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Background Methods Results Conclusion Production of platelet concentrates (PCs) involves several steps that significantly affect platelet behavior. To gain a deeper understanding of how storage conditions impact donor platelet recirculation and functionality post‐transfusion, ex vivo platelet labeling is a feasible approach. However, before pursuing clinical investigations of platelet recirculation and function in humans, we aimed to determine the effects of pathogen inactivation technology (PIT) and storage conditions (4°C vs. room temperature [RT]) on phenotype and function of biotinylated platelets compared to conventional PIT PCs for transfusion.Nine PCs were prepared in 61% additive solution from 45 buffy coats (five buffy coats each). A pool‐and‐split of three units was used to prepare three equivalent PCs: two labeled with biotin and stored at RT or 4°C, and one without labeling and stored at RT. All PCs were then treated by PIT (amotosalen/UVA) and stored for 14 days. Labeling efficiency, platelet concentration, metabolic parameters, aggregation response (ADP, collagen, co‐aggregation with epinephrine), and platelet phenotype (CD42b, CD62‐P, phosphatidylserine) at the basal stage and upon stimulation (ADP or TRAP‐6) were performed.Labeling efficiency of PIT and 4°C PCs was stable over 14 days of storage. Differences in platelet function and phenotype were mainly due to the storage temperature and not the biotinylation process. Phenotypes at baseline or after stimulation were equivalent in biotin‐positive and biotin‐negative platelets.Biotin‐labeled platelets can effectively enable investigation of the effects of PIT and storage temperature for clinical studies. This method shows great potential for improving platelet transfusion knowledge. [ABSTRACT FROM AUTHOR]

Objectives Cryoprecipitated antihemophilic factor (cryo) has been used for fibrinogen replacement in actively bleeding patients, dysfibrinogenemia, and hypofibrinogenemia. Cryo has a shelf life of 4 to 6 hours after thawing and a long turnaround time in issuing the product, posing a major limitation of its use. Recently, the US Food and Drug Administration approved Pathogen Reduced Cryoprecipitated Fibrinogen Complex (INTERCEPT Fibrinogen Complex [IFC]) for the treatment of bleeding associated with fibrinogen deficiency, which can be stored at room temperature and has a shelf life of 5 days after thawing. Methods We identified locations and specific end users with high cryoprecipitate utilization and waste. We partnered with our blood supplier to use IFC in these locations. We analyzed waste and turnaround time before and after implementation. Results Operative locations had a waste rate that exceeded nonoperative locations (16.7% vs 3%) and were targeted for IFC implementation. IFC was added to our inventory to replace all cryo orders from adult operating rooms, and waste decreased to 2.2% in these locations. Overall waste of cryoprecipitated products across all locations was reduced from 8.8% to 2.4%. The turnaround time for cryoprecipitated products was reduced by 58% from 30.4 minutes to 14.6 minutes. Conclusions There has been a substantial decrease in waste with improved turnaround time after IFC implementation. This has improved blood bank logistics, improved efficiency of patient care, and reduced costly waste. [ABSTRACT FROM AUTHOR]

Introduction: Hospital‐based transfusion involves hundreds of daily medical decisions. Medical decision‐making under uncertainty is susceptible to cognitive biases which can lead to systematic errors of reasoning and suboptimal patient care. Here we review common cognitive biases that may be relevant for transfusion practice. Materials and Methods: Biases were selected based on categorical diversity, evidence from healthcare contexts, and relevance for transfusion medicine. For each bias, we provide background psychology literature, representative clinical examples, considerations for transfusion medicine, and strategies for mitigation. Results: We report seven cognitive biases relating to memory (availability heuristic, limited memory), interpretation (framing effects, anchoring bias), and incentives (search satisficing, sunk cost fallacy, feedback sanction). Conclusion: Pitfalls of reasoning due to cognitive biases are prominent in medical decision making and relevant for hospital transfusion medicine. An awareness of these phenomena might stimulate further research, encourage corrective measures, and motivate nudge‐based interventions to improve transfusion practice. [ABSTRACT FROM AUTHOR]

Background: The characteristic feature of immune cytopenias involves the process of extravascular phagocytosis, wherein macrophages in the spleen and/or liver engage in the destruction of blood cells that have been opsonized by auto‐ or alloantibodies. Therefore, new treatments that prevent phagocytosis will be advantageous, especially for short‐term usage along with alternative options. Study Design and Methods: KB‐208, a small molecule drug, previously shown to be efficacious for the in vitro inhibition of phagocytosis was synthesized. A passive antibody mouse model of immune thrombocytopenia (ITP) was used. Three different mouse strains (BALB/c, C57BL/6, CD1) were used to determine the efficacy of KB‐208 compared with IVIG to ameliorate the ITP. Toxicity was investigated after 60‐day chronic administration of KB‐208 by a biochemistry panel, gross necroscopy and histopathology. Results: KB‐208 showed similar efficacy to ameliorate the thrombocytopenia compared with IVIG in all three mouse strains. This small molecule drug was effective at 1 mg/kg in ameliorating ITP, in comparison with IVIG at 1000–2500 mg/kg. KB‐208 did not affect other blood parameters or elevate serum biochemistry markers of toxicity nor were any abnormal histopathological findings found. Conclusion: KB‐208 is similar to IVIG for the amelioration of ITP in multiple mouse strains. Chronic administration of KB‐208 for 60 days did not demonstrate in vivo toxicity. These findings indicate that KB‐208 is efficacious, without significant in vivo toxicities in mice, and is a potential small molecule candidate for further evaluation to be used in the treatment of ITP and possibly all immune cytopenias where phagocytosis is responsible for the pathophysiology. [ABSTRACT FROM AUTHOR]

Background: Intravenous immunoglobulin (IVIG) shortage represents an emerging issue in transfusion medicine. Limited data are available to determine effective strategies for optimal use. The objective of this retrospective observational study was to determine the impact of institutional measures on IVIG use at a large academic center. Methods: IVIG infusions from November 26, 2018 to September 25, 2022 were categorized according to their appropriateness (Recommended, Option of treatment, or Unrecommended), based on provincial guidelines, and separated into three phases: Reference, Transition, and Post‐Implementation phases, the latter following the adoption of restrictive measures, including mandatory standardized order forms, a blood bank gatekeeping strategy, and the creation of a stewardship committee. Results: A total of 5431 IVIG infusions were administered to 544 patients, accounting for 295,033 g. The most common indication categories were neurology (30.4%), immunology (29.0%), and hematology (17.4%). From Reference to Post‐Implementation phase, IVIG infusions decreased from 2275 to 2000 with unrecommended indications dropping from 9.5% to 7.4% (p = 0.01), and a global reduction of 23.0% (from 131,163 g to 100,936 g of IVIG). Decrease in chronic immunomodulation accounted for 48.3% of total reduction (14,610 g of 30,227 g), whereas single‐use immunomodulation, 40.5% (12,237 g of 30,227 g). Moreover, an absolute reduction of 16.9% was observed in orders exceeding the recommended doses (20.8% to 3.9%; p < 0.0001). Together, the unrecommended and excessive IVIG doses decreased from 19,975 g (15.2%) to 6670 g (6.6%). Conclusions: A global reduction in IVIG use and a preferential decrease in the unrecommended orders were observed, most likely attributable to the bundle of restrictive strategies implemented. [ABSTRACT FROM AUTHOR]

