Measurement of Free Hemoglobin Percentage in Stored Packed Red Blood Cells Units by Colorimetric Method

Aims:To measure free hemoglobin percentage in stored packed red blood cells units by colorimetric method.Study Design:This is a descriptive, hospital based case study.Place and Duration of Study:Khartoum central blood bank during the period from June to September 2021.Methodology:A total of thirty-six packed red blood cells blood bags with Citrate-Phosphate-Dextrose-Adenine-one (CPDA-1) stored at 2-6°C for 35 days were withdrawn aseptically on days one; 14, and day 35. Free hemoglobin concentration was measured with Drabkin's method through digital photoelectric colorimeter in which the percentage of hemolysis was calculated, and PH values were measured by a PH meter (ADWA). Mean and standard deviation ofeach day were calculated by statistical package for social science (SPSS)computer program version 22.0.Results:The results showed statistically significant elevation in percentages of free plasma hemoglobin with prolongation of storage duration periods; day one compared with day 14 (P= 0.001), day one compared with day 35(P= 0.001) and day 14 compared with day 35 (P= 0.001). No significant correlation was observed between the degree of hemolysis in day 35 with PH values (P= 0.9).Conclusion:This study concluded that prolonged storage is associated with elevation of free plasma hemoglobin level indicative of progressive hemolysis.

Evaluation of Sysmex XN-3000 for Detection of Schistocyte / 中国实验血液学杂志

OBJECTIVE@#Compared with the method of optical microscopy, to evaluate the accuracy of fragmented red cells(FRC) detection by Sysmex XN-3000.@*METHODS@#A total of 111 samples were collected from patients diagnosed as thrombotic thrombocytopenic purpura, autoimmune disease, hematological disease, malignant tumor and health examination in our hospital from June 2019 to February 2021, including 74 cases in the case group and 37 cases in the healthy control group. All samples were detected by optical microscope and Sysmex XN-3000, respectively. ROC was used to evaluate the detection ability of Sysmex XN-3000 for schistocyte. Bland-Altman method was used to evaluate the consistency of the results of the two methods for detection of schistocyte, and Pearson correlation analysis was conducted for the difference of the results.@*RESULTS@#The area under the ROC curve was 0.890(95% CI: 0.828-0.952, P<0.01). Sysmex XN-3000 count did not quantitatively agree with schistocyte counts by microscopy in the case group(mean of difference:-1.53, 95% limits of agreement: -8.78~5.72). There was a weak positive correlation between platelet count and the difference of analyzer and microscopic results (r=0.32,P<0.05).@*CONCLUSION@#Sysmex XN-3000 can be used as a reference for qualitative determination of schistocyte. However, the sensitivity of Sysmex XN-3000 should be improved. It is still necessary to combine with manual microscopy. The quantitative results are not reliable now and cannot be used as a reference for monitoring the results of schistocyte in clinical patients after treatment.

Caso clínico: Paciente doble heterocigoto para Hemoglobina New York (HB Kaohsiung) y Alfa Talasemia (­α3.7/αα) / Double heterozygous patient for New York Hemoglobin (HB Kaohsiung) and Alpha Thalassemia (­α3.7/αα)

Resumen Se reporta el caso de una paciente adulta, asintomática, sin historial familiar de anemia o enfermedades crónicas, atendida en el Laboratorio Clínico del Área de Salud de Aserrí que acude a control salud por seguimiento a tratamiento de anemia. Se revisa el histórico del expediente médico del propositus, donde se evidencia que el VCM por debajo del límite de referencia normal, hace incurrir al médico tratante en el error de asociar microcitosis con anemia ferropriva. Sin embargo, el Laboratorio Clínico de Aserrí cuenta con un algoritmo de donde se deriva que los índices y la morfología obtenidos en este hemograma son sugestivos de Talasemia, por lo que se envía la muestra al Laboratorio de Estudios Especializados e Investigación del Hospital Nacional de Niños Dr. Carlos Sáenz Herrera para realizar una electroforesis de hemoglobina. En este análisis se detecta una variante de hemoglobina. A nuestro buen saber, no se ha descrito anteriomente un caso de doble heterocigota como el aquí mencionado, por lo que se reporta el primer caso en Costa Rica de un doble heterocigota hemoglobina New York/-3.7 Alfa Talasemia.

