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This document is a systematic review that discusses the challenges and inconsistencies in diagnosing cold agglutinins (CA), which are IgM autoantibodies that can cause hemolysis. The review aims to inform future research on the diagnostic investigation and interpretation of CA by describing serological techniques and cut-offs for diagnosing cold agglutinin disease (CAD) or cold agglutinin syndrome (CAS). The authors conducted a literature search and included 56 articles in their analysis, which revealed a lack of standardized definitions and thresholds for diagnosing clinically significant CA. The document provides a summary of various studies and case series related to cold agglutinins (CA), examining different aspects such as the number of participants with CA, the underlying clinical diseases studied, and the definition of CA. It presents a range of perspectives and findings from different studies. The article discusses the lack of consistency in defining the characteristics of cold agglutinin disease (CAD) in autoimmune hemolytic anemia (AIHA). The most commonly used laboratory test for diagnosing CAD is the direct antiglobulin test (DAT), which detects complement deposition on red blood cells. However, the clinical utility of DAT testing and the interpretation of results are variable. CA titers, which reflect the concentration and avidity of cold agglutinins, are also widely used but do not always correlate with disease severity. The determination of thermal amplitude [Extracted from the article]

Background: Correct classification of transfusion reactions is important not only for effective patient care and donor management but also for accurate tracking of events in hemovigilance systems. We compared the ability of a generative artificial intelligence (AI) system to correctly diagnose hypothetical clinical situations as transfusion reactions in comparison to previous studies reporting the accuracy of transfusion medicine (TM) specialists in assessing these cases. Methods: An AI system was requested to assess 36 case scenarios to provide a diagnosis, severity, and imputability of the transfusion reactions using the CDC National Healthcare Safety Network (NHSN) criteria. Responses were compared to an expert panel's classifications and to the published responses of a panel of TM specialists. Additionally, the AI's responses were compared to the TM specialists' prior attempts to use the TrDDx web‐based algorithm for the five most challenging cases. Results: The AI's classification accuracy varied widely depending on the NHSN category. The AI accurately classified all transfusion‐associated circulatory overload and transfusion‐related acute lung injury cases, exceeding TM specialists' assessments. Conversely, it did not correctly identify any cases in select NHSN categories such as DSTR. Overall accuracy among all diagnostic categories was 48.7% for AI responses versus 72.1% for prior TM specialist responses (p = 0.005). AI‐generated responses included non‐standard terminology, limited severity assessments, and no imputability determinations. Discussion: A generative AI system may have a role in helping healthcare providers to consider transfusion reaction categories that might be missed, but caution is advised in applying the AI's output to transfusion reaction classification at present. [ABSTRACT FROM AUTHOR]

The article discusses the historically low board pass rates in Blood Banking/Transfusion Medicine (BB/TM) and explores the possible causes. The authors suggest that the impact of the COVID-19 pandemic, including disruptions in education and training, may have contributed to the poor performance on the examination. They also mention the migration of trainee education from in-person settings to online learning during the pandemic and the need for further studies to evaluate the effectiveness of virtual learning. The authors conducted an investigation and found that the low pass rate in 2022 was not due to an issue with the standard setting process. However, they observed that the pass rate in 2021 was also lower than previous years, possibly reflecting the early phase of the pandemic's impact. The article concludes by noting that the BB/TM board pass rate in 2023 reached an all-time high, suggesting a return to normalcy in the post-COVID era. [Extracted from the article]

