Nancy Robitaille

Pathogen inactivation: making decisions about new technologies Report of a consensus conference

Methods to remove and inactivate pathogens, used extensively in the manufacture of plasma protein fractions, have all but eliminated transmission of infectious agents by these products. 1 Technologies for reducing the risk of infection from single donor blood components have not been embraced as enthusiastically. Several methods have been introduced in Europe. Treatment with solvent/detergent (S/D) or methylene blue have both been applied to plasma components, and psoralen treatment of platelets (PLTs) has begun in several countries. 2-4 Although S/D-treated pooled plasma has been approved for use in the United States and Canada, none of these methods has been adopted for single-donor products in North America. Reasons for slow acceptance include 1) the current safety of the volunteer blood supply; 2) the success of surveillance and development of screening tests to deal with emerging pathogens; 3) the inability of current technologies to inactivate some agents such as spores, prions, and certain small nonencapsulated viruses; 4) concerns regarding remote risks from the residual chemical agents used during the pathogen inactivation (PI) process; 5) absence of any single method to treat whole blood or all components; and 6) the costeffectiveness of these technologies especially compared to strategies to reduce noninfectious risks of transfusion. 5

Complications of apheresis in children

BACKGROUND: Although the frequency of complications in adults undergoing therapeutic apheresis is low, there are little data in children.

Length of storage and in vitro immunomodulation induced by prestorage leukoreduced red blood cells

BACKGROUND: The relationship between length of storage of red blood cell (RBC) units and biochemical changes has been well studied, but little is known about the progression of cellular immunomodulative properties in blood recipients. This study aims to quantify in vitro T‐cell activation and cytokine release by white blood cells, after incubation with supernatants from leukoreduced RBCs.

Association between plasma transfusions and clinical outcome in critically ill children: a prospective observational study

Plasma transfusions are commonly used in adult and paediatric intensive care units. Recent data suggest an association between plasma transfusions and worse clinical outcome in adult trauma patients. To date, no prospective paediatric study has addressed this issue. Our objective was to prospectively analyse the association between plasma transfusions and clinical outcome of critically ill children.

Allergic transfusion reactions from blood components donated by IgA‐deficient donors with and without anti‐IgA: a comparative retrospective study

Background and Objectives  IgA deficiency is common (1/500) and up to 40% of affected individuals will develop anti‐IgA. A few studies suggested that passive transfusion of anti‐IgA was not associated with an increased risk of allergic reactions. This study was designed to assess the safety of transfusing blood components containing anti‐IgA.

Airway hyperreactivity is frequent in non‐asthmatic children with sickle cell disease

Asthma is associated with poorer outcomes in sickle cell disease (SCD). Whether AHR can exist in SCD as a distinct entity, separate and independent of asthma, is unknown.

Intravenous immunoglobulin–associated thrombosis: is it such a rare event? Report of a pediatric case and of the Quebec Hemovigilance System

Intravenous immunoglobulin (IVIG) is frequently given in autoimmune disorders. Side effects are usually mild but severe complications such as thrombosis may occur. After one patient with IVIG‐associated thrombotic complication at Sainte‐Justine Hospital, the incidence of serious adverse events (SAEs) reported to the Quebec Hemovigilance System (QHS) was reviewed.

Transfusion-related Epstein-Barr virus infection among stem cell transplant recipients: a retrospective cohort study in children

BACKGROUND: Blood safety warrants strict screening measures to minimize the risk of transmitting blood‐borne pathogens. However, transfusion‐transmitted infections for which testing is not currently performed continue to be a concern. Among these untested agents is Epstein‐Barr virus (EBV) which, in the transplant setting, is associated with lymphoproliferative disease, a potentially fatal cancer. The aim of this study was to analyze the incidence of posttransplant EBV infection and its association with administration of blood products in children receiving a hematopoietic stem cell (HSC) graft.

Respiratory Dysfunction Associated With RBC Transfusion in Critically Ill Children: A Prospective Cohort Study.

Objective: Respiratory complications associated with RBC transfusions may be underestimated in PICUs because current definitions exclude patients with preexisting respiratory dysfunction. This study aims to determine the prevalence and characterize the risk factors and outcomes of new or progressive respiratory dysfunction observed after RBC transfusion in critically ill children. Design: Prospective cohort study of all children admitted over a 1-year period. Setting: A multidisciplinary PICU in a tertiary pediatric university hospital. Patients: Patients who received a RBC transfusion while in PICU. Interventions: None. Measurements and Main Results: Two independent adjudicators established the diagnosis of respiratory dysfunction. A respiratory dysfunction associated with transfusion was considered new if it appeared after the first RBC transfusion in PICU. A progressive respiratory dysfunction associated with transfusion was diagnosed if the respiratory dysfunction was present before the transfusion and the PaO2/FIO2 or the SpO2/FIO2 ratio dropped by at least 20% thereafter. Among 842 children admitted into the PICU, 136 received at least one RBC transfusion and were analyzed. Fifty-eight cases of respiratory dysfunction associated with transfusion (43% of transfused patients) were detected, including nine new respiratory dysfunction associated with transfusion (7%) and 49 progressive respiratory dysfunction associated with transfusion (36%). Higher severity of illness, multiple organ dysfunction syndrome prior to transfusion, and volume (mL/kg) of RBC transfusion were independently associated with respiratory dysfunction associated with transfusion. A dose-response relationship was observed between transfusion volume (mL/kg) and the prevalence of respiratory dysfunction associated with transfusion. Patients with respiratory dysfunction associated with transfusion had more progressive multiple organ dysfunction and less ventilation-free and PICU-free days at day 28. Conclusions: Development of respiratory dysfunction associated with transfusion is frequent in PICU and occurs mainly in patients with prior respiratory dysfunction, who would not be identified using current definitions for transfusion-associated complications. A cause-effect relationship cannot be confirmed. However, the high prevalence and the serious adverse outcomes associated with respiratory dysfunction associated with transfusion suggest that this complication should be further studied.

Detection of Epstein-Barr virus in leucoreduced blood products.

This study examined the prevalence of three human herpesviruses (HHV), namely HHV‐4 (Epstein–Barr virus/EBV), HHV‐6b and HHV‐7 in leucoreduced blood products obtained from the Sainte‐Justine Hospital blood bank. A total of 100 specimens, including 34 red blood cell concentrates, 33 platelet bags and 33 plasma units, were collected and screened by a sensitive PCR assay using virus‐specific primers. Positive units were then retested by quantitative PCR. Of the 100 specimens, one platelet unit tested positive for EBV.