ABO‐incompatible transplantations are increasingly gaining relevance with advancements in therapeutic modalities, thus allowing patients to receive timely solid organ transplants. Therapeutic apheresis (TA) procedures remain instrumental as a preconditioning measure to enable such transplants. This survey was undertaken to find out current trends and practices of TA across major transplant centers in India. The survey was drafted by a working group of transfusion and transplant immunology specialists from six different centers in India. Data were obtained via the use of an online questionnaire. Results were categorized into eight categories: hospital information, range of titers for preconditioning, considerations prior to starting TA, TA procedure details, role of pharmacotherapy in TA, policy for reuse of columns, risk of rebound, and the role of transfusion medicine specialists. The survey highlighted the modalities as well as the methodologies of various TA procedures used across different major transplant centers in India. With the increase in ABO‐incompatible kidney and liver transplants across the country, the role of transfusion medicine and transplant immunology specialists have become vital in preconditioning regimes enabling the viability and success of such transplants. This was a unique survey that provided us a snapshot of current trends and practices of TA in preconditioning of patients for ABO‐incompatible transplants in India. [ABSTRACT FROM AUTHOR]

Platelet concentrates undergo progressive changes during storage, such as a decrease in pH. Additionally, pH and lactate production showed the strongest correlation with platelet survival in posttransfusion viability studies. pH measurement is a straightforward method for evaluating the quality control of blood components in blood bank practice. Our aim was to compare three pH assessment methods for canine platelet concentrates. The pH values of the canine platelet concentrates were assessed on the first day of storage using a calibrated pH meter, a portable gas analyzer and pH-indicator strips. The results from the pH meter and portable gas analyzer measurements were similar. The pH indicator strips presented higher average values compared to the other more reliable methods evaluated, which could result in the use of inadequate blood components. In conclusion, it is recommended to implement pH measurements using a pH meter for quality control in veterinary blood banks. [ABSTRACT FROM AUTHOR]

Background and Objectives Materials and Methods Results Conclusion In the setting of tissue hypoxia, S‐nitrosylated haemoglobin (SNO‐Hb) plays crucial roles in the control of blood flow. This is associated with decreased oxygen affinity to haemoglobin and increase in tissue oxygenation. Red blood cell (RBC) transfusion is primarily performed to improve tissue oxygenation in anaemic patients. RBCs after storage undergo a variety of biochemical and functional alterations, including deficiency of nitric oxide (NO) bioactivity. However, how donor characteristics affect NO levels during RBC storage is unclear. We sought to investigate the association of blood donor age, gender and storage duration with NO and SNO‐Hb levels in blood units.Blood samples from 42 healthy younger (≤30 years) and older (≥45 years) donors were collected and stored for up to 42 days. Total NO kits were used to detect total nitrite and nitrate levels in blood storage solution. SNO‐Hb levels in RBCs were detected and analysed by quantitative mass spectrometry.Total NO levels in the blood storage solution significantly increased with donor age and storage duration. Proteomic analysis revealed that RBCs from older donors, particularly older females, significantly lost SNO‐Hb during storage. Our findings indicate that RBCs from older donors are associated with reduced SNO‐Hb levels and increased NO metabolites in storage solution after ≥35 days storage.The findings suggest stored RBCs from older donors may have reduced capacity to deliver oxygen to tissues under hypoxia. A shorter shelf life may be required for storing RBCs from older donors, particularly older females. [ABSTRACT FROM AUTHOR]

Background Case Presentation Methods Results Conclusion At the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital of Southern Denmark, Aabenraa.A 72‐year‐old male patient presented for pretransfusion testing prior to hernia surgery. He typed as O RhD negative without discrepancies, but the antibody screen showed weakly positive reactions. Routine investigations showed discrepancies, leading to further investigations.Various serological tests were performed using in‐house and commercial red test cells suspended in different suspension media and with different column agglutination cards and cassettes. Further investigations included washing of test cells, testing alternative saline solutions, varying incubation temperatures, testing without antihuman‐globulin, and applying proteolytic enzymes.Reactivity was present with red cells suspended in ID‐CellStab (BioRad) but not in Red Cell Diluent (Quidel‐Ortho). Reactivity was abolished by using trypsin‐treated cells, indicating either the presence of an antibody reacting with—or unspecific agglutination depending on—a trypsin‐sensitive protein, in both cases enhanced by ID‐CellStab.This case highlights the importance of recognising reagent‐dependent reactivity in serological testing. Adjustments to the suspension media resolved the incompatibility. Immunohematology laboratories should consider potential reagent interference when unexpected agglutination occurs. [ABSTRACT FROM AUTHOR]

Background: Granulocyte concentrates (GCs) are usually prepared by single-donor apheresis after G-CSF pretreatment and have to be transfused within 24 h after cell collection because of the rapid decrease in pH and cell survival due to high lactate production by red blood cell contamination. GCs pooled from buffy coats of whole blood donations could improve the availability of these products. Methods to reduce red blood cell and platelet contamination may improve storability. We developed a manufacturing process for pooled GCs and investigated cell viability and functionality over time. Methods: Six ABO blood group-identical buffy coats were pooled. Subsequently, the red blood cells spontaneously sedimented after the addition of hydroxyethyl starch. The resulting leukocyte-enriched supernatant was washed twice with saline to reduce platelets and was resuspended in ABO-identical donor plasma. The leukocyte concentrate was transferred to a platelet storage bag and stored up to 72 h at 20–24°C w/o agitation. Cell count and viability, pH, blood gases, phagocytosis, and oxidative burst activity were monitored. Results: The number of red blood cells and platelets was reduced to 0.4% and 6.1% of the baseline levels. About 50% of the original present leukocytes could be extracted (n = 76). In the course of 72 h of storage, there were no significant changes in white blood cell counts (p = 0.12). The viability exceeded 98% during the entire period. The rate of granulocytes performing phagocytosis and oxidative burst remained above 95% anytime. Conclusion: GCs prepared from pooled buffy coats provide a precious alternative to granulocytes obtained from apheresis. Reduction of red blood cells and platelets by more than 90% extends the maximum shelf life of GCs from 24 h to 72 h. For a therapeutic dose of at least 1 × 1010 granulocytes, 15–20 buffy coats are required. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of COVID-19 is slightly lower, and its mortality is higher in beta-thalassemia patients than in the general population. We evaluated the impact of COVID-19 in terms of incidence, clinical course, management, and specific antibody response to vaccination, in a cohort of patients with beta-thalassemia major. Methods: We retrospectively enrolled all transfusion-dependent beta-thalassemia major patients attending the Thalassemia Day Care Center of the University Hospital of Sassari, Italy, from March 1, 2020, to May 31, 2021. For each patient, demographic, clinical, laboratory, instrumental, and therapy data were collected. Patients aged ≥16 years received two doses of mRNA COVID-19 vaccine. Anti-SARS-CoV-2 serum antibodies were tested before and after the first vaccine dose. Results: A total of 68 patients (median age: 36.5 years; IQR: 13–42 years) were included. Nasopharyngeal swab (NPS) for SARS-CoV-2 detection by RT-PCR was positive in 5 (7.35%) of 68 patients (4 symptomatic). No COVID-19-related complications, hospitalizations, or deaths were observed. The transfusion regimen and iron chelation therapy were not significantly changed. Prior to COVID-19 vaccination, anti-SARS-CoV-2 antibodies were tested in 61 patients, 51 negative and 10 positive; five of the latter were also positive for SARS-CoV-2 on NPS. The 46 vaccinated subjects had an antibody response, with higher levels in subjects previously infected with SARS-CoV-2. Conclusion: Our findings suggest that patients with beta-thalassemia major are not at a higher risk of contracting SARS-CoV-2 infection and developing a severe form of COVID-19 despite being considered more vulnerable than the general population. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to establish a comprehensive human erythrocyte antigen (HEA) frequency data set for Koreans. It also sought to develop a mobile app that facilitates the calculation of the frequencies of specific antigen-negative red blood cell units and the average number of units required for antigen typing. Methods Human erythrocyte antigen frequencies were compiled from large-scale blood donor data and 5 previous papers. Based on the collected data, we developed a mobile calculator app for HEA frequency and evaluated its usability. Results Human erythrocyte antigen frequency data for 20 blood group systems, including the ABO, Rh, MNS, Duffy, Kidd, and Diego systems, were established. The app was designed to enable users to select the desired phenotype from a drop-down menu and display the calculated frequency at the bottom. The number of units required for antigen typing to find 1 compatible red blood cell unit was also displayed. Five users participated in app evaluation and rated the functionality and information categories highly. In quizzes prompting users to calculate frequencies using the app, all participants provided correct answers, confirming the app's user-friendly functionality. Conclusions This app, which encompasses comprehensive HEA frequency data, is expected to find multiple uses in transfusion medicine, including optimizing blood bank workflow and defining rare blood groups in Korea. [ABSTRACT FROM AUTHOR]

