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Anemia is frequent in preterm infants. Red blood cell transfusion practices vary between different centers. The objective of this study was to review red blood cell transfusion practices in preterm infants between 2020 and 2021. This was a narrative review that included studies published on PubMed (Medline) and Web of Science between October 2020 and October 2021. Ten studies were included finally. Red blood cell transfusion frequency was variable. Some neonatal units did not report transfusion protocols. Most studies reported volumes of 10-15 ml/kg per transfusion. The implementation of an anemia care bundle and adoption of restrictive transfusion resulted in a reduction in the number of transfusions, the volume transfused, and a reduction in the rate of multiple transfusions. We suggest that neonatal units that care for preterm infants should have a transfusion protocol based on the best evidence available and this issue may improve.
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Introducción: la terapia transfusional es un procedimiento terapéutico que ha contribuido a disminuir la mortalidad, y mejorar la calidad de vida de pacientes con diversas patologías. La utilización de guías en la práctica transfusional, contribuye a la utilización racional de las mismas. Objetivo: describir las características de los niños de 1 mes a 14 años 11 meses hospitalizados en el Centro Hospitalario Pereira Rossell durante el 2019 que recibieron transfusión de sangre desplasmatizada. Metodología: estudio descriptivo retrospectivo. Se incluyeron los niños entre 1 mes y 14 años 11 meses asistidos en emergencia, unidad de reanimación, cuidados moderados, intermedios e intensivos del Centro Hospitalario Pereira Rossell. Variables: edad, sexo, área de asistencia, motivo de ingreso, indicación de transfusión, cifras de Hb pre y post-transfusión, clasificación de la anemia, dosis. Resultados: se incluyeron 160 transfusiones correspondientes a 97 pacientes, 56% eran de sexo masculino. Media de edad 3 años, 52% < 1 año. El motivo de ingreso más frecuente fue patología respiratoria infecciosa 37%. El 79% fueron transfundidos en unidad de cuidados intermedios e intensivos. Media Hb pre-transfusión 7,45 g/dL y post-transfusión de 10,1 g/dL. Predominó la anemia moderada, normocítica-normocrómica, pura. La dosis media de sangre desplasmatizada transfundida fue 12 cc/kg. Conclusiones: en esta serie predominaron los pacientes de sexo masculino y menores a un año que ingresaron principalmente por patología respiratoria infecciosa. La mayoría de los pacientes transfundidos estaban en cuidados intensivos. Futuros estudios, de diseño prospectivo, que incluyan pacientes de todos los escenarios asistenciales y de otros prestadores de salud, contribuirán a continuar el estudio de los pacientes transfundidos y a la elaboración de recomendaciones o protocolos locales.
Introduction: Transfusion therapy is a therapeutic procedure that has contributed to reducing mortality and improving the quality of life of patients with various pathologies. The use of guides in transfusion practice contributes to their rational use. Objective: To describe the characteristics of children from 1 month to 14 years 11 months who were hospitalized in the Centro Hospitalario Pereira Rossell during 2019 who received a red blood cell transfusion. Methodology: Retrospective descriptive study. Children aged 1 month to 14 years and 11 months assisted in the emergency, moderate, intermediate and intensive care of the Centro Hospitalario Pereira Rossell were included in the study. Variables: age, sex, area of care, reason for admission, indication for transfusion, Hb figures before and after transfusion, classification of anaemia, dose. The study protocol was approved by the Institutional Ethics Committee. Results:160 transfusions corresponding to 97 patients were included, 56% were male. Mean age 3 years, 52% <1 year. The most frequent reason for admission was infectious respiratory disease 37%. 79% were transfused in the intermediate and intensive care unit. Mean Hb pre-transfusion 7.45 g/dL and post- transfusion of 10.1 g/dL. Moderate, normocytic-normochromic, pure anaemia predominated. The mean dose of deplasmatized blood transfused was 12 cc/kg. Conclusions: In this series, male patients less than one year of age predominated, admitted mainly for infectious respiratory disease. Most of the transfused patients were in intensive care. Future studies of prospective design that include patients from all healthcare settings and from other healthcare providers, will contribute to continuing the study of transfused patients and to the development of local recommendations or protocols.
