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Red blood cell (RBC) concentrates are stored in additive solutions at 4 o C for up to 42 days, whereas platelets concentrates (PCs) are stored at 22 o C with continuous agitation for up to 5 to 7 days, according national regulations, and the use or not of pathogen inactivation procedures. Storage induces cellular lesion and alters either RBC or platelet metabolism, and is associated with protein alterations. Some age-related alterations prove reversible, while other changes are irreversible, notably following protein oxidation. It is likely that any irreversible damage affects the blood component quality and thus the transfusion efficiency. Nevertheless, there still exists a debate surrounding the impact of storage lesions, for both RBCs and PCs. Uncertainty is not completely resolved. Several studies show a tendency for poorer outcomes to occur in patients receiving older blood products; however, no clear significant association has yet been demonstrated. The present short review aims to promote a better understanding of the occurrence of storage lesions, with particular emphasis on biochemical modifications opening discussions of the future advancement of blood transfusion processes. The paper is also an advocacy for the implementation of an independent international organization in charge of planning and controlling clinical studies in transfusion medicine, in order to base transfusion medicine practices both on security principles, but also on clinical evidences. [ABSTRACT FROM AUTHOR]

Résumé L’éthique est un des piliers nécessaires à la résolution des tensions qui naissent lorsque les valeurs se confrontent. Cet outil doit être au service des grands débats de la médecine, notamment de la médecine transfusionnelle ; elle ne doit pas être prise en otage des valeurs que certains imposent à ceux qui ne partagent pas leurs opinions. Tout au long de la chaîne transfusionnelle, un ensemble de valeurs se disputent, se croisent et s’affrontent. Les mots utilisés avec précision, les définitions claires et le courage de les mettre à nus, de porter un regard ouvert sur le monde avec bienveillance, c’est cet ensemble d’éléments essentiels qui caractérisaient la pensée et l’esprit d’ouverture qui animaient Jean-Jacques Lefrère lorsqu’il ouvrait les portes de l’éthique. Ethics is on the cross road of off values that are present along the ways of transfusion medicine. This is an important tool to afford opinions as well as debates that always emerge when discussing transfusion medicine. The wording is particularly important; this was one among several others that characterized the soul of Jean-Jacques Lefrère when he opened the doors of the ethical issues of transfusion medicine. [ABSTRACT FROM AUTHOR]

Résumé: Le don de sang représente un acte solidaire. Il est le plus souvent bénévole et, selon les pays et les circonstances, non rémunéré. Les éléments de la réflexion éthique sont, entre autres, l’augmentation des besoins, les critères d’exclusion de plus en plus nombreux, l’exigence sécuritaire et les modifications des structures de nos sociétés. Compte tenu de cela, les acteurs de la chaîne transfusionnelle doivent s’interroger sur certains paramètres : la valeur du don, le sens du bénévolat, l’opportunité de rémunérer l’acte de livrer une partie de soi, non plus comme un don et comme une expression d’altruisme et de solidarité, mais comme une prestation commerciale définie par des règles économiques. [ABSTRACT FROM AUTHOR]

Background and Objectives Microparticles (MPs) are small phospholipid vesicles of less than 1 µm, shed in blood flow by various cell types. These MPs are involved in several biological processes and diseases. MPs have also been detected in blood products; however, their role in transfused patients is unknown. The purpose of this study was to characterize those MPs in blood bank conditions. Materials and Methods Qualitative and quantitative experiments using flow cytometry or proteomic techniques were performed on MPs derived from erythrocytes concentrates. In order to count MPs, they were either isolated by various centrifugation procedures or counted directly in erythrocyte concentrates. Results A 20-fold increase after 50 days of storage at 4°C was observed (from 3370 ± 1180 MPs/µl at day 5 to 64 850 ± 37 800 MPs/µl at day 50). Proteomic analysis revealed changes of protein expression comparing MPs to erythrocyte membranes. Finally, the expression of Rh blood group antigens was shown on MPs generated during erythrocyte storage. Conclusions Our work provides evidence that storage of red blood cell is associated with the generation of MPs characterized by particular proteomic profiles. These results contribute to fundamental knowledge of transfused blood products. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyse the transfusion-related events recorded in a general university hospital.The method we used was retrospective analysis of the data collected between 1999 and 2003.The incidence of transfusion reactions (n = 394) was 4·19 per 1000 blood products distributed: 59% (n = 231) were febrile non-haemolytic transfusion reactions; 22% (n = 88) were caused by allergy; 5% (n = 21) were caused by bacterial infection; and 14% (n = 54) were classified as other reactions. Platelet concentrates gave rise to a significantly greater number of reactions than erythrocyte concentrates and fresh-frozen plasma. Transfusion errors and near-miss events were also observed and were analysed separately. A series of transfusion-related events, such as haemosiderosis, metabolic disturbances or volume overload, were not reported.Our experience prompts us to propose a more comprehensive classification and codification of transfusion-related events. [ABSTRACT FROM AUTHOR]