[Objective] To evaluate the immunogenicity of red blood cell blood group antigens in the population of Xi'an. [Methods] Data on blood group antigens of voluntary blood donors from the Shaanxi Province Blood Center and unexpected antibody detection results from clinically submitted cases between January 2019 and May 2024 were analyzed. The Giblett blood group antigen immunogenicity calculation formula was used to calculate the immunogenicity of blood group antigens based on the frequency of unexpected antibodies and the probability of antigen-negative patients receiving antigen-positive red blood cells. The relative immunogenicity of each blood group antigen was obtained by multiplying the immunogenicity of the K antigen (0.095). [Results] A total of 30 921 individuals were included for red blood cell blood group antigen analysis, with 511 cases of unexpected antibody identification. The ranking of red blood cell blood group antigen immunogenicity for the overall population was: Wra>E>Dib>Fya>K>C>e>c>Dia>Jka>M>Lea>Jkb>Leb>Fyb>S, while for males, it was: Dib>Wra>E>K>Fya>C>e>c>M>Dia>Jka>Fyb>Lea>Leb>Jkb>S. [Conclusion] Based on the immunogenicity ranking from strong to weak of red blood cell antigens in the population of Xi'an, this study provides theoretical support for the expansion and matching of antigens, and technical support for achieving precise red blood cell transfusions to improve transfusion efficacy and safety.

INTRODUCTION: Platelet transfusion has been therapeutically used in patients with thrombocytopenia and platelet function defects over the years. The use of advanced techniques may add value in assessing the quality of platelet products. The aim of the study was to assess stored platelet concentrates (PCs) prepared in blood banks for platelet indices, clot strength, and platelet function. MATERIALS AND METHODS: Apart from the routine quality check parameters (platelet count, volume, pH, swirling, and sterility), 24-h-old PCs derived by the platelet-rich plasma method (PRP-PC) were prospectively assessed for various platelet indices using hematology analyzer and clot strength using thromboelastography (TEG). Platelet function (platelet activation and aggregation) was assessed using flow cytometry and compared with freshly prepared PRP. RESULTS: A total of 43 PRP-PCs that were analyzed had a mean volume of 69.1 ± 5.1 mL, a pH of 6.8 ± 0.3, and a platelet count of 738.8 ± 312.9 × 103 cells/μL. Swirling was present in all. The platelet distribution width, mean platelet volume, platelet-large cell ratio, plateletcrit, and immature platelet fraction were 9.4 ± 2.7 fL, 8.7 ± 1.2 fL, 16.9% ± 8.9%, 0.6% ± 0.3%, and 4.4% ± 3.9%, respectively. The r-time, k-time, alpha angle, and maximum amplitude were 15 ± 0.3 min, 2.1 ± 0.4 min, 65.2° ± 2.3°, and 76.1 ± 10.1 mm, respectively. Delayed clot initiation and higher clot strength were observed in in 60% (n = 21) and 71.4% (n = 25) of products, respectively Platelet activation of PRP-PC was significantly lower than PRP (0.4 [0.1%–42%] vs. 10.5 [0.8%–32.4%]; P = 0.002). However, platelet aggregation of PRP-PC was significantly higher than PRP (62.0 [26.7%–88.7%] vs. 33.4 [4.9%–55.8%]; P = 0.003). CONCLUSION: Platelet indices, TEG, and flow cytometry analysis provides useful information to assess the quality of PCs. However, the variable effects of processing and storage on platelet activity need further exploration.

OBJECTIVE: The objective of the study is to assess the satisfaction level of doctors regarding their competence in the blood transfusion process and their reflection on training at the undergraduate level. BACKGROUND: Transfusion errors due to suboptimal knowledge and lack of training can lead to grave outcomes. Therefore, to optimize patient care, a thorough understanding of transfusion medicine basics is highly imperative for all medical graduates. METHODOLOGY: This survey was conducted online through Google forms with a questionnaire consisting of 15 questions. 8 medical colleges (4 government and 4 private) were selected by random cluster sampling technique. Data were analyzed with SPSS version 23. RESULTS: Of 502 participants, 53.8% were females and 69.9% were graduates of public medical colleges. About 84.6% did not receive any formal training on transfusion during graduation. Almost 82% felt that the current curriculum is not designed to meet their practical needs of blood transfusion and 52% agreed that knowledge of transfusion medicine is required for undergraduates. The survey also revealed that 70.5% of participants believed that whole blood is required for most patients and 49.8% did not feel confident to manage transfusion-related complications by themselves. CONCLUSION: Our survey showed that our undergraduate curriculum is not aligned with the practical transfusion needs of a young doctor. As transfusions are being carried out by these young doctors, this needs to be addressed by revising the current curriculum and incorporating teaching and hands-on training to our medical graduates.

BACKGROUND AND OBJECTIVE: Blood transfusion is an essential component of health care. However, several issues can hamper the promotion and sustainability of voluntary blood donation programs. This article is about a hackathon in the field of transfusion medicine that was designed to stimulate original ideas to promote voluntary blood donation. MATERIALS AND METHODS: The transfusion medicine hackathon was conducted as a joint project of an educational institute, the Asian Association of Transfusion Medicine, and the Innovation Center. It was conducted in eight main phases, which included planning and preparation, choosing the problem statement, participant recruitment and registration, launch, and mentoring as the first steps. Participants presented their ideas in the ideation phase, and the top five teams were selected for the prototyping phase. Selection was based on innovation/originality (10 points), feasibility (10 points), and social impact (5 points). In the prototype phase, two teams were selected as winners and were awarded by the organizers. RESULTS: A total of 36 multidisciplinary teams representing various parts of India pitched innovative ideas. The majority have proposed new strategies for the retention of blood donors to maintain the donor pool and teams came up with novel ideas aimed at enhancing the overall blood donation experience. One of the winning teams completed the project and launched the product. CONCLUSION: Health-care hackathons promote interdisciplinary education and innovation. This is a first-of-its-kind effort from the field of transfusion medicine to explore a hackathon platform to promote voluntary blood donation.