Introdução: a terapia transfusional é um procedimento terapêutico que tem contribuído para reduzir a mortalidade e melhorar a qualidade de vida de pacientes com diversas patologias. A utilização de diretrizes na prática transfusional contribui para o seu uso racional. Objetivo: descrever as características das crianças de 1 mês a 14 anos e 11 meses internadas no Centro Hospitalario Pereira Rossell durante o ano de 2019 que receberam transfusão de sangue desplasmatizado. Metodologia: estudo descritivo retrospectivo. Foram incluídas crianças com idade entre 1 mês e 14 anos e 11 meses atendidas na emergência, unidade de reanimação, cuidados moderados, intermediários e intensivos do Centro Hospitalario Pereira Rossell. Variáveis: idade, sexo, área de atendimento, motivo da admissão, indicação de transfusão, valores de Hb pré e pós-transfusão, classificação da anemia, dose. Resultados: foram incluídas 160 transfusões correspondentes a 97 pacientes, 56% eram do sexo masculino. A idade média foi de 3 anos, 52% < 1 ano. O motivo mais frequente de admissão foi pato- logia respiratória infecciosa (37%). 79% foram transfundidos na unidade de tratamento intermediário e intensivo. Hb média pré-transfusional de 7,45 g/dL e Hb pós-transfusional de 10,1 g/dL. Predominou a anemia moderada, normocítica-normocrômica e pura. A dose média de sangue desplasmatizado transfundida foi de 12 cc/kg. Conclusões: nesta série, houve uma predominância de pacientes do sexo masculino com menos de um ano de idade que foram admitidos principalmente por patologia respiratória infecciosa. A maioria dos pacientes transfundidos estava em tratamento intensivo. Estudos prospectivos futuros incluindo pacientes de todos os ambientes de atendimento e outros presta- dores de serviços de saúde, contribuirão para um estudo mais aprofundado dos pacientes transfundidos e para o desenvolvimento de recomendações ou protocolos locais.
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Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Transfusion Reaction , Anemia/therapy , Retrospective Studies , Age and Sex DistributionABSTRACT
Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.
Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.
Subject(s)
Humans , Wounds and Injuries , Cardiopulmonary Resuscitation , Endovascular Procedures , Aorta , Blood Transfusion , Balloon Occlusion , HemorrhageABSTRACT
【Objective】 To retrospectively analyze the indexes of autologous blood transfusion during heart valve replacement, in order to provide reference for allogeneic blood transfusion during heart valve replacement surgery under direct vision. 【Methods】 The data of 180 patients who underwent heart valve replacement in our hospital from January 2020 to December 2021 were analyzed retrospectively. The patients were divided into allogeneic and non-allogeneic blood transfusion group based on whether allogeneic blood was transfused during the operation, and the general data and 24 hours pre- and post-operative clinical examination indexes were compared. 【Results】 Multivariate logistic regression analysis showed that age (OR=1.110, 95% CI: 1.058-1.165, P<0.05) and intraoperative cardiopulmonary bypass time (OR=1.062, 95% CI: 1.038-1.086, P<0.05) were risk factors for allogeneic blood transfusion, and preoperative Hb content (OR=0.910, 95%CI: 0.868-0.953, P<0.05) was a protective factor. The RBC count(4.16±0.73 vs 4.52±0.71)×1012/L and Hb(120.94±17.97 vs 136.57±19.33) g/L at 24 hours preoperative in the allogeneic transfusion group were lower than those in the non-allogeneic transfusion group, and the RBC(3.51±0.53 vs 4.13±0.78)×1012/L, Hb(114.15±11.68 vs 124.79±14.96)g/L and platelet count(124.28±32.11 vs 148.29±26.62)×109/L at 24 hours postoperative were significantly lower than those in the non-allogeneic transfusion group (P<0.05). 【Conclusion】 Age and intraoperative cardiopulmonary bypass time are the risk factors for autologous and allogeneic blood transfusion during heart valve replacement under direct vision, and the preoperative Hb content is a protective factor. It is necessary to evaluate the symptomatic treatment of patients before operation and reduce allogeneic blood transfusion.
