Exploring the potential harm of varied blood storage on patients undergoing cardiovascular surgery.

BACKGROUND AND OBJECTIVES: Debate exists surrounding the optimal duration of red blood cell (RBC) storage. A hypothesis emerging from previous research suggests that exposure to fresh blood may be harmful to patients undergoing cardiac surgery. This study uses a large transfusion medicine database to explore the association between in-hospital mortality and red cell storage duration. MATERIALS AND METHODS: This is an exploratory retrospective cohort study of all adult patients at Hamilton, Canada, over a 14-year period that received at least one allogeneic red cell transfusion during their hospitalization for cardiac surgery requiring bypass. The primary outcome for the study was in-hospital death. Analysis was performed using multivariate Cox regression modelling with time-dependent and time-independent covariates and stratification variables. Five models with varying definitions for short, intermediate and prolonged duration of RBC storage were tested. RESULTS: From March 2004 to December 2017, 11,205 patients met the inclusion criteria and were included in the regression analyses. No significant effect of short-duration red storage on patient mortality was observed in all statistical models, with the red cells stored for the longest duration as the reference group. When patients who received exclusively fresh (hazard ratio [HR] 1.040, 95% confidence interval [CI] 0.588-1.841, p-value = 0.893) and older aged (HR 1.038, 95% CI 0.769-1.1.402, p-value = 0.0801) RBCs were compared with those who received exclusively mid-age red cells as the reference, statistical significance was similarly not reached. CONCLUSION: Red cells stored for the shortest duration are not associated with increased risk of mortality among cardiac surgery patients.

A retrospective analysis of haemolytic reactions to intravenous immunoglobulin using data from the Transfusion-Transmitted Injuries Surveillance System (Ontario).

BACKGROUND AND OBJECTIVES: Haemolysis can occur following intravenous immunoglobulin (IVIG) infusion. Haemovigilance data were analysed using a novel approach for including two control groups with no haemolysis to IVIG. Objectives included a summary of all reactions to IVIG, rate estimates and analysis of haemolytic reactions including risk factors. MATERIALS AND METHODS: Canadian haemovigilance data from Ontario (2013-2021), IVIG distribution and transfusion data from the blood supplier, and data from a large local transfusion registry were used. An 'other-reactions' control group included patients with IVIG reactions that were not haemolytic, and registry patients with no-reaction were the 'no-reaction controls'. Descriptive analysis and two logistic regression models for the different control groups were performed. RESULTS: One thousand one hundred and seventy reactions were included. Most common were febrile non haemolytic (26.1%), minor allergic (24.5%) and IVIG headache (15.3%) followed by haemolytic 10.9% (128/1170). Haemolytic reaction rates decreased over time: rates since 2020 estimated between 1.5 and 2.9/1000 kg IVIG used. The regression model for other-reaction controls identified two risk factors for haemolysis: non-O blood group recipients compared with group O recipients (p value = 0.0106) and IVIG dose per 10 g increase (OR 1.359; 95% CI 1.225-1.506). The model using no-reaction controls gave similar results and also showed no pre-medication was associated with a higher risk of haemolysis (OR 29.084; 95% CI 1.989-425.312). CONCLUSION: The frequency of haemolytic reactions has decreased over time. We confirmed non-O blood group recipients and IVIG dose as risk factors for haemolysis and raise the hypothesis that no pre-medication may increase the risk of haemolysis.

Perception of blood donation among employees of healthcare organizations during COVID-19 pandemic: A national multicenter cross-sectional study.