Background: In recent years, the field of transfusion medicine for dogs has advanced significantly, becoming a crucial aspect of veterinary clinical practice. Nowadays, blood still remains a fundamental biological source and the welfare and health status of eligible species-specific blood donors are essential for veterinary transfusion medicine. Aim: This study focused on evaluating two shelters in Central Italy (Marche region), located in Tolentino (TS) and in Camerino (CS), in order to assess the potential of the shelter dogs as canine blood donors. Methods: We evaluated a total of 45 dogs from these shelters based on physical (age and size), clinical, behavioural, and blood analysis criteria described in the Italian Ministerial Guideline for Veterinary Transfusion Medicine (2016). Results: At the TS shelter, out of 206 resident dogs, 125 met the donation criteria (60.68%), with 28 (13.59%) selected for the study due to the impossibility to collect the samplings or other exclusion causes. In the CS shelter, of the 149 dogs, 17 (11.41%) were identified as potential blood donors and included in the study. Among these, seven dogs (25%) from TS and five dogs (29.41%) from CS were found to have DEA1 negative blood group. High percentages (TS = 25.24%, CS = 40.27%) of dogs were excluded for seniority and 29.53% in CS for behavioural issues. Notable f indings included reduced erythrocyte mean corpuscular volume [mean TS = 63.93 fl; CS = 64.00 fl] and Reticulocyte Hemoglobin [mean TS = 22.39 pg; CS = 21.38 pg]. Additionally, in both shelters' dogs showed a modest increase in eosinophils levels [mean TS = 1.59 K/μl; CS = 1.02 K/μl]. Conclusion: Shelter dogs can fulfill the blood donation requirements set by the Italian Ministerial Guideline on Veterinary Transfusion Medicine. They are generally in good health and present a low risk of transmitting parasitic diseases; however, many are ineligible for donation due to behavioural pathologies or temperament issues and seniority. [Open Vet J 2024; 14(8.000): 1779-1788]

Background: The subject of pre‐job training for transfusion service laboratory technicians is very important. The key is how to make a reasonable systematic training programme to improve the effectiveness of training. Methods: A prospective training programme was conducted and an assessment was performed at enrollment (baseline) and reassessment after 3‐months training, using the same tools with a validated questionnaire. Results: Clinical competency‐oriented prospective pre‐job training significantly improves the clinical transfusion‐related comprehensive skills of new employees. The post‐training assessment score was significantly affected by undergraduate major. Conclusion: This study provided a clinical competency‐oriented training programme for new employees in the department of transfusion medicine that could effectively enhance their comprehensive abilities. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood products are scarce resources. Audits on the use of red blood cells (RBCs) in tertiary centers have repeatedly highlighted inappropriate use. Earlier retrospective audit at our local community hospitals has demonstrated that only 85% and 54% of all requests met Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (Hb) of 80 g/L or less and single unit, respectively. We sought to improve RBC utilization by 15% over a period of 12 months (meeting Choosing Wisely Canada criteria of pre-transfusion Hb ≤80g/L by >80% and single-unit transfusion by >65%). Methods: Following repeated PDSA (Plan-Do-Study-Act) cycles, we implemented educational strategies, prospective transfusion medicine (TM) technologist--led screening of orders, and an RBC order set. Results: The 3-month median percentages of appropriate RBC use for pre-transfusion Hb and single unit (September-November 2021) across all 3 hospitals were 90% and 71%, respectively. Overall, the rate of appropriate RBCs based on pre-transfusion Hb remained above target (>80%), with minimal improvement across all hospitals (median percentage at pre- and post-technologist screening periods of 87% and 90%, respectively). The median percentage of appropriate RBCs based on single-unit transfusion orders has improved across all Niagara Health hospitals with sustained targets (3-month median percentage at pre- and post-technologist screening and most recent time periods of 54%, 56%, and 71%, respectively). Conclusions: We have taken a collaborative, multifaceted approach to optimizing utilization of RBCs across the Niagara Health hospitals. The rates of appropriate RBC use were comparable with the provincial and national accreditation benchmark standards. In particular, the TM technologist--led screening was effective in producing sustained improvement with respect to single-unit transfusion. One of the balancing outcomes was increasing workload on technologists. Local and provincial efforts are needed to facilitate recruitment and retention of laboratory technologists, especially in community hospitals. [ABSTRACT FROM AUTHOR]

Background: Trauma remains the leading cause of pediatric mortality in the United States. Although use of massive transfusion protocols (MTPs) in this population is widespread, optimal pediatric resuscitation is not well established. We sought to assess contemporary pediatric MTP practice in the United States. Study Design and Methods: A web‐based survey was designed by the Association for the Advancement of Blood & Biotherapies (AABB) Pediatric Transfusion Medicine Subsection and distributed to select American College of Surgeons (ACS) Level I Verified pediatric trauma centers. The survey assessed current MTP policy, implementation, and recent changes in practice. Results: Response rate was 55% (22/40). Almost half of the respondents were from the South. The median RBC:plasma ratio was 1 (interquartile range 1–1.5). Protocolized fibrinogen supplementation was common while integration of antifibrinolytic therapy into MTPs was infrequent. Viscoelastic testing (VET) was available at most sites, 71% (15/21, one site did not respond), and was generally utilized on an ad‐hoc basis. Roughly, a third of sites had changed their MTP in the past 3 years due to blood supply issues, and about a third reported having group O Whole Blood on‐site. Conclusion: MTP practice is similar throughout the United States. Though fibrinogen supplementation is common—other emerging interventions such as antifibrinolytic therapy or utilization of routine viscoelastic testing—are not widespread. Pediatric transfusion medicine experts must continue to follow practice change, as contemporary large trials begin to characterize new supportive modalities to optimize resuscitation in pediatric trauma patients. [ABSTRACT FROM AUTHOR]

A 48-year-old female presented to the emergency department with severe fatigue. Admission laboratory test results were hemoglobin 6.6 g/dL, platelet count 287,000/μL, and white blood cell count 25,200/μL. Lactate dehydrogenase was elevated at 898 U/L, haptoglobin was markedly decreased (< 31 mg/dL), indirect bilirubin was elevated (5.3 mg/dL), and the absolute reticulocyte count was low at 0.0050/μL. A sample was sent to the immunohematology reference laboratory. The direct antiglobulin test immunoglobulin G was negative; C3 was 1+. All cells were reactive at immediate spin phase, indirect antiglobulin testing (IAT) with polyethylene glycol, with low ionic strength saline, neat, prewarm, and in the solid phase. All cells were nonreactive at IAT-ficin. Additional testing included a cold antibody titer that was 1:4096 and thermal amplitude studies demonstrating reactivity of 2+ at 37°C. These results were consistent with a clinically significant anti-Pr and cold agglutinin disease (CAD). Although rituximab is effective in autoimmune hemolytic anemia, this may take weeks. The patient was treated with pegcetacoplan, a pegylated peptide that targets C3 inhibiting hemolysis. The patient was discharged on day 29 with a hemoglobin of 8 g/dL. This is a report of one of the first patients successfully treated with pegcetacoplan for CAD. [ABSTRACT FROM AUTHOR]

Background: In recent years, the field of transfusion medicine for dogs has advanced significantly, becoming a crucial aspect of veterinary clinical practice. Nowadays, blood still remains a fundamental biological source and the welfare and health status of eligible species-specific blood donors are essential for veterinary transfusion medicine. Aim: This study focused on evaluating two shelters in Central Italy (Marche region), located in Tolentino (TS) and in Camerino (CS), in order to assess the potential of the shelter dogs as canine blood donors. Methods: We evaluated a total of 45 dogs from these shelters based on physical (age and size), clinical, behavioural, and blood analysis criteria described in the Italian Ministerial Guideline for Veterinary Transfusion Medicine (2016). Results: At the TS shelter, out of 206 resident dogs, 125 met the donation criteria (60.68%), with 28 (13.59%) selected for the study due to the impossibility to collect the samplings or other exclusion causes. In the CS shelter, of the 149 dogs, 17 (11.41%) were identified as potential blood donors and included in the study. Among these, seven dogs (25%) from TS and five dogs (29.41%) from CS were found to have DEA1 negative blood group. High percentages (TS = 25.24%, CS = 40.27%) of dogs were excluded for seniority and 29.53% in CS for behavioural issues. Notable findings included reduced erythrocyte mean corpuscular volume [mean TS = 63.93 fl; CS = 64.00 fl] and Reticulocyte Hemoglobin [mean TS = 22.39 pg; CS = 21.38 pg]. Additionally, in both shelters’ dogs showed a modest increase in eosinophils levels [mean TS = 1.59 K/μl; CS = 1.02 K/μl]. Conclusion: Shelter dogs can fulfill the blood donation requirements set by the Italian Ministerial Guideline on Veterinary Transfusion Medicine. They are generally in good health and present a low risk of transmitting parasitic diseases; however, many are ineligible for donation due to behavioural pathologies or temperament issues and seniority. [ABSTRACT FROM AUTHOR]

