Weeks Of Transfusion Research Articles

Incidence of Red Cell Antibody Formation Following Massive Transfusion Protocol: Experience of a Single Institution.

Injured patients in hemorrhagic shock have a survival benefit with massive transfusion protocol (MTP). While there are many published studies on the transfusion management of massively bleeding patients, the risk of alloimmunization in patients that have received products during an MTP activation is relatively unknown. Therefore, we sought to determine the frequency of new antibody formation in MTP patients that received blood products from an uncrossmatched megapack. We conducted a retrospective data review of patients who underwent an MTP activation for trauma resuscitation between May 2014 and July 2020. Data were collected from patients who met the following criteria: MTP was activated, the patients received at least one unit of packed red blood cells, one unit of fresh frozen plasma, one unit of platelets, and had a repeat type and screen within 6 weeks of transfusion. These inclusion criteria resulted in 28 patients over the 6-year timeframe. Overall, the risk of alloimmunization secondary to MTP is 3.6% in our trauma patient population. The newly developed antibodies post-MTP are considered clinically significant, meaning they can cause hemolysis if exposed to donor red blood cells containing those antigens. Blood products should be given preferentially over crystalloids to acutely bleeding patients to prevent ischemic injury during an MTP activation despite the risk of alloimmunization. In our single-institution study, the alloimmunization rate in massive transfusions where patients receive uncrossmatched red blood cells is similar to those receiving crossmatched red blood cells.

Correlation of Component Blood Transfusion of Hypertension Patients with Pregnancy and Postpartum Hemorrhage.

To analyze the correlation of component blood transfusion and prognosis of patients with pregnancy-induced hypertension (PIH) and postpartum hemorrhage (PPH) in assisted reproductive technology (ART). A retrospective analysis of clinical data on 85 pregnant women with ART-induced PIH and PPH was completed. They were divided into observation group and control group based on whether there was component transfusion after massive hemorrhage. The plasma coagulation and blood platelet-related indexes of the two groups of patients were assayed before blood transfusion, 24 hours after blood transfusion, and 12 weeks post-partum. The incidence of adverse reactions of blood transfusion within one week of blood transfusion, the proportion of patients transferred to the general ward, the blood pressure, and biochemical indexes at 12 weeks postpartum were recorded. There was no significant difference in coagulation function before blood transfusion between the two groups of patients (p > 0.05). After 24 hours of massive blood transfusion, APTT, PT, and TT in the observation group were obviously shorter than those in the control group (p < 0.001), whereas FIB and PLT were higher than the control group (p < 0.01). In contrast to the control group at 12 weeks postpartum, the APTT, TT, and PT of the observation group were shortened (p < 0.05), while the FIB level was higher (p < 0.01). The probability of adverse reactions of transfusion in the observation group was lower than the control group (p < 0.05). The correlation between component transfusion and disease improvement after one week of transfusion and 12 weeks postpartum was 0.350 (0.159 - 0.530) (p < 0.01) and 0.441 (0.258 - 0.608) (p < 0.001). Component blood transfusion in ART-induced PIH patients can improve their coagulation function, reduce the probability of adverse reactions caused by massive blood transfusion, and improve their prognosis.

Shortened antibody screening interval has decreased the incidence of delayed hemolytic transfusion reactions

Aims: To ascertain the effects of allowable sampling time prior to red cell transfusion when screening for alloantibodies, we compared antibody detection rates and frequencies of delayed hemolytic transfusion reactions (DHTRs) among patients drawn within two weeks versus patients drawn within one week of transfusion. Methods: Alloantibody screening for 32,601 patients from January 1997 through August 2006 was done within two weeks of transfusion, and for 44,896 patients from September 2006 through March 2017 was done within one week. Among transfusion recipients, 6,234 screened within two weeks and 8,066 screened within one week were evaluated for DHTR. Results: Alloantibodies were detected in 1.2% of cases screened within two weeks and in 1.3% of cases screened within one week, with no statistical difference. Anti-Fyb was more frequently detected (115.8 versus 39.9 per 100,000 patients) among those screened within one week (p &lt;0.001); anti-Dia showed a similar trend, but without statistical significance (p =0.065), whereas anti-c was less frequently detected (p &lt;0.05). The number of DHTRs observed was significantly lower among those screened within one week, with two cases (1 in 4,031) versus eight (1 in 779) among those screened within 2 weeks (p &lt;0.05). Conclusion: By shortening allowable sampling period for red cell alloantibody screening from within two weeks to within one week of transfusion, the detection rate of clinically significant antibodies, except for anti-c, increased, and the frequency of DHTR recipients decreased.

Do blood transfusions make a difference when you are dying?