Background: Although the safety and therapeutic efficacy of COVID‐19 convalescent plasma (CCP) has been extensively evaluated, the safety of CCP donation has not been explored in a multi‐institutional context. Study design and methods: Nine blood collection organizations (BCOs) participated in a multi‐institutional donor hemovigilance effort to assess the safety of CCP donation. Donor adverse events (DAEs) were defined according to the Standard for Surveillance of Complications Related to Blood Donation, and severity was assessed using the severity grading tool. Multivariate analysis was performed to determine attributes associated with DAE severity. Results: The overall DAE rate was 37.7 per 1000 donations. Repeat apheresis and apheresis‐naïve donors experienced adverse event rates of 19.9 and 49.8 per 1000 donations, respectively. Female donors contributed 51.9% of CCP donations with a DAE rate of 49.4 per 1000 donations. The DAE rate for male donors was 27.4 per 1000 donations. Vasovagal reactions accounted for over half of all reported DAEs (51.1%). After adjustment, volume of CCP donated was associated with vasovagal reaction severity (odds ratio [OR] 6.5, 95% confidence interval [CI] 2.5–17.1). Donor age and donation history were also associated with DAE severity. Considerable differences in DAE types and rates were observed across the participating BCOs despite the use of standardized hemovigilance definitions. Conclusion: The safety of CCP donation appears comparable to that of conventional apheresis plasma donation with similar associated risk factors for DAE types and severity. [ABSTRACT FROM AUTHOR]

Background: Patient safety remains a critical issue in health care. Adverse events related to blood transfusion constitute a threat to patient safety. The aim of this study is to compare and contrast reporting trends of patient safety events that occur during the transfusion of blood components in pediatric and adult hospital care settings.Study Design and Methods: This is a multicenter analysis of reported patient safety incidents occurring during the administration of blood components for four children's and 21 adult hospitals from January 2010 through September 2017. Denominators were pediatric or adult transfusions per year for a subset of two pediatric and two adult hospitals able to provide denominators for the complete reporting period. Rates were calculated on the subset of four hospitals per 100,000 components transfused with Pearson's chi square for comparison (p < 0.05 as significant).Results: There were 1902 reports for an estimated 1.1 million transfusions: 358 reports from pediatric hospitals and 1544 reports from adult hospitals. From hospitals able to provide denominator data; there were 192 reports for 128,560 pediatric transfusions and 183 reports for 377,563 adult transfusions. The reporting rate per 100,000 components from these four hospitals was 149 for pediatric and 48 for adult reports (p < 0.01).Conclusion: This analysis demonstrates the continued need for transfusion safety practices. The type of incident reports differed in the pediatric setting compared to the adult setting. Understanding patient safety event reporting trends related to blood transfusion will help target hemovigilance education and interventions to the appropriate patient populations. [ABSTRACT FROM AUTHOR]

Background: Wrong blood in tube (WBIT) errors are a preventable cause of ABO-mismatched RBC transfusions. Electronic patient identification systems (e.g., scanning a patient's wristband barcode before pretransfusion sample collection) are thought to reduce WBIT errors, but the effectiveness of these systems is unclear.Study Design and Methods: Part 1: Using retrospective data, we compared pretransfusion sample WBIT rates at hospitals using manual patient identification (n = 16 sites; >1.6 million samples) with WBIT rates at hospitals using electronic patient identification for some or all sample collections (n = 4 sites; >0.5 million samples). Also, we compared WBIT rates after implementation of electronic patient identification with preimplementation WBIT rates. Causes and frequencies of WBIT errors were evaluated at each site. Part 2: Transfusion service laboratories (n = 18) prospectively typed mislabeled (rejected) samples (n = 2844) to determine WBIT rates among samples with minor labeling errors.Results: Part 1: The overall unadjusted WBIT rate at sites using manual patient identification was 1:10,110 versus 1:35,806 for sites using electronic identification (p < 0.0001). Correcting for repeat samples and silent WBIT errors yielded overall adjusted WBIT rates of 1:3046 for sites using manual identification and 1:14,606 for sites using electronic identification (p < 0.0001), with wide variation among individual sites. Part 2: The unadjusted WBIT rate among mislabeled (rejected) samples was 1:71 (adjusted WBIT rate, 1:28).Conclusion: In this study, using electronic patient identification at the time of pretransfusion sample collection was associated with approximately fivefold fewer WBIT errors compared with using manual patient identification. WBIT rates were high among mislabeled (rejected) samples, confirming that rejecting samples with even minor labeling errors helps mitigate the risk of ABO-incompatible transfusions. [ABSTRACT FROM AUTHOR]

