Proceedings of the AABB blood center executive summit.

AABB hosted the Blood Center Executive Summit on 20 October 2019 during the AABB Annual Meeting in San Antonio, Texas. The session was sponsored by the Commonwealth Transfusion Foundation, a nonprofit, private foundation whose mission is to inspire and champion research and education that optimizes clinical outcomes in transfusion medicine and ensures a safe and sustainable blood supply for the United States. The Summit focused on the intersection of blood centers and plasma centers. Presenters and attendees explored existing and needed data, regulatory requirements, risks and benefits of different donor models, and future direction of the plasma community and blood centers. The Summit also identified priority issues that warrant further investigation and provide opportunities to drive progress. Introductory remarks provided context for the Summit presentations. Debra BenAvram, FASAE, CAE, Chief Executive Officer, AABB (Bethesda, Maryland), noted that during the past year, she and other AABB staff have had many discussions with blood center executives on key issues and challenges. In these talks, many executives requested that AABB provide programming specifically for this member segment. The Summit is a direct result of those requests, and the AABB supports a fruitful discussion as well as important and actionable next steps. Kevin Belanger, DHS, MS, MT(ASCP)SBB, President and Chief Executive Officer of the Shepeard Community Blood Center (Evans, Georgia), observed that he and his colleagues have seen a decrease in the donor base and, at the same time, an increase in plasma centers. He also noted that the resulting discussions about competition and donor compensation have been muted. The Summit provides a forum for a broad, open discussion that can be the start of something important. As chair of the Summit planning committee, he thanked both panelists and audience members for participating. Bob Carden, Chief Executive Officer of the Commonwealth Transfusion Foundation (Richmond, Virginia), who moderated the Summit, joined BenAvram and Belanger in welcoming participants to the day's presentations. He emphasized the need for data and noted that one outcome of the day would be a list of potential research projects that could be pursued and considered for funding.

A retrospective observational study of leucoreductive strategies to manage patients with acute myeloid leukaemia presenting with hyperleucocytosis.

Acute myeloid leukaemia (AML) patients with hyperleucocytosis have higher early mortality, lower complete remission (CR) and overall survival (OS). Whether different pre-induction leucoreduction strategies can improve outcome is unknown. A single centre retrospective cohort study was conducted on AML patients with a white blood cell count (WBC) >100 × 10(9) /l between 1987 and 1997, and on all AML patients between 1998 and 2006, to determine (a) the effect of four different leucoreductive strategies (leukapheresis, hydroxycarbamide, leukapheresis and hydroxycarbamide or no pre-induction leucoreduction) on early (day 28) mortality, CR, and OS; and (b) whether a high presenting WBC remains a negative predictor of OS in patients surviving induction (first 28 d). In the 1998-2006 cohort (n = 702), higher WBC was associated with higher early mortality and lower OS but its effects were greatly diminished in patients who survived the first 28 d (Hazard Ratio 1·094 vs. 1·002). A WBC of 34·1 × 10(9) /l had the highest sensitivity (75·6%) and specificity (67·4%) for early mortality. None of the four leucoreduction strategies differed significantly in early mortality, CR, or OS in patients with WBC>100 × 10(9) /l (n = 166). The number of leucostatic signs was a significant predictor of early mortality (P < 0·0001) and OS (P = 0·0007). The results suggest that AML patients with hyperleucocytosis should be induced, if eligible, without pre-induction leucoreduction.

The development of West Nile virus safety policies by Canadian blood services: guiding principles and a comparison between Canada and the United States.

To address the emerging threat of West Nile virus (WNV) to the blood supply, Canadian Blood Services (CBS) made a series of policy decisions that were either similar to those adopted in the United States or more stringent than policies formulated in the United States at the same time. More stringent Canadian policies included the development of an in-house WNV RNA assay, the stockpiling of frozen plasma components in the winter for transfusion in WNV-affected areas in the summer, a special recruitment campaign for red blood cell collections before the start of the 2003 WNV season, and an inventory exchange (ie, WNV-tested for untested red blood cells) initiated 2 weeks after the onset of WNV screening, as well as the implementation of targeted individual-donation WNV testing on August 2, 2004, in the absence of any positive donors or clinical cases of WNV infection in Canada. The general principles that guided CBS decision making with regard to WNV safety included application of the precautionary principle, harmonization with policies in the United States, a consideration of logistic issues, compliance with Health Canada requests, responsiveness to public expectations about transfusion safety, and transparency in decision making with timely communication to stakeholders. Before implementing WNV blood safety policies, CBS assessed their impact on blood availability. When policies were implemented, data were obtained quickly to ensure that the prior impact assessments were accurate. This review discusses the guiding principles affecting CBS policy development and compares CBS WNV safety policies to policies adopted in the United States.

Predictive ability of sequential surveys in determining donor loss from increasingly stringent variant Creutzfeldt-Jakob disease deferral policies.