Recent blood transfusion guidelines published by the UK National Institute for Health and Care Excellence (2015) recommend restrictive single unit transfusion practices with a threshold haemoglobin level of 70 g/l. While these guidelines do not specifically relate to palliative care patients, neither do they exclude them. Prompted by these guidelines, and studies questioning the costs and benefits of red cell transfusions, a retrospective review of the electronic patient records was undertaken to explore the use and impact of blood transfusions over a 54-month period on the in-patient unit of a 14-bedded hospice in the UK. The objective was to identify the reasons for transfusion and documented evidence of benefit and outcome. Results showed that transfusions were infrequent, the reason given for transfusion was fatigue in 84% of cases, benefit was reported in 39%, and 50% died within 4 weeks of transfusion. These findings are similar to those of other studies highlighting the low level of benefit and short survival time post-transfusion. Anaemia is common in the palliative population and fatigue is increasingly prevalent in the final weeks of life. It has been postulated that fatigue may provide protection from suffering at this time, suggesting that appropriate selection of patients for transfusion is important to prevent the potential to do harm. The use of validated tools, goal setting conversations, and an algorithm for the management of fatigue have now been implemented to support more rational transfusion decisions in the hospice.

Hyperhemolytic Transfusion Reactions in Non-Sickle Cell Anemia Patients

AbstractAbstract 1183 IntroductionHyperhemolytic transfusion reaction syndrome (HHTR) has been appreciated in allo-immunized patients with sickle cell anemia. In these patients, transfusion precipitates hemolysis of both donor RBCs and the recipient's native RBCs, leading to post-transfusion hemoglobin level below baseline. Recognition is important because it is life-threatening and has unique management. Despite the severe degree of anemia, the most important treatment for HHTR is generally to halt the cascade of hemolysis by withholding transfusion. We present the first case series of HHTR in non-sickle cell patients observed in a tertiary academic medical center. MethodsWe reviewed records of four patients treated by one of us. We also retrospectively search for any additional patient charts from those with diagnosis of HHTR from 1996 to 2012 from institutional database and also searched patients under ICD-9 codes for hemolytic transfusion reactions (999.83 to 85) from 2009 to 2011. Patients with sickle cell disease were excluded. HHTR was defined as post-transfusion hemoglobin level below baseline accompanied by clinical and laboratory evidences of hemolysis, and the recurrence of HHTR after repeated transfusions. ResultsFour non-sickle cell patients who fulfilled criteria of HHTR were identified. Mean age was 34.7. Three were African-Americans, one was Caucasian, and all were females. Two patients had iron deficiency anemia, one had systemic lupus erythematosus, and one had no past medical history. The average amount of transfused PRBC was 5.83±0.3units per person. After transfusion, hemoglobin reached nadir (mean decrease from baseline 38%) within two to three weeks of initial transfusion. Corrected reticulocyte counts were typically low (<2%). All had symptomatic hemolysis often accompanied by chills, jaundice, elevated LDH and unconjugated bilirubin. Post-transfusion analysis of allo-immunization revealed three patients with de novo development of multiple allo-antibodies. The most common alloantibodies were anti-C, c and E. Various therapies including IV steroid, IVIg and erythropoietin were applied, but the most effective management was withholding further transfusion. One patient with consecutive transfusions expired after severe hemolysis. Three patients survived from HHTR and hemoglobin recovered to 72% of their baselines. ConclusionWe have demonstrated the first case series of HHTR in non-sickle cell patients and defined its clinical characteristics. HHTR in non-sickle cell patients results in 38% decline of hemoglobin within two to three weeks of transfusion. De novo development of allo-antibodies strongly suggests that the exaggerated destruction of self and non-self cells may be secondary to acute induction of allo-immunity against non-self RBCs and subsequent complement activation leading to bystander hemolysis of self RBCs. HHTR is a unique and lethal complication of transfusion which occurs in both sickle and non-sickle cell patients. Withholding transfusion is a crucial strategy to HHTR. Thus, it is important not to reserve the diagnosis to sickle cell patients of African-American descent, but to recognize that this can occur in any transfused patient. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Pulmonary Hypertension Is Uncommon In Well-Transfused Thalassemia Major Patients

