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Introduction: In this report, we describe a training program in emergency whole blood collection and transfusion for medical students at the University of Bergen. The overall aim of the program is to improve the availability of early balanced blood transfusion for the treatment of patients with life-threatening bleeding in rural health care services., Study Design and Methods: The voluntary training program provides the knowledge needed to practice emergency whole blood transfusions and understand the system for emergency whole blood collection in the framework of a civilian walking blood bank (WBB). It includes theoretical and practical sessions. In-person teaching and web-based learning resources are provided. An anonymous survey of the students attending the training course in the autumn of 2022 and spring 2023 was performed., Results: 128 of 178 students participated in the practical training. 88 of 128 (69%) responded to the survey. 82 (93%) performed blood typing, 71 (81%) performed donor interviews, 61 (69%) partially performed whole blood collection (up to blood in bag) and 27 (30%) participated in complete whole blood collection and performed autologous reinfusion. No complications occurred during training. The students reported that the training course increased their understanding of how to ensure access to emergency blood transfusion by the use of a WBB., Discussion: Structured theoretical and practical training in emergency whole blood collection and emergency transfusion is feasible and of interest to medical students. A multidisciplinary approach to student training in emergency whole blood collection and transfusion should be considered., (© 2023 AABB.)

Background: Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use., Study Design and Methods: Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff., Results: Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1-35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion., Discussion: The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding., (© 2021 The Authors. Transfusion published by Wiley Periodicals LLC. on behalf of AABB.)

Early identification of sepsis followed by diagnostic blood cultures and prompt administration of appropriate intravenous antibiotics covering all likely pathogen remains the corner stone in the initial management of sepsis. Source control, obtained by harvesting microbiological cultures and removal or drainage of the infected foci, is mandatory. However, optimization of hemodynamically unstable patients including volume support supplemented with vasopressor, inotropic and transfusion of red blood cells (RBCs) in case of persistent hypoperfusion have the potential to reduce morbidity and mortality. Given the imbalance between the ability of the cardiovascular system to deliver enough oxygen to meet the oxygen demand, transfusion of RBCs should theoretically provide the ideal solution to the challenge. However, both changes in the septic patients' RBCs induced by endogenous factors as well as the storage lesion affecting transfused RBCs have negative effects on the microcirculation. RBC morphology, distribution of fatty acids on the membrane surface, RBC deformability needed for capillary circulation and the nitrogen oxide (NO) signaling systems are involved. Although these deteriorating effects develop during storage, transfusion of fresh RBCs has not proven to be beneficial, possibly due to limitations of the studies performed. Until better evidence exists, transfusion guidelines recommend a restrictive strategy of RBC transfusion i.e. transfuse when hemoglobin (Hb)<7g/dL in septic patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Information about patient survival after transfusion of multiple blood volumes is limited, and most reports have focused on trauma patients., Study Design and Methods: Retrospective study of blood use and survival at 11 hospitals in six nations between 2009 and 2013. Ultramassive transfusion (UMT) was defined as transfusion of 20 or more red blood cell (RBC) units over the course of any 2 consecutive calendar days., Results: A total of 1975 patients received UMT and a representative sample of 1360 patients was studied in detail. Patients were grouped into seven diagnostic categories: solid organ transplantation (n = 411), cardiac or major vascular surgery (n = 317), general surgery (n = 228), trauma (n = 221), general medicine (n = 124), obstetrics (n = 23), and other (n = 36). During the 7 days after initiation of UMT, these patients used more than 120,000 blood components. The median (interquartile range) blood use was 35 (26-50) RBC units, 30 (20-47) plasma units, and 7 (4-13) platelet doses. Five- and 30-day survival significantly declined with increasing RBC use. Overall survivals of patients receiving UMT were 71% (5 day) and 60% (30 day), and in the subset of 165 patients receiving 60 or more RBC units over 2 consecutive days, 5-day survival was 54% ranging from 17% (trauma) to 75% (solid organ transplant). The decline in survival with increasing RBC transfusions was minimal for patients undergoing solid organ transplantation and was most pronounced for trauma and nonsurgical bleeding patients., Conclusion: Trauma was not the leading cause of UMT. Increasing RBC requirements were significantly associated with decreasing survival. However, survival was more strongly associated with diagnostic category than total RBCs transfused, with highest survival rates in solid organ transplant surgery., (© 2015 AABB.)