Background: Children are known to be physiologically and biochemically different from adults. However, there are no multi-institutional studies examining the differences in the frequency, type, and severity of transfusion reactions in pediatric versus adult patients. This study aims to characterize differences between pediatric and adult patients regarding adverse responses to transfusions.Study Design and Methods: This is a retrospective data analysis of nine children's hospitals and 35 adult hospitals from January 2009 through December 2015. Included were pediatric and adult patients who had a reported reaction to transfusion of any blood component. Rates are reported as per 100,000 transfusions for comparison between pediatric and adult patients.Results: Pediatric patients had an overall higher reaction rate compared to adults: 538 versus 252 per 100,000 transfusions, notably higher for red blood cell (577 vs. 278 per 100,000; p < 0.001) and platelet (833 vs. 358 per 100,000; p < 0.001) transfusions. Statistically higher rates of allergic reactions, febrile nonhemolytic reactions, and acute hemolytic reactions were observed in pediatric patients. Adults had a higher rate of delayed serologic transfusion reactions, delayed hemolytic transfusion reactions, and transfusion-associated circulatory overload.Conclusion: Pediatric patients had double the rate of transfusion reactions compared to adults. The nationally reported data on reaction rates are consistent with this study's findings in adults but much lower than the observed rates for pediatric patients. Future studies are needed to address the differences in reaction rates, particularly in allergic and febrile reactions, and to further address blood transfusion practices in the pediatric patient population. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that more than 20% of laboratories would have recommended inaccurate doses of Rh immune globulin (RhIG) in hypothetical cases. Efforts have been made in educating laboratories in correct dosing calculations; however, obstetricians are most often responsible for ordering RhIG. The objective of this study was to assess knowledge of RhIG indications and dosing among obstetrics and gynecology (OB/GYN) physicians in the United States.Study Design and Methods: An anonymous 17- question online survey was distributed to all OB/GYN resident and attending physicians affiliated with US residency training programs.Results: A total of 165 surveys were collected, with 139 fully completed. Ninety-two percent of respondents correctly recognized the need for RhIG in D- patients with negative antibody screens. In a scenario of a fetomaternal hemorrhage (FMH) of 45 mL, only 22% of respondents correctly chose the appropriate RhIG dosage. Of those who were correct, 10% had correctly identified 30 mL as the amount of fetal whole blood covered by one dose of RhIG, while 48% incorrectly identified 15 mL (n = 31). A total of 49.3% of respondents reported residency as the most recent formal training on RhIG dosing and 35% reported never (n = 140).Conclusions: Our study found that OB/GYN physicians are knowledgeable regarding indications for RhIG immunoprophylaxis but were insufficient at calculating dosages in cases of FMH. More standardized education and training among OB/GYN physicians may decrease the risk of maternal alloimmunization, in part because RhIG dosage recommendations from laboratories are not standard practice. [ABSTRACT FROM AUTHOR]

Background: Warm-reactive autoantibodies (WAAs) are the most common cause of autoimmune hemolytic anemia (AIHA) and can also be present without clinically significant hemolysis. WAAs complicate immunohematological testing, yet there is no commonly accepted approach to laboratory evaluation and red blood cell (RBC) selection.Study Design and Methods: We searched PubMed/Cochrane Central for articles that described testing methodology and blood selection for patients with WAAs. We developed a 31-question survey regarding local practice for immunohematology testing and RBC selection in patients with WAAs (with or without AIHA).Results: Eighty-six studies met the inclusion criteria and the aims of this review. Most of the literature was comprised of retrospective studies that often did not correlate laboratory results with clinical findings. Evidence-based protocols to guide testing and RBC selection for transfusion in patients with WAAs are lacking. Individuals representing 54 laboratories completed the survey. The responses indicated that numerous methodologies are used to identify underlying alloantibodies: 75% of respondents use autoadsorption; in patients who have a recent history of transfusion, 76% of respondents use alloadsorption; 58% of respondents perform direct antiglobulin testing (DAT) each time the indirect antiglobulin test is positive; and 48% perform eluate studies at the initial identification of WAAs. Responding laboratories may use phenotyping (98%) or genotyping (80%) at some point in the work-up. Seventy-five percent of respondents provide phenotype-matched or genotype-matched RBCs for transfusion.Conclusion: There is wide variability in immunohematology testing and RBC selection practices for patients who have WAAs (with or without AIHA). Future studies are needed to evaluate and compare the effectiveness of different testing algorithms and transfusion strategies. [ABSTRACT FROM AUTHOR]

