issues, several innovative surgical techniques have been proposed and have shown promising results. LDLT is associated with donor safety concerns, technical complexity, and small-for-size issues. Nonetheless, accumulated experience and technical know-how from large-volume Asian LDLT centers have led to progress in LDLT. Further technical refinement and investigation to overcome the disadvantages of partial grafts will broaden the applicability of LDLT.

Comparison of Two Htlv-I/Ii Small Platform Assays Potentially Suitable for Tissue Donor Screening in the United States

Background: Human T-cell lymphotrophic virus (HTLV) type I has been linked to adult T-cell leukemia/lymphoma (ATL) and HTLV-I associated myelopathy (HAM). Transmission of HTLV by blood and organ transplantation has been documented, with some infections leading to clinical disease. Since December 31, 2009 organ donors in the US are no longer tested for anti-HTLV antibodies. This decision was prompted, at least in part, by discontinuation of Abbott HTLV-I/II EIA and absence of a suitable FDA-approved replacement. However, tissue donors are still being tested for HTLV-I/II using a combination of validated research assays or large platform test (PRIZM). Confirmatory testing is not routinely performed, and the number of false positive organ donors is unknown. Aim: To share our experience with 2 HTLV-I/II EIAs currently in FDA application process. Method: We evaluated multiple lots of Avioq HTLV-I/II (RUO) EIA (Avioq, Inc., Research Triangle Park, NC) and MP Diagnostics HTLV I/II 4.1 ELISA System (IUO) (MP Biomedicals, Irwine, CA). The Avioq EIA (RUO) utilizes antigens derived from purified and inactivated HTLV-I viral lysate, a purified HTLV-II viral lysate, and a recombinant HTLV-I p21E antigen. The MP Bio EIA (IUO) uses recombinant proteins gp46-I, gp46-II, GD21 and MGK. The recombinant envelope proteins are derived from the central region of the external glycoprotein of the respective HTLV-I and HTLV-II gp46. We tested at least 3 lots of each assay using a panel of well pedigreed specimens with known HTLV-I/II status including 11 specimens with false positive or indeterminate HTLV-I/II reactivity. We also tested “in real time” 1700 tissue donors' specimens by Avioq and 4811 tissue donors by MP Bio EIA. Results: Both assays passed and performed comparably with our evaluation panel. In contrast to the discontinued Abbott EIA that incorrectly identified 10/11 difficult specimens both Avioq and MPBio EIAs correctly called 10/11 false positive and indeterminate specimens (see Table below). However, during “real time” testing we observed that the Avioq assay consistently detected HTLV-I/II reactive donors 4 times (1.53% v. 0.37% respectively, p< 0.0001) more often as the MP Bio assay. When we tested randomly chosen subset of Avioq reactive specimens with HTLV Western Blot none of the specimens were confirmed.Table: [Assays Performance with Evaluation Panel]Conclusions: Both prospective HTLV-I/II assays performed better than the discontinued Abbott HTLV-I/II EIA and offer significantly improved performance for anti-HTLV-I/II antibodies screening. Only one company (MP Bio) offers HTLV-I/II EIA and HTLV-I/II WB with subtyping. Careful consideration of screening HTLV-I/II assay will prevent unnecessary donor loss.

Massive transfusion: An overview of the main characteristics and potential risks associated with substances used for correction of a coagulopathy

Massive transfusion (MT) is an empiric mode of treatment advocated for uncontrolled bleeding and massive haemorrhage, aiming at optimal resuscitation and aggressive correction of coagulopathy. Conventional guidelines recommend early administration of crystalloids and colloids in conjunction with red cells, where the red cell also plays a critical haemostatic function. Plasma and platelets are only used in patients with microvascular bleeding with PT/APTT values >1.5 times the normal values and if PLT counts are below 50×109/L.Massive transfusion carries a significant mortality rate (40%), which increases with the number of volume expanders and blood components transfused. Controversies still exist over the optimal ratio of blood components with respect to overall clinical outcomes and collateral damage. While inadequate transfusion is believed to be associated with poor outcomes but empirical over transfusion results in unnecessary donor exposure with an increased rate of sepsis, transfusion overload and infusion of variable amounts of some biological response modifiers (BRMs), which have the potential to cause additional harm. Alternative strategies, such as early use of tranexamic acid are helpful. However in trauma settings the use of warm fresh whole blood (WFWB) instead of reconstituted components with a different ratio of stored components might be the most cost effective and safer option to improve the patient’s survival rate and minimise collateral damage. This manuscript, after a brief summary of standard medical intervention in massive transfusion focuses on the main characteristics of various substances currently available to overcome massive transfusion coagulopathy. The relative levels of some BRMs in fresh and aged blood components of the same origin are highlighted and some myths and unresolved issues related to massive transfusion practice are discussed.In brief, the coagulopathy in MT is a complex phenomenon, often complicated by chronic activation of coagulation, platelets, complement and vascular endothelial cells, where haemolysis, microvesiculation, exposure of phosphatidyl serine positive cells, altered red cells with reduced adhesive proteins and the presence of some BRM, could play a pivotal role in the coagulopathy and untoward effects. The challenges of improving the safety of massive transfusion remain as numerous and as varied as ever. The answer may reside in appropriate studies on designer whole blood, combined with new innovative tools to diagnosis a coagulopathy and an evidence based mode of therapy to establish the optimal survival benefit of patients, always taking into account the concept of harm reduction and reduction of collateral damage.

