Air-drop blood supply in the French Army.

BACKGROUND: Haemorrhagic shock remains the leading cause of preventable death in overseas and austere settings. Transfusion of blood components is critical in the management of this kind of injury. For French naval and ground military units, this supply often takes too long considering the short shelf-life of red blood cell concentrates (RBCs) and the limited duration of transport in cooling containers (five to six days). Air-drop supply could be an alternative to overcome these difficulties on the condition that air-drop does not cause damage to blood units. METHODS: After a period of study and technical development of packaging, four air-drops at medium and high altitudes were performed with an aircraft of the French Air Force. After this, one air-drop was carried out at medium altitude with 10 RBCs and 10 French lyophilised plasma (FLYP). A second air-drop was performed with a soldier carrying one FLYP unit at 12 000 feet. For these air-drops real blood products were used, and quality control testing and temperature monitoring were performed. RESULTS: The temperatures inside the containers were within the normal ranges. Visual inspection indicated that transfusion packaging and dumped products did not undergo deterioration. The quality control data on RBCs and FLYP, including haemostasis, suggested no difference before and after air-drop. DISCUSSION: The operational implementation of the air-drop of blood products seems to be one of the solutions for the supply of blood products in military austere settings or far forward on battlefield, allowing safe and early transfusion.

[Laser assisted hatching: Rouen University Hospital outcomes]. / Eclosion embryonnaire assistée: évaluation des indications au CHU de Rouen.

OBJECTIVE: Despite technical progress in In Vitro Fertilisation (IVF) procedure, embryo implantation rate remains low. Assisted hatching has been proposed to facilitate natural embryo hatching and implantation. PATIENTS AND METHODS: Our study has evaluated whether laser assisted hatching improves implantation, pregnancy and live birth rates in different cases. We studied retrospectively 143 IVF cycles concerning more than 38 years old women, 166 IVF cycles after two previous implantation failures and 180 frozen-thawed embryo transfers. RESULTS: Population characteristics were comparable in hatched and control groups. Implantation, pregnancy and live birth rates in women more than 38 years old were comparable with or without assisted hatching. Concerning repeated implantation failures, even if implantation, pregnancy and live birth rates were higher in assisted hatching group (FIV or ICSI), the differences were not significant. After frozen-thawed embryo transfers, implantation rate was significantly better with assisted hatching (19.14% vs 8.84% [p=0.02]). DISCUSSION AND CONCLUSION: Assisted hatching improves embryo implantation rate after frozen-thawed embryo transfer.

[Risk analysis of postoperative anemia through biological databases querying]. / Méthode d'analyse du risque d'exposition à l'anémie postopératoire par interrogation des bases de données de biologie.

INTRODUCTION: The assessment of postoperative care relies mainly on spontaneous reporting of major adverse events (MAE). We propose an alternative approach that we have tested on the measurement of the risk of postoperative anemia which is frequentely associated with anaesthethic related deaths. METHODS: The procedure consisted in extracting the electronic sheet generated by the biological analyser and merging it with the anesthesia data base with a filter based on patient's location in the hospital. The orthopedic surgery ward was chosen because of the frequency of full blood count (FBC) associated with the prescription of low weight molecular heparin in this setting. All FBC of the year 2005 were analysed. A risk stratification was achieved according to the conbination of age and depth of anemia. Medical charts of patients exposed to the greatest risk were reviewed. RESULTS: FBC of 691 orthopaedic surgery patients were analysed. Haemoglobin levels (Hb) less than 8g/dl were observed in 41 (5.9%) patients. Two consecutive Hb less than 8g/dl were founded in 18 patients (2.6%), eight (1.2%) charts of patients exposed to the highest risk were reviewed and six cases of no-transfusion or delayed transfusion were identified. CONCLUSION: A global approach to the risk of postoperative anemia but also of MAE related to postoperative haemorrage can be obtained by monitoring electronic databases.

[Thrombotic thrombocytopenic purpura: a case report]. / Le purpura thrombotique thrombocytopénique: à propos d'un cas.

We report a case of thrombotic thrombocytopenic purpura (TTP) in a 60 years-old woman with Sjogren's syndrome. Symptomatology on admission leads to evoke the diagnosis of TTP. Biological results allow to set the diagnosis. Actually, association of haemolytic anaemia, schizocytes and thrombocytopenia are in favour of TTP. Undetectable ADAMTS 13 activity (below 5%) confirms the diagnosis. In congenital TTP, plasma ADAMTS 13 is absent or severely reduced as a consequence of mutations in the two ADAMTS 13 gene. In acquired TTP, circulating antibodies inhibit plasma ADAMTS 13 activity. In those cases, further biological studies are needed to find a cause of TTP. Follow-up implies standard laboratory tests. Plasma exchanges are progressively tapered after normalization of platelets count.

