Whole blood in disaster and major incident planning

Transfusion emergency preparedness is increasingly becoming an integrated part of major incident planning. The spectrum of planning extends from the sophisticated healthcare system dealing with multiple casualties, to the isolated healthcare facility resuscitating the critically ill patient with massive haemorrhage. Transfusion preparedness should follow risk assessment and be nested within the wider emergency planning system. The response should be designed to deliver both safety and sufficiency of transfusion support and includes diagnostics, donation and distribution. The biggest transfusion risks in emergency situations are those of red cell ABO incompatibility and delayed provision. Sufficiency and supply may be compromised when communities are isolated and cannot access mutual support. Planning may need to consider local collection and testing of blood as a further resilience measure. Considerations include demand planning; inventory management and transfusion triage; a whole blood preparedness model; resilience and resupply and the human factor. We suggest a whole blood programme can simplify the whole vein‐to‐vein process for production, laboratory and clinical staff and can be integrated into a range of healthcare systems.     

Blood transfusion services in the countries that joined EU in the last years: Poland

The activity of Polish Blood Transfusion Service (BTS) is based on the Public Blood Transfusion Service Act voted by the Polish Parliament. There are 21 regional blood transfusion centers, one military blood transfusion center and one blood transfusion center (BTC) of the Ministry of Internal Affairs. The Institute of Haematology and Transfusion Medicine (IHTM) is responsible for issuing guidelines for blood transfusion medicine. All BTCs must have an accreditation from the Ministry of Health. In Poland, there is a national system of haemovigilance. Hospitals are obliged to immediately report all post‐transfusion complications and ‘near‐miss’ events. Immunological, viral, bacterial as well as transfusion‐related acute lung injury reactions are supervised by IHTM. Qualification improvement and training of personnel is one of the priorities of Polish BTS.     

成分输血在25例外科手术患者大出血的应用

目的探讨成分输血在抢救外科手术患者手术中大出血的临床疗效。方法回顾性分析25例大量输血手术患者的临床资料,根据患者病情分为择期手术组和急诊手术组,统计分析患者输注红细胞悬液（CRCs）、新鲜冰冻血浆（FFP）、浓缩血小板（PC）和冷沉淀（Cryo）等成分血的种类和剂量以及输注后的不良反应。结果25例大出血患者经成分输血抢救后出血症状均得到控制,并获得良好的疗效;输注量最大的血液品种是红细胞悬液,两组大量输血手术患者手术前、后实验室检查结果比较无显著性差异（P〉0．05）。结论成分输血在外科手术患者手术中大出血时应用可获得良好的止血效果,为手术继续进行提供了很好的机会,但在各种成分血液用量上有很大差异,应根据患者的出血情况和实验室检查结果输注不同的成分血液。     

Thalassaemia in Iran: Thalassaemia prevention and blood adequacy for thalassaemia treatment

Thalassaemia major is a hereditary disease mostly prevalent in the region called ‘thalassaemia belt’. Iran is one of the countries situated in thalassaemia belt. Four per cent of Iranian population is the carriers of beta‐thalassaemia gene. So far 18 783 major thalassaemics have been registered in Iran, and this number is the highest registered figure for thalassaemia among the world countries. The thalassaemia prevention program has started since 1995 in Iran that has led to a significant decrease in newborn cases so that the downward rate of new thalassaemia births was estimated to be 82·3% in 2009; this is a considerable success among developing Islamic countries. Iran enjoys a national blood network that ensures blood adequacy for thalassaemics. All blood donations are donated by voluntary blood donors, and the rate of blood donations by regular voluntary blood donors reached 54·07% in 2016. In recent years, through the care provided and measures taken the prevalence rate of HCV and HIV has declined the lowest level and it makes blood safety in Iran abreast of that in developed countries. Given the success of thalassaemia prevention program in Iran and blood adequacy for thalassaemics, Iran can act as the role model for the countries located on thalassaemia belt particularly in the Middle East and the North Africa.     

Complications of plasma exchange in patients with neurological diseases

Summary Plasma exchange has proven to be effective in diseases of established or presumed autoimmune etiology as well as in hyperviscosity syndromes and some rare metabolic disorders. Its application is thought to be relatively safe; nevertheless, severe complications may occur. We therefore analyzed the complications of 291 exchanges in 39 patients with neurological diseases. Minor complications developed in 4.8% and major complications in 2.7% of procedures, including one death. Severe infections and technical problems have been the most serious side effects, sometimes followed by organ failure or even death.Abbreviations ARDS adult respiratory distress syndrome - FFP fresh frozen plasma - GBS Guillain-Barré syndrome - LDL low density lipoproteins - MS multiple sclerosis - MG myasthenia gravis - PNP polyneuropathy     

Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos,Nigeria

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection.     

