Simulated effects of ferritin screening on C-reactive protein levels in recruited blood donors.

BACKGROUND AND OBJECTIVES: Ferritin is commonly measured to evaluate iron stores in the body. Some countries have added or considered adding ferritin lower bounds to donor eligibility criteria. Ferritin is also elevated by inflammation. The main goal of this study is to estimate how different ferritin cut-offs would affect the proportion of donors with a C-reactive protein (CRP) level over 3 mg/L, which is the decision limit of the highest chronic cardiovascular risk. MATERIALS AND METHODS: To simulate recruitment of new blood donors, we selected participants from two Finnish general population cohorts, namely FINRISK 1997 (n = 5369) and Health 2000 (n = 3278), that would likely fulfil the selection criteria of blood donation. We then calculated the proportion of individuals with high-sensitivity CRP values above 3 mg/L, over a range of ferritin values. RESULTS: We found that for several ferritin cut-offs the proportion of potential donors with CRP > 3 mg/L would rise by a statistically significant amount. The trend was significant and similar for all subgroups but weaker for non-menstruating women as well as men. CONCLUSION: Our results show that screening a population of potential blood donors with ferritin cut-offs raises the number of people with CRP > 3 mg/L within the blood donor population.

Hepatitis E Virus in Finland: Epidemiology and Risk in Blood Donors and in the General Population.

Autochthonous hepatitis E (HEV) cases have been increasingly recognized and reported in Europe, caused predominantly by the zoonotic HEV genotype 3. The clinical picture is highly variable, from asymptomatic to acute severe or prolonged hepatitis in immunocompromised patients. The main route of transmission to humans in Europe is the ingestion of undercooked pork meat. Transfusion-transmitted HEV infections have also been reported. The aim of the study was to determine the HEV epidemiology and risk in the Finnish blood donor population. A total of 23,137 samples from Finnish blood donors were screened for HEV RNA from individual samples and 1012 samples for HEV antibodies. Additionally, laboratory-confirmed hepatitis E cases in 2016-2022 were extracted from national surveillance data. The HEV RNA prevalence data was used to estimate the risk of transfusion transmission of HEV in the Finnish blood transfusion setting. Four HEV RNA-positive were found, resulting in 1:5784 (0.02%) RNA prevalence. All HEV RNA-positive samples were IgM-negative, and genotyped samples represented genotype HEV 3c. HEV IgG seroprevalence was 7.4%. From the HEV RNA rate found in this study and data on blood component usage in Finland in 2020, the risk estimate for a severe transfusion-transmitted HEV infection is 1:1,377,000 components or one in every 6-7 years. In conclusion, the results indicate that the risk of transfusion-transmitted HEV (HEV TTI) in Finland is low. However, continuous follow-up of the HEV epidemiology in relation to the transfusion risk landscape in Finland is necessary, as well as promoting awareness in the medical community of the small risk for HEV TTI, especially for immunocompromised patients.

Determining optimal locations for blood distribution centers.

BACKGROUND: Blood banks have to be thoughtful about supply chain decisions to effectively satisfy the blood product demand of hospitals. These decisions include the number and locations of distribution centers (DC), as this has a strong impact on both transportation cost and the ability to deliver emergency orders in time. STUDY DESIGN AND METHODS: We propose a mixed-integer linear programming approach to find optimal DC locations for supplying individual hospitals. The model maximizes the number of hospitals reachable from a DC within a given time-limit, and minimizes transportation cost. The minimal amount of data required is a set of hospital locations. The model can be further attuned to the user's needs by adding various model extensions. The model's use is demonstrated by two case studies, considering the blood banks of the Netherlands and Finland. RESULTS: For both case studies re-locating the DCs would result in a reduction of transportation cost of about 10% without affecting the reliability of delivery. In addition, to save facility exploitation costs, the number of DCs may be reduced in both countries while maintaining the reliability of delivery. The model was also shown to be robust against changes in hospital ordering behavior. DISCUSSION: We demonstrated the general usability and added value of the model by successfully optimizing the blood supply chains of the Netherlands and Finland, which differ substantially. Nonetheless, in both countries potential savings in both transportation and facility exploitation cost could be shown. The model code is open source and freely accessible online.

Applications of genomic medicine in the treatment of diseases.

Individualized medicine, based on a detailed mapping of the patient's disease mechanisms, is becoming an essential part of treatment for an increasing number of diseases. In the past few years, the possibility to determine the abnormal genome and transcriptome of diseased cells at a reasonable cost has been the major advance. The vast amount of data accumulated from one patient will set requirements for data extraction tools, in order to have the essential information affecting the treatment of the patient information quickly and reliably at the disposal of attending physicians. A computerized decision support system connected to the information systems of the hospital is an integral part of individualized treatment. Although the application of genomic and other profiling information is challenging, individualization of medication provides great promises more effective and safer treatment.

Retrospective analysis of capillary hemoglobin recovery in nearly 1 200 000 blood donor returns.