Toward the end of World War I and during World War II, whole-blood transfusions were the primary agent in the treatment of military traumatic hemorrhage. However, after World War II, the fractionation of whole blood into its components became widely accepted and replaced whole-blood transfusion to better accommodate specific blood deficiencies, logistics, and financial reasons. This transition occurred with very few clinical trials to determine which patient populations or scenarios would or would not benefit from the change. A smaller population of patients with trauma hemorrhage will require massive transfusion (>10 U packed red blood cells in 24 h) occurring in 3% to 5% of civilian and 10% of military traumas. Advocates for hemostatic resuscitation have turned toward a ratio-balanced component therapy using packed red blood cells-fresh frozen plasma-platelet concentration in a 1:1:1 ratio due to whole-blood limited availability. However, this "reconstituted" whole blood is associated with a significantly anemic, thrombocytopenic, and coagulopathic product compared with whole blood. In addition, several recent military studies suggest a survival advantage of early use of whole blood, but the safety concerns have limited is widespread civilian use. Based on extensive military experience as well as recent published literature, low-titer leukocyte reduced cold-store type O whole blood carries low adverse risks and maintains its hemostatic properties for up to 21 days. A prospective randomized trial comparing whole blood versus ratio balanced component therapy is proposed with rationale provided.

The Blood Far Forward (BFF) research program was established to conduct blood product efficacy and safety studies, donor performance studies, and research on optimal training methods to improve the safety of blood collection and transfusion performed by Norwegian Naval Special Operation Commando soldiers. The use of intravenous fluids for volume replacement during hemorrhagic shock is controversial, but it is currently the standard of care. In the far-forward environment, large volume resuscitation for massive bleeding is a great challenge. Crystalloid and colloid solutions add weight and bulk to the medic's kit, require temperature sensitive storage, and should be warmed before infusion to prevent hypothermia. Excessive use of these solutions causes a dilutional coagulopathy, acidosis, and potentially increased inflammatory injury compared with blood products. Type-specific whole blood from an uninjured combat companion on the other hand is almost always available. It is warm, replaces intravascular volume, and provides oxygen delivery and hemostatic capacity to prevent or treat shock and coagulopathy. Whole blood may be ideal for the resuscitation of combat casualties with hemorrhagic shock. BFF program pilot studies on use of platelet-sparing leukoreduction filters, whole blood transport tolerance, donor performance, and autologous reinfusion of 24-hour ambient temperature stored whole blood have been performed and suggest the feasibility of expanding whole blood use in resuscitation. If successful, the BFF program will change tactics, techniques, and procedures with a new lifesaving capability., (© 2013 American Association of Blood Banks.)

Background: One of the most frequent causes of transfusion-associated morbidity or mortality is the transfusion of the wrong blood to the wrong patient. This problem persists in spite of the incorporation of numerous procedures into the pretransfusion checking process in an effort to improve patient safety. A qualitative study was undertaken to understand this process from the perspective of those who administer blood products and to identify concerns and suggestions to improve safety., Study Design and Methods: Twelve focus group discussions and seven individual interviews were conducted at six hospitals in five countries (n = 72 individuals). Health care professionals from a variety of clinical areas participated. Data analysis identified common themes using the constant comparison method., Results: Five major themes emerged from the analysis: the pretransfusion checking process, training, policy, error, and monitoring. Findings include the following: staff were aware and appreciative of the seriousness of errors and were receptive to continuous monitoring, the focus was on checking the bag label with the paperwork rather than the bag label with the patient at the bedside, training methods varied with most perceived to have minimal effectiveness, and access to policies was challenging and keeping up to date was difficult. Other factors that could contribute to errors included high volume of workload distractions and interruptions and familiarity or lack of familiarity with patients., Conclusions: Multiple factors can contribute to errors during the pretransfusion checking limiting the effectiveness of any individual intervention designed to improve safety. Areas of further research to improve safety of blood administration were identified., (© 2012 American Association of Blood Banks.)