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【Objective】 To systematically evaluate the safety and efficacy of intraoperative cell salvage (IOCS) for placenta previa women undergoing cesarean section. 【Methods】 The PubMed, Web of Science, Embase, the Cochrane Library of clinical trials, China National Knowledge Infrastructure (CNKI) and Wan Fang databases were searched from inception to September 2022. The standardized mean differences (SMDs) or relative risk (RR) and 95% confidence intervals (CIs) and prediction intervals (PIs) regarding the comparison between the IOCS and allogeneic blood transfusion (ABT) groups were analyzed using R software Version 4.1.2 and Stata Version 12.0. 【Results】 Five RCTs and ten retrospective cohort studies were included in this meta-analysis. Analysis of cohort studies showed that compared with the ABT group, women with placenta previa who underwent IOCS had generally higher postoperative hemoglobin (Hb) (SMD, 0.626; 95% CI: 0.103 to 1.149; 95% PI: -1.320 to 2.572) and hematocrit (Hct) (SMD, 0.617; 95% CI: 0.130 to 1.104; 95% PI: -1.084 to 2.317) levels. In RCTs, we observed that placenta previa women undergoing IOCS were almost 72.7% less likely to suffer from adverse events AEs than the ABT group (RR, 0.273; 95% CI, 0.082 to 0.904). The difference in postoperative prothrombin time (PT), activated prothrombin time (APTT), fibrinogen (Fib) concentration, blood urea nitrogen (BUN) and creatinine (Cr) between the IOCS and ABT group did not reach statistical significance. 【Conclusion】 Women with placenta previa who undergo IOCS have higher postoperative Hb and Hct concentrations compared to those treated with ABT. IOCS has no major effects on postoperative coagulation parameters and renal function parameters. IOCS is associated with a significantly lower risk of transfusion-related AEs among women undergoing cesarean section.
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The recently officially approved and released health industry standard Standard for Blood Storage(WS 399-2023) by the National Health Commission is the latest revised version of Standard for Blood Storage(WS 399-2012), which mainly stipulates the storage requirements for whole blood, red blood cells, platelets, granulocytes, plasma and irradiated blood. It applies to blood collection and supply institutions and healthcare institutions, and is the guideline for the safe use of blood.
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【Objective】 To explore the feasibility of blood transfusion compatibility testing for multiple myeloma(MM) patients treated with anti-CD38 monoclonal antibody daratumumab (DARA) after DARA-Fab fragment blocking, and to evaluate the transfusion efficacy by comparing with dithiothreitol(DTT) method. 【Methods】 After DARA was prepared into DARA-Fab fragments using PierceFab preparation kit, the neutralization effects of different volumes (5, 10, 15, 30 μL) on screening cells and panel cells were confirmed. DARA-Fab fragments and screening cells with specific antigens and corresponding monoclonal antibody reagents were used as the experimental group and the control group with the same volume of saline for incubating and centrifugin.Twenty MM patients treated with DARA were selected for cross-matching with DARA-Fab and DTT respectively, and the laboratory indexes before and after transfusion were statistically analyzed, and the two blood matching methods were compared. 【Results】 After incubating and centrifuging, the results of DARA-Fab fragments(15, 30 μL) with screening cells and serum mixed with DARA were negative, while those of DARA-Fab(5, 10 μL) were positive. 15μL DARA-Fab treated antibody identification cells (2, 3, 4, 5, 7, 9, 11) were negative, antibody identification cells (1, 6, 8, 10, 12) were negative after 30 μL DARA-Fab fragments treatment; the results of MNS, Duffy, Kidd, Kell, Lewis, Rh blood group system of the experimental group were consistent with those of the control group; the hemoglobin (Hb) (g/L) of 20 patients after infusion of RBC (73.90±1.90) was significantly higher than that before transfusion (63.60±1.58), P0.05).And no statistical difference was noticed in Hb (10.75±1.04 vs 10.30±0.98), TBil (3.31±1.47 vs 3.31±0.55), DBIL(2.76±1.24 vs 2.60±0.83), and I-Bil(1.97±0.40 vs 2.82±0.53) between the DTT treatment method and the DARA Fab fragment treatment before and after transfusion(P>0.05). 【Conclusion】 DARA-Fab can remove the interference of RBC on cross matching by blocking CD38 antigen. This method has no effect on the antigens of common RBC blood group systems, and shows significant blood transfusion efficacy as that of DTT method.
