Shan Yuan

Moderate and severe adverse events associated with apheresis donations: incidences and risk factors

BACKGROUND: The goal of this observational retrospective study was to evaluate various donor and procedural variables as potential risk factors for different types of moderate to severe adverse events (AEs) during apheresis collections.

Motivating factors and deterrents for blood donation among donors at a university campus–based collection center

BACKGROUND: Insight into motivating factors and barriers for blood donation, especially for young people and underrepresented minorities, is important to donor recruitment and retention. We surveyed donors at a new blood collection facility based on a large, ethnically diverse university campus.

Autoimmune hemolytic anemia in pediatric liver or combined liver and small bowel transplant patients: a case series and review of the literature

BACKGROUND: Autoimmune hemolytic anemia (AIHA) occurring after solid organ transplantation is an infrequently reported entity. We describe in this report six cases of AIHA in pediatric liver or combined liver and small bowel transplant patients.

Risk factors for acute, moderate to severe donor reactions associated with multicomponent apheresis collections.

BACKGROUND: Legitimate concerns exist over the safety of donors during multicomponent apheresis collections (MACs), when large volumes of red blood cells (RBCs) and plasma are removed. This study evaluates the predictive value of various donor‐ and procedure‐related variables for moderate to severe donor acute adverse events (AAEs).

A severe case of atypical hemolytic uremic syndrome associated with pneumococcal infection and T activation treated successfully with plasma exchange

BACKGROUND: A severe nondiarrheal form of hemolytic uremic syndrome in children is associated with pneumococcal infection (pHUS). Neuraminidase released by the pneumococci may cleave N‐acetylneuraminic acid residues on red blood cells (RBCs), leading to the exposure of the T cryptantigen and polyagglutinability of RBCs, a process known as T activation. Data suggest a pathogenic role of exposed T antigens on glomeruli interacting with naturally occurring anti‐T in the development of renal dysfunction in pHUS. By reducing the levels of anti‐T and neuraminidase, plasma exchange (PE) may have a role in the treatment of severe cases of pHUS.

How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) provides lifesaving hemodynamic and respiratory support to neonatal and pediatric patients with a variety of congenital or acquired cardiopulmonary defects. Successful ECMO support requires close collaboration among multiple services, including critical care medicine, perfusion, and transfusion medicine services. Neonatal and pediatric ECMO patients require significant transfusion support, both at the time of cannulation and after the ECMO circuit has been established, often with little advance notice. Thus a number of communication and logistic issues must be addressed through a multidisciplinary approach to ensure both good patient outcome and judicious use of resources. In this article, we describe our protocol for transfusion support for ECMO and potential ECMO patients, which was developed to address a number of issues, including identifying and stratifiying ECMO candidate patients, streamlining the ordering and communication processes, and improving blood product turnaround times and availability. Additional measures of quality improvement are also discussed. As the number of centers performing ECMO procedures remains high, we believe that our experience may be of interest to our colleagues in transfusion medicine and critical care.

Comparison of a gel microcolumn assay with the conventional tube test for red blood cell alloantibody titration

BACKGROUND: Titration is a semiquantitative method used to estimate red blood cell (RBC) alloantibody reactivity. The conventional tube test (CTT) technique is the traditional method for performing titration studies. The gel microcolumn assay (GMA) is also a sensitive method to detect RBC alloantibodies. The aim of this study was to compare a GMA with the CTT technique in the performance of Rh and K alloantibody titration.

A readily available assay for anti-immunoglobulin A: is this what we have been waiting for?

