Recombinant erythropoietin as alternative to red cell transfusion in sickle cell disease

Disturbances in the physiological regulation of erythropoietin (EPO) in patients with sickle cell disease (SCD) may contribute to worsening anaemia and increased transfusion requirements, but the use of recombinant EPO in this group of patients is controversial. The objective of this study was to evaluate the use of this drug in adult patients with SCD and its effects on haemoglobin levels and transfusion requirements. We conducted a retrospective analysis at the University of Campinas, with nineteen adults with a diagnosis of SCD (HbSS and HbS/β⁺ thalassaemia), who had received at least 1 year of EPO therapy between 2007 and 2014. Haemoglobin concentrations and trends of variation in transfused RBC volumes were compared before and after EPO administration. We observed that seven patients had a good response to treatment (Hb increment higher than 1·5 g/dl) and nine had a partial response (0·5–1·5 g/dl increment) and there was a significant decrease in the need for transfusion amongst those who usually required regular transfusions. There were no increases in the rates of vaso‐occlusive crisis or venous thromboembolism in comparison to the year before the onset of the therapy. Erythropoietin therapy led to a marked increase in haemoglobin concentration with a concomitant decrease in the demand for transfusion. Considering all complications related to allogeneic transfusion, we believe that EPO therapy represents an important therapeutic tool in sickle cell anaemia.     

红细胞输注效果及影响因素的回顾性分析

目的：探讨住院患者红细胞输注的临床疗效，倡导制定个体化输血的策略。方法：回顾分析2006年10月-2007年12月我院患者红细胞输注效果与其年龄、性别、输血前血红蛋白浓度、输血次数、既往输血史、原发疾病的关系。结果：7277例患者中，出现红细胞输注不佳有894例（12．3％）；而在7277例患者实行了11264次输血治疗中发生1387次红细胞输注不佳（12．3％）。红细胞输注不佳与患者年龄、性别、输血前Hb浓度无关，与疾病、输血次数和既往输血史有着密切的关系。肿瘤和血液病患者、输血不良反应的发生、输血次数越多、既往输血总量越多，则发生红细胞输注不佳概率越高。结论：临床红纽胞输注效果与患者体内免疫状况密切相关，应当对不同的输血患者，制定独立、安全、有效的个体化输血策略。     

Changes in circulating inflammatory markers following febrile non‐haemolytic transfusion reactions to leucoreduced red cells

It would be desirable to be able to distinguish fever as a result of febrile non‐haemolytic transfusion reactions (FNHTR) from other febrile conditions. To further characterize the inflammatory feature of FNHTR, we measured a large panel of inflammatory markers in pre‐ and posttransfusion plasma samples from patients with and without FNHTR following the transfusion of leucoreduced red blood cells. As FNHTR patients only displayed a significant increase in IL‐6, we conclude that changes in plasma cytokine levels during FNHTR are unlikely to be used diagnostically. An incidental finding of a distinct cytokine pattern in pretransfusion samples from FNHTR patients warrants further investigations, as it might be used to characterize the nature of FNHTR and to predict the risk of these adverse events.     

Towards bedside washing of stored red blood cells: a prototype of a simple apparatus based on microscale sedimentation in normal gravity

Background and Objectives

Infusion of by‐products of red blood cell (RBC) storage‐induced degradation as well as of the residual plasma proteins and the anticoagulant‐preservative solution contained in units of stored blood serve no therapeutic purpose and may be harmful to some patients. Here, we describe a prototype of a gravity‐driven system for bedside washing of stored RBCs.

Materials and Methods

Stored RBCs were diluted to 10% haematocrit (Hct) with normal saline, matching the conventional washing procedure. The dilute RBC suspensions were passed through a column of coiled tubing to allow RBC sedimentation in normal gravity, thus separating them from the washing solution. Washed RBCs were collected using bifurcations located along the tubing. Washing efficiency was quantified by measuring Hct, morphology, deformability, free haemoglobin and total‐free protein.

Results

The gravity‐driven washing system operating at 0·5 ml/min produced washed RBCs with final Hct of 36·7 ± 3·4% (32·3–41·2%, n = 10) and waste Hct of 3·4 ± 0·7% (2·4–4·3%, n = 10), while removing 80% of free haemoglobin and 90% of total‐free protein. Washing improved the ability of stored RBCs to perfuse an artificial microvascular network by 20%. The efficiency of washing performed using the gravity‐driven system was not significantly different than that of conventional centrifugation.

Conclusions

This proof‐of‐concept study demonstrates the feasibility of washing stored RBCs using a simple, disposable system with efficiency comparable to that of conventional centrifugation, and thus represents a significant first step towards enabling low‐cost washing of stored blood at bedside.     

Haemoglobin glycation (Hb1Ac) increases during red blood cell storage: a MALDI‐TOF mass‐spectrometry‐based investigation

Haemoglobin A_1c (HbA_1c) represents a key biomarker in diabetes diagnosis and management, as it is indicative of recent blood glucose concentrations. Glycation of haemoglobin is a non‐enzymatic irreversible process that is promoted by the prolonged exposure of erythrocytes to high glucose concentrations, a condition that is known to occur under blood banking conditions. However, controversial data indicate no clear hint as to whether and to which extent HbA_1c accumulates during red blood cell storage. Hereby, we propose the application of a validated MALDI‐TOF mass‐spectrometry‐based method to this issue and report the observation about HbA_1c levels apparently increasing over storage progression.     

A study of blood transfusion services at a district hospital in Malawi

Background and objectives Severe anaemia is an important cause of mortality in developing countries. However, few studies have explored the use of and possibilities for blood transfusion services. The aims of this study are to explore the use of blood transfusion services at a hospital in sub‐Saharan Africa and to assess the quality of the transfusion services according to WHO guidelines. Materials and methods Patient age, gender, haemoglobin (Hb) level, diagnosis, hospital department and replacement donations were recorded for all blood transfusions administered at a district hospital in Malawi in January 2010. The laboratory equipment and procedures were scored according to WHO guidelines. Results The mean Hb of transfused patients was 4·8 g/dl. Fifty‐seven per cent (59/104) of the transfusions were given to children diagnosed with malaria, and 17% (18/104) were given to pregnant women. During the study period, blood was in stock and available for transfusion within 1 h of requisition. The equipment and procedures at this hospital met the main criteria for an adequate WHO stage of development. Conclusion In contrast to the advanced transfusion medicine in developed nations, our findings highlight the persistent and urgent need for life‐saving blood transfusions in especially young children and pregnant women in Africa. The results indicate that blood transfusion services adapted to local conditions may be a realistic solution for providing safe blood products in developing countries. Serious challenges, such as HIV transmission and sustainable organization of low‐risk blood donations should be addressed to assure access to safe blood products.     

Red cell storage and prognosis

During storage of red blood cells (RBC), these cells develop storage lesions. The clinical relevance of these storage lesions is heavily discussed in literature. In this review, different aspects of the storage lesion are shown and how these potentially affect posttransfusion performance of the RBC. An overview of the conflicting literature on the clinical relevance of prolonged storage is given, summarizing the evidence on associations with mortality, length of stay, (postoperative) infections and organ failure. Subsequently, possible explanations are given for the conflicting results in the clinical studies and suggestions on how to proceed.