Rapid and reliable Rhesus D typing is crucial for blood donation centers. In instances of massive blood transfusion or reduced antigen expression, DNA-based phenotype prediction becomes mandatory. Our molecular RHD typing approach involves an initial real-time PCR for the most common aberrant RHD types in our region, RHD*01W.1 (weak D type 1), RHD*01W.2 (weak D type 2), RHD*01W.3 (weak D type 3), and RHD*07.01 (DVII). For comprehensive coverage, Sanger sequencing of RHD coding regions is performed in the case of PCR target-negative results. We evaluated the specificity and accuracy of these methods using the recently launched LightCycler® PRO real-time platform. All findings demonstrated remarkable accuracy. Notably, the LightCycler® PRO instrument offers a distinct advantage in data interpretation and integration via the HL7 interface. This study underlines the importance of including advanced molecular techniques in blood typing protocols, especially in scenarios where conventional serological methods may be insufficient. [ABSTRACT FROM AUTHOR]

Introduction: The blood requisition form functions as a vital communication link between requesting physicians and blood bank staff. The proper completion of blood request forms (BRFs) is a frequently overlooked aspect by clinicians and insufficient information or errors during the BRF completion process can significantly affect the quality of laboratory results and consequently impact patient outcomes, resulting in increased resource wastage and a higher risk of inappropriate therapy. Aims & Objectives: This study aims to assess the completeness and consistency of blood requisition forms submitted to the Blood Bank of a tertiary care hospital in Lahore with the objective of identifying gaps to improve documentation practices and enhance patient safety Place and Duration of Study: The study was conducted at the Blood Bank of Shalamar Hospital, Lahore, over six months, from July 2020 to December 2020. The Institutional Review Board (IRB) of Shalamar Medical and Dental College (SMDC) reviewed and granted approval for the study protocol (SMDC-IRB/AL/101/2021). Materials & Methods: A cross-sectional, retrospective study was undertaken at the Blood Bank of Shalamar Hospital Lahore from July 2020 to December 2020. Data was retrieved from previous blood bank records, specifically focusing on the completeness of blood requisition forms. All blood requisition forms received at the Blood Bank of Shalamar Hospital during the study period were included in the analysis. Key variables assessed included age, gender, ward, provisional diagnosis, history of previous transfusion, history of transfusion reaction, and units of component requested. Data analysis was carried out using SPSS version 20.0. Descriptive statistics were applied to summarize data, with results presented as frequencies and percentages. Results: A comprehensive evaluation of 1000 blood requisition forms (BRFs) was conducted to assess their completeness and legibility. Among the analyzed BRFs, demographic data, including age was mentioned in 72.5% (n=725), gender in 75% (n=750), and ward in 67.2% (n=672). Pertaining to clinical information, the provisional diagnosis was documented in 48.7% (n=487), the history of previous transfusions achieved a completion rate of 62.4% (n=624), and the history of transfusion reactions was documented in 62.8% (n=628). The details of units of requested components and blood group were satisfactorily completed in 74.5% (n=745). Conclusion: The current study identified deficiencies in BRF completion, revealing a lack of appropriate demographic and clinical data for patients. The efficacy of audits assessing proper transfusion practices and the optimal functioning of the blood bank relies on the evaluation of meticulously filled BRFs.

• Telemedicine, particularly through video-interviewing (VI), is vital for improving healthcare access in remote areas, especially in transfusion medicine. • The manuscript highlights its benefits in our blood centre where VI enhances consultation timeliness and serology reactive blood donor notification. Telemedicine facilitates expertise access, knowledge sharing, virtual training, and strengthening local healthcare thus improving transfusion services in remote high-altitude hilly regions. • Embracing telemedicine with technological advancements, like AI and mobile health apps, offers future enhancements and may help optimize transfusion practices in underserved regions of Uttarakhand India. [ABSTRACT FROM AUTHOR]

BACKGROUND: Except for public health case reports, the incidence of Zika virus (ZIKV), chikungunya virus (CHIKV), and dengue virus (DENV) infection are not available to assess the potential blood transfusion safety threat in Brazil. METHODS: Pools of 6 donation samples (MP6) left over from human immunodeficiency virus, hepatitis B virus, and hepatitis C virus nucleic acid testing were combined to create MP18 pools (3 MP6 pools). Samples were tested using the Grifols triplex ZIKV, CHIKV, and DENV real-time transcription mediated amplification assay to estimate prevalence of RNAemia and incidence, and to compare these results to case reports in São Paulo, Belo Horizonte, Recife, and Rio de Janeiro, from April 2016 through June 2019. RESULTS: ZIKV, CHIKV, and DENV RNAemia were found from donors who donated without overt symptoms of infection that would have led to deferral. The highest RNAemic donation prevalence was 1.2% (95% CI, .8%-1.9%) for DENV in Belo Horizonte in May 2019. Arbovirus infections varied by location and time of year, and were not always aligned with annual arbovirus outbreak seasons in different regions of the country. CONCLUSIONS: Testing donations for arboviruses in Brazil can contribute to public health. Transfusion recipients were likely exposed to ZIKV, CHIKV, and DENV viremic blood components during the study period.