Effective poxvirus removal by sterile filtration during manufacture of plasma derivatives

As a consequence of the September 2001 terrorist events, programs to protect against further such acts including potentially the use of biological warfare agents have been launched in the USA and elsewhere. As part of these initiatives, Vaccinia virus was procured for the pre-emptive vaccination of key personnel against smallpox as well as population-wide protection after an eventual exposure. The introduction of this live virus into a population at a relatively large scale represents a theoretical challenge for the safety of the blood supply, and potentially for plasma for fractionation. To strengthen further the demonstration of safety margins for plasma derived products against Vaccinia virus, the capacity of sterile filtration procedures to remove the virus was investigated. An infectivity assay for the Vaccinia virus strain which represents the majority of smallpox vaccine stocks available currently was used to investigate the potential removal of this virus by sterile filtration processes during the manufacture of plasma derivatives. Vaccinia virus behaves as predicted based on its size, i.e., an artificially added virus load is removed about 10,000-fold by the sterile filtration procedures tested. As the current investigation covered a range of different protein concentrations, filter materials and filters from different manufacturers, the results obtained are considered to be widely applicable. The current investigation supports further the high safety margins of plasma derivatives against any potential Vaccinia virus content of plasma for fractionation. As the large size is a general feature of Orthopox viruses, the results would also provide assurance against poxviruses identified more recently, for example, Monkeypox virus.     

原发性颅内Rosai-Dorfman病

目的 探讨原发性颅内Rosai-Dorfman病的临床病理特征。方法 对1例术前经影像学诊断为原发性颅内脑膜肿瘤患者，复习病史和影像学资料，手术标本常规病理制片，组织学检查和免疫组织化学标记S-100蛋白、CD68、GFAP、CKpan、EMA、vimentin、CD20、CD79α、CD3和CD43，并复习文献。结果 患者为老年女性，MRI显示病变位于左侧颅顶部脑膜并累及脑实质，组织学显示多量淡染的组织细胞、浆细胞和淋巴细胞组成的背景伴纤维化，同时组织细胞内有多量吞噬的淋巴细胞，免疫标记显示组织细胞表达S-100蛋白和CD68。结论 原发于颅内Rosai-Dorfman病是一种极其少见组织细胞异常增生性病变，病理诊断时需与颅内非特异性炎性病变和浆细胞肉芽肿等鉴别，该病变组织细胞S-100蛋白和CD68表达阳性是诊断本病的可靠依据。     

Blood,ideology, science and the birth of the ISBT

The ISBT/SITS was founded at the second international congress of blood transfusion in Paris in 1937. The world was influenced heavily by totalitarian ideologies, which a.o. tried to use science to confirm their superiority. The Nazi ideology was built on peculiar speculations on human blood, race and heritage, but although similar ideas were widespread, our society was founded as a purely scientific organization independent of ideological influence. The designation ‘International’ initially signified ‘European’, but after the end of World War 2, our society has become more and more of a global one.     

Tracking blood products in hospitals using radio frequency identification: Lessons from a pilot implementation

Automated identification and data capture systems, such as bar code and radio frequency identification (RFID), can be a key enabler for reducing errors and enhancing safety throughout the blood product supply chain. This project was funded by a Small Business Technology Transfer grant from the US National Institutes for Health. It represents the first comprehensive investigation to introduce RFID technology for automatic identification, tracking and monitoring of blood products across the blood banking spectrum. The System covers both blood center and hospital domains. The focus of this paper is to share lessons learned from our pilot, in a hospital domain, as performed at the University of Iowa Hospitals and Clinics (UIHC), in USA. UIHC is a Level I Trauma Center with over 760 beds; it administers more than 34,000 blood products per year. In 2005, UIHC developed a system using bar-code technology named INFORMM Patient Record (IPR) to prevent patient identification errors in blood transfusion. After implementing IPR, UIHC realized substantial improvements in prevention and detection of transfusion errors. The objective of the pilot was to assess RFID technology in transfusion services from four perspectives: safety, operational efficiency, performance reliability, and organizational impact. A significant outcome of this pilot was a comparison between IPR and the RFID System in terms of safety standards and performance. For this purpose, the two systems were run side-by-side using IPR as the benchmark, thus allowing extrapolation of the proven benefits of IPR to the RFID System. The pilot was performed from May 1 until May 28, 2012. The scope was limited to the “Blood and Marrow Transplant Unit” (14-beds) and to a remote storage location in the “Emergency Department”. During the pilot, the RFID and IPR systems collected over 35 samples and processed a total of 144 units. Data was collected from various reports and exception extracts from both systems, and from weekly user survey responses of UIHC personnel involved in the pilot. The RFID System successfully performed all the trace, tracking and safety checks as specified in the processes selected for this pilot. Both the RFID System and the IPR system executed every transaction back-to-back, equally detecting and preventing process errors. Both systems achieved an 83% reduction in process errors by replacing the manual based procedures for tracking and identification purposes. Error reduction also resulted in savings in labor costs. With the RFID System, the visibility and traceability of specimens and products were greatly improved. Our ROI analysis predicts a productivity gain of 10% with a Payback period of 2·5 years and a net present value of benefits equal to $485,000 in a 5 year horizon. The pilot was executed as planned and the assessment of the RFID System was successfully accomplished. Throughout the pilot, the System provided robust functionality equivalent to IPR. The pilot showed that the RFID System can provide high standards of safety for prevention and detection of errors, along with productivity gains.     