Background: In 2007, previous syphilis infection was diagnosed in a blood donor who had given blood regularly for 15 years. This was discovered when the donor was tested for syphilis, as a new donor in another blood bank. The time of infection is unknown. An expert group, set up by The Norwegian Directorate of Health, was commissioned to evaluate the risk of syphilis transmission through blood products in Norway., Material and Methods: The expert group based its evaluation on the epidemiology of syphilis, risk of infection and properties of the syphilis bacterium, especially in relation to blood donation. Specific information about the actual incident, made available by the Norwegian Directorate of Health, was also evaluated., Results: Of 54 blood recipients 21 were alive and 18 (86 %) were tested for syphilis, all with a negative result. For 11 deceased the hospital records were studied without discovering signs of syphilis infection., Interpretation: The risk of transfusion-transmitted syphilis is low for several reasons: The prevalence of syphilis in the population is low, a compulsory interview and completion of a questionnaire before donation in Norway excludes patients who are ill or at risk of being infected; the proportion of fresh blood donations is very low and syphilis bacteria die quickly during normal storage conditions for blood. An incidental infection is symptomatic and easily treated by antibiotics. The expert group recommends to not start syphilis testing of each blood donor but to continue the present routine testing of new donors.

Unfortunately, transfusion errors continue to pose a major clinical problem. In practice there is a remarkable lack of understanding of the reasons behind transfusion medicine, a worrying disregard for protocol and an offhand attitude to bedside checking. Clearly transfusion medicine education, as often said, must be more extensively incorporated into the core curriculum of medical, nursing and laboratory staff. In this immunological case report, following accurate pre-transfusion procedures and routine laboratory testing, we highlight, once more, that it would be better for the patient to rely on proper bedside checking rather than on their own immune system in order to avoid serious side effects related to transfusions. Albeight this case we had "a happy ending", we must always bear in mind that one cannot compromise on safety and the quality care of patients., ((c) 2010 Elsevier Ltd. All rights reserved.)

Background: In patients scheduled for major orthopedic surgery, the presence of anemia before surgery can preclude the transfusion requirements. Iron deficiency anemia is believed to be a major cause of anemia, especially in the elderly. The importance of screening patients undergoing major orthopedic surgery in Norway for anemia and iron deficiency has not been investigated. The aim of the present study was to investigate if preoperative testing of iron status could predict transfusion requirement related to major elective orthopedic surgery., Material and Methods: Retrospective and prospective investigations were carried out on patients undergoing major elective orthopedic surgery on knee and hip arthroplasty. Patients were screened for hemoglobin, hematocrit, CRP and iron status (s-ferritin, s-iron, s-total iron binding capacity) before surgery. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 15.0., Results and Interpretation: There was no correlation between the iron status before surgery and the need for transfusion during and after surgery, although anemia before surgery was a predictor for the need for transfusion. Based in our limited study we could not recommend iron status screening before surgery. However further studies are needed to truly establish the incidence and the underlying etiology, in order to reduce the transfusion requirements.

Background: Transfusion of the incorrect blood component is a frequent serious incident associated with transfusion and often involves misidentification of the patient and/or the unit of blood. The objective of this study was to assess the effect of a simple intervention designed to improve performance of the bedside check and to observe the durability of any effect. The intervention was a tag on blood bags reminding staff to check the patient's wristband. The tag was positioned in such a way that the transfusionist was required to remove the tag to spike the unit., Study Design and Methods: The intervention was tested in a multicenter cluster-randomized controlled trial incorporating short-term and long-term follow-up periods. The primary endpoint was the proportion of patients transfused with red cell units for whom the key elements of the bedside check were all correctly completed., Results: Fifteen matched-paired clinical areas at 12 participating hospitals in six countries were included in the trial. Combining data from all participating hospitals, the bedside check was correctly performed in 37 percent of transfusions during the baseline audit period. There was no evidence of a favorable effect of the intervention immediately after its introduction (pooled odds ratio, 1.09; 95% confidence interval, 0.54-2.17). There was similarly no evidence of a favorable effect after continued use of the intervention for an additional 8 weeks., Conclusions: A simple intervention in the form of a barrier warning label on blood bags reminding staff to check the patient's wristband failed to improve bedside transfusion practice. The robust study design developed for this study could be applied to investigate other interventions to improve the safety of bedside transfusion practice.