Summary Sickle cell disease (SCD) is one of the most common genetic disorders in the world predominantly affecting economically disadvantaged populations. There is a notable discrepancy between the growing adult SCD population and available diagnostic and therapeutic interventions for SCD. Sickle cell hepatopathy (SCH) is an all‐inclusive term to describe the acute and chronic liver manifestations of SCD. The pathophysiology of SCH follows no defined pattern or sequence that poses challenges to clinicians and researchers alike. Evidence is lacking for this underreported disease at various levels from diagnostic to therapeutic options. This paper reviews the basic pathophysiology, clinical features, biochemical and radiological findings of various SCH manifestations and outlines the management of each condition. Old and new therapy options in SCD including hydroxyurea, red blood cell exchange transfusion, ursodeoxycholic acid, voxelotor, l‐glutamine and crizanlizumab have been reviewed to investigate the role of these options in treating SCH. The role of liver transplant, haematopoietic stem cell transplant and gene therapy in SCH patients have been reviewed. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Blood transfusion is an essential component of health care. However, several issues can hamper the promotion and sustainability of voluntary blood donation programs. This article is about a hackathon in the field of transfusion medicine that was designed to stimulate original ideas to promote voluntary blood donation. MATERIALS AND METHODS: The transfusion medicine hackathon was conducted as a joint project of an educational institute, the Asian Association of Transfusion Medicine, and the Innovation Center. It was conducted in eight main phases, which included planning and preparation, choosing the problem statement, participant recruitment and registration, launch, and mentoring as the first steps. Participants presented their ideas in the ideation phase, and the top five teams were selected for the prototyping phase. Selection was based on innovation/originality (10 points), feasibility (10 points), and social impact (5 points). In the prototype phase, two teams were selected as winners and were awarded by the organizers. RESULTS: A total of 36 multidisciplinary teams representing various parts of India pitched innovative ideas. The majority have proposed new strategies for the retention of blood donors to maintain the donor pool and teams came up with novel ideas aimed at enhancing the overall blood donation experience. One of the winning teams completed the project and launched the product. CONCLUSION: Health-care hackathons promote interdisciplinary education and innovation. This is a first-of-its-kind effort from the field of transfusion medicine to explore a hackathon platform to promote voluntary blood donation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the study is to assess the satisfaction level of doctors regarding their competence in the blood transfusion process and their reflection on training at the undergraduate level. BACKGROUND: Transfusion errors due to suboptimal knowledge and lack of training can lead to grave outcomes. Therefore, to optimize patient care, a thorough understanding of transfusion medicine basics is highly imperative for all medical graduates. METHODOLOGY: This survey was conducted online through Google forms with a questionnaire consisting of 15 questions. 8 medical colleges (4 government and 4 private) were selected by random cluster sampling technique. Data were analyzed with SPSS version 23. RESULTS: Of 502 participants, 53.8% were females and 69.9% were graduates of public medical colleges. About 84.6% did not receive any formal training on transfusion during graduation. Almost 82% felt that the current curriculum is not designed to meet their practical needs of blood transfusion and 52% agreed that knowledge of transfusion medicine is required for undergraduates. The survey also revealed that 70.5% of participants believed that whole blood is required for most patients and 49.8% did not feel confident to manage transfusion-related complications by themselves. CONCLUSION: Our survey showed that our undergraduate curriculum is not aligned with the practical transfusion needs of a young doctor. As transfusions are being carried out by these young doctors, this needs to be addressed by revising the current curriculum and incorporating teaching and hands-on training to our medical graduates. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Platelet transfusion has been therapeutically used in patients with thrombocytopenia and platelet function defects over the years. The use of advanced techniques may add value in assessing the quality of platelet products. The aim of the study was to assess stored platelet concentrates (PCs) prepared in blood banks for platelet indices, clot strength, and platelet function. MATERIALS AND METHODS: Apart from the routine quality check parameters (platelet count, volume, pH, swirling, and sterility), 24-h-old PCs derived by the platelet-rich plasma method (PRP-PC) were prospectively assessed for various platelet indices using hematology analyzer and clot strength using thromboelastography (TEG). Platelet function (platelet activation and aggregation) was assessed using flow cytometry and compared with freshly prepared PRP. RESULTS: A total of 43 PRP-PCs that were analyzed had a mean volume of 69.1 ± 5.1 mL, a pH of 6.8 ± 0.3, and a platelet count of 738.8 ± 312.9 × 103 cells/μL. Swirling was present in all. The platelet distribution width, mean platelet volume, platelet-large cell ratio, plateletcrit, and immature platelet fraction were 9.4 ± 2.7 fL, 8.7 ± 1.2 fL, 16.9% ± 8.9%, 0.6% ± 0.3%, and 4.4% ± 3.9%, respectively. The r-time, k-time, alpha angle, and maximum amplitude were 15 ± 0.3 min, 2.1 ± 0.4 min, 65.2° ± 2.3°, and 76.1 ± 10.1 mm, respectively. Delayed clot initiation and higher clot strength were observed in in 60% (n = 21) and 71.4% (n = 25) of products, respectively Platelet activation of PRP-PC was significantly lower than PRP (0.4 [0.1%–42%] vs. 10.5 [0.8%–32.4%]; P = 0.002). However, platelet aggregation of PRP-PC was significantly higher than PRP (62.0 [26.7%–88.7%] vs. 33.4 [4.9%–55.8%]; P = 0.003). CONCLUSION: Platelet indices, TEG, and flow cytometry analysis provides useful information to assess the quality of PCs. However, the variable effects of processing and storage on platelet activity need further exploration. [ABSTRACT FROM AUTHOR]

Granulocyte transfusions are indicated for patients with severe neutropenia and evidence of bacterial or fungal infection who are unresponsive to standard antimicrobial therapy. With a limited expiration time of 24 hours after collection, granulocytes are often transfused before results of infectious-disease screening tests are available, and before a transfusion service can perform a risk assessment if postdonation information is provided after the collection. The case we describe herein demonstrates a clinical scenario meeting indications for granulocyte transfusion, coupled with the clinical management undertaken after the granulocyte donor disclosed a positive result for a COVID-19 self-test taken 1 day after donation. In this case, the patient did not develop new COVID-19 symptoms and tested negative for COVID-19 after transfusion of the implicated unit. These findings add to the body of evidence in the literature that COVID-19 is not transmitted via blood transfusion. [ABSTRACT FROM AUTHOR]

The Heidenhain variant of Creutzfeld-Jakob disease (CJD) is a rare form that initially presents with visual disturbances. In early stages, the presentation can mimic neuromyelitis optica spectrum disorders (NMOSD) and lead to unnecessary treatment modalities. Herein, we describe a case of a 66-year-old man who presented with bilateral vision loss and retro-orbital discomfort. In addition to immunosuppressive therapy, he received 4 rounds of therapeutic plasma exchange after his preliminary diagnosis of NMOSD. We were surprised to note that his condition did not show improvement but deteriorated, with severe neurocognitive symptoms. Eventually, CJD was suspected, and real-time quaking-induced conversion (RT-QuIC) was performed. By the time the diagnosis of Heidenhain variant of CJD was confirmed, the patient was discharged to hospice care and died shortly after. [ABSTRACT FROM AUTHOR]

In this study, it was aimed to investigate bacterial contamination in apheresis platelet suspensions (APS) by automated blood culture system and flow cytometry method (FCM). 33 spiked APS each using 11 bacterial strains (5 standard strains, 6 clinical isolates), were prepared in three different dilutions (1–10, 10–50, 50-100 cfu/mL), incubated in two different temperatures (35–37 °C and 22–24 °C) and different incubation times (18–96 h) evaluated by FCM. This three different dilutions were also inoculated into special platelet culture bottles (BacT/ALERT® BPA) and loaded into the blood culture system. Additionally 80 APSs routinely prepared in the Transfusion Center were evaluated by both FCM and the blood culture system. Platelets were lysed by freeze-thaw method. All spiked samples were positive with BacT/ALERT® BPA in 12–18 h. In 96 h incubation at 22–24 °C, the presence of bacteria was detected by FCM in all other samples (31/33) except low dilutions (1–10 and 10–100 CFU/ml) of K.pneumoniae standard strain. In the 35–37 °C, the presence of bacteria was detected by FCM in all samples (33/33) after 48 h of incubation. In routine APS one sample detected as positive (Bacillus simplex) with BacT/ALERT® BPA and no positivity was detected by FCM. The freeze-thaw method, which we have optimized for the lysis of platelets, is very practical and can be easily applied. The BacT/ALERT® system has been found to be very sensitive in detecting bacterial contamination in PSs. Flow cytometry method has been found to be successful, fast, easy to use and low cost in detecting bacterial contamination in PSs. [ABSTRACT FROM AUTHOR]

Introduction: In veterinary medicine there are few readily available products for platelet transfusion to patients with thrombocytopenia. Commercial tabletop platelet concentrating systems have recently become available to veterinarians, primarily directed towards uses associated with regenerative medicine. These systems could potentially be used to produce fresh concentrated platelets for use in transfusion medicine. This study evaluated the concentration, activation, and sterility of a double centrifugation platelet concentrate (PC) produced by a commercial benchtop system. Methods: Ten healthy dogs were studied. Whole blood was collected and mixed with ACD-A in a 1:7.6 ratio of ACD-A to whole blood. 12 mL of this mixture was processed into PC via single centrifugation, while 60 mL of the anticoagulated whole blood was processed via a commercial double centrifugation system. Both types of PC were evaluated for platelet concentration, CD62P expression with and without thrombin stimulation, and for sterility. Results: Mean platelet count in the double centrifuged PC was 863 ± 352 × 10³/µL, with very low white blood cell contamination (median of 0.47 × 10³ leukocyte/µL (range 0.15-2.18 × 10³/µL)). The double-centrifuged PC had similar baseline activation characteristics (as determined by P-selectin expression) as the single centrifuge PC (0.76% vs. 0.72% unstimulated, 30.5% vs. 34.9% stimulated, p = 0.432). Discussion: The benchtop PC system studied here did not cause activation of platelets during production and produced a sterile product that can be further investigated as a source of fresh platelet concentrates for transfusion purposes. [ABSTRACT FROM AUTHOR]

