Is it reasonable for the use of Rh-ee blood? A hospital-based survey from a southern medical center in Taiwan.

Identification of alloantibodies and achieving a reduction in the rate of red blood cell (RBC) alloimmunization are important issues to prevent transfusion complications. The aim of this study was to identify the antigen and alloantibodies in our patients and to study the association of alloimmunization with previous transfusion. Transfusion records from the blood bank of Kaohsiung Medical University Hospital between 2015 and 2017 were retrospectively enrolled in the study. Antigen and antibody identification was performed using routine blood bank methods. In total, 56,422 transfusion records from 2015 to 2017 were included in the study. Among them, 1858 alloantibody episodes were found in the pre-transfusion survey, and anti-Mia, anti-E, and cold antibodies were the most common alloantibodies, with a prevalence of 3.29% (1858/56,422). Among them, 130 episodes involved newly found alloantibodies with no alloantibodies found in the previous transfusion survey. Tracing back to these newly transfusion-induced alloantibodies, the antibody was found with a mean of 10.8 ± 7.8 units of packed RBC transfusion, a mean of 66.3 ± 52.8 days, and with a mean of 4.3 ± 2.7 times of transfusion from the first transfusion therapy. An antibody survey revealed that Rh-ee (62.1%) was the most common phenotype in these newly identified antibodies. In summary, this hospital-based study revealed that RBC alloantibody rates were present at rates of 3.29%, with anti-Mia, anti-E, and cold antibodies being the most common alloantibodies. Among them, anti-E was the most commonly developed alloantibody. Given that the Rh-ee group is the most common phenotype in our population, the strategy of using Rh-ee blood for Rh-ee recipients is reasonable for transfusion safety.

Successful large-volume leukapheresis for hematopoietic stem cell collection in a very-low-weight brain tumor infant with coagulopathy.

Peripheral apheresis has become a safe procedure to collect hematopoietic stem cells, even in pediatric patients and donors. However, the apheresis procedure for small and sick children is more complicated due to difficult venous access, relatively large extracorporeal volume, toxicity of citrate, and unstable hemostasis. We report a small and sick child with refractory medulloblastoma, impaired liver function, and coagulopathy after several major cycles of cisplatin-based chemotherapy. She successfully received large-volume leukapheresis for hematopoietic stem cell collection, although the patient experienced severe coagulopathy during the procedures. Health care providers should be alert to this potential risk.

The physician compliance of red blood cell transfusion by computerized transfusion decision support system.

"When should we trigger a transfusion?" is always a critical question between the patient's benefits and risks in red blood cell (RBC) transfusion. A computerized transfusion decision support system (CTDSS) has been used since September 2004 in an academic medical center with 1400 beds. In this study, the factors affecting RBC transfusion were investigated. In total 20,551 RBC-transfusion episodes between January and December 2008 were reviewed. The nearest hemoglobin concentration before transfusion is defined as the transfusion trigger. The physician compliance, the factors associated with the transfusion triggers and posttransfusion hemoglobin increment were investigated. The physician compliance is 83.1%. The transfusion trigger is 8.32 ± 1.84 (mean ± standard deviation) g/dL. The transfusion triggers are statistically significant in terms of both different order sources and disease types (p<0.05).The posttransfusion hemoglobin level increased in two-thirds of the episodes. The percentages of hemoglobin increments after transfusion are dependent on the transfusion triggers. Appropriate transfusion practice may reduce the overuse of blood components and improve transfusion quality. CTDSS should be more powerful to intervene in the appropriateness of transfusion practice.

The effects of a computerized transfusion decision support system on physician compliance and its appropriateness for fresh frozen plasma use in a medical center.

Fresh frozen plasma (FFP) transfusion remains a significant issue for blood banks because of a lack of consensus regarding its appropriate use. To study the factors influencing physician compliance, we evaluated FFP transfusion episodes in the year 2008, using a computerized transfusion decision support system. A total of 10,926 episodes were reviewed. The demographic data, physician compliance, and therapeutic efficacy were investigated. The physician noncompliance rate was 46.5%. The highest number was ordered by the hepatobiliary division, which might be due to the high incidence of liver cirrhosis and hepatoma in Taiwan. Excluding the cases for plasma exchange and emergency surgery, 31.2% of episodes had abnormal coagulation results before transfusions. The therapeutic efficacy is statistically significant in patients with abnormal pretransfusion coagulation tests (P < .001). Computerization may be a favorable trend in medical management systems, but it should be more functional to improve medical quality.