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【Objective】 To explore the feasibility of establishing quantifiable evaluation system combined with PDCA in improving blood transfusion medical record. 【Methods】 A working group was set up in our hospital to establish an evaluation system for blood transfusion medical record according to relevant norms and literature. The data from September 2022 to February 2023 were used as the control group, and data from from April to May 2023 as the study group. PDCA was used to analyze the causes for poor quality of medical record. The quality of medical record was continuous improved for two months and the results were analyzed. 【Results】 Comparison between the research group and the control group showed that the score of blood transfusion consent (item A), blood transfusion application (item B), blood transfusion evaluation (item C), blood transfusion serious hazard (item F) increased respectively as 17.50±5.54 vs 21.08±3.75 (P<0.01), 16.22±2.05 vs 17.33±1.85 (P<0.01), 13.05±3.5 vs 14.72±1.97 (P<0.01), 7.9±1.44 vs 8.7±0.92 (P<0.01), and the total score of medical record was 85.36±7.5 vs 93.05±5.04 (P<0.01). The qualified rate of medical record increased from 82.2% to 98.3%(P<0.01). 【Conclusion】 The establishment of quantifiable blood transfusion medical record evaluation system combined with PDCA can help realize timely regulation and standardization of blood transfusion medical record.
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In clinical practice, red blood cell infusion needs to be based on the patient′s hemoglobin level. However, different guidelines recommend different thresholds for red blood cell infusion and the timing of blood transfusion initiation is still controversial due to the presence of these different thresholds. Meanwhile, the use of allogeneic blood products carries a certain risk of transfusion-related infections or organ damage. Therefore, initiating red blood cell infusion requires more evidence. This review discusses some new methods, namely central venous oxygen saturation, arterial venous oxygen difference, near-infrared spectroscopy, and perioperative transfusion trigger score. It aims to help evaluate blood transfusion trigger and provide reference for doctors when making transfusion decisions.
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【Objective】 To explore the application of machine learning in scientific and rational blood preparation and predictive analysis for surgical blood usage before liver transplantation surgery. 【Methods】 Clinical basic information including gender, age, clinical diagnosis and surgical methods of 356 liver transplantation patients were collected. The duration (Time) and preoperative laboratory test results of hemoglobin (Hb), hematocrit (Hct), platelet count (Plt), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), total bilirubin (TBIL), albumin (ALB), creatinine (Crea) and total protein (TP), as well as the amount of intraoperative blood transfusion were collected. A machine learning model capable of predicting the risk of massive blood transfusion during liver transplantation surgery was established by Python, and was evaluated to select the optimal predictive model. 【Results】 Among the 7 machine learning models constructed, the logistic regression model performed the best (AUROC: 0.90, F1 score: 0.82), with an accuracy of 79.44% and precision of 79.69%, followed by the random forest classifier (AUROC: 0.87, F1 score: 0.83), with an accuracy of 79.44% and precision of 77.94%. 【Conclusion】 Establishing a machine learning prediction model by Python is of significant clinical importance for scientific blood preparation, predicting the risk of massive blood transfusion and ensuring the safety of blood use in liver transplantation surgery.