Background and Objectives Patient blood management reduces unnecessary transfusions to improve patients' health. Familiarity of physicians with this program is necessary to improve the outcomes of patients health. This study was conducted to evaluate the effect of education on the level of knowledge of residents in medical centers in Yazd, 2022-2023. Materials and Methods The study was a before and after quasi-experimental intervention. 57 medical residents participated. A 20 question questionnaire measured the residents' knowledge level in patient blood management before and after the education. The validity of the questionnaire was measured by a survey of experienced physicians in the management of patient's blood. Reliability with Cronbach's alpha test was 0.8. The data were analyzed using t and Paired-t tests in SPSS 20 software. Results 35 participants (61.4%) were women and 22 (38.6%) were men. Their mean age was 30.58 ± 5.45 years.The average knowledge scores were 9.38 ± 3.77 and 14.01 ± 3.50 before and after education, respectively (p < 0.001). The lowest response rate before instructions pertained to evaluation of patients' anemia before surgery and knowledge of autologous blood usage. The knowledge score had no significant relationship with age, sex, blood prescription history, and medical practice duration. Conclusions Education effectively increased the knowledge of residents. It is suggested to include hold targeted educational programs with emphasis on the areas of anemia management and the use of autologous blood, publish educational guides, and include transfusion medicine and the patient's blood management program in medical education curricula. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day‐to‐day clinical care. These gaps are prevalent in resource‐limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context‐appropriate up‐to‐date education, (2) teaching participants how to independently deliver a case‐based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. Materials and Methods: In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train‐the‐trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in‐person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. Results: Fifty‐one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self‐rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. Conclusion: Transfusion medicine education in Rwanda using a train‐the‐trainer approach was well‐received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project. [ABSTRACT FROM AUTHOR]

OBJECTIVE Determine the hemolytic effect of an 18-µm microaggregate blood filter during in vitro sea turtle whole blood transfusions as well as describe the average diameter of leatherback (Dermochelys coriacea) and Kemp’s ridley sea turtle (Lepidochelys kempii) RBCs. ANIMALS 5 green (Chelonia mydas), 5 loggerhead (Caretta caretta), and 5 Kemp’s ridley sea turtles (total n = 15). METHODS Heparinized sea turtle blood was infused at 60 mL/h through a microbore extension set without and then with a postsyringe, inline 18-µm microaggregate blood filter. Pre- and postfiltration PCV, Hct, total solids, sodium, chloride, potassium, glucose, and free plasma hemoglobin concentrations were measured. With the use of light microscopy and archived blood smears, the maximum and minimum diameter of 20 RBCs from each of the 5 leatherback and 5 Kemp’s ridley sea turtles were measured with a calibrated ocular micrometer using 400X magnification. RESULTS There were no significant differences between pre- and postfiltration samples for Hct, total solids, sodium, chloride, potassium, glucose, and free plasma hemoglobin concentrations; however, there was a significant median postfiltration decrease in PCV of approximately 4%, representing a 13% decrease of the total RBCs transfused. Average maximum diameters for leatherback and Kemp’s ridley sea turtle RBCs were 19.7 and 16.1 µm, respectively. CLINICAL RELEVANCE Although the 18-µm microaggregate blood filter does not hemolyze transfused sea turtle RBCs and is likely safe for in vivo blood transfusions, the filter’s pores may retain a small proportion of infused RBCs given their diameter. [ABSTRACT FROM AUTHOR]

• Transfusion therapy is an indispensable form of treatment, and important element of the public health system. • Epidemiology is crucial for ensuring the safety of transfusion treatment, by continuous surveillance and timely identification mitigation of risks. • Surveillance systems provide tools for risk assessment and management, in order to estimate the magnitude of any health effect that derives from decisions of policy makers. • Surveillance of adverse reactions and adverse events associated with blood transfusion, has demonstrated the importance of multidisciplinary cooperation between blood and public health services. Transfusion therapy is an indispensable form of treatment, and an important element of the public health system. Due to its origin, blood's clinical use is associated with various risks that may cause adverse reactions and events. Progress in quality and safety of blood components has eliminated numerous risks, especially those of infectious origin. However, some risks cannot be predicted, while others cannot always be prevented. Globalisation and climate change constantly favour the spread of infectious agents. Against this, epidemiology plays a central role in ensuring the safety of transfusion treatment, by continuous surveillance and timely identification of risks, and in the development of routine and additional tests as measures for risk mitigation. As a quantitative discipline based on research methods, epidemiology is a method of reasoning; it relies on the generation and testing of hypotheses; it utilises other scientific resources, particularly in the field of blood donation and blood transfusion, thus having many applications. The main focus falls on transfusion-transmissible infections, and on environmental or occupational diseases, injuries, disabilities and death causes at large. The practice of epidemiology relies on a systematic approach and measurement of disease frequencies. Surveillance is a key element, involving continuously gathering, analysing, and evaluating data regarding diseases, morbidity and mortality, and disseminating the conclusions of the analyses to relevant competent authorities; in this way, action is taken for disease prevention and control. Surveillance systems also provide an important tool for risk assessment, a method to assess and characterise the critical parameters in the functionality of equipment, systems or processes of using scientific data in order to estimate the magnitude of any health effect that derives from decisions of policy makers. Epidemiological surveillance, particularly for the incidence of adverse reactions and adverse events associated with blood transfusion at the national and international levels, has demonstrated the importance of multidisciplinary cooperation between blood and public health services. [ABSTRACT FROM AUTHOR]

Background: Blood donors are screened for medication use to determine their health status and to ensure that the collection will be safe and efficacious for transfusion. Although stringent medication deferral guidelines exist for human blood donors, no consensus exists as to which medications should be permitted among canine donors. Methods: A brief survey regarding canine donor screening methods was distributed to an online hematology and transfusion medicine group and included questions pertaining to commonly prescribed medications and consumption of a raw food diet. Key Findings: The survey results demonstrate that more than half of the respondents accept canine donors given thyroid supplements, whereas respondents were split as to whether they accept canine donors given antihistamines chronically. Most survey respondents exclude canine donors taking anti‐inflammatory or anti‐itch medications unless in acute circumstances and only after a washout period. More than half of the survey respondents exclude dogs fed a raw food diet. Significance: The survey results demonstrate that there is no obvious agreement regarding which medications to permit in canine donors. Evidence‐based guidelines are needed to inform best practices and the subsequent decisions made by donor programs. [ABSTRACT FROM AUTHOR]

Comparing the effect of serious game and problem-based learning on nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing. In this quasi-experimental study, 76 undergraduate nursing students were enrolled through a convenience sampling method, and were allocated to one of the three groups of serious game, problem-based learning, and control through the block randomization method. Data were collected using a valid and reliable 3-part researcher-made tool, completed before and two weeks after the intervention. Statistical analysis was performed using paired t -test, analysis of covariance, and Bonferroni post hoc test. A significance level of <0.05 was considered. After the intervention, mean scores of both knowledge and clinical decision-making skill increased significantly in both intervention groups (p < 0.05). Mean post-test scores of both knowledge and clinical decision-making skill in the serious game group, and only clinical decision-making skill in the problem-based learning group were significantly higher than the control group (p < 0.05). However, no significant difference was observed regarding mean post-test scores of both knowledge and clinical decision-making skill between the intervention groups (p > 0.05). Both serious game and problem-based learning are proven to be effective in improving nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing. Since learning now occurs beyond classrooms and the new generation of students spend most of their time in virtual places, utilizing technology-based teaching methods like serious games can benefit both educators and students by providing continuous education, saving their time and expenses, etc. • Combining serious games and problem-based learning methods are effective in improving nursing students' knowledge and clinical decision-making skills when it comes to applying transfusion medicine in pediatric nursing. • Quiz-based serious games enhance knowledge acquisition. • Problem-based learning enhances clinical decision-making skills. [ABSTRACT FROM AUTHOR]

