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1.
BMC Infect Dis ; 20(1): 736, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028232

RESUMEN

BACKGROUND: Blood transfusion is associated with potential risks of transfusion-transmitted infections (TTIs). Different strategies are needed to monitor blood safety and screen the donors' efficacy, such as evaluation of the prevalence and trends of TTIs. This study was conducted to evaluate the prevalence and trends of TTIs, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus (HTLV 1/2), and the impact of the donors' characteristics such as age, sex, and donor status on the prevalence of TTIs in blood donors in seven large provinces of Iran from 2010 to 2018. METHODS: This study was conducted on the data collected from all blood donations in seven Iranian Blood Transfusion Centers including Ardabil, Alborz, Guilan, West Azarbaijan, North, Razavi, and South Khorasan from April 2010 to March 2018. Demographic characteristics, number of donations, donor status, and screening and confirmatory serological results of all blood donations were collected from Iranian Blood Transfusion Organizations (IBTO) national database. The prevalence and trend of HBV, HCV, HIV, and HTLV 1/2 infections were reported according to the donation year and donor's characteristics. RESULTS: The analysis of the prevalence and trend of TTIs in 3,622,860 blood donors showed a significant decreasing trend in first-time and regular donors. Additionally, compared to first- time donors, regular donors made safer blood donations with lower risks of HBV, HIV, HCV and HTLV 1/2 (P < 0.0001). Although the prevalence of HTLV 1/2 and HBV was higher in females, TTIs had a significant decreasing trend in males and females. Finally, it was found that the prevalence of HBV and HTLV 1/2 increased with age up to 40-49 years and then decreased thereafter. CONCLUSIONS: The decreasing trends of TTIs in Iranian donors during 9 years may indicate that the various strategies implemented by IBTO have been effective in recent years. Other factors such as a decrease in the prevalence of specific TTIs in the general population might have also contributed to these declines.


Asunto(s)
Seguridad de la Sangre , Infecciones por VIH/diagnóstico , Infecciones por HTLV-I/diagnóstico , Hepatitis B/diagnóstico , Hepatitis C/diagnóstico , Adolescente , Adulto , Donantes de Sangre/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Infecciones por HTLV-I/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Reacción a la Transfusión/diagnóstico , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/virología , Adulto Joven
2.
J Med Life ; 13(2): 211-218, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32742516

RESUMEN

The present study aimed to propose a model for the national hemovigilance information system with a database approach, considering the importance and necessity of developing an information system for such a network. This is an applied, descriptive, and cross-sectional study, which was conducted in 2018. The research population comprised hemovigilance information systems in advanced countries, including the USA, UK, Australia, and France. Data were collected from library sources and the Internet from 2000 to 2018. The proposed model for the national hemovigilance information system was introduced using comparative tables and based on the similarities and differences of systems in the studied countries. The proposed model was then validated using the two-step Delphi technique through a researcher-made questionnaire whose validity was confirmed, and reliability was approved by a Cronbach's alpha of 94%. The final model of the national hemovigilance information system comprised five main components: goals, organizations involved in the blood transfusion process, databases of blood transfusion organizations, data transfer flow between the databases of blood transfusion organizations, and transferable datasets, and hemovigilance-related committees. This model was approved by experts with an >85% agreement coefficient. The national hemovigilance information system with a database approach can improve blood transfusion health by providing access to reliable sources on blood transfusion complications to everyone, especially the medical community. Thus, it is essential to implement this standard accurately and precisely control the practical methods of this process based on international guidelines.


Asunto(s)
Seguridad de la Sangre , Sistemas de Información , Modelos Teóricos , Transfusión Sanguínea , Estudios Transversales , Humanos , Irán , Reproducibilidad de los Resultados , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/etiología
3.
BMC Infect Dis ; 20(1): 617, 2020 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-32819294

RESUMEN

BACKGROUND: Millions of lives around the world are being saved annually through blood transfusion. However, blood transfusion is among the essential vehicles for transmitting infections. The overall prevalence of Transfusion Transmissible Infections among blood donors differs around the world, reflecting the variation in the prevalence of these infections. This study aims to assess the prevalence and trends of Transfusion Transmissible Infections among blood donors in Qatar. METHODS: This is a cross-sectional study utilizing donation records of 5 years from January 2013 to December 2017. We included in the study results for all screening and confirmatory tests for Hepatitis B Virus, Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Syphilis and Malaria. RESULTS: Among the 190,509 donations received at the donation centre during the study period, about 91% of donations were received from males and 9% from females. The overall positivity rate for all tests was 1.87, 2.23, 1.78, 2.31, 2.67% for the years 2013 through 2017, with an increasing yearly trend by 6% each year. The overall positivity rates for Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Hepatitis B Virus, Syphilis and Malaria (2013-2017) were 0.60, 0.18, 0.30, 0.43 and 0.20%, respectively. CONCLUSION: The overall positivity rate of all tests combined for the Transfusion Transmissible Infections demonstrated a gradually increasing trend from 2013 to 2017. However, the trend for each infection (Hepatitis C Virus, Hepatitis B Virus, Syphilis and Malaria) was fluctuating except for Human T-lymphotropic Virus-I/II, which was increasing. Supporting the development of effective prevention and control strategies requires further comprehensive investigations for better estimation of the burden of these infections.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Reacción a la Transfusión/epidemiología , Adolescente , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por HTLV-II/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Malaria/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Qatar/epidemiología , Sífilis/epidemiología , Adulto Joven
4.
J Clin Invest ; 130(9): 4791-4797, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32525844