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【Objective】 To investigate the blood transfusion compatibility test results of a child with thalassemia after delayed hemolysis reaction, and to formulate transfusion strategies based on other clinical data to ensure the safety of clinical blood use. 【Methods】 A comprehensive analysis was conducted on the transfusion compatibility test results of a child with thalassemia, combined with Rh blood type system detection, blood transfusion history, serum bilirubin changes, clinical symptoms and other data to determine the occurrence of delayed hemolytic reaction, and formulate the subsequent appropriate blood matching strategies. 【Results】 On admission, the blood type of the patient was B DccEE, with hemoglobin (Hb) 38 g/L, reticulocyte ratio (Ret%) 2.92%, total bilirubin (TBil) 65.8 μmol/L, direct bilirubin (DBil) 12.0 μmol/L, indirect Bilirubin (IBil) 53.8 μmol/L, negative for unexpected antibody screening, no agglutination or hemolysis on both primary and secondary sides of the cross-matching over with type B DCcEe donors, negative for direct anti human globulin test(DAT), negative for indirect anti human globulin test (IAT), lactate dehydrogenase(LDH) 1 050 U/L, aspartate aminotransferase(AST) 113 U/L, urine occult blood 2+, urine bilinogen 4+, and a history of red blood cell transfusion 5 days before admission. The above results indicated that the child had a delayed hemolytic reaction, then type B DccEE leukocyte-depleted suspension red blood cell was transfused, and various indicators improved after transfusion. 【Conclusion】 Appropriate blood matching strategies should be formulated based on the results of blood transfusion compatibility testing and other clinical data before transfusion for children with thalassemia in order to effectively ensure transfusion safety.
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【Objective】 To explore a transfusion therapeutic plan for hemolytic disease of the newborn(HDN) caused by anti-c antibodies in mother of Asian-type DEL. 【Methods】 The ABO blood type and Rh phenotype of the mother and child were determined using the saline tube method. The mother′s RhD negativity was confirmed through classical anti-human globulin testing and RhD adsorption-elution test. The mother′s unexpected antibodies were screened and their titers were measured using classical anti-human globulin testing, antibody card test and polyamine method. Cross-matching was conducted. The three hemolysis tests were performed by antibody card test. The mother′s RHD gene typing was conducted using a commercially available RHD negative identification gene detection kit (PCR-SSP method). 【Results】 The mother exhibited a CCee Rh serological phenotype, and the DEL gene test confirmed the presence of RHD*1227A, indicating the production of anti-c antibodies. The infant displayed a DCcEe Rh serological phenotype, positive for direct antiglobulin test and red cell elution. Based on the mother′s obstetric history, clinical manifestations of the infant and blood examination results, the diagnosis was HDN caused by anti-c antibodies. 【Conclusion】 For infants with HDN caused by anti-c antibodies in mother of Asian-type DEL, DCCee Rh phenotype red blood cell transfusion is recommended, while CCee Rh phenotype deglycerolized red blood cell transfusion is recommended for the mother.
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<b>Objective</b> To investigate the differences and the immunocompatibility of wild-type (WT), four-gene modified (TKO/hCD55) and six-gene modified (TKO/hCD55/hCD46/hTBM) pig erythrocytes with human serum. <b>Methods</b> The blood samples were collected from 20 volunteers with different blood groups. WT, TKO/hCD55, TKO/hCD55/hCD46/hTBM pig erythrocytes, ABO-compatible (ABO-C) and ABO-incompatible (ABO-I) human erythrocytes were exposed to human serum of different blood groups, respectively. The blood agglutination and antigen-antibody binding levels (IgG, IgM) and complement-dependent cytotoxicity were detected. The immunocompatibility of two types of genetically modified pig erythrocytes with human serum was evaluated. <b>Results</b> No significant blood agglutination was observed in the ABO-C group. The blood agglutination levels in the WT and ABO-I groups were higher than those in the TKO/hCD55 and TKO/hCD55/hCD46/hTBM groups (all <i>P</i><0.001). The level of erythrocyte lysis in the WT group was higher than those in the ABO-C, TKO/hCD55 and TKO/hCD55/hCD46/hTBM groups. The level of erythrocyte lysis in the ABO-I group was higher than those in the TKO/hCD55 and TKO/hCD55/hCD46/hTBM groups (both <i>P</i><0.01). The pig erythrocyte binding level with IgM and IgG in the TKO/hCD55 group was lower than those in the WT and ABO-I groups. The pig erythrocyte binding level with IgG and IgM in the TKO/hCD55/hCD46/hTBM group was lower than that in the WT group and pig erythrocyte binding level with IgG was lower than that in the ABO-I group (all <i>P</i><0.05). <b>Conclusions</b> The immunocompatibility of genetically modified pig erythrocytes is better than that of wild-type pigs and close to that of ABO-C pigs. Humanized pig erythrocytes may be considered as a blood source when blood sources are extremely scarce.