summary. The aim of this study is to describe a newly implemented haemovigilance system in a general university hospital. We present a series of short cases, highlighting particular aspects of the reports, and an overview of all reported incidents between 1999 and 2001. Incidents related to transfusion of blood products were reported by the clinicians using a standard preformatted form, giving a synopsis of the incident. After analysis, we distinguished, on the one hand, transfusion reactions, that are transfusions which engendered signs or symptoms, and, on the other hand, the incidents where management errors and/or dysfunctions took place. Over 3 years, 233 incidents were reported, corresponding to 4·2 events for 1000 blood products delivered. Of the 233, 198 (85%) were acute transfusion reactions and 35 (15%) were management errors and/or dysfunctions. Platelet units gave rise to statistically (P < 0·001) more transfusion reactions (10·7‰) than red blood cells (3·5‰) and fresh frozen plasma (0·8‰), particularly febrile nonhaemolytic transfusion reactions and allergic reactions. A detailed analysis of some of the transfusion incident reports revealed complex deviations and/or failures of the procedures in place in the hospital, allowing the implementation of corrective and preventive measures. Thus, the haemovigilance system in place in the ‘Centre Hospitalier Universitaire Vaudois, CHUV’ appears to constitute an excellent instrument for monitoring the security of blood transfusion. [ABSTRACT FROM AUTHOR]

Blood is apart from the rest of the tissues as this fluid is overseen by basic and applied life and humanistic sciences. Blood is the essence of human functioning. It is the object of one of the most commonly known cancers, leukemia. It is life-saving in transfusion – a property that also gives blood a special credit and questions blood as a valuable merchandise or as no ones' property but common good. But blood is also scandalous after the tainted blood affair in the 1980s and 1990s. Blood is further inseparable from most religious practices, both forefront and hidden (magic cults). It is frightening as it is versed in legitimate and illegitimate combats; it is poured to compensate offenses or debts in many civilizations. Any time blood comes forefront, rationale science leaves it to irrational digressions. Even the very same life-saving transfusion, is beaten by groups of opponents on religious grounds. Further, at a time blood cells and molecules are scrutinized, no one can claim having a complete understanding of what blood is, off the vasculature, as – to study it – one has to alter it. The study of blood is fascinating for all colleges of an academy and not many topics can share this property: chemists, physicists, geneticists, physiologists, medical doctors, philosophers, ethicists, theologians, artists, historicists, anthropologists, sociologists, etc. have all contributed to depict different, specific, aspects of blood. The present review aims at merging different aspects of blood to give pathophysiologists a platform to better understand fears and hopes related to this special tissue, when dealing with patients of theirs. [ABSTRACT FROM AUTHOR]

Abstract Transfusion has become extremely safe but can still be associated with adverse reactions. Some adverse reactions can be mitigated by applying measures to donor selection, the process of separating blood components as well as hospital-based procedures consisting in matching the donor and the recipient; special attention is given to optimizing the best fit between the component and the beneficiary, which is not only an immuno-hematological challenge (fresh versus old blood, testing for certain viruses such as CMV, parvovirus B19, etc.). Considerable progress has also been achieved to strengthen the overall quality and safety of the whole transfusion chain. Guidelines and recommendations have resulted in substantial progress, and the recent revisiting of patients as part of a more holistic approach has enabled blood management programs to be created. Such programs, when wisely applied in a context of optimal blood use, reinforce patient safety; they enhance hospital recognition of transfusion and hemovigilance specialists as useful players acting in the interests of patients in full compliance with hospital budgets. This review considers the step-by-step processes that reinforce transfusion safety and identifies hurdles that cannot yet be properly addressed; it proposes steps for further progress, in light of personalized medicine. [ABSTRACT FROM AUTHOR]