BACKGROUND: Predonation screening questions about travel increase the safety of the blood supply from diseases such as variant Creutzfeldt-Jakob disease (vCJD) and malaria. This study examines the ability of sequential surveys to predict actual travel deferrals and the operational validity of travel questions. STUDY DESIGN AND METHODS: To assess donor travel histories before implementing key deferral policies, two donor surveys were carried out at Canadian Blood Services collection sites in February 1999 (8026 donors) and March 2001 (13,623 donors). In-person interviews were carried out with 1530 donors to assess the operational validity of the short travel question. Time-series analysis was used to determine whether there was a change in deferrals when deferral policies were implemented. Predicted donor loss estimates based on survey results were compared with actual deferrals. RESULTS: Deferrals increased significantly (p < 0.05) when vCJD deferral policies were implemented in October 1999 and September 2001, but not in October 2000. Survey data accurately predicted deferrals 6 months after implementation from the initial policy (2.51% predicted vs. 2.51% actual), but there were fewer deferrals than predicted for the second (2.89% predicted vs. 2.26% actual, p < 0.01) and third deferral policies (3.10% predicted vs. 1.89% actual, p < 0.01). There was 96 percent agreement between donor responses to a short screening question and a detailed travel history. CONCLUSION: The initial survey accurately predicted the actual donor deferral rate, but the deferral rate was less than predicted for subsequent, more stringent donor deferral policies. Donors answered a short travel question suitable for donor screening similarly to a very detailed travel history.

Review of the quality monitoring methods used by countries using or implementing universal leukoreduction.

Several countries are implementing or have implemented universal leukoreduction (ULR). Specifications, leukocyte counting, and monitoring methods were essential elements in achieving process confidence and conformance. A review of these protocols is presented. A questionnaire was prepared, agreed, and circulated, and responses were collated. Different specifications have been adopted as well as disparate approaches to leukocyte counting and residual leukocyte monitoring. Parametric, nonparametric, and pass-rate methods of analysis were used. Despite these differences, users were satisfied that the methodologies were providing assurance of component quality.

Incidence and estimated rates of residual risk for HIV, hepatitis C, hepatitis B and human T-cell lymphotropic viruses in blood donors in Canada, 1990-2000.

BACKGROUND: Since 1990, the Canadian Red Cross Society and Canadian Blood Services have been testing blood donors for hepatitis C virus (HCV) antibody and HCV nucleic acids and have supplemented HIV antibody testing with p24 antigen testing. We report trends in the incidence of blood-transmissible viral markers and estimates of the risk of undetected infection in donors over the last decade. METHODS: We extracted anonymous donor and blood-transmissible disease information from the Canadian Blood Services National Epidemiology Donor Database for 8.9 million donations from 2.1 million donors between June 1990 and December 2000. The risk of transfusion-transmitted infection (or "residual risk") refers to the chance that an infected donation escapes detection because of a laboratory test's window period (i.e., the time between infection and detection of the virus by that test). We determined the probability of residual contamination of a unit of blood after testing by using the incidence/window period model, which is based on the incidence of infection in repeat donors and the window period for each laboratory test. The viral markers evaluated in the study were HIV, HCV, hepatitis B virus (HBV) and human T-cell lymphotropic virus (HTLV). RESULTS: Except for HBV, the transmissible-disease rates of the other evaluated viruses decreased over the study period, with less of a decrease for HTLV. In 2000, the transmissible-disease-positive rate per 100 000 donations was 0.38 for HIV, 16.83 for HCV, 12.40 for HBV and 1.77 for HTLV. The residual risk of HIV, HCV and HTLV decreased over the study period; the residual risk of HBV fluctuated throughout the decade. The current residual risk per million donations is 0.10 for HIV, 0.35 for HCV, 13.88 for HBV and 0.95 for HTLV. INTERPRETATION: Except for HBV, the estimated risk of undetected infection (residual risk) has decreased over time. The rates of transmissible disease and the probability of undetected transmission of infection are at par with, if not lower than, those reported for other industrialized countries.

Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions.

CONTEXT: A number of countries have implemented a policy of universal leukoreduction of their blood supply, but the potential role of leukoreduction in decreasing postoperative mortality and infection is unclear. OBJECTIVE: To evaluate clinical outcomes following adoption of a national universal prestorage leukoreduction program for blood transfusions. DESIGN, SETTING, AND POPULATION: Retrospective before-and-after cohort study conducted from August 1998 to August 2000 in 23 academic and community hospitals throughout Canada, enrolling 14 786 patients who received red blood cell transfusions following cardiac surgery or repair of hip fracture, or who required intensive care following a surgical intervention or multiple trauma. INTERVENTION: Universal prestorage leukoreduction program introduced by 2 Canadian blood agencies. A total of 6982 patients were enrolled during the control period and 7804 patients were enrolled following prestorage leukoreduction. MAIN OUTCOME MEASURES: All-cause in-hospital mortality and serious nosocomial infections (pneumonia, bacteremia, septic shock, all surgical site infections) occurring after first transfusion and at least 2 days after index procedure or intensive care unit admission. Secondary outcomes included rates of posttransfusion fever and antibiotic use. RESULTS: Unadjusted in-hospital mortality rates were significantly lower following the introduction of leukoreduction compared with the control period (6.19% vs 7.03%, respectively; P =.04). Compared with the control period, the adjusted odds of death following leukoreduction were reduced (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.75-0.99), but serious nosocomial infections did not decrease (adjusted OR, 0.97; 95% CI, 0.87-1.09). The frequency of posttransfusion fevers decreased significantly following leukoreduction (adjusted OR, 0.86; 95% CI, 0.79-0.94), as did antibiotic use (adjusted OR, 0.90; 95% CI, 0.82-0.99). CONCLUSION: A national universal leukoreduction program is potentially associated with decreased mortality as well as decreased fever episodes and antibiotic use after red blood cell transfusion in high-risk patients.