The Norwegian guidelines for transfusion are harmonised in terms of standards with the European directives, but we have two areas where there are substantial differences. First, in Norway a blood donor is defined as a patient in legal terms. Secondly, we have stricter criteria for geographical origin of the people who are allowed to donate blood than most other countries. It is a challenge to provide information stating that these guidelines are related to the risk of transmitting infectious disease rather than discrimination. Increased focus on hemovigilance and closer contact between the blood banks and the national health authorities will be major issues in future work to improve the quality of Transfusion Medicine in Norway.

Background: In warm autoimmune haemolytic anaemia, patients have red cell autoantibodies that complicate the serological compatibility testing before transfusion. Different autoadsorption techniques are utilised for more extensive pretransfusion testing. We reviewed the literature on blood transfusion in these patients. We also present our experience with autoadsorption by papain and polyethylene glycol methods., Material and Methods: Blood samples from 13 patients with warm autoantibodies were analysed in parallel. After autoadsorption, antibody screening and identification tests were performed to detect possible red cell alloantibodies. If the serological testing is inadequate, clinically important alloantibodies can be ignored before transfusion, which can lead to haemolytic transfusion reactions., Results: Autoantibodies were completely adsorbed in six of the 13 patients. In five, alloantibodies were detected. In three patients, different results were obtained with the two different techniques., Interpretation: Restrictive transfusion practice in warm autoimmune haemolytic anaemia is recommended. Adequate pretransfusion testing in a specialised laboratory is required before transfusion. Autoadsorption with polyethylene glycol and papain can supplement each other in pretransfusion testing.

Background: When a transfused patient develops multiple or weak blood group antibodies, posttransfusion phenotyping is useful in antibody identification. To perform a correct phenotyping after transfusion, isolation of autologous red cells is necessary. However, mature autologous red cells are impossible to separate from their donor counterparts. Since the proportion of autologous reticulocytes compared to donor reticulocytes increases rapidly after transfusion, selective isolation of reticulocytes provides autologous cells for antigen typing., Study Design and Methods: Extensive phenotyping was performed on red cells from 10 surgical patients before transfusion and on red cells and reticulocytes after the transfusion of 5 or more red cell units. Reticulocytes were isolated by using an antibody against the human transferrin receptor coupled to magnetic beads., Results: The data showed nearly full agreement between pretransfusion phenotyping of red cells and posttransfusion typing of reticulocytes. Correct phenotyping of transferred patients could be obtained 8 to 10 hours after transfusion using isolated reticulocytes., Conclusion: This method is helpful in selecting compatible blood when patients have developed antibodies and have an urgent need for further transfusions.

SUMMARY Background and Objective: Although several studies focus on red blood cell (RBC) alloantibody distribution in selected patient populations, few address the specificity and frequency in all relevant groups. This study reports alloantibody frequency, distribution and the relationship to age and gender in blood donors, pregnant women and potential recipients of blood products. Methods: This historical cohort study included 55 462 consecutive antibody screening tests from a tertiary Western Norwegian Hospital. Descriptive statistics were performed, and the results were compared with the literature. Results: The detection and immunisation frequency for the whole cohort were 0·39 and 0·51%, respectively, whereas the RBC alloantibody prevalence was 0·73%. The most frequent RBC alloantibodies were anti‐E (20·1%), anti‐M (18·7%), anti‐K (9·8%), anti‐D (8·9%) and anti‐Fy(a) (7·0%). In pregnant women, the most frequent RBC alloantibodies were anti‐M, anti‐D and anti‐Le(a) (20·8, 18·9 and 18·9%, respectively), whereas there was no anti‐K detected. Anti‐E and anti‐M were the dominating RBC alloantibodies in the pre‐transfusion testing of in‐hospital patients (24·1 and 17·1%, respectively). Eighteen (9·2%) persons in the total cohort had two RBC alloantibodies, six persons had three alloantibodies, and two persons had four alloantibodies. Rh and K typing to prevent future immunisations was only performed in 21·0% of the individuals who presented with a new alloantibody; despite that, 50·5% of the detected alloantibodies had such specificities. Conclusions: The immunisation frequency and the level of anti‐K are low compared to national and international studies. Rh and K phenotype‐matched blood transfusions might be a feasible future strategy to further decrease RBC alloantibodies. [ABSTRACT FROM AUTHOR]