Background: Daratumumab (DARA) consistently interferes with routine blood bank serologic testing by directly binding to CD38 expressed on reagent red blood cells (RBCs). Treating RBCs with dithiothreitol (DTT) eliminates the DARA interference. We conducted an international, multicenter, blinded study aimed at validating the DTT method for use by blood bank laboratories worldwide.Study Design and Methods: Paired plasma sample unknowns were sent to 25 participating blood bank laboratories. Sample 1 was spiked with DARA only (10 µg/mL), and Sample 2 with DARA plus a clinically significant RBC antibody (anti-D [n = 6], anti-Fya [n = 9], or anti-s [n = 10]). Sites were instructed to perform an antibody screen with and without DTT-treated RBCs and to use a DTT-treated RBC panel for antibody identification. Qualitative data about the DTT method were collected by online survey. The primary outcome was the proportion of study sites able to identify the antibody unknown in the presence of DARA.Results: All sites observed the DARA interference with the antibody screen. The DARA interference was seen with all testing methods (gel, tube, or solid phase). Using the DTT method, 25 of 25 sites (100%) successfully identified the antibody unknown in the presence of DARA. Feedback on the DTT method was positive, with 17 of 19 (90%) sites responding to the survey indicating that they planned to use the DTT method to test clinical samples from DARA-treated patients.Conclusion: The DTT method is robust and reproducible and can be implemented by transfusion services worldwide to help provide safe blood products to patients treated with DARA. [ABSTRACT FROM AUTHOR]

Importance: More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain.Objective: To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion.Evidence Review: Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes.Findings: It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dL (strong recommendation, moderate quality evidence). A restrictive RBC transfusion threshold of 8 g/dL is recommended for patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease (strong recommendation, moderate quality evidence). The restrictive transfusion threshold of 7 g/dL is likely comparable with 8 g/dL, but RCT evidence is not available for all patient categories. These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion-dependent anemia (not recommended due to insufficient evidence). Recommendation 2: patients, including neonates, should receive RBC units selected at any point within their licensed dating period (standard issue) rather than limiting patients to transfusion of only fresh (storage length: <10 days) RBC units (strong recommendation, moderate quality evidence).Conclusions and Relevance: Research in RBC transfusion medicine has significantly advanced the science in recent years and provides high-quality evidence to inform guidelines. A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued. [ABSTRACT FROM AUTHOR]

Introduction: Fresh frozen plasma (FFP) is a frequently used human blood product to reverse the effects of vitamin K antagonists. While FFP is relatively economical, its large fluid volume can lead to hospitalization complications, therefore increasing the overall cost of use.Materials& Methods: A recently published article by Sarode et al., in Circulation, described the rate of volume overload associated with FFP use for reversal of vitamin K antagonists. This condition, described as transfusion-associated circulatory overload, has a defined rate of intensive care admission, which also has a well-reported average cost. The additional monetary value of intensive care unit admission and caring for fluid overload is then compared to the cost of another product, four-factor prothrombin complex concentrates, which does not, as per the Sarode paper, result in fluid overload.Results: The increased costs attributed to FFP-associated fluid overload for vitamin K antagonist reversal partly defrays the increased upfront cost of four-factor prothrombin complex concentrates.Discussion: FFP is commonly used to acutely reverse the effects of vitamin K antagonists. However, its use requires significant time for infusion, may lead to fluid overload, and is not fully effective in compete anticoagulation reversal. One alternative therapy for anticoagulant reversal is use of prothrombin complex concentrates, which are rapidly infused, are not associated with fluid overload, and are effective in complete reversal of coagulation measurements. This should be considered for patients with acute bleeding emergencies. [ABSTRACT FROM AUTHOR]