Action plan to regain unnecessary deferred blood donors due to malaria risk in Turkey

Malaria was expected to be a major problem during blood donation in Turkey due to existence of malaria cases in southeastern region of Turkey. The present study aimed for the first time, to investigate malaria in “donors deferred for malaria risk” and to determine the regional rates of malaria deferral in Turkey. Blood samples were collected from several Blood Banks of southeastern provinces where local malaria cases still exist and from Blood Bank of Ege University Medical School (EUMS) located in western Turkey where malaria is eradicated decades ago. Plasmodium spp. and specific antibodies were investigated by stained smears, antigen detection, PCR and ELISA. Among the donors deferred for malaria risk, Plasmodium spp. were not detected by microscopy, PCR or antigen detection. Seroprevalances were 2% and 3.92% in western and southeastern regions, respectively. Rate of donor deferral for malaria risk was 0.9% in EUMS and deferrals were exclusively because of travel to southeastern Turkey. In southeastern provinces, deferrals were mainly due to malaria like fever history. The present study first time assessed regional rates of donor deferral due to malaria risk in Turkey. Previously, malaria was expected to be a major problem during blood donation in Turkey due to existence of malaria cases in southeastern region of Turkey. The results of the study showed that 97% of the deferrals were unnecessary. In conclusion, to reduce unnecessary donor deferrals in Turkey, in addition to comprehensive questioning for malaria history, the usage of a malaria antibody screening method should be initiated prior to deferral decision.

THE "LOCAL DORSAL ADIPOFASCIAL FLAP" FOR VOLAR DIGITAL DEFECTS: A CASE REPORT

The coverage of volar digital defects can be achieved by a variety of surgical options. Although frequently used and reliable, these procedures entail the need for a second stage for flap release, meticulous dissection, sacrifice of a digital artery of the uninvolved digit, or delayed mobilization resulting in digital stiffness. The ideal surgical procedure for such defects should be a simple, single-stage surgery that allows early mobilization and return to function and at the same time avoiding unnecessary donor site morbidity from an uninvolved digit. The "local dorsal adipofascial flap" is a simple procedure that does not need a secondary procedure for flap release and affords early range of motion and return to function. We used this new flap technique in two digits with volar defects in a single patient. At ten months after flap coverage, the fingers were fully functional with good healing of the "local dorsal adipofascial flap."

836 Audit of Neonatal Blood Transfusions

Introduction: Blood transfusions are very common on a neonatal unit. Patients often need a large number of blood transfusions but each may be as little as 8mls. To reduce donor exposure and wastage of blood each standard unit is split into 6 parts or a Pedipack which may be all or partly allocated to 1 infant. Our guideline was developed in 2007 and a prospective audit showed good compliance with no unnecessary donor exposure, but wastage due to inappropriate allocation of a full pedipack. Aims: This was a retrospective re-audit of all babies who had received a blood transfusion to ensure continued compliance with the protocol and to monitor donor exposure and the wastage of blood units. Results: Babies received between 1 and 17 blood transfusions. For babies ≤28 weeks gestation who did not receive pedipacks as per protocol they were exposed to up to 6 unnecessary donors. For babies >28 weeks 15% were allocated an inappropriate full pedipack resulting in wastage. Conclusions: There was very poor adherence to the protocol resulting in unnecessary exposure to multiple donors and excessive wastage. This was felt to be due to poor compliance with the guideline, poor communication between the neonatal unit and blood bank staff and an increase in the need for blood transfusions resulting in a lack of availability of full pedipacks. Recommendations: To provide teaching sessions for all staff. To improve communication between the neonatal unit and blood transfusion. To re-audit to ensure that improvements have occurred.

The Use of Mitten-Shaped Thin Abdominal Flap for the Coverage of Extensive Compound Dorsal Hand Defect in a Pediatric Patient

Background: Severe hand trauma in small children has special social, psychological, aesthetic and functional implications that mandate comprehensive treatment strategies. Because of the miniaturized size of the limbs and the incautiousness of the little kids, the injury tends to have a substantial severity and extent. Moreover, the physicians will encounter considerable difficulties while attempting the reconstructive task and implementing the post operative care, also owing to the tiny structural components and the uncooperativeness of the toddlers. Aim and Objectives: To reconstruct the severe hand injury in Pediatrics by using the abdominal flap was an efficient and safety method. Materials and Methods: This report describes an 18-month-old boy who sustained 3rd degree contact burn over his left dorsal hand with multiple extensor tendon loss, joint and bone exposure, and large skin defect due to autonomic cup-sealing machine injury. He received abdominal flap transfer for wound coverage in conjunction with immediate tendon and lateral bands reconstruction using tensor fascia lata graft. A whole body spica was used to prevent premature detachment of the limb from the abdomen donor site during the two weeks period of immobilization. A special ”mitten like” flap design was utilized, which served to ensure a stable limb anchorage and enable maximal contact surface between the two parties with minimal enrollment of unnecessary donor tissue. An optimal thinning of the flap thickness can be achieved without safety concern. The flap was divided two weeks later and two more surgeries were conducted subsequently to separate the syndactylous fingers. A reasonable final functional result was obtained without significant donor site morbidity. The rational and technical details as well as the special measure of postoperative immobilization were described in this article. Results: No flap partial necrosis or total necrosis was found in each surgery including of reconstructive and division operation. No donor site co-morbidity was noted. Three hundred eighteen days after abdominal flap surgery, or 155 days following complete flap division, no significant complication related either to the donor or recipient sites and an acceptable functional performance is achieved. Conclusion: The method of traditional abdominal flap transfer, is easy to execute, highly accountable, vastly flexible and versatile in flap design, and would be particularly valuable for young aged individual.