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Objective To analyze risk factors for perioperative blood transfusion in elderly patients undergoing uni-lateral primary total hip arthroplasty and develop a prediction model.Methods The study retrospectively collected 467 elderly patients receiving unilateral primary total hip arthroplasty between January 2013 and October 2021 at Peking Union Medical College Hospital.The 70%of the data were used as the training set and the 30%of the data were used as the testing set.Patients were divided into the transfusion and no-transfusion groups based on the presence or absence of perioperative blood transfusion.Univariate analysis and multivariable logistic regression were conducted to analyze patient demographic characteristics,surgical information,and preoperative laboratory tests for identifying risk factors.Clinical experience was combined to establish a prediction model and draw the nomogram.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the model in the tes-ting set.Results A total of 91 patients(19.5%)received perioperative blood transfusion.Multivariable logistic re-gression suggested the history of coronary artery disease,prolonged operation time,and lower preoperative hemoglo-bin were risk factors for perioperative blood transfusion(P＜0.05).The prediction model was constructed based on the results of statistical analysis and clinical experience,including the history of coronary artery disease,operation time,preoperative hemoglobin,age,and American Society of Anesthesiologists(ASA)physical status＞Ⅱ.The area under the receiver operating characteristic curve(AUC)of the model was 0.809.Conclusions The prediction model for perioperative blood transfusion in elderly patients undergoing unilateral total hip arthroplasty had a good performance and could assist in clinical practice.
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Perioperative blood loss in pediatric cardiac surgery is related to the significant increase of blood transfusion,which leads to adverse events of blood transfusion and worsens the prognosis.Perioper-ative blood protection has important clinical significance in reducing adverse reactions to blood transfusion and alleviating blood supply tension.Cardiopulmonary bypass plays an important role in the management of perioperative blood protection practices.This article reviews the latest progress for blood protection in perfu-sion and blood product infusion strategies during cardiopulmonary bypass,providing reference for physicians to transfuse blood in children undergoing cardiopulmonary bypass during pediatric heart surgery.
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Blood transfusion accuracy is crucial for disease treatment and emergency rescue. Prior to a blood transfusion, it is essential to perform a number of tests to assure proper clinical treatment and reduce the risk of complications. Pre-transfusion testing refers primarily to the blood group, coagulation, and infection to assure transfusion safety and prevent cross-infection. Blood type, cross-matching blood, fibrinogen, viral hepatitis, human immunodeficiency virus, and syphilis are routine pre-transfusion tests. Immunoassay is the traditional clinical pretransfusion detection method. With the expansion of clinical treatment requirements from hospital to on-site treatment, new technologies, such as electrochemical sensing, microfluidics, and spectroscopy technology, are being developed gradually for rapid detection prior to blood transfusion. The development of technologies including colloidal gold immunity and biochips has facilitated the shift from large-scale laboratory equipment to portable testing for pre-transfusion screening. Further, the introduction of artificial intelligence technologies such as machine learning, biometric technology, and computer vision has contributed to the advancement of intelligent pre-transfusion testing. This article reviews the various application scenarios, benefits, and drawbacks of different pre-transfusion detection technologies, analyzes the application of a series of new technologies in pre-transfusion detection and its future development trend, and provides a reference for promoting the development of pre-transfusion detection and even rapid disease marker detection.