SUMMARY: Objectives: To describe the change in massive transfusion (MT) practice in a single Norwegian centre throughout the period 2002–2015. Background: MT support for traumatic haemorrhage has changed since the mid‐2000s. However, life‐threatening haemorrhage may occur in other clinical specialties. In 2007, Haukeland University Hospital (HUS) introduced a universal MT programme including education, Acute Transfusion Packages (ATPs) and thromboelastography. Methods/Materials: A retrospective review was performed of all MT episodes defined as ≥10 red cell concentrates (RCC) in 24 h. Episodes were identified using the laboratory information system. Patient records were reviewed manually for demographics, transfusion indication, haemostatic drugs and mortality. The ATPs contained six units RCC, six units Octaplas and two platelet concentrates (four buffy coats/apheresis in platelet additive solution (PAS)). Results: A total of 410 episodes were identified in 410 patients. The mean patient age was 60 years (9–94), with a male predominance (64%); 87·1% of MT episodes were in support of surgery (cardiac services 42·7%; trauma 17·6%), and 29·8% of MTs involved platelet inhibitors, with 82·6% of these undergoing cardiac procedures. MT accounted for 2·8% of all RCCs and 3·4% of platelets issued. The mean ratio of blood components RCC: plasma: platelets changed from 1·0 : 0·37 : 0·39 in 2002–2006 (n = 149) to 1·0 : 0·79 : 0·85 in 2008–2015 (n = 241, P < 0·001). A sub‐analysis showed that cardiac specialities used proportionally more plasma and platelets. Conclusion: The MT programme changed transfusion practice, resulting in greater use of plasma and platelets. MT was primarily used in major surgery. The practice in cardiac surgery may reflect changes in antiplatelet medication. [ABSTRACT FROM AUTHOR]

The success of whole blood transfusion in military operational settings has engaged a debate on reintroduction of cold-stored whole blood in treatment of critical bleeding in civilian health care. The haemostatic function of platelets stored cold at 4°C has however been questioned. In this review, we discuss the effects of cold storage on platelets, whether stored in whole blood or as platelet concentrates. Cold storage of platelets was abandoned during the 1970s due to reduced circulation time. Haemostatic superiority of cold-stored platelets was however suggested. In vitro studies show reduced risk of bacterial contamination and equal or superior haemostatic qualities in cold-stored platelet concentrates when evaluated by metabolic measures and aggregation response. Data on cold-stored platelet concentrates from thrombocytopenic patients and healthy volunteers indicate improved platelet aggregation and reduced bleeding. A randomized controlled trial in paediatric patients undergoing cardiac surgery, showed reduced blood loss and improved platelet aggregation responses after transfusion with whole blood stored cold for up to 48 h, and platelets stored cold within whole blood for up to 15 days provide similar post-storage platelet viability as platelet concentrates or apheresis platelets stored for less than 3 days. Animal studies also suggest efficacy of cold-stored platelets. A study investigating the effects of cold-stored apheresis platelets in patients undergoing cardiothoracic is currently being performed in Bergen, Norway showing promising results. We conclude that in vitro and clinical studies indicate that cold-stored platelets may be beneficial in treatment of critical bleeding. [ABSTRACT FROM AUTHOR]

Background and Objectives A photochemical treatment process ( PCT) utilizing amotosalen and UVA light ( INTERCEPT™ Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components ( PCT- PLT) administered across a broad patient population. Materials and Methods This open-label, observational haemovigilance programme of PCT- PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events ( SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT- PLT transfusion. Results Over the course of 7 years in the study centres, 4067 patients received 19 175 PCT- PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0·6%) were classified an acute transfusion reaction ( ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0·4%) and urticaria (41, 0·2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0·1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT- PLT. Conclusion This longitudinal haemovigilance safety programme to monitor PCT- PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components. [ABSTRACT FROM AUTHOR]

Red blood cell concentrates (RCCs) are the major blood component transfused to patients. There is a great variability in patient response, depending on both the patient's blood volume and haemoglobin content in the RCC. Standardisation of transfusion practice is needed to improve the prediction of patient outcome. We hypothesise that labelling of RCCs with haemoglobin content will add possibilities for the standardisation of transfusion practice. Data from multiple international transfusion services regarding haemoglobin content and weight or volume of RCC were collected and analysed. We demonstrate a strong and highly significant correlation between haemoglobin content with both weight and volume of the RCCs. A linear regression model was used to assess these relationships, and it demonstrates how haemoglobin content can be estimated for different cell production processes. We recommend the use of weight or volume of the RCCs as the basis of estimating haemoglobin in the RCC and postulate that this can be used in future studies to explore the effects of a haemoglobin dose-based transfusion system. As the weight - and sometimes the volume - of the blood bag is easily accessible, in contrast to direct haemoglobin measurements from each individual unit, this method is feasible and simple. [ABSTRACT FROM AUTHOR]