RESUMEN

BACKGROUNDConvalescent plasma is the only antibody-based therapy currently available for patients with coronavirus disease 2019 (COVID-19). It has robust historical precedence and sound biological plausibility. Although promising, convalescent plasma has not yet been shown to be safe as a treatment for COVID-19.METHODSThus, we analyzed key safety metrics after transfusion of ABO-compatible human COVID-19 convalescent plasma in 5000 hospitalized adults with severe or life-threatening COVID-19, with 66% in the intensive care unit, as part of the US FDA expanded access program for COVID-19 convalescent plasma.RESULTSThe incidence of all serious adverse events (SAEs), including mortality rate (0.3%), in the first 4 hours after transfusion was <1%. Of the 36 reported SAEs, there were 25 reported incidences of related SAEs, including mortality (n = 4), transfusion-associated circulatory overload (n = 7), transfusion-related acute lung injury (n = 11), and severe allergic transfusion reactions (n = 3). However, only 2 of 36 SAEs were judged as definitely related to the convalescent plasma transfusion by the treating physician. The 7-day mortality rate was 14.9%.CONCLUSIONGiven the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive. These early indicators suggest that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19.TRIAL REGISTRATIONClinicalTrials.gov NCT04338360.FUNDINGMayo Clinic, Biomedical Advanced Research and Development Authority (75A50120C00096), National Center for Advancing Translational Sciences (UL1TR002377), National Heart, Lung, and Blood Institute (5R35HL139854 and R01 HL059842), National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK07352), Natural Sciences and Engineering Research Council of Canada (PDF-532926-2019), National Institute of Allergy and Infectious Disease (R21 AI145356, R21 AI152318, and AI152078), Schwab Charitable Fund, United Health Group, National Basketball Association, Millennium Pharmaceuticals, and Octapharma USA Inc.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ensayos de Uso Compasivo , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Inmunización Pasiva/efectos adversos , Inmunización Pasiva/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Seguridad , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/etiología , Lesión Pulmonar Aguda Postransfusional/epidemiología , Lesión Pulmonar Aguda Postransfusional/etiología , Estados Unidos/epidemiología , United States Food and Drug Administration , Adulto Joven
5.
Transfusion ; 60(5): 974-985, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32357261

RESUMEN

BACKGROUND: The high incidence of septic transfusion reactions (STRs) led to testing being mandated by AABB from 2004. This was implemented by primary culture of single-donor apheresis platelets (APs) from 2004 and prestorage pooled platelets (PSPPs) from 2007. STUDY DESIGN/METHODS: Platelet (PLT) aliquots were cultured at issue and transfusion reactions evaluated at our hospital. Bacterial contamination and STR rates (shown as rates per million transfusions in Results) were evaluated before and after introduction of primary culture by blood centers that used a microbial detection system (BacT/ALERT, bioMerieux) or enhanced bacterial detection system (eBDS, Haemonetics). RESULTS: A total of 28,457 PLTs were cultured during pre-primary culture periods (44.7% APs; 55.3% at-issue pooled PLTs [AIPPs]) and 97,595 during post-primary culture periods (79.3% APs; 20.7% PSPPs). Forty-three contaminated units were identified in preculture and 34 in postculture periods (rates, 1511 vs. 348; p < 0.0001). Contamination rates of APs were significantly lower than AIPPs in the preculture (393 vs. 2415; p < 0.0001) but not postculture period compared to PSPPs (387 vs. 198; p = 0.9). STR rates (79 vs. 90; p = 0.98) were unchanged with APs but decreased considerably with pooled PLTs (826 vs. 50; p = 0.0006). Contamination (299 vs. 324; p = 0.84) and STR rates (25 vs. 116; p = 0.22) were similar for PLTs tested by BacT/ALERT and eBDS primary culture methods. A change in donor skin preparation method in 2012 was associated with decreased contamination and STR rates. CONCLUSION: Primary culture significantly reduced bacterial contamination and STR associated with pooled but not AP PLTs. Measures such as secondary testing near time of use or pathogen reduction are needed to further reduce STRs.


Asunto(s)
Infecciones Bacterianas/epidemiología , Contaminación de Medicamentos/estadística & datos numéricos , Transfusión de Plaquetas , Cultivo Primario de Células , Sepsis/epidemiología , Reacción a la Transfusión/epidemiología , Centros Médicos Académicos , Adulto , Infecciones Bacterianas/sangre , Infecciones Bacterianas/transmisión , Eliminación de Componentes Sanguíneos/efectos adversos , Eliminación de Componentes Sanguíneos/historia , Eliminación de Componentes Sanguíneos/normas , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Plaquetas/citología , Plaquetas/microbiología , Seguridad de la Sangre/efectos adversos , Seguridad de la Sangre/historia , Seguridad de la Sangre/estadística & datos numéricos , Transfusión Sanguínea/historia , Transfusión Sanguínea/estadística & datos numéricos , Células Cultivadas , Niño , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Incidencia , Transfusión de Plaquetas/efectos adversos , Transfusión de Plaquetas/historia , Transfusión de Plaquetas/estadística & datos numéricos , Cultivo Primario de Células/historia , Cultivo Primario de Células/normas , Cultivo Primario de Células/estadística & datos numéricos , Estudios Retrospectivos , Sepsis/sangre , Sepsis/etiología , Reacción a la Transfusión/microbiología , Estados Unidos/epidemiología
6.
Transfusion ; 60(5): 1015-1023, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32306410