Introduction of a program for voluntary blood donations in Iran (blood transfusion status in Iran)

Background A national and well-coordinated system is very effective for blood self sufficiency of a country; this system might be committed to follow all requirements and standards. It should manifest itself strong and well-established in reality and practice so that all potential donors trust it and contribute. Iranian Blood Transfusion Organization (IBTO) is an example of a centralized network with 200 centers in 31 provinces which could only be decentralized in some aspects of blood donor recruitment based on the cultural and regional attributes of the people there. Methods The mission of IBTO is to provide and ensure a safe and adequate blood supply in Iran. Selection of low risk donors in pre-donation consultation and interview sessions based on behavioral, medical and demographic factors has improved the transfusion safety even before specific lab screening tests have been conducted; Standardization of criteria for donor eligibility and exclusion, and donor screening procedures are all priorities and most importantly the collection of all blood donations just from voluntary nonremunerated (VNR) blood donors. In fact, a lot of efforts concentrated on recruitment of VNR donors and to this end the Blood Donor Recruitment and Retention Office was established. A variety of measures were made to increase the number of voluntary regular donors including technical efforts, information dissemination activities, demographic studies, campaigns, awareness raising programs, publicity, publications, commemorative ceremonies and the like. Results The annual donation index in Iran has greatly increased from 0.39 in 1974 to 25.3 in 2010–2011. Accordingly we have been witness to increasing trend of blood donation reaching about 2 million blood units in 2011, all of which obtained from voluntary non-remunerated blood donors with the annual index of 26 per 1000 population. Conclusions It shows that every country based on its needs should establish a very effective and safe program to raise the number of its voluntary blood donors and to this end centralization of activities monitored by a headquarters and implementation of an efficient recruitment plan by which all aspects are covered and monitored: ranging from stages prior to donor selection including campaigns and activities to motivate populations to embark on donation, donor selection, screening, retention, statistical audit, continuous evaluation of donation sites, ease of access to donation centers, demographic attributes, donor reactions, to post donation era to ensure high return rate and so on so forth. All in all, availability and affordability are the issues which should be always guaranteed.     

Methodological considerations for linked blood donor‐component‐recipient analyses in transfusion medicine research

In recent years, there has been a concerted effort to improve our understanding of the quality and effectiveness of transfused blood components. The expanding use of large datasets built from electronic health records allows the investigation of potential benefits or adverse outcomes associated with transfusion therapy. Together with information regarding blood donor demographics and component collection and manufacturing, these datasets permit evaluation of associations between donor or component factors and transfusion recipient outcomes. Large linked 'vein‐to‐vein' datasets provide the power to study exposures relevant to transfusion efficacy and safety, many of which would not otherwise be amenable to study for practical or sample size reasons. Analyses of these large donor‐component‐recipient datasets allow for characterization of the populations under study and provide an evidence base for future clinical studies. Knowledge generated from linked analyses has the potential to change the way donors are selected and how components are processed, stored and allocated. However, unrecognized confounding and biased statistical methods continue to be limitations in the study of transfusion exposures and patient outcomes. Given these challenges, results of observational studies of blood donor demographics, storage age and transfusion practice have been conflicting. This review summarizes statistical and methodological challenges in analyses of linked blood donor, component and transfusion recipient outcomes.     