Background and Objectives Red blood cell concentrates (RBCs) are the major blood component transfused. Although the haemoglobin content is variable, the transfusion dose is prescribed as units of red cell concentrates. Thus, by chance, large volume patients may receive a low haemoglobin dose and low volume patients may be transfused with haemoglobin-rich RBCs. The aim of this study was to evaluate whether the haemoglobin increment (grams per litre) in the patient can be predicted from the haemoglobin dose (in grams) transfused, with and without correction for estimated blood volume. If this is true, it may be possible to achieve the predicted transfusion outcome by selecting RBCs for each patient. Materials and Methods Haemodynamically stable patients scheduled for day treatment with transfusion of RBCs were recorded. A total of 52 transfusions episodes, 27 for women and 25 for men, were recorded. Blood volumes were estimated, haemoglobin content in the RBCs was measured before transfusion, and pre- and post-transfusion haemoglobin concentrations were obtained. Results The haemoglobin content of the RBCs prepared for transfusion showed a wide range, varying from 38·7 g/unit to 69·0 g/unit. There were statistically significant correlations between haemoglobin concentration in the RBCs and haemoglobin increment in patients. Conclusion Post-transfusion increment in circulating haemoglobin can be predicted from the haemoglobin content of transfused cells, but knowledge of the patient’s blood volume improves the accuracy of prediction. It may be feasible to select the high haemoglobin content RBC for patients with largest blood volume and vice versa. [ABSTRACT FROM AUTHOR]

Background and Objectives The impact of a poor iron status on the difficulties to keep recruitment of new donors at pace with the ongoing increased demand for blood transfusions was studied by comparing the iron status of new donors recruited in 1993–1997 and in 2005–2006. Materials and Methods Iron status was defined by haemoglobin and serum ferritin. Inclusion criteria for approving new donors were haemoglobin ≥ 12·5 g/dl for women and ≥ 13·5 g/dl for men, and serum ferritin > 15 µg/l for both genders. Data were gathered retrospectively from 943 subjects (55% women) in the 1990 ties and prospectively from 1013 subjects (63% women) 10 years later. Results In women, there was a significant fall in haemoglobin and serum ferritin mean values from 13·2 to 13·1 g/dl and from 30·9 to 26·9 µg/l, respectively. Rejection due to low haemoglobin was significantly increased from 14% to 24%. In men, there were minor changes that did not affect rejection rates. Conclusion Iron status of women who want to serve as blood donors has deteriorated in the last 10 years, leading to an increased rejection due to haemoglobin below the inclusion criterion for blood donors. [ABSTRACT FROM AUTHOR]

Background: Reactions after a blood transfusion could be allergic because of passive transfer of immunoglobulin E (IgE) antibodies from allergic donors. Aims of the study: To compare spectrum and prevalence of IgE antibodies in blood donors from Sweden and Norway. Methods: Using the ImmunoCAP method, serum samples from 1002 blood donors from Sweden and 500 from Norway were analysed for IgE antibodies to common inhalant and food allergens and allergens common in a hospital environment, such as penicilloyl G and latex. Results: As many as 23.6–27.3% of the donors had IgE antibodies to at least one of the 14 allergens tested. Of these 6.8–16.7% had extremely high concentrations, i.e. >35 kUA/l corresponding to 100 times the cut-off for a positive allergy test. Most donors were sensitized to pollens, dander and mite but several had very high levels of IgE antibodies to penicilloyl G, latex and peanut. The pattern of sensitizing allergens differed between Sweden and Norway. Conclusions: High serum levels of IgE antibodies to various allergens are common among blood donors and the degree of sensitization and spectrum of involved allergen varies between geographical regions. Present routines to identify IgE sensitized, potential risk, donors are not satisfactory; the sensitivity of selection procedures is about 25%. [ABSTRACT FROM AUTHOR]