AbstractAbstract 4273 Introduction:Pulmonary hypertension is a common and serious cardiovascular complication in patients with thalassemia intermedia and sickle cell disease. Circulating platelet and erythrocyte fragments, as well as cell-free hemoglobin from intravascular hemolysis, may contribute to nitric oxide depletion, intimal proliferation, and pulmonary vascular remodeling. Splenectomy has been also been associated with pulmonary hypertension in some studies. Ineffective erythropoiesis, via release of PLGF and elevation of other proinflammitory cytokines, has also been associated with pulmonary hypertension. However, the risk for pulmonary hypertension in thalassemia major patients remains controversial, with prevalence estimates ranging from 10%-60%. We report echocardiography results from 80 thalassemia major patients enrolled in the Early Detection of Iron Cardiomyopathy Trial (EDICT) at Children's Hospital Los Angeles. Methods:Patients were enrolled from August 2004 until May 2009 in a combined cross-sectional and observational trial probing for early predictors of cardiac dysfunction. Patient visits were scheduled within one week of transfusion. All patients underwent echocardiography and cardiac MRI analysis within 4 months of each other; most were performed during the same clinical visit (median time between scans one day). Comprehensive assessments of pulmonary artery pressure (tricuspid and pulmonary regurgitation velocities), systolic function, and diastolic function were performed using two dimensional imaging, M-mode, and routine and tissue Doppler. All images were collected by experienced echocardiography technicians and analyzed by the principal investigator. Three to five beat averages were used to improve measurement stability. Tricuspid regurgitation (TR) jet was only reported if a full envelope was recognized; at our institution, the upper limit of normal for TR jet is 2.7 m/s. Results:Patient demographics are summarized in Table 1. Patients were gender-balanced and well distributed between 11 and 47 years of age. Patients who had been splenectomized (N=34) tended to be older. Iron overload was severe, with a mean liver iron concentration of 12.4 ± 14.2 mg/g dry weight. Roughly half of the patients had detectable cardiac iron and 9% had overt left ventricular dysfunction (LVEF < 56%). TR jet was detectable in 62/80 patients. Only one patient exhibited pulmonary artery hypertension (TR jet 2.9 m/s), however this patient also had severe cardiac iron overload and overt left ventricular systolic and diastolic dysfunction (LVEF 42.7%, E/E' 10). Two patients had TR jets of 2.6 ms and three had TR jets of 2.5 m/s. Pulmonary insufficiency jets were normal in all patients.TR velocity did not correlate with age, cardiac index, cardiac iron or liver iron, but demonstrated a weak (r=0.29, p=0.02) association with left ventricular diastolic dysfunction (E/E′). Discussion:The EDICT patient cohort suggests a low risk for pulmonary hypertension in well-transfused thalassemia major patients. The single elevated TR jet was explained by iron cardiomyopathy and normalized (2.2 m/s) after two years of aggressive chelation therapy. TR velocities at the upper limits of normal (2.5-2.7 m/s) were observed in five patients; these have been associated with poor outcomes in some sickle cell disease cohorts, but not in thalassemia major. Long-term surveillance remains critical as pulmonary hypertension risk may increase with age. Disclosures:Harmatz:Novartis: Research Funding. Coates:Novartis: Research Funding, Speakers Bureau. Wood:Novartis: Research Funding; Ferrokin Biosciences: Consultancy.

Induction and prevention of virus-associated malignant lymphoma by serial transmission of EBV-related virus from cynomolgus by blood transfusion in rabbits.

Epstein-Barr virus (EBV)-related herpesvirus (Si-IIA-EBV) was serially transmitted for 3 passages from rabbit to rabbit of the opposite sex by blood transfusion, which subsequently induced virus-associated rabbit lymphomas. The virus could be transmitted by transfusion with 15-20 ml of whole blood (7/7) or irradiated blood (1/6) from the EBV-related virus-infected rabbits, but there was no transmission with transfusion of cell-free plasma (0/6) from the infected rabbits. Passive anti-EBV-VCA IgG (x 20 approximately x 10) titers decreased during the first 1-2 weeks in the transfused rabbits. The virus-transmitted rabbits showed a gradual increase in antibody titers ranging from peak titers of x 640 to x 2560 after 3 weeks of transfusion. The recipient origin of malignant lymphoma that developed in the first rabbit transfused by infected blood was confirmed by chromosomal analysis. This rabbit model thus shows that EBV-related herpesvirus is serially transmissible by blood transfusion and that transmission can not be completely prevented by irradiation of blood, but removal of blood cells is the best way to prevent transmission of EBV-related virus. Therefore, this animal model provides a convenient in vivo system for studies of the prevention and therapy of transfusion-related transmission of EBV and EBV-associated lymphoproliferative diseases in immunocompromised human beings.