Abstract Plasma for direct therapeutic use is a fast-evolving blood component in terms of its production and presentation. More than a dozen forms are available worldwide, which is often overlooked since most countries apply policies making only one or very few forms available for treating patients in need. It is most often reserved for the same three clinical indications, i.e. overall clotting-factor deficiency, reversal of vitamin K antagonists in the context of active bleeding or prior to urgent surgery, and therapeutic plasma exchange. The level of evidence is often less robust than generally acknowledged for such major indications while novel indications are tending to emerge in medical and trauma settings. This short review explores classical views and new prospects opened up by novel presentations and statuses for therapeutic plasma. [ABSTRACT FROM AUTHOR]

Résumé Une discussion autour du thème du non-profit, l’un des piliers majeurs du don (de sang) dit éthique, a fait l’objet d’un séminaire en novembre 2016 à Paris. Ce principe est intimement lié à celui du bénévolat, bien que les deux notions soient distinctes, la première s’adressant davantage aux institutions et la seconde aux individus, mais il est aussi communément entendu que les individus ne sont pas appelés à obtenir un profit de leur don, quand bien même ils seraient bénévoles puisque des formes de bénévolats rémunérés ou compensés existent. Le non-profit est une notion essentielle car il se réfère au caractère de « bien public » du sang en tant que ressource pouvant faire l’objet d’un partage solidaire ; un des questionnements les plus actuels est lié à la capacité— ou non —des secteurs exclusivement publics à assurer la couverture en produits sanguins en particulier médicamenteux (fractions dérivées du plasma) capables de répondre à tous les besoins sans qu’ils aient besoin d’avoir recours au système privé à but lucratif. The not-for-profit issue has been debated in November 2016 in Paris; this issue is one of the four canonical pillars of ethical blood donation. It is intimately bound to benevolence though it is distinct, as not-for-profit calls for institutions while benevolence calls for individuals. It is indeed intended that voluntary blood donors do not benefit from their donation and are thus non-remunerated. Not-for-profit is essential since it refers to the public character of blood as a putative public resource aimed at being shared as a tribute of solidarity. A central question however is linked to the capacity— or not —of public sectors to ensure that blood components are universally available, with special mention to plasma derived drugs, without the contribution of the for profit, private sector. [ABSTRACT FROM AUTHOR]

Résumé Le volontariat est l’un des quatre grands principes éthiques du don de sang, consacré par l’usage mais pas par la législation. De plus, à l’heure du « marketing », nécessaire pour l’atteinte des objectifs non seulement quantitatifs mais aussi qualitatifs de la collecte, des messages sont adressés aux donneurs de sang qui pourraient altérer stricto sensu la notion de volontariat. Ce séminaire – partie d’une série de séminaires en éthique transfusionnelle – avait pour objectif de discuter de la notion de volontariat au don de sang et de sa fragilité, en faisant appel à d’autres expériences que le don de sang, et en invitant des spécialistes de nombreuses disciplines des sciences médicales, humaines et juridiques à en débattre. Voluntariness stands for one of the four pillars of ethics in blood donation; it is, however, more related to tradition than to legislation. Because it seems necessary to apply “marketing” techniques to blood collection in order to meet the needs in blood components, both in terms of quantity and quality, one wonders if this may be at the expense of this principle of voluntariness. This seminar–belonging actually to a series of seminars in Ethics in Transfusion Medicine–aimed at questioning the possible weakness of voluntariness in the field of blood donation. To achieve this goal, specialists of numerous disciplines in medical sciences, law and humanities gathered to discuss all related issues to voluntariness in blood donation. [ABSTRACT FROM AUTHOR]

The current issues debate brings together experts around the themes of self-sufficiency (in its national and European aspects) and of needs in cellular blood products. The point of view of the manufacturer and prescribers of blood products are confronted. [ABSTRACT FROM AUTHOR]