Abstract An asymptomatic adult female, with no previous family history of anemia or chronic diseases, goes to consultation at Aserrí ´s Clínic for anemia follow up. A history review of the medical record shows that MCV is below the lower reference range. This MCV value induces the physician to treat the patient for iron deficiency anemia. Using the algorithm of the Clinical Laboratory in Aserrí, such erythrocytic indices are suggestive of Thalassemia. For these reason a blood sample is sent for hemoglobin electrophoresis and molecular analysis at the specialized hematology laboratory at the National Children´s Hospital. A variant hemoglobin is detected. To our knowledge, this is the first case of compound heterozygous for Hemoglobin New York/-3.7 Alfa Thalassemia in Costa Rica.

Identification and characterization of Cromer blood group anti-IFC / 中国输血杂志

【Objective】 To explore the identification method and characteristics of anti-IFC against Cromer blood group. 【Methods】 ABO blood group was identified by tube method, and Rh blood group was identified by Rh typing card. Irregular antibody screening and antibody identification were carried out using microtube column agglutination technology(MCAT). The serum of the patient reacted with panel cells treated with antitrypsin, trypsin and bromelain respectively to determine the specificity of the antibody. The serum was inhibited with pure CD55 protein for antibody identification. The DAF, the regulatory gene of Cromer blood group system, was amplified and sequenced. The expression of CD55 on cell membrane was analyzed by flow cytometry. 【Results】 The patient′s blood type was B, CcDEe. The patient′s serum reacted with all the untreated panel red cells, bromelain-treated red cells, trpsin-treated red cells, and DTT treated red cells.It was negative with chymotypsin-treated cells and could be neutralized by CD55 protein. No mutation was found by DAF sequencing. The expression of CD55 on patient′s cell membrane was deficient. 【Conclusion】 This high frequency antibody was identified as anti-IFC. The transient depression in CD55 protein may due to the patient′s GI system abnormalities.

Em busca do melhor aproveitamento de bolsas de concentrado de hemácia de baixo volume / In search of the best use of bags low-volume red blood cells concentrate

RESUMO: Introdução: A produção de bolsas de sangue total com volume inferior ao esperado é prevista na Portaria de Consolidação no 05/2017, porém, a sua dispensação hoje leva em consideração apenas o teor de hemoglobinas e hematócrito da bolsa. Objetivo: Determinar, a partir dos parâmetros técnicos brasileiros existentes, os critérios para o melhor aproveitamento para bolsas de concentrados de hemácias de baixo volume (CHBV) produzidas na Fundação HEMOPA. Material e métodos: Foram analisados volume, teor de hemoglobina e hematócrito de 525 bolsas de CHBV provenientes de bolsas duplas sem adição de conservante; triplas convencional com adição de SAG-M (soro fisiológico, adenina, glicose e manitol); triplas top and bottom (TAB) com adição de SAG-M; e quádruplas TAB com filtro "in line" e adição de SAG-M. Resultados: Foi observado que 71,43% (375/525) das bolsas de CHBV, independente do tipo da bolsa, apresentavam-se em conformidade para hematócrito e teor de hemoglobina em relação à legislação. As bolsas duplas e triplas convencionais apresentaram os maiores valores de teor de hemoglobina. Observou-se ainda que as bolsas de sangue total coletadas com volumes entre 350 e 404 ml geraram bolsas de CHBV com os menores índices de descarte. O maior descarte das bolsas de CHBV ocorreu quando o volume final ≤250 mL e hemoglobina ≤ 16 g/dL. Conclusão: Observou-se que o melhor aproveitamento das bolsas de CHBV ocorreu quando as bolsas de sangue total se encontravam com volumes entre 350 e 404 mL e as bolsas de CHBV apresentavam volume final ≥ 250 mL e hemoglobina ≥ 16g/dL.(AU)

