TRANSFUSION PRACTICE, POST-TRANSFUSION COMPLICATIONS AND RISK FACTORS IN SICKLE CELL DISEASE IN SENEGAL, WEST AFRICA.

Context and Objectives: Blood transfusions (BT) remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. We aim to assess infectious markers, red cell alloimmunization and iron overload secondary to BT in SCD patients. Materials and Methods: This is a case-control study included 253 SCD (153 SCD-transfused and 100 SCD non-transfused). We evaluated the transfusion practice (modalities, indications), post-transfusion complications (infections, alloimmunization, iron overload) and risk factors of these complications (socio-demographic, clinical, biological). Results: Median age was 28.5 years (5 - 59). Sex ratio was 0.86. Homozygous SCD was more common (95.3%). Simple BT was performed in 92.8% and transfusion exchange in 18.9%. Transfusion indications were dominated by acute anemia (57.06%) and vaso-occlusive crisis (VOCs) (14%). Red blood cell concentrates (RBC) were administered to 93.46%. Median number of RBC received per patient was 10 (2 - 48). The prevalence of VHC in SCD-transfused was 1.33% and 2% for VHB. Anti-HIV antibodies were not found. Red cell alloimmunization frequency was 16%. The most common alloantibodies were anti-rhesus (34.19%) and anti-Kell (23.67%). Iron overload was detected in 7.84%. The number of RBC transfused was the only risk factor for alloimmunization (p = 0.03) and iron overload (p = 0.023). BT frequency was not related to infectious transmission. Conclusion: Despite advances in blood safety, BT therapy is still a risk for SCD polytransfused patients. Although infectious transmission has rare, the risk of alloimmunization and iron overload is high in these patients.

Uncrossmatched Blood Transfusion for Resuscitation Patients at the Emergency Department

BACKGROUND: Patients with uncontrolled blood loss often require immediate blood transfusion after the bleeding is stopped. If it is an emergency situation, blood that has not been tested for compatibility (uncrossmatched red blood cell [URBC] products) can be used. However, no studies have been conducted to evaluate the effectiveness of this protocol. AIM: The aim of the study is to evaluate the effectiveness of URBC transfusion in Srinagarind Hospital’s emergency department (ED). METHODS: This was a cross-sectional study that reviewed the medical records of ninty Thai patients over 18 years of age who received at least one unit of blood through URBC transfusion in the Srinagarind Hospital ED from September 2016 to August 2018. RESULTS: The average age of the patients was 47.23 ± 18.2 years, and 73.3% were male. A total of 149 units of URBC were provided, with 54.44% of recipients being trauma patients and 27.78% being gastrointestinal bleeding patients. The 24-h and in-hospital mortality rates were 58.89 and 72.22%, respectively. There were no cases of acute blood transfusion complications or inappropriate URBC transfusion. CONCLUSIONS: The transfusion of URBC necessary in patients with uncontrolled bleeding. No complications were found due to acute blood transfusion.

Retrospective Study of Blood Transfusion Complications in the Capital Region of Denmark from 1999-2017: Characteristics of Potentially “Dangerous” Blood Donors?s

Objectives: We hypothesized that the blood donors most frequently involved in complications would induce more and severe immunologic transfusion complications compared to other donors, i.e. potentially “dangerous”. Secondary aims were differences in demographic variables. Background: Donor-related mechanisms may contribute to allogeneic blood transfusion complications and may represent a dangerous treatment adverse event. Materials and Methods: By analyzing transfusion data from the Capital Region of Denmark from January 1, 1999 to December 31, 2017; 2,574,646 blood transfusions and 9,779 transfusion complications from 194,432 blood donors were included in our dataset. We divided donors into three groups based on the number of complications and complication frequency (potentially “dangerous” vs. two differently defined control groups i.e. control 1 and control 2), and compared the nature of transfusion complications and demographic variables by statistical analysis. Results: There were no differences in the proportion of complication types between the potentially “dangerous” donors and control donors, and no difference in the proportion of complications from RBCs, plasma or platelets according to ABO and RhD blood types. However, more potentially “dangerous” donors were female and had ABO blood type B compared to control donors (p<0.001 and p<0.01, respectively). The potentially “dangerous” donors were younger compared to control donors (40.36 years vs. 45.24 years and 42.84 years, p<0.001). Conclusion: The potentially “dangerous” did not display more/severe immunologic transfusion complications compared to control donors. However, they differed in regards to gender, age and blood type. Further research regarding the differences in complication frequency per donor and demographic variety is warranted.