RESUMEN

BACKGROUND: Hematopoietic cell infusion-related adverse events (HCI-AEs) in hematopoietic stem cell transplantations (HSCTs) have been largely attributed to toxicity of dimethyl sulfoxide (DMSO) for cryopreservation, but HSC products also contain various cells and plasma components. Our recent prospective study of 1125 HSCT recipients revealed the highest overall HCI-AE rate in bone marrow transplantation (BMT) using fresh/noncryopreserved products, although products of peripheral blood stem cell transplantation and cord blood transplantation (CBT) are generally cryopreserved with DMSO containing smaller plasma volumes. We aimed to clarify if product volume and component effects are more substantial in small recipients including children. STUDY DESIGN AND METHODS: We performed subgroup analysis on 219 recipients of 45 kg or less body weight (whole small recipients), including 90 children (pediatric recipients), from the original cohort (general recipients). RESULTS: Whereas overall HCI-AE rates did not differ among hematopoietic stem cell sources in the general recipients, bradycardia most often occurred after CBT in whole small recipients. Conversely, whole small and general recipients shared the same trend of having the highest rate of hypertension in BMT. The overall HCI-AE rate was higher in allogeneic HSCT compared with autologous HSCT. Notably, pediatric recipients showed a 10-fold higher incidence of nausea and vomiting in allogeneic HSCT compared with autologous HSCT, suggesting a possible role of allogeneic antigens. Multivariate analysis identified a relatively large infusion volume per body weight as a significant factor correlating with HCI-AE in whole small recipients. CONCLUSIONS: We should be aware of product volume and specific HCI-AEs such as nausea and vomiting in small patients including children.


Asunto(s)
Peso Corporal/fisiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Reacción a la Transfusión/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Criopreservación/métodos , Criopreservación/estadística & datos numéricos , Crioprotectores/efectos adversos , Dimetilsulfóxido/efectos adversos , Femenino , Células Madre Hematopoyéticas , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Trasplante de Células Madre de Sangre Periférica/estadística & datos numéricos , Reacción a la Transfusión/etiología , Trasplante Homólogo/efectos adversos , Trasplante Homólogo/estadística & datos numéricos , Adulto Joven
7.
Transfusion ; 60(5): 997-1002, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32275069

RESUMEN

BACKGROUND: Effective and financially viable mitigation approaches are needed to reduce bacterial contamination of platelets in the US. Expected costs of large-volume delayed sampling (LVDS), which would be performed by a blood center prior to shipment to a hospital, were compared to those of pathogen reduction (PR), point-of-release testing (PORt), and secondary bacterial culture (SBC). METHODS: Using a Markov-based decision-tree model, the financial and clinical impact of implementing all variants of LVDS, PR, PORt, and SBC described in FDA guidance were evaluated from a hospital perspective. Hospitals were assumed to acquire leukoreduced apheresis platelets, with LVDS adding $30 per unit. Monte Carlo simulations were run to estimate the direct medical costs for platelet acquisition, testing, transfusion, and possible complications associated with each approach. Input parameters, including test sensitivity and specificity, were drawn from existing literature and costs (2018US$) were based on a hospital perspective. A one-way sensitivity analysis varied the assumed additional cost of LVDS. RESULTS: Under an approach of LVDS (7-day), the total cost per transfused unit is $735.78, which falls between estimates for SBC (7-day) and PORt. Assuming 20,000 transfusions each year, LVDS would cost $14.72 million annually. Per-unit LVDS costs would need to be less than $22.32 to be cheaper per transfusion than all other strategies, less than $32.02 to be cheaper than SBC (7-day), and less than $196.19 to be cheaper than PR (5-day). CONCLUSIONS: LVDS is an effective and cost-competitive approach, assuming additional costs to blood centers and associated charges to hospitals are modest.


Asunto(s)
Infecciones Bacterianas/prevención & control , Contaminación de Medicamentos/prevención & control , Control de Infecciones , Transfusión de Plaquetas/economía , Transfusión de Plaquetas/estadística & datos numéricos , Plaquetoferesis , Cultivo Primario de Células/economía , Infecciones Bacterianas/economía , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/transmisión , Bancos de Sangre/economía , Bancos de Sangre/normas , Bancos de Sangre/estadística & datos numéricos , Plaquetas/microbiología , Seguridad de la Sangre/economía , Seguridad de la Sangre/métodos , Seguridad de la Sangre/normas , Recolección de Muestras de Sangre/efectos adversos , Recolección de Muestras de Sangre/economía , Recolección de Muestras de Sangre/normas , Recolección de Muestras de Sangre/estadística & datos numéricos , Costos y Análisis de Costo , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/normas , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Contaminación de Medicamentos/economía , Contaminación de Medicamentos/estadística & datos numéricos , Estudios de Factibilidad , Humanos , Ciencia de la Implementación , Control de Infecciones/economía , Control de Infecciones/métodos , Técnicas Microbiológicas , Plaquetoferesis/efectos adversos , Plaquetoferesis/economía , Plaquetoferesis/métodos , Plaquetoferesis/normas , Cultivo Primario de Células/métodos , Cultivo Primario de Células/normas , Cultivo Primario de Células/estadística & datos numéricos , Conducta de Reducción del Riesgo , Tamaño de la Muestra , Factores de Tiempo , Tiempo de Tratamiento/economía , Tiempo de Tratamiento/estadística & datos numéricos , Reacción a la Transfusión/economía , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/microbiología , Reacción a la Transfusión/prevención & control
8.
Transfusion ; 60(5): 986-996, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32181889