BACKGROUND: Maintaining a safe and adequate blood supply during a crisis is a major challenge facing blood banks around the world. With the recent global COVID-19 crisis and the enforced "stay at home" lockdown, access to blood donors was limited. Since employees of healthcare facilities may act as potential blood donors, their perception of blood donation and their willingness to donate during the pandemic period is important to be assessed. STUDY DESIGN AND METHOD: A national cross-sectional study at six centers in Saudi Arabia was conducted using an online-based questionnaire that was distributed to all healthcare employees in these facilities between June and August 2020. RESULTS: Among the total of 1664 participants, 63.2% (n = 1051) did not donate blood during the last 2 years. However, 53% (n = 882) of participants reported they are likely to donate blood during the COVID-19 crisis. Furthermore, 85% (n = 1424) did not donate blood during the current pandemic, with the biggest worries of getting the COVID-19 infection in the donor center. The main concerns of participants were about adherence to physical distancing requirements and the safety of the donation procedure. The majority of health care participants (88.2%) support implementing a hospital policy for a voluntary blood donation by employees during crises. CONCLUSION: Recruitment of more blood donors among health care employees is a feasible solution to improve the blood supply during a crisis. This should be based on efforts throughout the year including regular awareness campaigns and effective communication.

Nationwide Seroprevalence of SARS-CoV-2 in Saudi Arabia.

BACKGROUND: Estimated seroprevalence of Coronavirus Infectious Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is a critical evidence for a better evaluation of the virus spread and monitoring the progress of COVID-19 pandemic in a population. In the Kingdom of Saudi Arabia (KSA), SARS-CoV-2 seroprevalence has been reported in specific regions, but an extensive nationwide study has not been reported. Here, we report a nationwide study to determine the prevalence of SARS-CoV-2 in the population of KSA during the pandemic, using serum samples from healthy blood donors, non-COVID patients and healthcare workers (HCWs) in six different regions of the kingdom, with addition samples from COVID-19 patients. METHODS: A total of 11,703 serum samples were collected from different regions of the KSA including; 5395 samples from residual healthy blood donors (D); 5877 samples from non-COVID patients collected through residual sera at clinical biochemistry labs from non-COVID patients (P); and 400 samples from consented HCWs. To determine the seroprevalence of SARS-CoV-2, all serum samples, in addition to positive control sera from RT-PCR confirmed COVID-19 patients, were subjected to in-house ELISA with a sample pooling strategy, which was further validated by testing individual samples that make up some of the pools, with a statistical estimation method to report seroprevalence estimates. RESULTS: Overall (combining D and P groups) seroprevalence estimate was around 11% in Saudi Arabia; and was 5.1% (Riyadh), 1.5% (Jazan), 18.4% (Qassim), 20.8% (Hail), 14.7% (ER; Alahsa), and 18.8% in Makkah. Makkah samples were only D group and had a rate of 24.4% and 12.8% in the cities of Makkah and Jeddah, respectively. The seroprevalence in Saudi Arabia across the sampled areas would be 12 times the reported COVID-19 infection rate. Among HCWs, 7.5% (4.95-10.16 CI 95%) had reactive antibodies to SARS-CoV-2 without reporting any previously confirmed infection. This was higher in HCWs with hypertension. The study also presents the demographics and prevalence of co-morbidities in HCWs and subset of non-COVID-19 population. INTERPRETATION: Our study estimates the overall national serological prevalence of COVID-19 in Saudi Arabia to be 11%, with an apparent disparity between regions. This indicates the prevalence of asymptomatic or mild unreported COVID-19 cases.

Incidence and severity of adverse events among platelet donors: A three-year retrospective study.