生物携氧治疗剂的研究：作用与应用

文题释义：生物携氧治疗剂：是指具有载氧气功能、维持血液渗透压和酸碱平衡及扩充血容量的人工制剂。目前主要有氟碳化合物和血红蛋白类氧载体两大类。与简单的扩容剂相比,生物携氧治疗剂除能维持血液渗透压、酸碱平衡和血容量外,还具有较好的携氧能力,能向局部缺氧组织输氧。是临床上一种具有广阔的应用前景的携氧制剂。 血红蛋白类氧载体(Hemoglobin-based oxgen carriers,HBOCs)：是一类通过血红蛋白分子表面化学修饰或分子间交联而形成分子量较大的血红蛋白制品,原料血红蛋白主要来源于人或动物血,目前应用较为广泛的是戊二醛聚合猪血红蛋白(pPolyCHb)和戊二醛聚合牛血红蛋(HBOC-201)。 背景：健康人献血虽然一定程度地缓解了临床用血的燃眉之急,但是单纯依靠健康人献血已不能从根本上解决血源短缺和血液安全性的问题。 目的：结合生物携氧治疗剂开发的意义,对生物携氧治疗剂所独有的特点进行阐述,总结近年来对生物携氧治疗剂的研究现状及应用进展,为进一步研究生物携氧治疗剂的作用及临床应用提供一定的理论基础。 方法：作者检索CNKI、万方、Pub Med等数据库中自2015年1月至2019年8月的相关文章,英文检索词为“blood substitute, hemoglobin oxygen carrier, artificial blood,oxygen-carrying therapeutic agent”,中文检索词为“血液代用品,血红蛋白类氧载体,人工血液,携氧治疗剂”,检索文献类型为研究原著、综述。初检文章418篇,再经过严格筛选后,对符合要求的46篇文献进行分类综述。 结果与结论：生物携氧治疗剂的临床效果较好,可维持血液渗透压、酸碱平衡和血容量,还具有较好的携氧能力,能向局部缺氧组织输氧并维持较长时间。它还具有易于贮存、便于运输等特点。生物携氧治疗剂在外科手术中得到广泛的应用,对扩充血容量、加快术后恢复有很大帮助,故其研发对于外科创伤及复苏、失血性休克、恶性贫血、心肌梗死等疾病均具有重要意义,并体现出良好的临床应用前景。 ORCID: 0000-0002-0365-4638(黄文华) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

The role of the transfusion nurse in the hospital and blood centre

The transfusion process is complex, involving many interlinking chains of events, and a multidisciplinary group of health professionals with different levels of awareness and understanding of transfusion practice. In recent years, many measures have been implemented to increase blood component safety and the clinical transfusion process. Haemovigilance programs report the greatest risks to patients from transfusion in many countries now relate to hospital-based steps in the process. The role of the Transfusion Nurse (TN) is evolving as an integral part of efforts to optimise appropriate use of blood components, reduce procedural risks and improve transfusion practice generally. The TN position is a relatively recent specialist role within hospitals and blood services, and continues to develop with growing experience of areas requiring intervention in the clinical setting, and increasing expectations for improvements in transfusion clinical governance. The role typically includes activities to improve clinician and patient awareness of transfusion issues and practical knowledge of blood product use, and therefore to improve clinical decision-making and enhance blood administration processes, along with responsibilities for education/training, auditing and adverse event follow-up. Within the Blood Service in Australia the role also covers approval and provision of specialised blood products along with many of the hospital-based TN functions. The TN serves as an expert resource and has been fundamental in development of tools, resources and skills in the following areas: - Patient blood management: - Education - Governance - Professional development - Research Benchmarking across organizations has demonstrated that availability and review of comparative data can be a powerful motivator of change. Reviews of the TN role/programmes highlighted their effectiveness and resulted in ongoing support/funding. Skills and attributes such as confidence, persistence, energy, excellent communication/ technical knowledge and clinical experience are key requirements for the roles success. Conclusion The specialist transfusion practitioner/Transfusion Nurse is an integral part of a multidisciplinary team, supporting efforts at institutional and national levels to reduce transfusion risks and improve practice.     

Proteomics and blood transfusion

Transfusion medicine is a clinical discipline characterized by one of the most advanced quality management systems, which is structured so as to assure the production of blood components and raw materials, for biopharmaceutical fractionation, that are safe, efficient and effective. During the production, pathogen inactivation and storage processes there is the risk of changes in the integrity of blood components, especially at the protein level. These changes could be the cause of some of the negative effects of transfusion therapy. It is therefore a major challenge to identify significant alterations of these products, and, in this context, proteomics can play a potentially relevant role in transfusion medicine to assess the protein composition of blood-derived therapeutics, particularly for identifying modified proteins. Proteomics can also provide a more detailed understanding of the proteins found in plasma derivatives, with particular regard to peptide and protein changes related to the various procedures used for protein purification and pathogen inactivation during the modern plasma industrial factionation. The latter could cause protein modifications and/or degradation and neoantigen production, with the potential to induce adverse effects in recipients. At present, blood component quality control is mainly focused on standardized quantitative assessment, providing relatively limited information about products. Proteomics allows a comprehensive study of protein modifications, qualitative and quantitative analysis, and high-throughput protein identification. Moreover, being the only tool to evaluate structural changes in proteins (or their degradation products) after their manipulation, and having the capacity to identify many new proteins, proteomics seems to be the most promising tool for global quality assessment and possible improvement of the production process of blood components and plasma derivatives. It can also provide comprehensive information about possible contaminants and neoantigens that may influence the immunogenic capacity of blood-derived therapeutics.