RESUMEN

BACKGROUND: Platelets have the highest bacterial contamination risk of all blood components, and septic transfusion reactions remain a problem. A good estimate of contamination rates could provide information about residual risk and inform optimal testing strategies. We performed a systematic review and meta-analysis of platelet contamination rates by primary culture. STUDY DESIGN AND METHODS: A literature search in December 2019 identified articles on platelet contamination rates using primary culture. We used meta-analysis to estimate the overall rate of contamination and meta-regression to identify heterogeneity. We studied the following sources of heterogeneity: collection method, sample volume, positivity criteria, and study date. Contamination rate estimates were obtained for apheresis (AP), platelet rich plasma (PRP), and buffy coat (BC) collection methods. RESULTS: The search identified 6102 studies, and 22 were included for meta-analysis. Among these 22 studies, there were 21 AP cohorts (4,072,022 components), 4 PRP cohorts (138,869 components), and 15 BC cohorts (1,474,679 components). The overall mean contamination rate per 1000 components was 0.51 (95% CI: 0.38-0.67) including AP (0.23, 95% CI: 0.18-0.28), PRP, (0.38, 95% CI: 0.15-0.70), and BC (1.12, 95% CI: 0.51-1.96). There was considerable variability within each collection method. Sample volume, positivity criteria, and publication year were significant sources of heterogeneity. CONCLUSION: The bacterial contamination rate of platelets by primary culture is 1 in 1961. AP and PRP components showed a lower contamination rate than BC components. There is clinically significant between-study variability for each method. Larger sample volumes increased sensitivity, and bacterial contamination rates have decreased over time.


Asunto(s)
Infecciones Bacterianas/sangre , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Plaquetas/microbiología , Contaminación de Medicamentos/estadística & datos numéricos , Transfusión de Plaquetas/estadística & datos numéricos , Cultivo Primario de Células/estadística & datos numéricos , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/transmisión , Técnicas Bacteriológicas , Eliminación de Componentes Sanguíneos/efectos adversos , Transfusión de Componentes Sanguíneos/efectos adversos , Transfusión de Componentes Sanguíneos/estadística & datos numéricos , Plaquetas/citología , Células Cultivadas , Humanos , Transfusión de Plaquetas/efectos adversos , Plasma Rico en Plaquetas/microbiología , Cultivo Primario de Células/métodos , Cultivo Primario de Células/normas , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/microbiología
9.
Vox Sang ; 115(3): 221-232, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32026497

RESUMEN

BACKGROUND AND OBJECTIVES: Children and pregnant women use 75% of the blood supply in sub-Saharan Africa (SSA) but face widespread blood shortages. To increase safe blood supply, Africa-specific evidence and strengthened capacity for transfusion research are needed. Our study analysed seven years of SSA transfusion publications, compared researched topics against priorities and enumerated SSA transfusion research collaborations. MATERIALS AND METHODS: Data on research topic, journal type, authors' institutions and country were extracted from transfusion-related SSA articles published between 2008 and 14 and used to construct a quantitative, graphic visualization of collaborations. Research topics were compared to those identified as priorities for SSA blood services in 2008 and 2015. RESULTS: Of the 2176, 267 articles (average 38/year) met criteria for analysis. They involved 1245 authors, 673 institutions, 59 countries (35 SSA) and 1375 collaborations. About 41% were on transfusion-transmitted infections. About 34% were published in specialist transfusion journals. Only 7% involved exclusively collaborations within SSA. Two of the top fifteen institutions by publication quantity were from outside SSA. CONCLUSION: Despite a general paucity of SSA-relevant transfusion research, Francophone SSA was well-represented. Published research topics are not well matched to SSA research priorities; research on supply, distribution, financing and systems is particularly neglected. The study provides a baseline against which to track any refocusing of research activity to better meet SSA's needs. Transfusion research hubs within and beyond SSA have been identified as a springboard network for expanding SSA transfusion research capacity.


Asunto(s)
Transfusión Sanguínea/estadística & datos numéricos , Reacción a la Transfusión/epidemiología , Adulto , África del Sur del Sahara/epidemiología , Niño , Femenino , Humanos , Masculino , Embarazo
10.
J Infect Public Health ; 13(2): 299-305, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31953019