[Not-for-profit: A report from the fourth annual symposium of ethics held by the National Institute for Blood Transfusion (France)]. / À propos du non-profit : rapport du quatrième symposium annuel d'éthique transfusionnelle de l'Institut national de la transfusion sanguine.

The not-for-profit issue has been debated in November 2016 in Paris; this issue is one of the four canonical pillars of ethical blood donation. It is intimately bound to benevolence though it is distinct, as not-for-profit calls for institutions while benevolence calls for individuals. It is indeed intended that voluntary blood donors do not benefit from their donation and are thus non-remunerated. Not-for-profit is essential since it refers to the public character of blood as a putative public resource aimed at being shared as a tribute of solidarity. A central question however is linked to the capacity- or not -of public sectors to ensure that blood components are universally available, with special mention to plasma derived drugs, without the contribution of the for profit, private sector.

[One case report of anti-JK1 antibody undetected on plasma sample]. / A propos d'un cas d'allo-immunisation anti-JK1 non dépisté sur plasma.

The sensitivity of the detection of irregular antibodies (DIA) is one of the fundamental bases of transfusion safety. Its implementation is specified in accordance with a very specific framework that allows the use of serum or plasma. The case reported here points out a failure to detect irregular antibodies in plasma sample. Thus a low intensity anti-JK1 antibody detected and identified in serum slipped through unnoticed in plasma. The difficulties to detect and identify this antibody, well-known as a deceptive and dangerous one, are being discussed in order to better assess the limitations of DIA.

In vitro fertilization outcomes after ablation of endometriomas using plasma energy: A retrospective case-control study.

OBJECTIVE: Ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy, because it could spare underlying ovarian parenchyma resulting in high spontaneous and overall pregnancy rates. After initial postoperative decrease, anti-mullerian hormone (AMH) level progressively increases several months after ablation. The aim of our study was to assess the outcomes of in vitro fertilization (IVF) in women managed for ovarian endometriomas by ablation using plasma energy, when compared to those in women free of endometriosis. METHODS: Retrospective preliminary case-control study, enrolling women undergoing IVF or IntraCytoplasmic Sperm Injection (ICSI), from July 2009 to December 2014. Cases were infertile women with previous ovarian endometrioma ablation using plasma energy and were matched by age, AMH level and assisted reproductive technique with controls presumed free of endometriosis. IVF/ICSI response (type of protocol, dose of gonadotrophin, number of oocytes, fertilization rate) and outcomes were compared between the two groups. RESULTS: In all, 37 cases were compared to 74 controls. Age (30.9±4.4 years vs. 31.7±4.2 years), AMH level (2.8±2ng/mL vs. 2.8±1.7ng/mL) and ART procedures (ICSI in 24.3% vs. 27%) were comparable between the two groups. Of the 37 cases, previous surgical procedures on right and left ovaries were performed in 27% and 21.6% of patients respectively, 81% of patients were nullipara. AFSr score was 73±41, while deep endometriosis infiltrated the rectum and the sigmoid colon in respectively 40.5% and 27% of patients. Despite a lower number of oocytes retrieved, cases presented better implantation rate, pregnancy and delivery rates per cycle, oocyte retrieval, transfer, and embryo, as well as superior cumulative birth rate per transfer. CONCLUSION: Ovarian endometrioma ablation using plasma energy is followed by good IVF/ICSI outcomes, suggesting that surgical procedure spares underlying ovarian parenchyma. These results consolidate those of previous studies reporting high spontaneous conception rate. Hence, ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy in patients presenting with endometriosis and pregnancy intention.

[Voluntariness and blood donation: Proceedings of an ethics seminar held at the National Institute for Blood Transfusion]. / Volontariat et don de sang : compte rendu d'un séminaire de l'Institut national de transfusion sanguine.

Voluntariness stands for one of the four pillars of ethics in blood donation; it is, however, more related to tradition than to legislation. Because it seems necessary to apply "marketing" techniques to blood collection in order to meet the needs in blood components, both in terms of quantity and quality, one wonders if this may be at the expense of this principle of voluntariness. This seminar-belonging actually to a series of seminars in Ethics in Transfusion Medicine-aimed at questioning the possible weakness of voluntariness in the field of blood donation. To achieve this goal, specialists of numerous disciplines in medical sciences, law and humanities gathered to discuss all related issues to voluntariness in blood donation.