A lthough anaphylactic transfusion reactions due to underlying immunoglobulin A deficiency (IgAD) are rare, it is not uncommon for transfusion medicine physicians to encounter patients with transfusion reactions with respiratory distress or hypotension, where the specter of anaphylaxis is raised. In such cases, IgAD with associated anti-IgA as the underlying cause must be excluded. Another common scenario is a patient with a purported history of IgAD, requiring a judgment in a limited time window as to whether special IgAdeficient blood components are needed for transfusion. In the majority of such cases, IgAD is not present in the patient, nor has it been an etiologic factor in a previous transfusion reaction. However, in most urgent situations, there are no diagnostic tests readily available to help us exclude the presence of IgAD or anti-IgA. Anaphylactic transfusion reactions are acute and potentially life-threatening events, and therefore it is incumbent upon physicians to identify at risk individuals and provide them with appropriate blood components to prevent such reactions. Severe anaphylactic reactions associated with IgAD and mediated by anti-IgA have been reported since 1968. There have been more than 40 case reports in the literature, but the true incidence of IgA anaphylactic transfusion reactions is still unknown. As recently pointed out by Sandler, many of the older reports of IgA anaphylactic transfusion reactions may actually represent examples of other entities, such as unrecognized transfusion-related acute lung injury, which may only have relatively mild respiratory distress. Other cases may be secondary to a variety of blood-soluble factors, such as latex, antibiotics, activated platelet (PLT) membrane fragments or PLT-derived microparticles, or cytokines generated in stored blood components. In Japan, where IgAD is rare, anti-haptoglobin antibodies are responsible for more anaphylactic transfusion reactions than anti-IgA. Furthermore, of the 359 samples referred to the American Red Cross National Reference Laboratory for suspected IgA anaphylactic transfusion reactions between 1978 and 1998, anti-IgA was identified only in 18% of the cases, suggesting that IgAD is only one of many causes for anaphylactic transfusion reactions. If anti-IgA can be shown to be absent in such cases, then IgA anaphylactic reactions can be essentially excluded, rendering provision of IgA-deficient blood components for future transfusions unnecessary. In many ethnic populations, IgAD is the most common primary immune deficiency. Among Caucasian persons, IgAD is often quoted to have a prevalence of 1 of 500 to 700 individuals. Although most patients are asymptomatic at the time of diagnosis, up to 80 percent show a predilection for sinopulmonary and gastrointestinal infections, as well as autoimmune disorders when followed for up to 20 years. IgAD is rarely of immediate clinical concern, except in the setting of blood transfusion, and only patients with severe IgAD whose plasma contain anti-IgA are at risk for IgA-mediated anaphylaxis. Such reactions in these individuals can be prevented by providing IgA-deficient blood components. Red blood cells (RBCs) from normal donors can be rendered IgA-deficient with thorough washing to minimize the plasma content, but plasma products must be prepared from IgA-deficient donors. PLTs can be washed, but the procedures required to remove enough plasma to prevent reactions can damage PLTs, limiting their recovery and survival. Registries of IgA-deficient donors have been established in the United States, Canada, Europe, and Asia. To ensure that IgA-deficient products contain only negligible amounts of IgA, most collection centers use stringent criteria to qualify potential donors as IgA-deficient. For example, all donors in the American Rare Donor Program (ARDP) database must have IgA levels less than 0.05 mg per dL, measured twice with high-sensitivity IgA assays. In most populations, only about half of the individuals who meet the clinical criteria of IgAD (serum IgA < 7 mg/dL) would have IgA concentration low enough to be qualified as an IgA-deficient donor. The Canadian Blood Services, in addition to using the same criterion of IgA level, also excludes donors with detectable anti-IgA. As a result, only 34 eligible donors were identified after screening 38,759 donor samples in one study. Therefore, IgA-deficient components are a scarce and precious resource that should be allocated with care and reserved for patients at risk for anaphylaxis. On the other hand, the need for such rare products for patients with a reported history of IgAD or anaphylactic transfusion reaction cannot be convincingly established in many cases. The current prevailing clinical definition of IgAD (serum IgA level below 7 mg/dL in an individual older than 4 years of age) was chosen in part because IgA concentrations cannot be measured reliably below this TRANSFUSION 2008;48:2048-2050.

How do we provide blood products to trauma patients

Theneedforlargevolumesofbloodcomponentsforsome patients, particularly those with the greatest risk of mor- tality, can arise before or within minutes of their arrival to the hospital. Recent data from one large trauma center in the United States showed that 62% of all RBC units were administered in the first 24 hours of admission, with 18% given uncrossmatched due to the urgency of transfusion. Although the majority (91%) of trauma patients were not transfused, the few (3%) that were massively transfused (i.e., receiving more than 10 units of RBCs) received more than 71% of all RBC units given. Furthermore, this sub- group of patients also had a high mortality rate of 39%. 5

Motivating Factors and Potential Deterrents to Blood Donation in High School Aged Blood Donors

Background. To ensure an adequate supply of blood, collection centers must design campaigns that successfully recruit and maintain an active donor pool. Understanding factors that motivate and deter individuals from donating may help centers develop targeted recruitment campaigns. These factors among high school aged blood donors have not yet been fully investigated. Study Design and Methods. A voluntary, anonymous survey was administered to student donors at high school mobile blood drives. The survey instrument asked the students to rate several potential motivating factors in their importance in the decision to donate blood and several potential deterring factors in their future decision whether or not to donate blood again. The survey also asked the students to rate the desirability of several potential incentives. Results. Motivating factors that reflected prosocial, empathetic, and altruistic thoughts and beliefs were rated highly by students. Pain from phlebotomy was most commonly chosen as potential deterrent. Movie tickets and cookies/snacks at the drive were rated as the most attractive incentives. Conclusion. High school aged blood donors are similar to other donor groups in their expressed motives for donating blood. This group may be unique in the factors that deter them from donating and in their preferences for different incentives.