RESUMEN

BACKGROUND: Screening of blood products is considered a mandatory protocol implemented in health care facilities in order to reduce the onset of transfusion-transmitted infections (TTIs). This study was aimed to determine the sero-prevalence of ABO and Rh blood groups and their associated TTIs among blood donors in the Central Region of Saudi Arabia. METHODS: This was retrospective study performed on the blood donors' records from March 2017 to December 2018 at Buraidah Central Hospital Blood Bank. Study was conducted on a total of 4590 blood donors. ABO and Rh typing was performed.The blood samples were also screened serologically for hepatitis B surface antigen (HBsAg), anti-hepatitis B core total antibodies (anti-HBc total), hepatitis C virus (HCV), human immunodeficiency viruses (HIV), human T-lymphotrophic virus-1 (HTLV-1) and veneral disease research laboratory test(VDRL) for syphilis. RESULTS: Out of 4590 blood donors, O positive blood group was found to be highest (42%), followed by A positive (23.4%), B positive (20.9%), O negative (5.45%), AB positive (3.4%), A negative (2.8%), B negative (2.1%) and AB negative (0.5%). Moreover, total number of Rh-negative donors was significantly lowered as compared with Rh-positive. Seroreactive tests were found to be positive in only 1.002% of all studied donors and mainly found in male donors. Among TTI, anti-HBc total was the highest (0.784%), followed by HBsAg, HCV, VDRL and TPHA. Whereas all tested donors were found to be negative for HIV infections. CONCLUSIONS: The information collected for the frequency of ABO blood phenotypic groups has a vital significance in establishing a simple blood group database. This study clearly determined significantly lower rate of seropositive TTIs among the studied blood donors but still steps are needed to improve the knowledge and to prevent the seropositive occurrence of TTIs.


Asunto(s)
Sistema del Grupo Sanguíneo ABO , Donantes de Sangre , Sistema del Grupo Sanguíneo Rh-Hr , Reacción a la Transfusión/epidemiología , Adolescente , Adulto , Anciano , Tipificación y Pruebas Cruzadas Sanguíneas , Transfusión Sanguínea/métodos , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis C/sangre , Hepatitis C/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita/epidemiología , Estudios Seroepidemiológicos , Sífilis/sangre , Sífilis/epidemiología , Reacción a la Transfusión/sangre , Adulto Joven
11.
Medicine (Baltimore) ; 99(2): e18739, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914091

RESUMEN

Autoimmune hemolytic anemia (AIHA) is a rare disease in which autoantibodies target red blood cells (RBCs), leading to anemia that ranges from no symptoms to severe life-threatening hemolysis. Little is known about the severity of anemia, blood transfusion efficiency and risk of transfusion-related reactions among hospitalized AIHA patients, especially in those with incompatible RBC transfusions.A retrospective study was conducted among hospitalized AIHA patients from January 2009 to December 2015 in a large tertiary care medical center in southwest China.A total of 450 AIHA hospitalized patients were recruited, of whom 97.3% had warm AIHA, 30.3% had primary AIHA, and 90.7% were treated with corticosteroids. On admission, approximately 3% of patients had an hemoglobin (Hb) <30 g/L, 34% had an Hb between 30 and 59.9 g/L, and 46% had an Hb ranging from 60 to 89.9 g/L. A total of 2509.5 U RBCs were transfused to AIHA patients, and 14 transfusion-related adverse reactions were recorded, without any hemolytic transfusion reactions. With an average transfusion trigger of 52.0 ±â€Š9.3 g/L, 59.7% of the patients received RBCs, and 55.8% of the transfusions were viewed as effective. Least incompatible RBCs were given in 39% of the transfusions, but the transfusion efficiency did not significantly decrease with these incompatible blood transfusions (P = .253). Primary AIHA patients with a nadir Hb of approximately 40 to 50 g/L during their hospital stay had the highest rate of remission and did not require a different total number of RBC transfusions (P = .068) or length of hospitalization (P = .194) compared to other groups with nadir Hb values <30 g/L, ≥30 and <40 g/L, ≥50 and <60 g/L, and ≥60 g/L.One-third of AIHA patients suffered from severe anemia during hospitalization, and transfusions, even with incompatible RBCs, were safe and efficient. However, transfusion triggers between 40 and 50 g/L seemed to benefit the most patients by alleviating the RBC destruction caused by autoantibodies, and a restrictive transfusion strategy was beneficial in AIHA patients.


Asunto(s)
Corticoesteroides/uso terapéutico , Anemia Hemolítica Autoinmune/fisiopatología , Anemia Hemolítica Autoinmune/terapia , Transfusión de Eritrocitos/métodos , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Adulto , Anemia Hemolítica Autoinmune/epidemiología , Transfusión de Eritrocitos/efectos adversos , Femenino , Hemoglobinas , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Reacción a la Transfusión/epidemiología
12.
Transfusion ; 60(5): 912-917, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31970781

RESUMEN

BACKGROUND: The Accreditation Council for Graduate Medical Education requires milestone reporting of the Six General Core Competencies. Additionally, Graduate Medical Education (GME) is transitioning to adopt competency-based education methodologies including entrustable professional activities (EPAs) for objective, observable, and measurable milestone progression. The College of American Pathologists published 19 EPAs, including one for transfusion-related adverse events. This survey study includes developing EPAs for transfusion reaction evaluation and assessing residents before and after implementing these EPAs. STUDY DESIGN AND METHODS: Three transfusion reaction EPAs were developed and implemented in July 2018 for the Postgraduate Year (PGY) 2 pathology residents. An online, anonymous survey was sent to all 21 pathology trainees before and one year after EPA implementation. In July 2018 and August 2019, each survey included the same six multiple-choice, single-response, confidence questions, with a rating scale of extremely, very, slightly, or not at all confident. This study was approved by the hospital's Institutional Review Board for Health Sciences Research and GME Committee. RESULTS: Analysis was performed on PGY2-4 residents. In 2018, 13 of 20 participants were analyzed. In 2019, 15 of 19 participants were analyzed. Number and percentage of responses were reported. The results showed an increase in trainee confidence, with the greatest improvement among the first class to use the EPAs. CONCLUSION: EPAs provide an effective framework for objective and measurable progression of trainees. One year after the implementation of transfusion reaction EPAs at our site, the trainees showed enhanced confidence levels in handling Blood Bank and Transfusion Medicine Services coverage.