ABSTRACT: Introduction: The production of whole blood bags with a lower volume than expected is approved in the Consolidation Ordinance number 05/2017; however, its dispensation today takes into account only the hemoglobin and hematocrit content of the bag. Objective: From the existing Brazilian technical parameters, determine the criteria for the best clinical use for low-volume red cell concentrate (LVRCC) bags produced at the HEMOPA Foundation. Material and methods: We analyzed volume, hemoglobin content, and hematocrit of 525 LVRCC bags from double bags without addition of preservative; conventional triple bags with the addition of SAG-M (saline, adenine, glucose, and mannitol); triples bags top and bottom (TAB) with the addition of SAG-M, and quadruple bags TAB with "in line" filter and the addition of SAG-M. Results: It was observed that 71.43% (375/525) of bags of LVRCC, regardless of bag type, were in conformance with hematocrit and hemoglobin content concerning Brazilian legislation. With the double and conventional triple bags, they had the highest values of hemoglobin content. It was also observed that the bags of whole blood collected with volumes between 350 and 404 mL generated LVRCC bags with the lowest rate of discard. The greatest discard of LVRCC bags occurred when the final volume ≤ 250 mL and hemoglobin ≤ 16 g/dL. Conclusion: It was observed that the best use of LVRCC bags occurred when the whole blood bags were between 350 and 404 mL and the LVRCC bags had a final volume ≥ 250 mL and hemoglobin ≥ 16 g/dL. (AU)

Acute blood transfusion reaction in a tertiary care hospital in Southern Punjab, Pakistan

Background: Blood transfusion is a lifesaving process but carries many risks. Majority of these had been reduced with better diagnostic and management strategies. But the risk of non-infectious adverse transfusion reactions though reduced but cannot be eliminated. Hemovigilance is the system to monitor such reactions.Methods: The objective of current study was to know the frequency of adverse transfusion reactions and to compare it with local and international data. Retrospective cross-sectional descriptive study was done in Ibn-e- Sina hospital. Adverse transfusion reactions reported to blood bank was analysed according to hospital protocol.Results: Out of 6050 blood transfusions 23 (0.38%) develop adverse transfusion reactions. Febrile nonhemolytic transfusion reaction was the commonest adverse event and whole blood was the component implicated.Conclusions: Adverse transfusion reactions are non-infectious complications of blood transfusion which in spite of all efforts cannot be avoided. Frequency of adverse transfusion reactions in our study was 0.38% and Febrile nonhemolytic transfusion reaction was commonest reported reaction type. Hemovigilance system is necessary to monitor, investigate and control such activities.

Aplasia pura de serie roja adquirida y enfermedad renal crónica en terapia de sustitución renal tipo hemodiálisis / Acquired pure aplasia of red cells and chronic kidney disease in renal replacement therapy type hemodialysis

La aplasia pura de serie roja (APSR) adquirida es un trastorno hematopoyético poco frecuente caracterizado por anemia normocítica y normocrómica, reticulocitopenia y ausencia de precursores eritroides en la médula ósea, frecuencia que ha ido incrementando en pacientes con enfermedad renal crónica. Presentamos el caso de un varón de 38 años de edad, con hipertensión arterial sistémica, en terapia hemodialítica. En su evolución cursa con anemia aguda, tras protocolo de estudio se objetivó una aplasia pura de células eritroides por anticuerpos anti eritropoyetina, el paciente recibió bolos de ciclofosfamida, quimioprofilaxis, terapia dialítica, se suspendió la eritropoyetina, presentando buena evolución, efectuándose posteriormente el trasplante renal.

Acquired pure red cells aplasia (PRCA) is a rare hematopoietic disorder characterized by normocytic and normochromic anemia, reticulocytopenia and absence of erythroid precursors in bone marrow, frequency that has been increasing in patients with chronic kidney disease. We present the case of a 38-year-old man with systemic hypertension in hemodialysis therapy. During the course of the disease, acute anemia was observed. After a study protocol, pure erythroid cell aplasia was detected by antierythropoietin antibodies, the patient received boluses of cyclophosphamide, chemoprophylaxis, dialysis therapy, erythropoietin was suspended, with favorable evolution. Subsequently, the kidney transplant.