[Transfusional record and blood grouping methods: essential factors of transfusion safety]. / Dossier transfusionnel et techniques de groupage sanguin: éléments essentiels de la sécurité transfusionnelle.

The clinical and biological control of the whole transfusion process is a major preoccupation for everyone dealing with blood transfusion. Specially when the patient is a female recipient or belongs to a group with a high prevalence of alloimmunisation. This case report points out the outstanding importance of the immune compatibility, which must be strongly maintained to prevent any harmful consequences. The transfusional record transmission and a simple and sensitive blood grouping test are essential to increase transfusion safety.

[Specificity of immunofluorescent methods detecting malarial antibodies: comparative study in the screening of blood donations]. / Spécificité des techniques sérologiques de dépistage des anticorps anti-paludéens en immunofluorescence: étude comparative dans la pratique de qualification du don de sang.

UNLABELLED: In France, no case of transfusion-transmitted malaria has been reported since 1994, reflecting the efficiency of the blood donations screening. However, an insufficiently specific serological assay leads to an unjustified loss of red cell units. MATERIALS AND METHODS: A retrospective study included 55 sera previously disqualified for the presence of malarial antibodies. We used different assays detecting these antibodies: Paludix, Falciparum-Spot without or with the elimination of natural antiglobulins by two different methods. RESULTS: Using Paludix, 87% of sera were negative (P < 0.001). With the sera treated for the elimination of natural antiglobulins by neutralisation or absorption, Falciparum-Spot(TM) gave respectively 87% and 94.5% of negative results. CONCLUSION: When using assays avoiding non-specific fluorescence, the number of false positive results significantly decreased. Because the number of blood donors travelling in at-risk countries is continuously rising, a sufficiently specific method to detect malarial antibodies should save a lot of red cell units.

[Blood transfusion security: one train may conceal another!]. / Sécurité transfusionnelle: un train peut en cacher un autre!

The discovery of antibodies with specificities that are directed toward antigens of high prevalence is a difficult situation to manage in emergency blood transfusion. The reactions they produce interfere with the identification of reactions due to other, clinically significant antibodies. We report a case which illustrates this problem in terms of transfusion safety and time to carry out the tests.

[Haemovigilance and blood safety in overseas military]. / Hémovigilance et sécurité transfusionnelle en opération extérieure.

The French military blood institute (FMBI) is the only military blood supplier in France. FMBI operates independently and autonomously under the Ministry of Defense's supervision, and accordingly, to the French, European and NATO technical and safety guidelines. FMBI is in charge of the collection, preparation and distribution of blood products to supply transfusion support to armed forces, especially during overseas operations. In overseas military, a primary physician is responsible for haemovigilance in permanent relation with an expert in the FMBI to manage any adverse reaction. Additionally, traceability of delivered or collected blood products during overseas operation represents a priority, allowing an appropriate management of transfusion inquiries and assessment of practices aiming to improve and update procedures and training. Transfusion safety in overseas operation is based on regular and specific training of people concerned by blood supply chain in exceptional situation.

[Prognosis factors in donor semen insemination: a 10-years follow-up study of 188 patients]. / Facteurs pronostiques en insémination avec sperme de donneur : suivi rétrospectif d'une cohorte de 188 patientes.

OBJECTIVES: Improving our practice by a constant evaluation is essential in the field of donor semen insemination (DI). Our center examined the prognosis factors for DI success in order to standardize patient treatment options. PATIENTS AND METHODS: We retrospectively analysed all couples referred for DI from January 2000 till December 2010. RESULTS: We analysed 551 cycles among 188 patients. Pregnancy rate by stimulation cycle was 19,8% with birth rate of 16.7%. The rate of pregnancy was improved till the fourth trial then plateau. On a patient-based analysis, success factors were age (P=0.04), previous successful DSI (P=0.02), and no previous failure of an ICSI-C (P=0.035). On a cycle-based analysis, success factors were the number of follicles greater than 15mm (P=0.04) and than 18mm (P=0.001). The percentage of 68.1 patients obtained a child by IVF-D after a failed DI. CONCLUSION: There are two predictive factors for DI success: the age of the patient and the number of mature follicles. It seems accurate to referred patients to IVF-D after four unsuccessful cycles of DSI. This recommendation may be adapted according to patient's age and hormonal evaluation.