Asunto(s)
Acreditación , Bancos de Sangre/normas , Competencia Clínica , Internado y Residencia , Patología Clínica , Medicina Transfusional/normas , Acreditación/normas , Ritmo Circadiano , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Estudios de Cohortes , Educación Basada en Competencias/normas , Educación de Postgrado en Medicina/normas , Evaluación Educacional/normas , Humanos , Internado y Residencia/normas , Patología Clínica/educación , Patología Clínica/normas , Patología Clínica/estadística & datos numéricos , Percepción , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudiantes de Medicina/psicología , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Medicina Transfusional/educación , Medicina Transfusional/organización & administración , Reacción a la Transfusión/epidemiología , Confianza
14.
J Trauma Acute Care Surg ; 88(1): 87-93, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31464874

RESUMEN

PURPOSE: Following US military implementation of a cold-stored whole blood program, several US trauma centers have begun incorporating uncrossmatched, group O cold-stored whole blood into civilian trauma resuscitation. We set out to evaluate the safety profile, transfusion reactions events, and impact of low-titer group O whole blood (LTO-WB) at our center. METHODS: In November 2017, we added LTO-WB to each of our helicopters and to our emergency department (ED) refrigerator, alongside that of existing red blood cells and plasma. We collected information on all patients with trauma receiving prehospital or ED transfusion of uncrossed, emergency release blood products between November 2017 and June 2018. Patients were divided into those receiving any LTO-WB and those receiving only red blood cell and or plasma (COMP). Serial hemolysis panels were obtained at 3 hours, 24 hours, and 48 hours. All data were run using STATA 12.1. Statistical significance was set at p < 0.05. RESULTS: One hundred ninety-eight patients received LTO-WB and 152 patients received COMP. There were no differences in age, sex, or mechanism. The LTO-WB patients had higher chest Abbreviated Injury Scale scores (median, 3 vs. 2; p = 0.027), as well as worse arrival base excess (median, -7 vs. -5; p = 0.014) and lactate (5.1 vs. 3.5; p < 0.001). The LTO-WB patients received less post-ED blood products than the COMP patients (median, 0 vs. 3; p = 0.001). There was no difference in survival (LTO-WB, 73%; COMP, 74%; p = 0.805). There were only two suspected transfusion reactions, both in the COMP group (p = 0.061). There was no difference in hemolysis panel values. Controlling for age, severity of injury, and prehospital physiology, LTO-WB was associated with a 53% reduction in post-ED blood product transfusion (odds ratio, 0.47; 0.23-0.94 95% CI; p = 0.033) and two-fold increase in likelihood of survival (odds ratio, 2.19; 1.01-4.76 95% CI; p = 0.047). CONCLUSION: Low-titer group O whole blood has similar evidence of laboratory hemolysis, similar transfusion reaction rates, and is associated with a reduction in post-ED transfusions and increase likelihood of survival. LEVEL OF EVIDENCE: Therapeutic, Level II.


Asunto(s)
Sistema del Grupo Sanguíneo ABO , Transfusión Sanguínea/métodos , Resucitación/efectos adversos , Reacción a la Transfusión/epidemiología , Heridas y Traumatismos/terapia , Escala Resumida de Traumatismos , Adulto , Ambulancias Aéreas/normas , Ambulancias Aéreas/estadística & datos numéricos , Tipificación y Pruebas Cruzadas Sanguíneas/normas , Transfusión Sanguínea/normas , Transfusión Sanguínea/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hemólisis , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resucitación/métodos , Resucitación/normas , Reacción a la Transfusión/sangre , Reacción a la Transfusión/etiología , Centros Traumatológicos/normas , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Heridas y Traumatismos/sangre , Heridas y Traumatismos/diagnóstico , Adulto Joven
15.
Turk J Haematol ; 37(1): 30-35, 2020 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-31475800

RESUMEN

Objective: First-time blood donors are the most common group of blood donors. They usually have different motivations for blood donation, some of which provoke the donors to hide risk factors of transfusion-transmissible infections (TTIs). Therefore, detection of TTIs among first-time donors is crucial and can decrease the rate of TTIs among blood recipients. This study aimed to evaluate the prevalence of TTIs among first-time donors in the transfusion center of Kohgiluyeh and Boyer-Ahmad Province (KBTC), Iran. Materials and Methods: This retrospective study was conducted with volunteer blood donors in 2004-2014 in the KBTC. Various data, including sex, confidential unit exclusion (CUE), previous donation history, and the laboratory findings of confirmatory tests, were extracted from blood donor software. Data were analyzed by SPSS using the chi-square test. Results: Among 198,501 blood donors, 52,527 (26.46%) were first-time donors, while 145,974 donors (73.54%) were repeat and regular donors. Most of the donors (94.5%) were male, while a minority (5.5%) were female. The CUE option was chosen by 2,237 (1.13%) donors. The incidence of hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) was 247 (0.13%) and 134 (0.07%) among the entire study population, respectively. Three donors (0.002%) had confirmed human immunodeficiency virus (HIV), while none of the blood donors were positive for syphilis. Most of the donors with positive HBsAg (95.8%), HCV (86.6%), and HIV (100%) infection were first-time donors. Conclusion: Since TTIs are more common among first-time blood donors than regular and repeat donors, special considerations should be taken into account for this common group of blood donors.