Clasificación automática de glóbulos rojos en frotis de sangre periférica / Healthy lifestyles and risk behavior of medical students

Introducción: El diagnóstico del estado eritrocitario en frotis de sangre periférica es un proceso realizado normalmente de forma manual a partir de observación microscópica, lo cual implica una considerable inversión de tiempo y recursos, además de posibles problemas de subjetividad y dificultad en la reproducibilidad del diagnóstico. Objetivo: Desarrollar una aplicación que permita la clasificación automática de glóbulos rojos en frotis de sangre periférica, de utilidad como herramienta de ayuda diagnóstica. Metodología: Se usaron técnicas de procesamiento de imágenes para segmentar los eritrocitos en las fotografías microscópicas y medir en ellos área, perímetro, solidez, circularidad, excentricidad, textura y dimensión box-counting. Se usó una red neuronal artificial para clasificar los eritrocitos según sus características en siete clases, incluyendo normalidad y seis alteraciones patológicas. La red se entrenó de acuerdo con la clasificación de 262 eritrocitos realizada por un hematólogo experto. Los desarrollos se hicieron en matlab®, una poderosa plataforma de computación científica. Resultados: La red escogida alcanza el 97.3% de aciertos en los datos de validación. Las equivocaciones en la red corresponden a células de dudosa clasificación aún para un experto, por presentar características correspondientes a varias clasificaciones patológicas. Conclusiones: La aplicación desarrollada clasifica de manera rápida y acertada los diferentes tipos de glóbulos rojos presentes en una muestra microscópica de frotis de sangre periférica, siendo de utilidad como herramienta de apoyo diagnóstico.

Introduction: The process of erythrocyte classification in peripheral blood smear is normally done manually from microscopic observation. This implies not only a considerable investment of time and resources but also brings potential problems of subjectivity and difficulty in the reproducibility of diagnosis. Objective: To develop an application that allows the automatic classification of red blood cells in peripheral blood smears, as a diagnostic aid tool. Methodology: Image processing techniques were used in order to segment erythrocytes in the microscopic photographs and to measure characteristics as area, perimeter, solidity, circularity, eccentricity, texture and boxcounting dimension. An artificial neural network was used to classify the red blood cells in the images in seven classes, including normal and six pathological changes, according to their characteristics. The network was trained according to the classification of 262 erythrocytes by an expert hematologist. The developments were made in matlab®, a powerful scientific computing platform. Results: The chosen network reaches 97.3% correct in the validation data. Mistakes in the network correspond to cells with various pathological classifications features, which make them difficult to classify even for an expert. Conclusions: The developed application classifies quickly and accurately the different types of red blood cells in a microscopic sample of peripheral blood smear, so it could be useful as a diagnostic support tool.

Motion characteristics of hyper-elastic red cells in shear flow based on immersed boundary method / 医用生物力学

Objective To numerically simulate the motion characteristics of red cells in shear flow, so as to provide theoretical references for exploring pathogenesis of cardiovascular diseases and conducting experimental studies of blood circulation. Methods The hyper-elastic model of red cells with membrane thickness was established. Based on feedback force method and finite element immersed boundary method, the deformation and motion of red cells in shear flow were simulated. The solid was defined as being hyper-elastic and solved by finite element method, while the fluid was defined as incompressible Newton fluid and solved by finite difference method. Results The tank tread-like motion characteristics of red cells in shear flow were gained by numerical simulation. The simulation results in the study were consistent with the results in the literature, which validated the reliability of the proposed method in the study. Conclusions The immersed boundary method adopted in the study shows obvious advantage in solving the large deformation problem by preferably demonstrating the whole process of red cell deformation in shear flow.

Some Blood Cell Changes and Alteration in Renal and Hepatic Function in Pre-eclampsia: A Study in Owerri Nigeria.