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【Objective】 To investigate the serological and molecular biology characteristics of ambiguous blood types among voluntary blood donors in Putian, and to file records for relevant donors for future reference in case of their own transfusion needs or emergency donations to others. 【Methods】 A total of 68 593 blood samples from voluntary blood donors in Putian Central Blood Station between January 1, 2019 and August 31, 2023 were collected and tested for blood types using serological methods. ABO gene (including promoters, enhancers and seven exons as well as their flanking sequences and intron 6) and FUT1 gene testing were performed on ambiguous blood types.3D models were constructed using Chimira and PyMOL software to predict the impact of gene mutations on enzyme structure. 【Results】 A total of 16 ABO subtypes were identified by serological methods, with the highest detection rate as the para-Bombay phenotype (0.73 per 10 000), followed by the cisAB phenotype (0.44 per 10 000). Gene analysis revealed 12 cases with known mutations (4 cases of FUT1.01N.06/FUT1.01N.06, 1 case of FUT1 01W.08/FUT1.01N.06, 2 cases of A2.08/B.01, 1 case of BA.02/O.01.01, 1 case of A3.07/O.01.01, 3 cases of cisAB.01/B.01), and key mutations were not found in 4 cases (2 cases of A1.02/B.01, 2 cases of A1.02/O.01.02). 3D molecular model analysis revealed that both A3.07 and FUT1.01W.08 allele can lead to a decrease in activity of the corresponding glycosyltransferases, resulting in the emergence of subtypes. 【Conclusion】 The most common phenotype causing discrepancies in ABO blood type testing among voluntary blood donors from Putian is the para-Bombay phenotype, with the most common allele being FUT1.01N.06.
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【Objective】 To study the changes in serum immunoglobulin levels in children with thalassemia who undergo repeated blood transfusions and explore their correlation with delayed hemolytic transfusion reactions(DHTR). 【Methods】 Serum samples from children with thalassemia who received blood transfusion treatment from June 2022 to April 2023 (observation group) and healthy children who underwent physical examination (control group) in our hospital were collected. The levels of serum immunoglobulins (IgG subtype, IgM, IgA, IgE and IgD) were detected using flow cytometry CBA multi-factor quantitative detection technology, and the differences between the two groups were compared. The children were divided into 4 groups according to different transfusion numbers: ≤10 numbers, 11-30 numbers, 31-50 numbers and >50 numbers, and the differences between different blood transfusion numbers and serum immunoglobulin levels in each group were compared using one-way analysis of variance (ANOVA). Children with thalassemia with DHTR were in the hemolysis group, and children with thalassemia who did not experience DHTR were in the non-hemolysis group. The changes in serum immunoglobulins (IgG subtypes, IgM, IgA, IgE and IgD) between the two groups were compared to explore the correlation between serum immunoglobulins in thalassemia children with repeated transfusion and DHTR. 【Results】 The levels of IgG1, IgG3, IgG4 and IgA in the observation group were significantly higher than those in the control group, with the increase of(2.07±2.12), (0.67±2.03), (0.30±0.37)and(6.04±11.40)mg/mL, respectively, while the level of IgD in observation group was significantly lower than that in the control group, with a decrease of(0.03±0.01)mg/mL, P0.05). IgG1 and IgG4 both significantly increased with the number of blood transfusions.The IgG1 in the 4 groups increased sequentially as(0.30±0.62), (0.41±0.51)and(3.60±3.48)mg/mL, and IgG4 increased sequentially as (0.12±0.13), (0.22±0.07) and (0.21±0.38)mg/mL. IgG2, IgM and IgD showed a significant decrease, with IgG 2, IgM, and IgD in four groups decreased as(0.91±1.50), (0.14±0.10)and(0.05±0.05)mg/mL, respectively, showing significant differences with the number of blood transfusions(P0.05). IgG1, IgG3 and IgG4 in the hemolysis group were significantly higher than those in the non-hemolysis group, with an increase of (4.44±3.41), (0.73±1.26)and(0.52±0.40), respectively(P0.05). 【Conclusion】 The serum immunoglobulin levels of children with thalassemia who undergo repeated blood transfusions are abnormal. There are differences in correlation between the number of blood transfusions and serum immunoglobulin levels among children with thalassemia who undergo repeated blood transfusions. The relevant serum immunoglobulins for DHTR in children with thalassemia who undergo repeated blood transfusions are IgG1, IgG3 and IgG4.
