Chinese expert consensus on clinical application of irradiated blood / 中国输血杂志

Transfusion associated graft versus host disease (TA-GVHD) is a serious transfusion adverse reaction. It is widely believed that transfusion of irradiated blood is the most effective method to prevent TA-GVHD. There are some problems in the application of irradiated blood in China, such as slow development, insufficient understanding, and non-standard application. This consensus was completed after in-depth discussion by experts in the fields of transfusion medicine, hematology, and pediatrics in China. The Writing Group mainly discuss key technical points and clinical applications related to irradiated blood, and proposes 23 related recommendations. This consensus aims to standardize and promote the rational use of irradiated blood, minimize the risk of TA-GVHD in recipients and lay the foundation for developing more standardized guidelines in the future.

The paradox of thrombotic thrombocytopenic purpura and the TACO challenge!

Thrombotic thrombocytopenic purpura (TTP) is a rare medical emergency characterized by the pentad of microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, and neurological dysfunction. TTP is an infrequent condition and is a thrombotic microangiopathy. TTP is essentially a clinical diagnosis. As untreated TTP has a high mortality, diagnosis is usually presumptive and prompt treatment with plasma exchange is highly beneficial and reduces mortality significantly. Therapeutic plasma exchange with fresh frozen plasma is the standard treatment of choice for TTP. Transfusion-associated reactions may occur in some patients further complicating the disease picture and prolonging hospital stay and recovery. Transfusion-associated circulatory overload and transfusion-associated acute lung injury are the leading cause of transfusion-related mortality. We present here the diagnostic and therapeutic challenges that we faced with a young male patient who presented with fever, jaundice, and seizures.

Current research of RBC alloantibodies associated with blood transfusion and its susceptibility factors / 中国输血杂志

Blood transfusion, an important auxiliary means of clinical treatment, however, is not absolutely safe and risk-free as the transfusion-associated RBC alloantibodies being a potential risk. The yielding rate of RBC alloantibodies in Chinese Han population is about 0.2%, and the researches concerning its production mechanism is particularly critical due to its important clinical significance in patients′ future blood transfusion or pregnancy. This paper reviews the current research status of red blood cell alloantibodies associated with blood transfusion and its susceptibility factors.

Analysis of risk factors for neonatal transfusion-associated necrotizing enterocolitis / 中国小儿急救医学

Objective@#To investigate the clinical relevant factors associated with transfusion associated necrotizing enterocolitis (TANEC) in order to reduce the incidence of neonatal necrotizing enterocolitis (NEC).@*Methods@#The clinical data of neonates admitted to the First Hospital of Lanzhou University and received blood transfusion therapy from January 2017 to June 2018 were collected, including perinatal factors, basic conditions of children, and comorbidities.According to the occurrence or absence of NEC within 48 hours after transfusion, the patients were divided into TANEC group and no-TANEC group.The clinical data of the two groups were compared.@*Results@#Univariate analysis showed that there were statistical differences (P<0.05) in the mode of delivery, gestational age, birth weight, neonatal sepsis, patent ductus arteriosus(PDA), neonatal respiratory distress syndrome (NRDS), and anemia.The logistic multivariate analysis revealed that gestational age(P<0.05, OR=0.772, 95%CI: 0.684-0.871), the birth weight(P<0.05, OR=0.236, 95%CI: 0.079-0.711)were protect fators of TANEC, the degree of anemia(mode 1: P<0.05, OR=3.129, 95%CI: 1.003-9.756; mode 2: P<0.05, OR=3.449, 95%CI: 1.024-11.609)and sepsis (mode 1: P<0.05, OR=6.327, 95%CI: 1.732-23.720; mode 2: P<0.05, OR=8.154, 95%CI: 2.122-31.336)were significant risk fators for TANEC.@*Conclusion@#The factors leading to the occurrence of TANEC are various.When transfused, the greater the gestational age, the higher the birth weight, the lower the risk of developing NEC.The more severe the combination of neonatal sepsis and anemia, the higher the risk of developing TANEC.Clinically, comprehensive measures should be taken to prevent neonatal anemia.According to the specific conditions of the children and the degree of anemia, a reasonable clinical strategy should be formulated to avoid blood transfusion to reduce the incidence of TANEC and improve the prognosis of the children.

A Case Report of Transfusion-associated Circulatory Overload

Transfusion-associated circulatory overload (TACO) is recently becoming more important than transfusion-related acute lung injury (TRALI) in terms of the number of patients with definite diagnosis as well as its prognosis. In order to diagnose TACO, it is helpful to recognize early the symptoms suspicious of transfusion reaction through electronic medical record system and computer network, and this will be of help for obtaining samples for brain natriuretic peptide (BNP) measurement before and after the onset of transfusion reaction. We report a case in which a transfusion reaction was diagnosed as TACO. A 62-year-old woman was admitted to the emergency room due to bleeding tendency. Two fresh frozen plasma units and one unit of leukocyte-reduced red blood cells were transfused. Blood pressure increased during transfusion, and the chest X-ray showed findings suggestive of newly developed pulmonary edema. N-terminal prohormone of BNP (NT-proBNP) test was carried out using the specimens in refrigerated storage. Compared with the NT-proBNP level measured 12 hours before the transfusion, that measured 6 hours after the transfusion was markedly increased (>48 fold of pre-transfusion level). As a result, this case was diagnosed with TACO.