Objective: Prolong platelet survival and functionality up to 28 days. Methods: A sample of apheresis platelets was evaluated, distributed in 3 groups according to the cryopreservative solution used: DMSO5%+2%albumin; DMSO5%+NaCl0,9% and DMSO5%+Dextrose2%. They were then frozen at -80 °C and thawed at 7, 14 and 28 days. The in vitro survival and viability were assessed by the post-thaw platelet count and the CD41, CD61 and CD42a staining percentages by flow cytometry. The functionality was determined with the percentage of post-stimulation aggregation with 1Nm-thrombin using the Chromo-Log490 aggregometer. The control group (CG) consisted of fresh platelets under constant agitation at 22 °C. Results: A total of 72 platelet aliquots was analyzed. The CG presented a platelet-count of 1934 ± 0.5 × 109/L and a 100% viability. The percentages of CD41, CD61 and CD42a labeling were 99, 98.5 and 96.5%, respectively. The percentage of aggregation was 99%. On day 7 of the post-freezing, the platelet count for groups 1, 2 and 3 was 1,844 ± 102, 1,856 ± 76 and 1,752 ± 226, with the viability of 98, 96 and 95%, respectively. On day 14, the counts were 1,722 ± 238, 1,649 ± 215 and 1,578 ± 223 with the viability of 96, 95 and 94% and, on day 28, they were 1,602 ± 374, 1,438.6 ± 429 and 1,406.6 ± 436, with the viability of 96, 94 and 93%, respectively. Group1 presented a higher expression of membrane antigens. Aggregation percentages were 90, 98 and 89% at day 7, 88%, 98 and 87% at day 14 and 84%, 95 and 82% at day of the 28 post-freezing, respectively, with group2 presenting the best results. Conclusion: The results support cryopreservation as a reasonable method to prolong platelet survival up to 28 days, maintaining its functionality and viability greater than 50%.

Background: Pathogen inactivation treatment (PIT) has been shown to alter platelet function, phenotype, morphology and to induce a faster aging of platelet concentrates (PCs). Key pieces of information are still missing to understand the impacts of PITs at the cellular level. Objectives: This study investigated the impact of amotosalen/UVA on PCs, from a post-translational modifications (PTM) point of view. Phosphoproteomic analyses were conducted on resting platelets, right after the amotosalen/UVA treatment and compared with untreated PCs. Method: A two-arm study setting was carried out to compare PIT (amotosalen/UVA) to untreated PCs, on day 1 post-donation. Based on a pool-and-split approach, 12 PCs were split into two groups (treated and untreated). Quantitative phosphoproteomics was performed using TMT technology to study the changes of phosphoproteins right after the PIT. Results: A total of 3,906 proteins and 7,334 phosphosites were identified, and 2,473 proteins and 2,214 phosphosites were observed in at least 5 to 6 replicates. Compared to untreated platelets, PIT platelets exhibited an upregulation of the phosphorylation effects, with 109 phosphosites identified with a higher than 2-fold change. Two pathways were clearly identified. The mitogen activated protein kinases (MAPKs) cascade, which triggers the granule secretion and the activation of the pS15 HSPB1. One of the shape change pathways was also observed with the inhibition of the Threonine 18 and Serine 19 phosphorylations on myosin light chain (MLC) protein after the amotosalen/UVA treatment. Conclusions: This work provides a deep insight into the impact of amotosalen/UVA treatment from a phosphoprotein viewpoint on resting platelets. Clear changes in phosphorylation of proteins belonging to different platelet pathways were quantified. This discovery corroborates previous findings and fills missing parts of the effect of photochemical treatments on platelets. [ABSTRACT FROM AUTHOR]

Background: In Australia, a man cannot donate blood if he has had sex with another man within the past 3 months. However, this policy has been criticized as being discriminatory as it does not consider lower risk subgroups, and led to calls for modifications to the policy that more accurately distinguish risk among gay, bisexual, and other men who have sex with men (GBM). Study Design and Methods: We used data from a nationally representative survey to estimate the proportion of GBM aged 18–74 years old who would be eligible to donate under current criteria and other scenarios. Results: Among the 5178 survey participants, 155 (3.0%) were classified as GBM based on survey responses, Among the GBM, 40.2% (95% CI 28.0%–53.7%) were eligible to donate based on current criteria, and 21.0% (95% CI 14.5%–29.5%) were ineligible due to the 3 months deferral alone. Eligibility among GBM, all men, and the population increased as criteria were removed. Under the new Australian plasma donation criteria, 73.6% (95% CI 64.4%–81.1%) of GBM, 68.4% (95% CI 65.5%–71.2%) of all men, and 60.8% (95% CI 58.8%–62.8%) of the full population were estimated to be eligible. Only 16.1% (95% CI 8.6%–28.1%) of GBM knew that the male‐to‐male sex deferral period is 3 months. Discussion: Changing the deferral criteria and sexual risk evaluation would lead to a higher proportion of GBM being eligible to donate blood. Knowledge of the current GBM deferral period is very low. Improved education about the current criteria and any future changes are required to improve blood donation rates. [ABSTRACT FROM AUTHOR]

Introduction: The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. The 2011 Patient blood management guidelines: module 1 — critical bleeding/massive transfusion were updated and published. Systematic reviews were conducted for pre‐specified research questions, and recommendations were based on meta‐analyses of included studies. Main recommendations: The critical bleeding/massive transfusion guideline includes seven recommendations and 11 good practice statements addressing: major haemorrhage protocols (MHPs) facilitating a multidisciplinary approach to haemorrhage control, correction of coagulopathy and normalisation of physiological derangement;measurement of physiological, biochemical and metabolic parameters in critical bleeding/massive transfusion;the optimal ratio of red blood cells to other blood components;the use of tranexamic acid;viscoelastic haemostatic assays; andcell salvage. Changes in management as a result of the guideline: The new guideline recommends MHPs be established as standard of care in all institutions managing patients with critical bleeding. In addition to routine physiological markers, the new guideline recommends temperature, biochemistry and coagulation profiles be measured early and frequently, providing parameters that define critical derangements. Ratio‐based MHPs should include no fewer than four units of fresh frozen plasma and one adult unit of platelets for every eight units of red blood cells. In the setting of trauma and obstetric haemorrhage, administration of tranexamic acid within three hours of bleeding onset is recommended. The use of recombinant activated factor VII (rFVIIa) is not recommended. There was insufficient evidence to make recommendations on the use of viscoelastic haemostatic assays or cell salvage as part of MHPs. [ABSTRACT FROM AUTHOR]

Background: In the pediatric care field, ensuring safe and effective blood transfusions, promptly identifying adverse reactions, and implementing appropriate interventions are crucial. Therefore, undergraduate nursing curricula need to be structured to meet these professional standards and prepare nursing students, as future team members, to respond to relevant clinical situations. The objective of this study was to investigate how problem- and task-based learning affects knowledge and clinical decision-making of undergraduate nursing students concerning the use of transfusion medicine in pediatric nursing. Material and methods: This quasi-experimental study involved 82 nursing students recruited from two nursing schools in Iran using convenience sampling. Participants received educational content through either problem- (n = 40) or task-based learning (n = 42) methods. A researcher-made tool, comprising three parts and proven to be valid and reliable, was utilized for data collection. The tool was administered both before and immediately after the intervention. Data were analyzed using Wilcoxon rank-sum, Mann-Whitney U, Spearman's correlation and multivariate analysis of covariance tests via SPSS v16.0. A p-value of