ABSTRACT
【Objective】 To analyze the characteristics of blood transfusion consultation cases and establish the consultation route, so as to provide reference for blood transfusion doctors to participate in blood transfusion consultation practice. 【Methods】 The cases involved in clinical transfusion consultation in the blood transfusion department of our hospital from 2020 to 2023 were collected from the hospital information system (HIS), and then classified by department and consultation type to summarize the main points of transfusion consultation, formulate transfusion consultation routes, and conduct typical cases analysis. 【Results】 There were 315 clinical transfusion consultations from 2020 to 2023, with an increasing trend year by year (26 in 2020, 67 in 2021, 81 in 2022, 141 in 2023). The consultations involved 24 departments, including cardiovascular medicine 14.0%(44/315), orthopedics 12.7%(40/315), intensive care medicine 8.9%(28/315), general medicine 8.3%(28/315), cardiopulmonary disease 6.0%(19/315), etc. There were 8 categories of consultations, including 35.6%(112/315) autologous ozonized blood transfusion, 23.8%(75/315) plasma exchange, 14.9%(47/315) perioperative mass blood preparation (transfusion), 11.4%(36/315) platelet- rich plasma therapy and 6.3%(20/315) autologous blood collection, etc. The clinical blood transfusion consultation route was formulated according to the consultation points. Six patients with various diseases were treated by blood transfusion department. With effective treatment measures taken, all of them improved and were discharged. 【Conclusion】 The summary of key points of clinical blood transfusion consultation and formulation of the blood transfusion consultation route by department of blood transfusion are conducive to the implementation of blood transfusion consultation and guarantee the safety of patients.
ABSTRACT
【Objective】 To retrospectively analyze the blood use of transfusion-dependent thalassemia (TDT) patients in 9 designated transfusion medical institutions from 2018 to 2023 in Nanning, and to evaluate the effect of " three designated " blood transfusion mode (hereby means TDT patients undergoing blood transfusion in designated transfusion medical institutions regularly) and " collection-based-supply" blood management mode on blood security of TDT patients. 【Methods】 The " three designated" blood transfusion mode was implemented to ensure that TDT patients registered in the local household registration (referred to as the " register" ) obtain the rights and interests of outpatient transfusion and blood security of designated medical institutions. The " collection-based-supply" blood management mode was implemented to assess the blood needs of "register" TDT patients and meet their needs to the maximum extent according to the blood inventory (collection). 【Results】 From 2018 to 2023, the total blood supply of "register" TDT patients was 10.37% of the total red blood supply of all medical institutions (138 509.5 U /1 335 788.0 U), with the highest proportion of type O blood as 46.34% (64 181.0 U/138 509.5 U) and the lowest proportion of type AB blood as 3.85% (5 331.0 U/138 509.5 U). In 2018, 9 transfusion medical institutions were designated for TDT patients.There were a total of 766 TDT patients in the register, with the per capita annual blood transfusion volume increased from 20.28 U (15 531.0 U/766 patients) in 2018 to 36.01 U (27 586.0 U/766 patients) in 2023, maintaining a positive growth every year(30.26%, 4.94%, 11.71%, 8.61%, 4.94% and 7.10%). 【Conclusion】 The " three designated" blood transfusion mode and the " collection-based-supply " blood management mode can effectively guarantee the blood supply of TDT patients.