Anti-CD3 Antibody Ameliorates Transfusion-Associated Graft-Versus-Host Disease in a Chemotherapy-Based Mouse Model With Busulfan and Fludarabine

ABSTRACT To establish a transfusion-associated graft-versus-host disease (TA-GVHD) mouse model with busulfan and fludarabine for effective treatment evaluation. BALB/c (H-2d) mice were injected with busulfan (15 mg/kg) and fludarabine (30 mg/kg) twice a day for 4 days. The mice were transfused with 106 T cell-depleted bone marrow (TCD-BM )and cells in different groups 3 days after chemotherapy: syngeneic BALB/c, MHC minor mismatch DBA/2 (H-2d), or MHC major mismatch C57BL/6(H2-b). Recipient BALB/c mice were injected with either blood only or blood+splenocyte. TA-GVHD was monitored in terms of body weight loss, clinical scores, and survival. Dexamethasone (50 mg/kg), cyclophosphamide (50 mg/kg), cyclosporine A (30 mg/kg), and anti-CD3 (1 mg/kg) were injected to each group to examine the treatments. Blood transfusion alone is insufficient to induce TA-GVHD in a chemotherapy-based mouse model. A MHC-mismatched TA-GVHD model can be induced by splenocyte and blood transfusion. This MHC-mismatched TA-GVHD model was resistant to dexamethasone treatment. Treatment based on anti-CD3 monoclonal antibody slightly ameliorated TA-GVHD. Treatment effectiveness was associated with T-cell depletion following activation by anti-CD3. Busulfan and fludarabine chemotherapy regimen can be used to establish a TA-GVHD mouse model. Anti-CD3 monoclonal antibody is a potential alternative to treat TA-GVHD.

Effect of 60 Co γ-ray irradiation on the quality of leukocyte-filtrated red blood cells suspension / 新乡医学院学报

Objective To investigate the effect of 60Co γ-ray irradiation on the quality of theleukocyte-filtrated red blood cells suspension.Methods Thirty bags of leukocyte-filtrated red blood cells were randomly divided into irradiation group(n =15) which was given 60Co γ-ray irradiation and control group(n =15) which was not given 60Co γ-ray irradiation.The content of extracellular K +,Na +,free hemoglobin (FHb),adenosine triphosphate (ATP) and 2,3-diphosphoglyceric acid (2,3-DPG) and pH value of the leukocyte-filtrated red blood cells were detected in the two groups.Results The content of K+,Na+,FHb,ATP,2,3-DPG and pH value in irradiation group was (5.20 ± 0.37) mmol · L-1,(140.22 ± 0.05) mmol · L-1,(0.44 ±0.04) mg· L-1,(5.18 ± 0.13)μmol· L-1,(3.34±0.30) mmol· L-1 and 6.85±0.02;the content of K +,Na +,FHb,ATP,2,3-DPG and pH value in the control group was(5.00 ± 0.40)mmol · L-1,(140.47 ± 0.83)mmol · L-1,(0.42 ± 0.08) mg · L-1,(5.22 ± 0.06) μmol · L-1,(3.56 ± 0.52) mmol · L-1 and 6.84 ± 0.05;there was no statistic difference in the content of K +,Na +,FHb,ATP,2,3-DPG,and pH value between the two groups(t =1.93,-1.67,-1.64,-2.02,1.77,1.82;P ＞ 0.05).Conclusion 6o Co γ-ray irradiation of the leukocyte-filtrated red blood cells can not effect the activity and function of red blood cells.

Clinical Usefulness of Human Immunodeficiency Virus(HIV)-1 p24 Antigen Testing / 대한수혈학회지

BACKGROUND: Recently some countries such as U.S.A. and Canada where human immunodeficiency virus(HIV) infection is rather prevalent, included HIV-1 p24 antigen test as a routine donor blood screening. This study was performed to evaluate the advantage of additional p24 antigen testing for the prevention of transfusion-associated AIDS infection in Korea. METHODS: Blood collected from 1726 volunteer blood donors, 16 HIV-positive patients, 39 sera from 4 commercial seroconversion panels, 15 sera included in low titer performance panel were tested with HIV-1 p24 Antigen ELISA Test System(Ortho Diagnostic Systems, U.S.A.). Anti-HIV antibody was also measured in parallel employing commercial kits produced by two world-famous companies. For some sera, western blot testing was additionally done. RESULTS: False-positive rate of p24 antigen testing was 0.06%. In 2 examples from 4 seroconversion panels, the p24 antigen test detected HIV infection 1-25 days and 11-47 days earlier than anti-HIV tests. CONCLUSION: Additional p24 antigen testing was found to have a potential to reduce transfusion-associated HIV infections. Including the p24 antigen testing as a routine donor screening should be considered if the number of transfusion-associated HIV infections continues to grow in Korea.

Research on Preparation of Leukocyte-Poor Platelet Concentrates by Centrifugation / 中国输血杂志

The platelet concentrates prepared by twofold centrifugation in tight quadruple-bag were subjected to the third centrifugation after their disaggregation to remove white and red blood cells from them. The effect of third centrifugation speed on the efficiency of platelet concentrates was treated. The observation of 65 bags undergoing the third 450Xg centrifugation showed that the white blood cell residual was 0. 07?108/L and the platelet recovery was 52. 5% of the whole blood, with the mediant being (5. 3?1. 6) ?1010per bag.The control study of 18-bag platelet concentrates demonstrated that the third centrifugation had no impact on the quality and extrasomatic function of platelets during their storage. The pH of leukocyte-poor platelet concentrates having been stored for 3 and 5 days was significantly higher than that of common platelet concentrates, making up 7. 2?0. 1,6. 6?0. 4,7. 1?0. 2 and 6. 3?0. 6(P