Intermittent Transfusions for Treatment of Thalassemia in the State of Georgia, 2007-2016

Background: Individuals with Non-Transfusion Dependent Thalassemia (NTDT) may require infrequent transfusions. Knowing transfusion history, while important, can be challenging in this subgroup. Study Design: Hospital discharge data in Georgia (2007-2016) was reviewed. Thalassemia patients were defined as ≥3 encounters with a thalassemia diagnosis code. Transfusion was defined by the presence of a diagnosis, CPT, revenue, or HCPCS code for red cell transfusion. Results: There were 428 patients identified; 57 received multi-site transfusions. Conclusion: Georgia hospitals provide intermittent transfusions to low volumes of probable NTDT patients. Patient and provider education may help assure adherence to best practices, avoiding serious transfusion complications.

Storage Time of Filtered Red Blood Cells and Post-Transfusion Complications (Review)

Red blood cells are the most required blood transfusion products worldwide. Safety and efficacy of blood transfusion are still relevant issues. Clarification of the causes and mechanisms of post-transfusion complications requires additional research.Aim of the review is to summarize the data of clinical and research studies on transfusion of red blood cell suspension with various storage times.Material. We selected 76 sources from Web of Science, Scopus, and RSCI databases containing pertinent clinical and scientific research data, as well as blood transfusion guidelines.Results. We reviewed the main stages of preparation and storage of filtered red blood cells, described biochemical and structural alterations occurring during blood storage, summarized clinical data on post-transfusion complications, and analyzed clinical consequences and molecular structure abnormalities of red blood cells in relation to their storage time.Conclusion. During long-term storage, red blood cells undergo significant structural and metabolic changes. The clinical use of relatively «old» red blood cells increases the risk of post-transfusion complications. However, the pathophysiological differences between «young» and «old» erythrocytes remain unclear. Large clinical and molecular research studies may add to our understanding of the complex issues related to blood transfusion.

Effect of blood storage on electrolyte levels

Background: Blood transfusion can be an immediate life saving measure in several acute conditions such as hemorrhage and anemia. However, various post transfusion complications are observed in patients which may be associated with the storage conditions of the collected blood. Electrolytes play a major role in maintaining homeostasis within the cells. Potassium is the most important extracellular cation responsible for maintenance of the cell integrity. Prolonged and improper storage of blood can lead to leakage of electrolytes, thus changing the cell morphology. This can adversely affect the patients who receive such blood. This study helps us analyze the effect of blood storage on electrolyte levels.Methods: For the study, 10ml of blood was collected from 30 blood bags containing CPDA-1 at the time of blood donation from 30 different volunteers. This blood containing the CPDA-1 was divided into 5 parts of 2ml and each 2ml sample was stored in plain bulbs. All the samples were stored at 4°C. Samples were tested to check for changes in the electrolyte (Na+, K+, Cl-) levels on day 0, 3, 7, 14 and 21. ANOVA was used to calculate the variance in the electrolyte levels.Results: Average sodium level on day 0 was 152.9±3.8 mEq/l. There was a significant decrease and it was measured at 139.5±4.8 mEq/l on day 21. Average potassium level on day 0 was 4.2±0.4 mEq/l. A significant spike was observed in potassium levels. The final reading of potassium level on day 21 was 15.2±0.7 mEq/l. Average chloride level on day 0 was 71.9±6.6 mEq/l which significantly declined to 67±5.9 mEq/l.Conclusions: Though blood is stored in proper conditions, a biochemical change occurs within the cells due to prolonged storage and thus affects its viability.

Antigen density dictates RBC clearance, but not antigen modulation, following incompatible RBC transfusion in mice