Asunto(s)
Donantes de Sangre , Transfusión Sanguínea , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/etiología , Femenino , Humanos , Irán/epidemiología , Masculino , Prevalencia , Vigilancia en Salud Pública , Estudios Retrospectivos , Reacción a la Transfusión/diagnóstico
16.
Rheumatology (Oxford) ; 59(4): 767-771, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-31504956

RESUMEN

OBJECTIVES: We examined the effectiveness of plasma exchange (PE) therapy to reduce the mortality of rapidly progressive interstitial lung disease (RP-ILD) in patients positive for anti-melanoma differentiation-associated gene 5 (MDA5) antibodies. METHODS: Among 142 patients newly diagnosed with PM/DM or clinically amyopathic DM from 2008 to 2019 at our hospital, 10 were diagnosed with refractory RP-ILD and were positive for anti-MDA5 antibodies. PE was used as an adjunct to standard therapy and consisted of fresh frozen plasma as replacement solution. The primary outcome was non-disease-specific mortality. RESULTS: Anti-MDA5 antibodies were detected in 28 patients, of whom 21 were diagnosed with RP-ILD and 10 were refractory to intensive immunosuppressive therapy. Six patients received PE (PE group) and four did not (non-PE group). The 1-year survival rate of the PE group was higher than that of the non-PE group (100% and 25%, respectively, P = 0.033). Regarding adverse events associated with PE, two patients had anaphylactic shock, one had high fever due to fresh frozen plasma allergy and one had a catheter infection. All adverse events resolved with appropriate treatment. CONCLUSION: We evaluated the association between 1-year survival rate and PE for refractory RP-ILD in patients positive for anti-MDA5 antibodies. Intensive immunosuppressive therapy improved the survival rate in RP-ILD patients with anti-MDA5 antibodies, but 20-30% of cases were still fatal. PE could be administered to patients with active infectious disease who were immunocompromised by intensive immunosuppressive therapy. PE may be considered in refractory RP-ILD patients positive for anti-MDA5 antibodies.


Asunto(s)
Autoanticuerpos/inmunología , Dermatomiositis/inmunología , Inmunosupresores/uso terapéutico , Helicasa Inducida por Interferón IFIH1/inmunología , Enfermedades Pulmonares Intersticiales/terapia , Intercambio Plasmático/métodos , Adulto , Anciano , Anafilaxia/epidemiología , Anafilaxia/etiología , Dermatomiositis/complicaciones , Resistencia a Medicamentos , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/inmunología , Masculino , Persona de Mediana Edad , Plasma , Intercambio Plasmático/efectos adversos , Plasmaféresis , Tasa de Supervivencia , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/etiología , Resultado del Tratamiento
17.
Curr Issues Mol Biol ; 36: 63-66, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31559970

RESUMEN

Prion diseases or transmissible spongiform encephalopathies (TSEs) are fatal neurological diseases that include Creutzfeldt-Jakob disease (CJD) in humans, scrapie in sheep and goats, bovine spongiform encephalopathy (BSE) in cattle, camel spongiform encephalopathy (CSE) in camels and chronic wasting disease (CWD) in cervids. A key event in prion diseases is the conversion of the cellular, host-encoded prion protein (PrPC) to its abnormal isoform (PrPSc) predominantly in the central nervous system of the infected host (Aguzzi et al., 2004). These diseases are transmissible under some circumstances, but unlike other transmissible disorders, prion diseases can also be caused by mutations in the host gene. The mechanism of prion spread among sheep and goats that develop natural scrapie is unknown. CWD, transmissible mink encephalopathy (TME), BSE, feline spongiform encephalopathy (FSE), and exotic ungulate encephalopathy (EUE) are all thought to occur after the consumption of prion-infected material. Most cases of human prion disease occur from unknown reasons, and greater than 20 mutations in the prion protein (PrP) gene may lead to inherited prion disease. In other instances, prion diseases are contracted by exposure to prion infectivity. These considerations raise the question of how a mere protein aggregate can bypass mucosal barriers, circumvent innate and adoptive immunity, and traverse the blood-brain barrier to give rise to brain disease. Here, we will briefly introduce a few topics in current prion studies.