Absence of D– alloimmunization in AIDS patients receiving D‐mismatched RBCs

More than 80 percent of D- patients who receive D+ blood become alloimmunized to the D antigen. Anemia occurs in most AIDS patients at some point in the disease. D- patients with AIDS may require blood transfusion and, during times of blood shortage, may receive D+ RBCs. They would be expected to become alloimmunized to the d antigen. The records of the transfusion service between January 1996 and July 2000 were reviewed for D- patients who received D+ blood. IATs were performed before the initial transfusion and subsequently when the patient required further RBC transfusion. Eight D- AIDS patients who received multiple transfusions (three women and five men; age range, 31-44 years; mean, 44 years) who received between 2 and 11 units (mean, 6.25) of D+ RBCs were identified. Antibody screens were performed at 8 to 65 weeks after transfusion. It was found that none of the eight D- AIDS patients developed anti-D. ABO antibodies were found as expected. During the same period, it was found that six D- patients admitted with other diagnoses who received 1 to 9 units of D+ RBCs, all developed anti-D within 7 to 19 weeks of transfusion. Patients with AIDS may not form alloantibodies to the D antigen. This may be attributable to their immunodepressed state, particularly to the decrease in CD4+ T lymphocytes. Therefore, during blood shortages, transfusion of D+ blood to D- AIDS patients may be without any subsequent consequence.

Evaluation of RNA and E2 antibodies in prospectively followed recipients of hepatitis G virus-infected blood.

Hepatitis G virus (HGV) has recently been cloned and tests for HGV RNA and envelope antibodies (anti-E2) have been developed. HGV infection is widespread among blood donors worldwide, but the clinical and serologic outcome of transfusion-associated HGV infection has not been fully characterized. Consecutive blood donors (n = 2210) were investigated for HGV markers (RNA and anti-E2). The recipients of HGV RNA-positive blood were followed for 1 year after transfusion. Forty-two blood donors (1.9%) were positive for HGV RNA. Eight recipients of HGV RNA-positive blood were retrospectively identified within 2 weeks of transfusion and prospectively followed. In four patients, the presence of anti-E2 before transfusion or an early antibody response protected them from reinfection or prevented HGV persistence, while, in the remaining four patients, transient or persistent viremia was detected shortly after exposure. None of the infected recipients had any evidence of liver disease. These results do not support the screening of donors to prevent transfusion-associated HGV infection.

SCREENING FOR HEPATITIS B VIRUS MARKERS IS NOT JUSTIFIED IN WEST AFRICAN TRANSFUSION CENTRES

62 severely anaemic Gambian children who were transfused with whole blood not screened for hepatitis B surface antigen (HBsAg) were followed for evidence of hepatitis B virus (HBV) infection over six months. 89% of donors and 44% of recipients before their transfusion had at least one HBV marker. Of the 54 recipient children surviving for the follow-up period, only 1 had a transient rise in liver enzymes. In 13 (37%) of 35 previously uninfected children HBV infection developed within twelve weeks of transfusion. Only 1 of these 13 children followed up at one year had become a persistent HBsAg carrier. The rate at which this cohort acquired persistent HBV infection or clinically important hepatitis was no greater than that in a cohort of similarly aged, non-transfused, children not admitted to hospital. In sub-Saharan Black Africa, where 15% of children have persistent HBV infection by the age of 10 years, HBV screening programmes in transfusion centres cannot at present be justified.

Transmission of Toxoplasmosis by Leukocyte (WBC) Transfusion

Disseminated toxoplamosis infections without an obvious source have been documented frequently in cancer patients. Two children with acute leukemia given WBC transfusions for granulocytopenia from a donor with chronic myelogenous leukemia (CML) developed toxoplasma gondii infection. The CML donor, with no history of toxoplasma infection had received no anti-leukemic therapy prior to leukapheresis and remained clinically well. The first child was given 0.35 × 1011 CML leukocytes. Three weeks later she developed skin rash, pneumonia, congestive heart failure, hepatitis, and seizures, accompanied by a rising toxoplasma dye titer to 1:8,000 (IgM = 1:160). She expired 3 months later with disseminated toxoplasmosis. The second child received 2.5×1011 leukocytes over a 7-day period four weeks prior to splenectomy for an E. coli splenic abscess. Concomitantly, her dye titer rose to 1:128 (IgM = 1:40). Toxoplasma gondii was isolated from the spleen and a single toxoplasma cyst was found on histologic examination. She died 1 month following surgery with toxoplasma cysts found in the lung and heart at necropsy. Retrospective examination of stored serum samples from the CML donor revealed that at the time of WBC donation she had a toxoplasma dye titer of 1:8,000 (IgM = 1:10, CF = 1:16). Leukocytes from the same donor were given to other leukemic patients. Both died within one week of transfusion without pathologic evidence of toxoplasma infection. Toxoplasma infection in two patients receiving leukocyte transfusions from a CML donor with serologic evidence of toxoplasmosis suggests the role of WBCs in the transmission of this dissease.