[Fresh whole blood transfusion for war surgery: the experience of the Kabul French combat support hospital from 2006 to 2009]. / Transfusion de sang frais total en temps de guerre : expérience du groupement médicochirurgical Warehouse durant la période 2006-2009.

OBJECTIVE: The specificities of military medicine have led to the maintenance of fresh whole blood (FWB) transfusion. STUDY DESIGN: The aim of our study was to evaluate this practice at the French military hospital in Kabul between 2006-2009. PATIENTS AND METHODS: During our study period, 19 FWB transfusions were performed and the data from 15 FWB transfusions could be analyzed. We studied the number of units by recipient, the characteristics of recipients, the results of blood tests performed after transfusion, the incidents in donors and recipients, the period for obtaining a unit of FWB and mortality of recipients. RESULTS: A total of 66 units of FWB were transfused in 15 patients. The median number of FWB units transfused was three per patient. Thirteen out of 15 (87%) were combat-related casualties. All units were tested before transfusion for HIV with rapid diagnostic tests. Every blood samples of donors were negative for pathogens screened at the French Blood Service. No incident in donors and in recipients was reported. The average time between collection and transfusion was 140±197minutes (median 43min). Mortality in recipients was 27% (n=4). CONCLUSION: In our study, the FWB transfusion was not associated with incidents. Nonetheless, this practice should be used only for exceptional situations like military conflicts where risks of FWB are lower than the absence of transfusion.

[Antibodies against high frequency antigen and total knee replacement]. / Anticorps antipublic et prothèse totale de genou.

We report the perioperative management of a woman expressing an antibody against high frequency red cell antigen (anti-Kel4 antibody anti-kpb) who was scheduled for a total knee replacement. A specific strategy was designed to afford this major orthopedic surgery, considering specially the occurrence of unusual bleeding higher than the average bleeding assessed in our hospital in this indication. The transfusion of incompatible red cells may be responsible for acute hemolytic reaction. An autologous transfusion program, including cryopreservation, erythropoietin and iron support, was provided. Three autologous red cells units were collected before surgery. Compatible homologous red cells units were also available at the French bank for rare blood groups. We report logistical and medical problems that have occurred during the perioperative period.

[Conventional in vitro fertilization and intracytoplasmic sperm injection in sibling oocytes following intrauterine inseminations failure]. / Fécondation in vitro mixte après échecs d'inséminations intra-utérines intraconjugales. Étude de cohorte au CHU de Rouen.

OBJECTIVES: To evaluate the results of the initial in vitro fertilization (IVF) procedure after intrauterine insemination (IUI) failure where half of the oocytes were inseminated as for conventional IVF and half of the oocytes where treated for intra cytoplasmic sperm injection (ICSI). PATIENTS AND METHODS: From the first of January 2001 to the 31st of December 2008, 75 couples failing to conceive with ovarian stimulation and IUI were included in this retrospective study. RESULTS: Among the 75 couples, 53 had IVF and ICSI in sibling oocytes and 22 had just ICSI because of an insufficient oocyte cohort. No significant difference was observed in fertilization, implantation and pregnancy rates between the different groups; however, a total fertilization failure was observed more frequently when conventional IVF was used compared to ICSI (11.3% vs 3.8%). These patients with fertilization failure on conventional IVF had a lower sperm count than those who obtained embryos but sperm parameters were normal according to World Health Organisation (WHO) criteria and our study did not find any predictive factor of fertilization failure. DISCUSSION AND CONCLUSION: Couples failing to conceive after controlled ovarian hyperstimulation and IUI may be proposed a mixed in vitro fertilization procedure (with conventional IVF and ICSI) in order to avoid a total fertilization failure. Moreover, this procedure will indicate the better IVF technology (conventional or ICSI) for the subsequent attempt.

[French European military haemovigilance guidelines]. / Déclinaisons militaires Françaises des directives Européennes en matière d'hémovigilance.

European military transfusion services follow operational guidelines established by their respective national health systems and conform with European Union directives and NATO standards as applicable to member countries. Certain features are common to all of these standards, especially the pre-selection of volunteer, almost exclusively unpaid donors. NATO requirements are very close to European guidelines, with the exception that NATO permits the use of blood products collected in emergency conditions in theater when circumstances allow no better option. Blood product traceability exists for every country but is not always centralized or computerized. Serious adverse event reporting relies on national haemovigilance networks. Military considerations become important mainly in overseas operations, where the overall policy is to implement the relevant national, European or NATO guidelines with adjustments made for unique wartime circumstances and the risk/benefit ratio for the individual patient needing a transfusion.