Aims: We studied some blood cell changes and alterations in renal and hepatic functions in pregnancy and pre-eclampsia and determined baselines for the population in owerri, south east Nigeria. Study Design: It was a cross sectional case control study conducted prospectively among antenatal women attending clinic at Holy Rosary, Federal Medical Centre and General Hospitals Owerri. The study included fifty non-pregnant, fifty pre-elampsia and fifty normotensive pregnant women of singleton gestation in their third trimester Place and Duration of Study: Sample: Antenatal unit of Holy Rosary, Federal Medical Centre and General Hospitals Owerri between May 2009 and June 2010. Methodology: The study included fifty (50) non-pregnant women, fifty (50) pregnant normotensive women and fifty (50) pre-eclamptic women of singleton gestation in their third trimester. Full blood count, liver function enzymes assay and some kidney function parameters was determined in all subjects. The subjects were selected under defined criteria. PE patients were at 28 to 42 wks of single-diastolic pressure of 110mmHg or more or two measurements of 90mmHg or more on two consecutive occasions of 6hours or more apart, urinary protein 2+ or more. The exclusion criteria include history of hypertension and proteinuria before conception or before 20wks of gestation, a history of antioxidant vitamins therapy during the last one year and smoking. Results: The result showed a significant (P = 0.05) decrease in Red cell distribution width coefficient of variance (RDW-CV), mean cell haemoglobin (MCH), platelet count (PC) and mean platelet volume- platelet count (MPV-PC) ratio in pre-eclampsia comaperd to normal pregnancy. Significant increases (P= 0.05) in red blood cell count, haemoglobin concentration, haematocrit, mean cell volume, mean platelet volume, platelet distribution width (PDW) and circulating large platelet ratio (PLCR) were found among the pre-eclamptic women. There was a significant (P = 0.05) increase in ALT, AST, ALP and LDH activities in pre-eclampsia when compared to both the normal and the pregnant controls. Urea, Creatinine and Uric acid concentrations had a significant increase (P = 0.05) in pre-eclampsia when compared to normal and pregnant controls Conclusion: The significant variation seen in these red cell parameters between the PC and NPC is attributable mainly to pregnancy than to pre-eclampsia. Pre-eclampsia though resulted in a marked platelet usage with a resulting shorter platelet life-span. A burden on the liver and kidney resulting from pre-eclampsia could have adversely affected protein metabolism which in turn may have affected erythropoesis. Results indicate that renal function is impaired in the presence of pre-eclampsia.

THE RESULT OF DETERMINATION RHESUS AND KELL GROUPS AMONG BLOOD DONORS OF ULAANBAATAR CITY / Шинэ санаа Шинэ нээлт

The result of this study show that the determination rate of the first screening test of Rhesus group D antigens negativity was 1.2%, where as the confirmation analysis decreased this rate to 1.18%. Similarly, the determination rate of the Kell K-antigen positivity rate was 0.9%. where as the confirmation test decreased this rate up-to ().X5%. These result show, that it is necessary to use confirmation test in routine diagnosis of blood sub-group determination. The Rh blood group system is of considerable importance in transfusion and clinical medicine. We have determined some clinically important red cell antigens such as C,c I), E,e in 97 Rh (+) blood donors, using the monoclonal antibodies "Erithrotest-Tsoliclon", produced at the Hematology company. Russian Federation. Among these Rh (•) blood donors prevail RIR2, R1R1 .R2R2 phenotypes accounting for 36.1%, 27.X% and 11.3% respectively. Among these Rh (-) blood donors prevail rr. rr'.rr" phenotypes accounting for 74%, 16% and 4% respectively.

Detection of bacterial growth in blood components using oxygen consumption as a surrogate marker in a tertiary oncology setup.

Microbiological contamination of blood and blood products is a well-recognised transfusion risk. This study was performed in the blood bank of our oncology centre, with an objective to detect bacterial contamination in our blood products using oxygen consumption as a surrogate marker [Pall Enhanced Bacterial Detection System (eBDS)]. Results revealed that the percentages of failed units were 1.16% for random donor platelets (RDP), 0.81% for single donor platelets (SDP) and 2.94% for packed red blood cells (PRBCs), of which one RDP and one SDP grew coagulase-negative staphylococcus, while one PRBC culture grew Gram-positive bacilli.

Haemoglobinopathies in Greece: prevention programme over the past 35 years.

At present, prevention of thalassaemia and sickle cell disease is the only realistic approach to control the birth of new patients in countries having high numbers of carriers. This is fully justified because avoiding the birth of an ever increasing number of patients may allow a more effective use of the available resources in improving the management of the patients surviving today and alleviate the already overloaded public health system from the inevitable tremendous and ever increasing cost. Moreover, prenatal diagnosis may help couples at risk to have non-thalassaemic children. Greece is one of the countries where the mean frequency of carriers is approximately 7.5 per cent (population 11 million) and has set up a nationwide programme for carrier identification in the early seventies; this is provided through a dozen of specific Units attached to the major Blood Transfusion Services of the country, on a voluntary basis and free of charge. Spread of information through mass media, the schools, and other groups has greatly contributed in creating the necessary sensitization; obstetricians and antenatal Clinics are also instrumental to this effect. Prenatal diagnosis is offered centrally (Athens) and covers satisfactorily the estimated needs (500-600 annually); the total number has already exceeded 35,000. According to information obtained from the major paediatric hospitals all over the country, the number of thalassaemia major or SCD admitted for treatment over the last ten years has been around 15 yearly (instead of an estimate of 120-130).

