Impact of Covid-19 epidemic on the activities of a blood centre, transfusion support for infected patients and clinical outcomes.

OBJECTIVES: We evaluated how the Severe Acute Respiratory disease from Coronavirus 2 (SARS-CoV-2) epidemic impacted transfusion services, transfusion support required by Covid-19 patients and their clinical outcome. BACKGROUND: In Italy, the first confirmed case of SARS-CoV-2 infection was registered on 21 February 2020. As of 20 April, about 250 000 cases were registered, 1143 of which were in the province of Pescara. METHODS: We compared transfusion services provided by the blood centre of Pescara between 1 March and 20 April 2019 and between 1 March and 20 April 2020. We assessed the number and type of blood components donated, those transfused in the various hospital departments and those transfused to Covid-19 patients. RESULTS: Compared to 2019, we documented a decrease of 32% in the number of donations. The number of transfusions increased by 139% in the infectious diseases department (IDD), dedicated to Covid-19 patients, and by 76% in the intensive care unit (ICU), whereas it markedly decreased in the other departments. Of 299 patients with Covid-19, 60 were transfused (20.1%). Transfused patients in the ICU were significantly younger than those in IDD and had a lower number of lymphocytes, lower post-transfusion increment of haemoglobin levels and higher D-dimer and C reactive protein values. Mortality rate was 60.7% among transfused patients in the ICU and 39.0% among those in the IDD (p = 0.02). CONCLUSION: The Covid-19 epidemic had a profound impact on transfusion activities. The important blood demand for Covid-19 patients was satisfied because of the reduction in activities in other hospital wards. Covid-19-positive transfused patients showed a very poor prognosis.

Development of the Platelet Efficacy Score (PEscore) to predict the efficacy of platelet transfusion in oncohematologic patients.

BACKGROUND: Despite the prophylactic use of platelet transfusion, hemorrhagic complications still represent an important cause of morbidity and mortality in patients with hematologic malignancies. Patient-related factors and characteristics of the transfused product can affect transfusion efficacy. STUDY DESIGN AND METHODS: The aim of this study was to develop and validate the Platelet Efficacy Score (PEscore), based on patient and product characteristics, to predict the likelihood of a satisfactory platelet transfusion (absolute increment ≥10.5 × 109 /L). This study utilized data relative to 16,265 platelet transfusions performed in 1592 oncohematologic patients. The whole sample was divided into two random samples: a training set, in which different patient-related and transfusion-related characteristics were included in a predictive model to develop the PEscore; and a validation set, in which the predictive properties of the PEscore were confirmed. In the training set, multilevel logistic regression analysis was performed in which the likelihood of attaining a satisfactory transfusion was modeled. RESULTS: The predictive score ranged between 0 and 30. Predictive properties of the PEscore were confirmed by the observed rates of satisfactory transfusions in the validation sample; the probability of a satisfactory transfusion was less than 10% for a score less than 12 and exceeded 50% if the score was 22 or higher. The likelihood of a satisfactory transfusion increased by 29% for a 1-unit increase in the PEscore (odds ratio, 1.29; 95% confidence interval, 1.27-1.31). CONCLUSION: The availability of a prediction score can increase transfusion efficacy, help the transfusion medicine specialist in the choice of the best product for the individual patient, and avoid waste of resources.

Survey of current practice for monitoring and management of platelet refractoriness in Italy.