ABSTRACT: Adverse events (AEs) are unfortunate consequences of platelet donation. This study reports the incidence and severity of AEs and the associated risk factors in platelet donation at a major blood donation center in Riyadh, Saudi Arabia.A review of donation records was conducted between 2014 and 2017. Eligible study participants were 5007 platelet donors who had donated 7969 times. Each donation was accounted for as a single study subject. Participants' characteristics were described and analyzed as potential contributing factors to adverse events.The average age of platelet donors was 30.0±7.3 years. First-time donors comprised (n = 3,100, 61.9%) of the sample, and 1907 (38.1%) were multiple donors (periodic/routine). Their average BMI was 28.6 ±â€Š4.9 kg/m2. Most donors have blood type "O" and Rheo "positive". The range of blood volume processed was 0 to 5273 ml, while the procedure duration ranged from 0 to 90 minutes. The average platelet yield was 3.8 ±â€Š3.5 ∗1011 platelets per unit, and the average collected volume was 257.6 ±â€Š86.1 ml. Incidence of AEs was 4.2%, of which 91.3% were mild and 8.7% were severe. AEs were vascular injuries (65.3%), vasovagal reactions (11.6%), and citrate toxicity (5.3%). AEs were associated with first-time donation, adj.OR (95%CI) = 1.5 (1.1-1.8) and lower BMI, adj. OR (95% CI) = 1.4 (1.1-1.8). Citrate toxicity was present in severe forms, unlike vascular injuries and vasovagal reactions that tended to be milder. Donors with hemoglobin levels above 16 g/dl, adj. OR (95% CI) = 1.3 (1.1-1.7) and platelet levels below 250,000, adj. OR (95% CI) = 1.3 (1.1-1.6) were more likely to contract AEs than others.Reporting adverse events is essential to establish a benchmark for the annual incidence rates to be compared against local and international figures. Blood donor centers should also take notice of blood donors characteristics that are associated with higher incidence and more severe forms of AEs during or after platelet donation.

Safety and Efficacy of Convalescent Plasma to Treat Severe COVID-19: Protocol for the Saudi Collaborative Multicenter Phase II Study.

BACKGROUND: The COVID-19 pandemic is expected to cause significant morbidity and mortality. The development of an effective vaccine will take several months to become available, and its affordability is unpredictable. Transfusion of convalescent plasma (CP) may provide passive immunity. Based on initial data from China, a group of hematologists, infectious disease specialists, and intensivists drafted this protocol in March 2020. OBJECTIVE: The aim of this study is to test the feasibility, safety, and efficacy of CP in treating patients with COVID-19 across Saudi Arabia. METHODS: Eligible patients with COVID-19 will be recruited for CP infusion according to the inclusion criteria. As COVID-19 has proven to be a moving target as far as its management is concerned, we will use current definitions according to the Ministry of Health (MOH) guidelines for diagnosis, treatment, and recovery. All CP recipients will receive supportive management including all available recommended therapies according to the available MOH guidelines. Eligible CP donors will be patients with COVID-19 who have fully recovered from their disease according to MOH recovery criteria as detailed in the inclusion criteria. CP donors have to qualify as blood donors according to MOH regulations except for the history of COVID-19 in the recent past. We will also test the CP donors for the presence of SARS-CoV-2 antibodies by a rapid test, and aliquots will be archived for future antibody titration. Due to the perceived benefit of CP, randomization was not considered. However, we will compare the outcome of the cohort treated with CP with those who did not receive CP due to a lack of consent or lack of availability. In this national collaborative study, there is a likelihood of not finding exactly matched control group patients. Hence, we plan to perform a propensity score matching of the CP recipients with the comparator group patients for the major characteristics. We plan to collect demographic, clinical, and laboratory characteristics of both groups and compare the outcomes. A total sample size of 575 patients, 115 CP recipients and 460 matched controls (1:4 ratio), will be sufficient to detect a clinically important hospital stay and 30-day mortality difference between the two groups with 80% power and a 5% level of significance. RESULTS: At present, patient recruitment is still ongoing, and the interim analysis of the first 40 patients will be shared soon. CONCLUSIONS: In this paper, we present a protocol for a national collaborative multicenter phase II study in Saudi Arabia for assessing the feasibility, safety, and potential efficacy of CP in treating patients with severe COVID-19. We plan to publish an interim report of the first 40 CP recipients and their matched comparators soon. TRIAL REGISTRATION: ClinicalTrials.gov NCT04347681; https://clinicaltrials.gov/ct2/show/NCT04347681. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/23543.