A randomized controlled trial comparing the frequency of acute reactions to plasma-removed platelets and prestorage WBC-reduced platelets.

BACKGROUND: Removal of the plasma supernatant from platelets before transfusion is effective in preventing acute reactions to platelets caused by cytokines. Prestorage WBC reduction of platelets may be even more effective at preventing reactions as the WBCs are removed and WBC-derived cytokines do not accumulate in this component. This study evaluates the effectiveness of plasma removal and two methods of prestorage WBC reduction for preventing acute reactions to platelets. STUDY DESIGN AND METHODS: Platelets given to adults with hematologic malignancies were randomly allocated to one of three types: plasma supernatant removed and a platelet storage solution added, whole blood-derived platelets that are prestorage WBC reduced by filtration before storage, and prestorage WBC-reduced apheresis platelets. Patients were monitored before, during, and after transfusion, and the severity of reactions was graded on a Likert scale. RESULTS: A total of 129 patients from four centers were given 1190 platelet transfusions. The overall frequency of reactions was 13.6 percent (162 of 1190), 21.3 percent (36 of 169) for the plasma-removed platelets, 11.4 percent (59 of 517) for random donor WBC-reduced platelets, and 13.3 percent (67 of 504) for apheresis WBC-reduced platelets (p=0.384). The overall frequency of severe reactions was 4.1 percent with plasma-removed platelets, 1.7 percent for whole blood-derived, prestorage WBC-reduced platelets, and 1.4 percent for prestorage WBC-reduced apheresis platelets. CONCLUSION: The frequency of reactions to plasma-removed platelets and prestorage WBC-reduced platelets was not significantly different; however, the power of the study for this comparison was low. There was no difference in the frequency of reactions to the two types of prestorage WBC-reduced platelets. The frequency of severe reactions to prestorage WBC-reduced platelets is low, occurring in only 1 to 2 percent of transfusions.

Erythropoiesis: Comparison of Cytotoxic Aldehyde Generation in Beta-Thalassemia Patients Chelated with Deferoxamine or Deferiprone (L1) Versus NO Chelation.

The mechanism of iron-induced organ failure in iron overload disorders is not known, but it is conjectured that excess iron-catalyzed free radical generation contributes to organ damage. We hypothesized that free radical generation, quantified by the presence of 20 separate cytotoxic aldehydes in plasma, would be significantly increased in non-chelated beta-thalassemia major patients, in comparison to those chelated with either deferiprone (L1) or deferoxamine (desferal). We also report on red cell glutathione peroxidase activity in these patient groups, an enzyme involved in averting the damaging effects of free radicals. Ten patients were chelated with nightly subcutaneous infusions of desferal and 10 received the experimental oral chelator L1. Body iron burden was assessed by serum ferritin and hepatic iron concentrations. In comparison to non-chelated controls, significant decreases of 62% and 64% in total cytotoxic aldehyde concentrations were observed in patients chelated with desferal and L1, respectively (p < 0.001). Significantly lower red cell glutathione peroxidase activity was also observed in non-chelated controls, in comparison to those chelated with either desferal or L1 (p < 0.001). This is the first report on the concentrations of cytotoxic aldehydes in non-chelated beta-thalassemia major patients, and the first to report on the effects of L1 against cytotoxic aldehyde formation in plasma of patients with iron-overload.

Role of N-methyl-D-aspartate and opiate receptors in nociception during and after ischaemia in rats.

We have investigated the effects of systemic administration of two N-methyl-D-aspartate (NMDA) receptor antagonists and two opiate agonists on nociception during and after tail ischaemia in conscious rats. The two NMDA receptor antagonists, D-2-amino-5-phosphonovalerate (APV) and ketamine hydrochloride, did not alter tail flick latencies in rats not subjected to ischaemia but inhibited post-ischaemic hyperalgesia (PIH) in a dose-dependent manner. Neither of these agents impaired motor function of the rats, as assessed by rotarod performance, suggesting a purely sensory antinociceptive effect. The antinociceptive effect of APV during reperfusion following ischaemia was not antagonised by the mu-opiate receptor antagonist naloxone (1 mg/kg). The two opiate receptor agonists, morphine and pethidine, increased tail flick latencies in rats not subjected to ischaemia, inhibited PIH in a dose-dependent manner, and also caused significant motor malfunction, all in naloxone-reversible fashion. We conclude that the role of the NMDA receptor in mediating afferent nociceptive traffic is confined to its involvement in neuronal events mediating hyperalgesia.