Serial assessment of biochemical parameters of red cell preparations to evaluate safety for neonatal transfusions.

Background & Objectives: Neonatologists often prefer fresh blood (<7 days) for neonatal transfusions. The main concerns for stored RBCs are ex vivo storage lesions that undermine red cell functions and may affect metabolic status of neonatal recipients. This study was designed to evaluate serial in vitro changes of biochemical parameters in different RBC preparations during storage to consider for neonatal transfusions even after storage beyond one week. Methods: Twenty five units each of whole blood (CPDA-1 RBC, SAGM RBC) were selected for serial biochemical parameter assessment after each fulfilled the quality criteria (volume and haematocrit). These units were tested serially for supernatant potassium, pH, lactate, haemoglobin, glucose and red cell 2,3 diphosphoglycerate (2,3 DPG) up to 21 days of storage. Results: Within each group of RBC, rise in mean concentration of potassium, lactate and plasma haemoglobin from day 1 to 21 of storage was significant in CPDA-1 RBC having the highest levels at day 21. From day 3 to 21, SAGM RBC had higher mean pH value than CPDA-1 RBC though this difference was not statistically significant. SAGM RBC had highest mean glucose concentration during storage than other two types of red cell preparations (P<0.005). Within each group, fall in mean 2,3 DPG concentration from day 1 to 7 was significant (P<0.05). A positive correlation existed between mean plasma potassium and haemoglobin in all three types of red cells (r=0.726, 0.419, 0.605 for CPDA-1 RBC, SAGM RBC and whole blood respectively, P<0.005). Interpretation & Conclusions: All the three red cell preparations tested revealed biochemical changes within acceptable limits of safety till 21 days of storage. CPDA-1 RBCs had the highest degree of these changes.

Monitoração e avaliação clínica da eficácia da transfusão de sangue total e concentrado de hemácias em cães / Monitoring and evaluation of the efficacy of whole blood and packed red cells transfusion in dogs

A terapia transfusional tem grande potencial de salvar vidas na clínica de pequenos animais, e é usada principalmente na terapêutica de emergência em animais anêmicos, entretanto este procedimento está associado a vários riscos. Uma das formas de minimizá-los é pela monitoração constante durante a transfusão sanguínea, permitindo assim avaliar a melhora clínica do paciente. O objetivo deste trabalho foi avaliar a eficácia da transfusão de sangue total e de concentrado de hemácias em cães anêmicos, por meio da monitoração dos parâmetros vitais. Foram avaliadas 77 transfusões em cães, sendo 52 de sangue total armazenado e 25 de concentrado de hemácias. Durante todo o procedimento aferiu-se (a cada 15-30 minutos) a temperatura, frequência cardíaca, frequência respiratória e a coloração de mucosas dos pacientes, além do tempo de preenchimento capilar. Os resultados obtidos mostraram que ambos os componentes promoveram melhora dos parâmetros avaliados a partir de 45 minutos do início da transfusão sanguínea, principalmente da frequência cardíaca, coloração de mucosas e tempo de preenchimento capilar (p<0,05). A transfusão bem sucedida proporcionou melhora clínica aparente a partir de duas horas do início do procedimento.

Transfusion therapy has a great potential to save lives in small animals practice, and it has been used mainly in the emergency treatment for anemic animals, although this procedure is related to certain risks. A manner to minimize these risks is through keeping close monitoring during the time of transfusion, which furthermore allows an evaluation of recovering of the patient. The aim of the present research was to evaluate the efficacy of whole blood and packed red cells transfusions in anemic dogs. Seventy-seven transfusions in dogs have been done, 52 of whole blood and 25 of packed red cells, measuring (every 15-30 minutes) temperature, cardiac and breathing frequency, mucous tissue color and capillaries filling time throughout the procedure. The outcome shows that both compounds, may cause improvements to every assessed parameters 45 minutes from the start of the transfusion mainly to cardiac frequency, mucous tissue color and capillaries filling time (p<0.05). The success of a transfusion ensures apparent clinical improvement from two hours of the onset of the procedure.