Objectives: While many studies have demonstrated problems with informed consent in current practice, there remains controversy on how to address this. The aim of this study was to evaluate the opinions, attitudes, practices, and training for informed consent. Methods: Medical students, residents, advanced practice providers, and attending physicians at an academic institution were invited to complete a survey on informed consent for transfusions and procedures through an electronic platform. Results: Most (94%, n = 304) respondents indicated previous training in informed consent, only 60% (n = 192) felt the training was adequate, and 35% (n = 92) indicated difficulties with informed consent. When asked what would aid in obtaining consent, 59% (n = 189) selected a written guideline, and 36% (n = 117) selected patient simulation. Conclusions: Only 60% of respondents felt their informed consent training was adequate. Multiple areas of difficulty in obtaining proper informed consent were identified that should be addressed with focused training or written guidelines. [ABSTRACT FROM AUTHOR]

Background: The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients. Methods: These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Recommendation 1: The AABB recommends that platelets should be transfused prophylactically to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 109 cells/L or less to reduce the risk for spontaneous bleeding. The AABB recommends transfusing up to a single apheresis unit or equivalent. Greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective. (Grade: strong recommendation; moderate-quality evidence) Recommendation 2: The AABB suggests prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count less than 20 × 109 cells/L. (Grade: weak recommendation; low-quality evidence) Recommendation 3: The AABB suggests prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence) Recommendation 4: The AABB suggests prophylactic platelet transfusion for patients having major elective nonneuraxial surgery with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence) Recommendation 5: The AABB recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. The AABB suggests platelet transfusion for patients having bypass who exhibit perioperative bleeding with thrombocytopenia and/or evidence of platelet dysfunction. (Grade: weak recommendation; very-low-quality evidence) Recommendation 6: The AABB cannot recommend for or against platelet transfusion for patients receiving antiplatelet therapy who have intracranial hemorrhage (traumatic or spontaneous). (Grade: uncertain recommendation; very-low-quality evidence) [ABSTRACT FROM AUTHOR]

Background Hormonal status influences haemostatic factors including fibrinogen, factor VII and plasminogen activator inhibitor ( PAI-1), and concentrations differ among men, premenopausal and postmenopausal women. This study examines how phases of the menstrual cycle influence variability of fibrinogen, factor VII and PAI-1. Design We studied 103 subjects (39 premenopausal women, 18 postmenopausal women and 46 men) during three, randomized, 8-week energy- and nutrient-controlled experimental diets in the Dietary Effects on Lipids and Thrombogenic Activity ( DELTA) Study. Fasting blood samples were collected weekly during the last 4 weeks of each diet period, and haemostatic factors were quantified. Two linear mixed-effects models were used for fibrinogen, factor VII and PAI-1: one to estimate and compare group-specific components of variance, and the other to estimate additional fixed effects representing cyclical functions of day of menstrual cycle in premenopausal women. Results Systematic cyclical variation with day of menstrual cycle was observed for fibrinogen ( P < 0·0001), factor VII ( P = 0·0012) and PAI-1 ( P = 0·0024) in premenopausal women. However, the amplitude of cycling was small relative to the total magnitude of intra-individual variability. In addition, the intra-individual variance and corresponding coefficient of variation observed in premenopausal women did not differ from postmenopausal women and men. Conclusions The variability in haemostatic factors in premenopausal women is no greater than for postmenopausal women or men. Consequently, premenopausal women can be included in studies investigating haemostatic factor responses without controlling for stage of menstrual cycle. [ABSTRACT FROM AUTHOR]