Asunto(s)
Enfermedades por Prión/genética , Priones/metabolismo , Deficiencias en la Proteostasis/metabolismo , Enfermedad de Alzheimer/metabolismo , Animales , Inocuidad de los Alimentos , Humanos , Enfermedad de Huntington/metabolismo , Inflamación/inmunología , Inflamación/metabolismo , Enfermedad de Parkinson/metabolismo , Enfermedades por Prión/enzimología , Enfermedades por Prión/metabolismo , Enfermedades por Prión/transmisión , Priones/genética , Priones/patogenicidad , Deficiencias en la Proteostasis/enzimología , Deficiencias en la Proteostasis/genética , Factores de Riesgo , Reacción a la Transfusión/epidemiología
18.
Br J Haematol ; 188(3): 465-472, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31566724

RESUMEN

Pathogen-reduced (PR) platelets are routinely used in many countries. Some studies reported changes in platelet and red blood cell (RBC) transfusion requirements in patients who received PR platelets when compared to conventional (CONV) platelets. Over a 28-month period we retrospectively analysed platelet utilisation, RBC transfusion trends, and transfusion reaction rates data from all transfused adult patients transfused at the Yale-New Haven Hospital, New Haven, CT, USA. We determined the number of RBC and platelet components administered between 2 and 24, 48, 72 or 96 h. A total of 3767 patients received 21 907 platelet components (CONV = 8912; PR = 12 995); 1,087 patients received only CONV platelets (1578 components) and 1,466 patients received only PR platelets (2604 components). The number of subsequently transfused platelet components was slightly higher following PR platelet components (P < 0·05); however, fewer RBCs were transfused following PR platelet administration (P < 0·05). The mean time-to-next platelet component transfusion was slightly shorter following PR platelet transfusion (P = 0·002). The rate of non-septic transfusion reactions did not differ (all P > 0·05). Septic transfusion reactions (N = 5) were seen only after CONV platelet transfusions (P = 0·011). These results provide evidence for comparable clinical efficacy of PR and CONV platelets. PR platelets eliminated septic transfusion reactions without increased risk of other types of transfusions with only slight increase in platelet utilisation.


Asunto(s)
Plaquetas , Desinfección , Transfusión de Plaquetas/efectos adversos , Reacción a la Transfusión/epidemiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
19.
Transfusion ; 60(3): 507-512, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-30907010

RESUMEN

BACKGROUND: Among labile blood products, platelet concentrates (PCs) are the leading cause of hypersensitivity transfusion reactions (HTRs). These reactions often lead to interruption of PC transfusion and can result in a prolonged transfusion process leading to significant morbidity and use of premedication and close monitoring for patients with a history of allergic transfusion reactions. The French hemovigilance database is one of the largest standardized databases providing information on HTRs following administration of labile blood products. In this study, we analyzed this database to assess the relative risk of HTR for each type of PC. STUDY DESIGN AND METHODS: HTRs following PC transfusion were retrospectively extracted from the e-Fit Hemovigilance database of the French National Agency for Medicines and Health Products Safety (ANSM). Frequencies were calculated using the number of specific PCs transfused. RESULTS: Between 2008 and 2014, the overall estimated incidence of HTRs following PC administration was calculated at 232 HTRs per 100,000 PCs transfused. The rate of HTRs was significantly higher with apheresis PC (337/100,000) than with buffy-coat PC (94/100,000). Platelets in additive solutions (PAS) were associated with a significantly lower frequency of HTRs when compared with PCs in native plasma. Amotosalen/UVA- PCs (APCs and BCPCs) which are always in PAS in France, exhibited the lowest frequency of HTRs when compared with their corresponding PCs in native plasma or in PAS (p < 10-7 in all comparisons). CONCLUSION: Our results showed that the type of PC and its processing may have an impact on the risk of HTR.


Asunto(s)
Transfusión Sanguínea , Reacción a la Transfusión/epidemiología , Plaquetas/citología , Plaquetas/efectos de los fármacos , Plaquetas/fisiología , Plaquetas/efectos de la radiación , Furocumarinas/farmacología , Humanos , Transfusión de Plaquetas/efectos adversos , Estudios Retrospectivos , Rayos Ultravioleta
20.
Vox Sang ; 115(2): 133-139, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31777098

RESUMEN

BACKGROUND AND OBJECTIVES: In Canada, the deferral for men who have sex with men (MSM) was decreased from a permanent deferral to a 5-year then a 12-month deferral. Current HIV testing can detect an HIV infection in donated blood within 2 weeks of exposure; thus, a 12-month deferral may be unnecessarily restrictive. We aimed to estimate the residual risk of HIV if the deferral were further decreased to 3 months. MATERIALS AND METHODS: Using a deterministic model with stochastic Monte Carlo simulation, residual risk of HIV was the sum of testing error, assay sensitivity and window-period risks. Data inputs were estimated from donor surveillance, donor surveys and published data. Residual risk was modelled at baseline and using three scenarios: (1) most likely - non-compliance, HIV prevalence and incidence rates of MSM are unchanged; (2) optimistic - non-compliance improves by 50%; and (3) pessimistic - non-compliance, HIV prevalence and incidence rates of MSM all double. RESULTS: HIV residual risk at baseline was 1 in 36·0 million donations (95% CI 1 in 1 504 907 million, 10·5 million); in the most likely scenario 1 in 34·2 million (1 in 225 534 million, 8·7 million); in the optimistic scenario 1 in 36·0 million (1 in 282 618 million, 9·5 million); in the pessimistic scenario 1 in 16·7 million (1 in 39 469 million, 6·0 million). All confidence intervals overlapped. CONCLUSION: With very low modelled risk under a 12-month deferral, the additional risk with a 3-month deferral is very low. This is true even with a pessimistic scenario.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Reacción a la Transfusión/epidemiología , Canadá , Humanos , Masculino , Prevalencia , Encuestas y Cuestionarios
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