Anemia e transfusões de concentrados de hemácias em pacientes graves nas UTI brasileiras (pelo FUNDO-AMIB) / Transfusion practices in brazilian Intensive Care Units (pelo FUNDO-AMIB)

JUSTIFICATIVA E OBJETIVOS: A anemia é uma condição comum em pacientes graves. A transfusão de hemoderivados aumenta de forma significativa o risco de transmissão de agentes infecciosos e afeta o perfil imunológico. O objetivo deste estudo foi avaliar a incidência de anemia e a prática de transfusão de hemácias em UTI brasileiras. MÉTODO: Estudo prospectivo, multicêntrico, realizado em 19 UTI em um período de duas semanas. A presença de anemia, as indicações e a utilização de concentrados de hemácias, foram avaliadas diariamente. As complicações que ocorreram durante a internação na UTI e após a transfusão da primeira unidade de concentrado de hemácias foram registradas. RESULTADOS: Um total de 33 por cento apresentava anemia na admissão na UTI e esta proporção aumentou para 55 por cento no final de sete dias de internação. Um total de 348 unidades de concentrado de hemácias foi transfundido em 86 pacientes (36,5 por cento). A média de suas unidades por paciente foi 4,1 ± 3,3 U. O nível de hemoglobina limiar para a transfusão de CH foi 7,7 ± 1,1 g/dL. Pacientes transfundidos tinham mais disfunções orgânicas avaliadas pelo escore SOFA (7,9 ± 4,6 versus 5,6 ± 3,8, transfundidos versus não transfundidos, p < 0,05). As taxas de mortalidade foram 43,5 por cento e 36,3 por cento em pacientes transfundidos e não transfundidos, respectivamente (RR 0,61-11,7, NS). Pacientes transfundidos tiveram número maior de complicações (1,58 ± 0,66 versus 1,33 ± 0,49, p = 0,0001). CONCLUSÕES: A anemia é comum em UTI brasileiras. O limiar transfusional de hemoglobina foi menor do que o observado em outros paises.

BACKGROUND AND OBJECTIVES: Anemia of critical illness is a multifactorial condition caused by blood loss, frequent phlebotomies and inadequate production of red blood cells (RBC). Controversy surrounds the most appropriate hemoglobin concentration "trigger" for transfusion of RBC. We aimed to evaluate transfusion practices in Brazilian ICUs. METHODS: A prospective study throughout a 2-week period in 19 Brazilian ICUs. Hemoglobin (Hb) level, transfusion rate, organ dysfunction assessment and 28-day mortality were evaluated. Primary indication for transfusion and pretransfusion hemoglobin level were collected for each transfusion. RESULTS: Two hundred thirty-one patients with an ICU length of stay longer than 48h were included. An Hb level lower than 10 g/dL was found in 33 percent on admission in the ICU. A total of 348 RBC units were transfused in 86 patients (36.5 percent). The mean pretransfusion hemoglobin level was 7.7 ± 1.1 g/dL. Transfused-patients had significantly higher SOFA score (7.9 ± 4.6 vs 5.6 ± 3.8, p < 0.05, respectively), days on mechanical ventilation (10.7 ± 8.2 vs 7.2 ± 6.4, p < 0.05) and days on vasoactive drugs (6.7 ± 6.4 vs 4.2 ± 4.0, p < 0.05) than non-transfused patients despite similar APACHE II scores (15.2 ± 8.1 vs 14.2 ± 8.1, NS). Transfused patients had higher mortality rate (43.5 percent) than non-transfused patients (36.3 percent) (RR 0.60-1.15, NS). Only one patient (0.28 percent) had febrile non-hemolytic transfusion and urticarial reactions. CONCLUSIONS: Anemia is common in critically ill patients.It seems from the present study that transfusion practices in Brazil have had a more restrictive approach with a lower limit "transfusion trigger".