Platelet transfusion failure is a common phenomenon affecting from 7% to 34% of haematology-oncology patients. Monitoring the efficacy of platelet transfusion through the evaluation of a post-transfusion platelet count and clinical response represent an important guide for subsequent transfusions and for the detection of refractoriness. The aim of this survey was to investigate physicians' attitudes and practices regarding the monitoring of platelet response and the management of platelet refractoriness. An e-mail based survey was conducted among the heads of blood banks with a hemapheresis ward in Italy. Heads of 64 centers out of the 122 initially identified (52%) completed the entire survey. Apheresis, buffy-coat pool, and platelet rich plasma represented an average of 46%, 38% and 17% of the total number of transfusions, respectively. In the prophylaxis of hemorrhagic episodes, most of the centers utilized as standard dose one unit of apheresis platelets (55.7%) and/or one unit of buffy-coat pool platelets (42.6%), while 11.4% of respondents used an average of 6 units of platelet rich plasma. In only 27.9% of the centers was the platelet dose established based on the body weight of the recipient. Only one-third of the centers evaluated the response to platelet transfusion in all patients, while the rate increased to 60% in onco-hematological patients. Among patients transfused on an outpatient basis, the rate dropped to 20%, and a platelet sample taken 10 min after transfusion was generally used. The survey documented a substantial lack of interaction between the clinician requesting the transfusion and the one responsible for the preparation and delivery of the product, with both figures involved in the diagnosis of refractoriness in only one-third of the centers. In conclusion, despite being a frequent condition, platelet refractoriness is still managed with a high degree of heterogeneity and often overlooked. Better adherence to existing guidelines and standard operating procedures, as well as the involvement of transfusion centers in prospective evaluations can help reduce this variability and improve the outcome of transfused patients.

ABO antibody titres: a multisite comparative study of equivalency and reproducibility for automated solid-phase and haemagglutination titration, and manual dilution with gel column agglutination technology.

BACKGROUND: ABO antibody titres are important in many clinical decisions; however, much variability is observed in titre results. For reliable and reproducible titre results, automated ABO titration methods have been developed. In this 10-site study, we evaluated the equivalency of the automated ABO titration assays on the Galileo NEO, a fully automated blood bank analyzer (Immucor, Inc.) to manual titration with gel Column Agglutination Technology (CAT), as well as the reproducibility of both methods. MATERIALS AND METHODS: Ten different locations participated in this study. The equivalency study included 70 random samples at each site. The reproducibility study tested the same blinded 30-sample panel at each study site. Anti-A and anti-B IgM and IgG antibody titres were tested with both the automated and manual methods; additionally, dithiothreitol (DTT) treatment was used to inactivate IgM antibodies in the manual CAT method. RESULTS: The equivalency between CAT manual method and Galileo NEO automated titres at each site ranged from 38 to 88%; equivalency for each isotype was 66.2% for IgM, 60.6% for IgG, and 88.5% for DTT-treated IgG. The reproducibility study evaluated the titre variation of each sample obtained from the 10 sites. The average titre ranges (in doubling dilutions) for the automated and manual methods, respectively, were 2.15±1.0 and 4.03±1.8 for IgM, and 1.53±0.7 and 4.10±1.9 for IgG; for the manual DTT-treated IgG, the average titre range was 3.45±1.8 doubling dilutions. DISCUSSION: The results demonstrated that the Galileo NEO automated and manual CAT ABO titres are not equivalent. However, the study also demonstrated that titre reproducibility is enhanced with the Galileo NEO automated ABO titration assays relative to the manual CAT ABO titration method. Therefore, to improve management of patients receiving care across multiple institutions, our study supports the use of automated ABO titration.

Bacterial contamination of platelets and septic transfusions: review of the literature and discussion on recent patents about biofilm treatment.

In spite of the improvements in transfusion safety occurred in the last decades, platelet septic transfusions still represent a cause for concern. Microbial screening of blood products cannot ensure transfusion sterility, so that pathogen inactivation methods and a timely management of infectious events actually play the most relevant role. Biofilm production has been associated to several human illnesses; also, it promotes bacterial adherence to platelet bags and colonization of recipient's catheter after transfusion. Therefore, facing biofilm communities is required to reduce the contamination risk and the occurrence of post-infusion events. In this context, the use of tigecycline as a wide-spectrum antibiofilm drug is discussed, along with recent patents about biofilm treatment by quorum-sensing blockers, bacteriophage-based therapy and antibiofilm oral compounds.