Description: Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children. Methods: These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use. To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay. Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence). Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence). Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence). Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence). [ABSTRACT FROM AUTHOR]

Nonleukoreduced units of red blood cells (RBCs) contain activated platelets (PLTs) that interact with white blood cells (WBCs) and may promote inflammation and thrombosis in the recipient. The aim of this study was to characterize PLT-WBC interactions (PLT-WBC aggregates [PLAs]), WBC apoptosis, WBC death, and the development of procoagulant activity in RBCs during storage. RBCs were prepared from volunteer donor blood and stored. Samples were analyzed with flow cytometry between Days 1 and 15 to measure PLT-monocyte aggregate (PMA) and PLT-neutrophil aggregate (PNA) formation, WBC apoptosis (annexin V binding), and cell death (binding of 7-aminoactinomycin D). Procoagulant activity in the supernatant of four RBC preparations was assessed between Days 1 and 39 using a clotting assay with and without the addition of an inhibitory anti-tissue factor (TF) antibody, αTF-5. PLA formation was extensive and maximal on Day 3 of storage (PNA, 23 ± 13%; PMA, 93 ± 4%; n = 6). Apoptosis was progressive throughout storage, with 95 ± 4% of neutrophils and 73 ± 19% of monocytes binding annexin V on Day 15. Cell death became measurable after apoptosis. Procoagulant activity was observed in all RBCs but with varying temporal patterns. It was partially TF dependent and removed with high-speed centrifugation, suggestive of an association with microparticles. The activation of PLTs during the storage of RBCs induces PLA formation that precedes WBC apoptosis and death. Procoagulant activity, likely associated with microparticles derived from apoptotic WBCs, may contribute to adverse effects of stored, nonleukoreduced RBCs. [ABSTRACT FROM AUTHOR]

Background: The extent of acceptability of red blood cells (RBCs) containing additive solutions (ASs) for low-volume neonatal transfusions among hospitals is unknown. Also unknown is whether hospitals have policies that address the risk of hyperkalemia associated with prolonged storage either with or without irradiation for neonatal transfusions.Study Design and Methods: A benchmarking survey of University HealthSystem Consortium members included questions regarding the acceptability of RBC units containing ASs for low-volume neonatal transfusions, policies addressing the length of RBC storage in AS, and policies regarding storage periods after irradiation.Results: Twenty-eight of 47 respondents (60%) accept the use of at least one AS (AS-1, AS-3, or AS-5). Twenty-one (45%) accept the use of all three ASs for neonatal transfusions. Thirty-seven of 45 respondents (82%) do not have a policy requiring washing of RBCs used for low-volume transfusions beyond a specified number of days of storage or days after irradiation.Conclusions: Although the majority of institutions will use ASs, a significant number of institutions will not. The reasons for these policies were not elicited. Most respondents did not have a policy requiring washing beyond a specified number of days of storage or days after irradiation. Since RBCs stored for prolonged periods of time after irradiation have increased plasma potassium, it is important to develop policies to prevent clinically significant posttransfusion hyperkalemia in at-risk patients when RBCs are irradiated and not used immediately. More work still needs to be done to resolve these fundamental precepts of neonatal transfusion. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The 2013 AABB blood collection, utilization, and patient blood management survey report" by B. I. Whitake and colleagues.