A Xenoreactive Complement Hemolytic Assay in Xenotransplantation / 대한진단검사의학회지

BACKGROUND: Xenotrasplantation is a possible alternative for organ shortage in clinical transplantation, but hyperacute xenograft rejection has been a big huddle. Pre-existing natural xenoreactive antibodies and consequent activation of the complement system are thought to play major roles in hyperacute rejection. To set a monitorig test for the hyperacute rejection in xenotransplantation, we optimised a complement hemolytic assay and evaluated its in-vitro precisions and clinical implications. METHODS: Complement hemolytic activities of normal human sera on rabbit or porcine red blood cells (RBCs) in each gelatin veronal buffer with or without dextrose were compared to retrieve optimal conditions for assay. The precision and activity range of normal human sera were evaluated at a given optimum condition. And we also assayed complement hemolytic activities of the sera obtained from various models of xenotransplantated animal, and assessed its association with other clinical parameters. RESULTS: The assay with rabbit RBCs in gelatin veronal buffer containing dextrose showed linear hemolytic reactions in the broadest range of serum dilutions with the least background hemolysis. Its intra- and inter-assay coefficient variation was 1.3% and 8.1%, respectively. The complement hemolytic activity was dependent on the serum levels of C3 and IgM. Severe hyperacute rejection in lung xenotransplantation was accompanied with a rapid decline of serum complement hemolytic activities compared to the basal level. CONCLUSIONS: The complement hemolytic assay using rabbit red cells has a clinically acceptable range of precision, and seems to be useful for the evaluation of hyperacute rejection in clinical xenotransplantation.

Blood Component Quality Control / 대한수혈학회지

BACKGROUND: Blood donations vary in composition because of considerable variation in donor cell counts and volume collected. In order to minimize the variation in end products, and reduce the likelihood of low quality products, Quality Assurance(QA) program is required. Quality control(QC) refers to procedures in which the potency, safety or purity of end products are periodically measured and related to a set of pre-existing criteria, called standards. We performed the blood component QC, the results of QC testing were analyzed according to the acceptance criteria for AABB(American Association of Blood Bank) and council of Europe and we defined QC parameters of each of blood components in Korea National Red Cross. METHODS: Between Jan. 2000 and Dec. 2000, 150 representative blood components with abnormal screening tests were evaluated to ensure that certain acceptance criteria were met. We tested the volume, hematocrit and hemoglobin in fifty units of packed red cells. We tested the volume, pH, platelet count, and WBC count in fifty units of platelet concentrates, and the volume and factor VIII in fifty unit of fresh frozen plasma. RESULTS: The values of volume, hematocrit and hemoglobin of packed red cells were 237 +/- 19mL, 74 +/- 3% and 55 +/- 4g/unit, respectively. 1 unit(2%) in hematocrit and 1 unit in hemoglobin revealed unacceptable results. The volume, pH, platelet count, and WBC count of platelet concentrates were 54 +/- 5mL, 6.6 +/- 0.3, 6.4 +/- 1.7 X 1010/unit, 0.03 +/- 0.03 X 109/unit, respectively. 7 units(14%) in pH revealed unacceptable results, but platelet and WBC count revealed acceptable results. The volume and factor VIII of fresh frozen plasma were 183 +/- 15mL and 112 +/- 65IU/dL, respectively. 19 units(38%) in factor VIII revealed unacceptable results. CONCLUSION: We suggest the volume, hematocrit and hemoglobin in packed red cells, the volume, pH, platelet count, and WBC count in platelet concentrates, and the volume and factor VIII in fresh frozen plasma as QC tests in Korea National Red Cross. To provide blood components which safety and effectiveness are ensured, we must define blood component QC considering the requirements testing, frequency, retesting, acceptance criteria, corrective action and resposibility. And blood centers should establish a Total Quality System(TQS) in order to ensure their processes and procedures including donor recruitment, collection of blood, laboratory testing, preparation of blood components and distribution.

Effect of Lingzhi Extract on Experimental Thrombosis and Metamorphosis of Red Cells in Bodies / 中成药

Following oral administration, Lingzhi Extract was found to show the actions against the thrombosis of both soterocyte and fibrin of rats, and of raising the metamorphosis capability of aging red cells in bodies. But there were no effects on the prothrombin time of rats and partial thrombozyme of kaolin

Membrane Oxidation Lesions of Stored Red Cell and Protecting Effect of Antioxidation Enzymes / 中国输血杂志

The experimental study of the lesions of red cell membrane caused by peroxi-dation was performed,indicating that having oxidized by superoxide anions,thered cell lesions in appearance were that there was formed the high molecular pro-tein cross-linked polymer,and the conjugated diene level was increased.And thesimilar feature of oxidation lesions was observed in the stored red cells.It wasshowed that antioxidation enzymes could inhibit the forming of protein cross-linkedpolymer and have certain protecting effect on red cell membrane being subject tolesion.