The appropriateness and physician compliance of platelet usage by a computerized transfusion decision support system in a medical center.

BACKGROUND: The prescribing of inappropriate platelet (PLT) transfusions is always a significant problem. A computerized transfusion decision support system (CTDSS) has been used in Kaohsiung Medical University Hospital since September 2004. In this study, the physician compliance and appropriateness of PLT usage after using the CTDSS were investigated. STUDY DESIGN AND METHODS: A total of 5887 PLT transfusion episodes between January and December 2008 were reviewed including the demographic data and the "true reason" for each transfusion practice. The pre- and posttransfusion PLT counts were retrieved. The physician compliance, the appropriateness of PLT usage, and the PLT increments after transfusion were investigated. RESULTS: Physician compliance was 85.4%, and the appropriateness of PLT usage was 69.6%. The most commonly chosen indication from the CTDSS was "prophylactic use, PLT count ≤20×10(9) /L." The highest inappropriate order rate was from the emergency department. More than half of the inappropriate episodes were from the surgery unit. The inappropriate rates were significant in terms of both different order sources and functional units (p<0.0001). The posttransfusion PLT counts increased in two-thirds of the episodes, and most of them were with the pretransfusion PLT counts of less than 50×10(9) /L. CONCLUSIONS: In Taiwan, the PLT concentration is too low-priced and this might cause the overuse of blood components. Under the global budget of National Health Insurance, preventing the overuse of blood components might serve as one of the mechanism to improve medical quality. The CTDSS should be more powerful and effective to intervene in the appropriateness of transfusion practice.

Molecular basis of the A2B in Taiwan.

Molecular genotyping of the ABO alleles has been widely used in ABO subgroups analysis and has been able to solve the rare ABO blood grouping discrepancies. The genotypes of sixty-one A2B phenotype donors recruited from the middle and south of Taiwan were analyzed by means of molecular methods. The A2B phenotype was initially identified by serological test. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to screen the ABO alleles at nucleotides (nt) 261 and 703 based on the nt differences found in the ABO alleles. The subgroups of the A2 allele were determined by the PCR-RFLP and direct sequencing methods. The discrepancies between the phenotype and genotype of the A2B were then studied by subcloning and nucleotide sequence analysis. Our results show that 55 of the 61 A2B donors (90%) are A205/B allele and two are A201/B allele. Four cases were heterozygotes of the cis-AB/O or B alleles. Two were cis-AB04/O allele, one was cis-AB01/O allele and the other was cis-AB02/B allele. In conclusion, most A2B genotypes belong to the A205/B allele in Taiwan. In this study, we report for the first time the presence of the A205, A201, and cis-AB02 alleles in Taiwan.

Optimization for the production of water-soluble polysaccharide from Pleurotus citrinopileatus in submerged culture and its antitumor effect.

In recent years, a number of studies have been done on the physiological effects of water-soluble polysaccharides (WSPS) and their antitumor and immuno-enhancing properties. Many edible mushrooms, in particular those rich in WSPS, not only taste good but also contain ingredients beneficial to the physiology of the human body. In this study, response surface methodology was used to determine the optimal conditions for the production of WSPS, including the C/N ratio, initial pH, and incubation temperature. The highest yield of WSPS was obtained by incubation with a C/N ratio of 40, initial pH 5.5, and an incubation temperature of 25 degrees C. WSPS were extracted by alcohol precipitation from the fermented broth of edible Pleurotus citrinopileatus. These extracts, referred to as SPPC in this paper, had a molecular mass of more than 10(5) Da and were largely made up of glucose and mannose. SPPC was fed to mice which had artificial pulmonary metastatic tumors. Changes in the percentage of the numbers of tumor cells and immune cells were determined by flow cytometry. Daily feeding of SPPC at a dosage of 50 mg/kg to tumor-bearing mice for 12 days resulted in a significant increase in the number of T cells, CD4+ cells, CD8+ cells, and macrophages, compared with mice that were not fed any SPPC. The proliferation rate of the pulmonary sarcoma lesions slowed down.