BACKGROUND: HLAMatchmaker (HLAMM) is an algorithm that determines donor-recipient histocompatibility based on HLA type. This study determines the effectiveness of HLAMM in identifying suitable platelet (PLT) donors for refractory patients. STUDY DESIGN AND METHODS: Data from a previous prospectively randomized multicenter study comparing cross-reactive group (CREG)-matched versus serologic crossmatch-selected PLT transfusions in refractory patients were analyzed. By use of HLAMM, the compatibility of donor-recipient pairings was determined as the number of donor triplet mismatches (TMMs) and eplet mismatches (EMMs) and compared against the posttransfusion PLT corrected count increment (CCI). The data included 73 patients who received up to two CREG-matched and crossmatch-selected PLT transfusions each (214 transfusions analyzed). RESULTS: TMM and EMM values correlated well with CREG match grade. A and BU matches had TMM and EMM values of 0; BX matches had TMMs and EMMs of 4 and 6 respectively; and C and D matches had TMMs of 10 to 21 and EMMs of 13 to 24. Fewer mismatches (TMM or EMM) predicted better transfusion outcomes (p < 0.05). The median 1-hour CCI was 8000 with TMMs of not more than 9 versus 6000 with TMMs of more than 9. The median 1-hour CCI was 7954 with EMMs of not more than 11 versus 6356 with EMMs of more than 11. The positive predictive value of the different methods in producing a 1-hour CCI of more than 7500 were comparable: TMM, 56 percent; EMM, 54 percent; CREG, 50 percent; and crossmatching, 45 percent (p > 0.05). CONCLUSIONS: HLAMM (both TMM and EMM) successfully identified donors associated with good transfusion outcomes in refractory recipients and represents an acceptable method of choosing donors for refractory patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transfusion of red blood cell (RBC) preparations is independently associated with adverse clinical outcomes in patients with acute cardiovascular disease. This study was designed to define mechanisms potentially contributing. STUDY DESIGN AND METHODS: The presence of platelets (PLTs), activated PLTs (PLTs expressing P-selectin), PLT-monocyte aggregates (PMAs), and PLT-neutrophil aggregates (PNAs) was determined in vitro with the use of flow cytometry in whole blood from healthy volunteers, in RBCs, and in whole blood after adding aliquots of RBCs. Both prestorage leukoreduced and nonleukoreduced RBCs were analyzed. Nonleukoreduced RBCs were subfractionated with the use of centrifugation and filtration to obtain a RBC-free and a cell-free fraction. Formation of PMAs and PNAs was determined in whole blood after the addition of aliquots of these subfractions. RESULTS: Nonleukoreduced RBCs contained 50 ± 18 percent of the PLTs found in whole blood from healthy volunteers, and 43 ± 16 percent of the PLTs were activated. Leukoreduced RBCs contained few PLTs (0.2 ± 0.1% of volunteer blood). The majority (>60%) of white blood cells (WBCs) in nonleukoreduced RBCs were associated with PLTs. The formation of PMAs and PNAs in whole blood was increased approximately fivefold after addition of nonleukoreduced-RBCs (p < 0.0001) and by less than twofold with leukoreduced RBCs (p = 0.01). Addition of the essentially cell-free fraction of nonleukoreduced RBCs did not increase the formation of PNA or PMA in whole blood significantly. CONCLUSION: RBC preparations, particularly nonleukoreduced RBCs, contain activated PLTs and PLT-WBC aggregates and induce formation of PLT-WBC aggregates. This may be one mechanism contributing to adverse outcomes linked to transfusions in patients with cardiovascular disease. [ABSTRACT FROM AUTHOR]

The article highlights a proposal for curriculum content in blood banking and transfusion medicine education in pathology residency programs. The need to provide and elaborate a common set of rotation objectives to help residency programs ensure adequate depth and breadth of training is recommended. Three particular areas are also considered including skill levels and duration of rotation.