Incompatible red blood cell (RBC) transfusion can result in life-threatening transfusion complications that can be challenging to manage in patients with transfusion-dependent anemia. However, not all incompatible RBC transfusions result in significant RBC removal. One factor that may regulate the outcome of incompatible RBC transfusion is the density of the incompatible antigen. Despite the potential influence of target antigen levels during incompatible RBC transfusion, a model system capable of defining the role of antigen density in this process has not been developed. In this study, we describe a novel model system of incompatible transfusion using donor mice that express different levels of the KEL antigen and recipients with varying anti-KEL antibody concentrations. Transfusion of KEL+ RBCs that express high or moderate KEL antigen levels results in rapid antibody-mediated RBC clearance. In contrast, relatively little RBC clearance was observed following the transfusion of KEL RBCs that express low KEL antigen levels. Intriguingly, unlike RBC clearance, loss of the KEL antigen from the transfused RBCs occurred at a similar rate regardless of the KEL antigen density following an incompatible transfusion. In addition to antigen density, anti-KEL antibody levels also regulated RBC removal and KEL antigen loss, suggesting that antigen density and antibody levels dictate incompatible RBC transfusion outcomes. These results demonstrate that antibody-induced antigen loss and RBC clearance can occur at distinct antigen density thresholds, providing important insight into factors that may dictate the outcome of an incompatible RBC transfusion.

Evaluation of Blood Transfusion Complications in Patients Undergoing Surgery

Introduction: Patients undergoing surgery may need transfusion of blood products for a variety of reasons. Therefore, this study aimed to determine the incidence of blood transfusion complications in patients undergoing surgery. Methods: The present study was performed as a cross-sectional study in 2020 at Shohadaye Tajrish Hospital in Tehran, Iran. A total of 1132 patients who had complications during surgery upon transfusion of blood and blood products from 2015 to 2020 were included in the census. To collect information, a checklist, including patients’ information, the type of product, and types of complications was used. SPSS software version 21 was used for data analysis. Results: In this study, 99.7% of the complications were acute, and in 91.1% of the cases, the severity of complications was mild. Of the confirmed complications, 46.4% were allergic reactions, and 43.8% were reported as non-hemolytic febrile reactions. A total of 91.1% of patients completely recovered after the onset of the complication, 6.2% had a partial disability, 0.4% had severe disability, and 0.3% died. Conclusion: The results showed that most patients had acute complications in terms of the type of complication and mild in terms of the severity, thus a completely regular program is recommended to control side effects related to blood and blood products transfusion.

A study of red blood cell alloimmunization and autoimmunization among 200 multitransfused Egyptian β thalassemia patients

The development of hemolytic erythrocyte alloantibodies and autoantibodies complicates transfusion therapy in thalassemia patients. These antibodies ultimately increase the need for blood and intensify transfusion complications. There is a scanty data on the frequency of RBC alloimmunization and autoimmunization in Egyptian β thalassemia patients as pretransfusion antibody screening is not routinely performed. We studied the frequency of alloimmunization and autoimmunization among 200 multiply transfused β thalassemia patients and investigated the factors that possibly affect antibody formation. Of the 200 patients in our study, 94 were males and 106 females, with the age range of 2–37 years. Alloantibodies were detected in 36 (18%) of the patients, while autoantibodies were detected in 33 (16.5%). The dominant alloantibodies were directed against Kell (33%) and Rh (24.4%) groups. Alloimmunization had a significant relationship with treatment duration and the frequency of transfusion (P = 0.007, 0.001, respectively). The presence of autoantibodies was significantly related to age (P = 0.001), total number of transfused units (P = 0.000) and splenectomy (P = 0.000). The high prevalence of alloimmunization in the study population disclosed the need for providing phenotypically matched cells for selective antigens especially for Kell and Rh subgroups to reduce risk of alloimmunization and increase the efficiency of blood transfusion.

Peningkatan Pemahaman Mengenai Menstruasi Melalui Penyuluhan Serta Pemeriksaan Golongan Darah Di Usia Dini

Menstruation is a physiological change in a woman's body that occurs periodically and is influenced by reproductive hormones either FSH-Estrogen or LH-Progesterone. In women, this usually occurs every month between teens to menopause, and lasts around 7-28 days. Knowing the characteristics of menstruation early is a very important thing to know because it is an early learning about the reproductive system and their health. Blood type is an inherited antigen on the surface of red blood cells. The two most important types of blood classification to know are the classification of ABO and Rhesus (Rh factor). Blood type examination is an activity that is sometimes overlooked by the community, in this case the needs of the Blood Type are carried out for clinical purposes such as: blood transfusions, preventing transfusion complications, and for pregnant women. According to empirical data obtained in 2017 the level of understanding of menstruation and blood type in primary schools is very low. For this reason, efforts are made to provide education and information as well as checks on children from an early age as a starting point for character building in improving education and knowledge in general and specifically regarding health