Measuring the concentration of capillary hemoglobin (cHb) is a standard procedure before blood donation. To further assess the time period needed for cHb recovery after blood donation and to have a more in-depth understanding of features of recovery, we used data-mining tools in a large, retrospective data pool containing all 1 163 524 donor returns that took place in Finland in 2010 to 2015. The results show that the average recovery times for cHb to return back to the level preceding donation were substantially longer, over 200 days in all age groups, than were the minimum allowed donation intervals. cHb recovery was especially poor in women under the age of 30 who returned to donate soon after the minimum allowed donation interval. It was of interest that frequent donors recovered substantially faster, with the average recovery times of ∼100 days in men and ∼200 days in women, than did infrequent donors, suggesting that there is a subpopulation of donors who can donate frequently without fear of iron deficiency. Return interval in fact explained only 1% of the variation in cHb recovery, which points to unknown, individual features, such as genetic or lifestyle factors, warranting further studies and suggesting that simply extending the allowed donation intervals may not suffice to improve cHb recovery. The study demonstrates that data mining of blood bank records is a powerful tool for depicting features of blood donor population.

[Changes in consumption of blood products in Finland from 2007 to 2014]. / Verivalmisteiden kulutuksen muutokset Suomessa vuosina 2007-2014.

The Finnish Red Cross Blood Service (FRCBS) collects and distributes all cellular blood products in Finland. The use of red cells in Finland follows neither the aging of the Finnish population nor morbidity. The use of red blood cells has diminished 34% during the last 20 years and half of this decrease has taken place during the last three years. Use of platelet preparations per inhabitant in Finland clearly exceeds European median. An enhanced IT support for the blood supply chain is needed to maximize the effectiveness of use of blood products.

Phosphorylated IGFBP-1 as a non-invasive predictor of liver fat in NAFLD.

Insulin-like growth factor binding protein 1 (IGFBP-1) is a potentially interesting marker for liver fat in NAFLD as it is exclusively produced by the liver, and insulin is its main regulator. We determined whether measurement of fasting serum phosphorylated IGFBP-1 (fS-pIGFBP-1) helps to predict liver fat compared to routinely available clinical parameters and PNPLA3 genotype at rs738409. Liver fat content (proton magnetic resonance spectroscopy) was measured in 378 subjects (62% women, age 43 [30-54] years, BMI 32.7 [28.1-39.7] kg/m(2), 46% with NAFLD). Subjects were randomized to discovery and validation groups, which were matched for clinical and biochemical parameters and PNPLA3 genotype. Multiple linear regression and Random Forest modeling were used to identify predictors of liver fat. The final model, % Liver Fat Equation', included age, fS-pIGFBP-1, S-ALT, waist-to-hip ratio, fP-Glucose and fS-Insulin (adjusted R(2) = 0.44 in the discovery group, 0.49 in the validation group, 0.47 in all subjects). The model was significantly better than a model without fS-pIGFBP-1 or S-ALT or S-AST alone. Random Forest modeling identified fS-p-IGFBP-1 as one of the top five predictors of liver fat (adjusted R(2) = 0.39). Therefore, measurement of fS-pIGFBP-1 may help in non-invasive prediction of liver fat content.

Season and time of day affect capillary blood hemoglobin level and low hemoglobin deferral in blood donors: analysis in a national blood bank.

BACKGROUND: Low hemoglobin (Hb) is the most common reason for temporary blood donor deferral. However, factors that affect Hb measurement may not portray donor health but reflect external circumstances. STUDY DESIGN AND METHODS: The effects of season, time of day, donor age, ABO, and D on capillary blood Hb level (cHb) and low Hb deferral were analyzed in 1,396,645 donor registrations from the years 2010 to 2014 in a national blood bank. RESULTS: cHb was lower in the summer (July mean 154.1 g/L in men, 139.6 g/L in women) and in the evening (7 pm mean 153.8 g/L in men, 138.9 g/L in women) than in the winter (January mean 156.9 g/L in men, 141.8 g/L in women) and in the morning (11 am mean 157.2 g/L in men, 142.8 g/L in women; all p < 0.0001). This affected donor deferral due to low Hb, with 7.8% donors deferred in July at 7 pm and 1.6% deferred in January at 11 am (p < 0.0001). With age, cHb increased in women and decreased in men. The lowest cHb was observed in blood group A (mean 154.9 g/L in men, 140.3 g/L in women) and the highest in blood group B (mean 156.6 g/L in men, 141.5 g/L in women). D had no practically significant effect on cHb. CONCLUSION: External factors, which do not reflect donor health, affect cHb and donor deferral due to low Hb. These factors should be considered when donor eligibility guidelines and procedures are developed.

Clinical laboratory sciences data transmission: the NPU coding system.

In health care services, technology requires that correct information be duly available to professionals, citizens and authorities, worldwide. Thus, clinical laboratory sciences require standardized electronic exchanges for results of laboratory examinations. The NPU (Nomenclature, Properties and Units) coding system provides a terminology for identification of result values (property values). It is structured according to BIPM, ISO, IUPAC and IFCC recommendations. It uses standard terms for established concepts and structured definitions describing: which part of the universe is examined, which component of relevance in that part, which kind-of-property is relevant. Unit and specifications can be added where relevant [System(spec)-Component(spec); kind-of-property(spec) = ? unit]. The English version of this terminology is freely accessible at http://dior.imt.liu.se/cnpu/ and http://www.labterm.dk, directly or through the IFCC and IUPAC websites. It has been nationally used for more than 10 years in Denmark and Sweden and has been translated into 6 other languages. The NPU coding system provides a terminology for dedicated kinds-of-property following the international recommendations. It fits well in the health network and is freely accessible. Clinical laboratory professionals worldwide will find many advantages in using the NPU coding system, notably with regards to an accreditation process.