BACKGROUND: A reduction in postoperative length of stay (PLOS) was recently demonstrated with the use of leukoreduced (LR) blood in cardiac surgery patients compared to a historical cohort who received non-LR blood. Follow-up data are now presented in a similar population after a 12-month period in which LR blood was no longer routinely used. STUDY DESIGN AND METHODS: This is an extension of a study in which all patients admitted over a 12-month period for open heart surgery were given LR blood (Group 2) and were compared against a historical cohort given non-LR blood (Group 1). This study measures the outcomes of a new cohort of patients admitted during a 12-month period where LR blood was no longer routinely used (Group 3). RESULTS: PLOS increased in patients who received transfusions with non-LR blood (Group 3, n = 595) versus patients with LR blood (Group 2, n = 645; p = 0.045 by nonparametric rank U test). Mean PLOS increased from 9.5 days (95% confidence interval [CI], 8.9-10.0) to 10.8 days (95% CI, 10.0-11.6). In comparison, an earlier cohort who received non-LR blood (Group 1, n = 501) had a mean PLOS of 10.1 days (95% CI, 9.4-10.7). With the exception of decreased red blood cell (RBC) usage in Group 3, there were no significant differences in non-RBC blood usage, estimated blood loss, bypass time, mediastinitis rates, operative mortality rate, or overall mix of cases. CONCLUSIONS: The use of non-LR blood for cardiac surgery was associated with an increased PLOS compared to the use of LR blood and supports our previous demonstration of the benefits of LR blood in cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Hemolysis due to D incompatibility in the setting of liver transplantation is less frequent than that associated with ABO incompatibility, but can represent an equally adverse event. Approximately 10 percent of ABO-compatible liver transplants involve a D- donor and a D+ recipient.Case Report: A case of severe D incompatibility resulting from liver transplantation in a 50-year-old O Rh+ man with end-stage liver disease who received an O Rh- liver allograft is reported. A declining hemoglobin level complicated the patient's postoperative course with laboratory evidence of anti-D-mediated hemolysis. Investigations revealed that the transplanted liver was from a female O Rh- donor with detectable antibodies against D, C, and K. The severity of the hemolytic anemia was such that the patient required two separate red blood cell (RBC) exchanges and intermittent RBC transfusions over the course of almost a year. In addition to the use of RBCs negative for D, C, and K, the patient underwent a variety of B-cell suppressive therapies including glucocorticosteroids, mycophenolate mofetil, and rituximab. A normalization of hemoglobin levels and a decrease in serum bilirubin did not occur until after a splenectomy on postoperative Day 321.Conclusion: This represents the sixth and most severe case reported of hemolysis resulting from D incompatibility in liver transplantation. When unexpected serologic findings are identified in a transplant recipient, obtaining more information on the donor may help guide transfusion support. [ABSTRACT FROM AUTHOR]

Background: Proven clinical benefits of leukoreduced blood components include reduced febrile nonhemolytic transfusion reactions, alloimmunization against HLA antigens, and CMV transmission. Immunomodulatory effects of leukoreduction have also been postulated to play a significant role in the clinical outcome of open heart surgery.Study Design and Methods: A prospective case control study was implemented in which all patients admitted over a 1-year period for open heart surgery at a single hospital were given leukoreduced blood products. Clinical outcomes were prospectively measured and compared to a historical cohort of patients from the previous year when leukoreduced blood products were not routinely used.Results: A significant improvement in the mean postoperative length of stay was seen in the study group (N = 645) versus control group (N = 501; 10.1 vs. 9.5 days; p = 0.005). No significant changes were seen in the rate of mediastinitis, operative mortality, or stay in the intensive care unit. There was no difference in the postoperative length of stay among study patients who did not receive transfusion (N = 308) versus control patients who did not receive transfusion (N = 296; 6.2 vs. 6.4 days; p = 0.104).Conclusions: The use of leukoreduced blood was associated with a decrease in the postoperative length of stay in the setting of open heart surgery. The mechanisms through which these changes in clinical outcomes are generated remain unknown. [ABSTRACT FROM AUTHOR]

The authors discuss a research by C.S. Cohn within the issue on the use of platelet-rich plasma (PRP) injections to treat orthopedic conditions. Topics discussed include efficacy of PRP injections in the treatment of persistent wounds, long-bone healing and musculoskeletal soft tissue injuries, and regulation of PRP injections by the U.S. Food and Drug Administration, and lack of quality and process control in the context of autologous PRP injections.

A letter to the editor is presented in response to the article "AABB validation study of the CDC's National Healthcare Safety Network Hemovigilance Module adverse events definitions protocol" which discusses classification of blood transfusion complications using computer algorithm.

A letter to the editor is presented that discusses laboratory cases in which pregnant women were found to have antibodies directed against low-incidence antigens.