The production of antibodies following blood transfusions is a complex process that involves many recipient and donor factors. Inflammation in the recipient is one important factor. As knowledge of ...the immune system, of oxygen, carbon dioxide, and nitric oxide pathways, and of hemostasis grows, more specific therapies will allow precise manipulation of the immune system and safer transfusions. Communication of patients' transfusion and immunotherapy histories with the laboratory, attention to detail in labeling pretransfusion specimens, checking patient and blood product identification before administration, and closely monitoring patients during transfusions remain critical to minimizing risks during transfusion therapy.
Evaluation of A plasma for incompatible patients Olsen, Gregory; Passwater, Michael; Huggins, Monique ...
Transfusion (Philadelphia, Pa.),
February 2021, 2021-Feb, 2021-02-00, 20210201, Volume:
61, Issue:
2
Journal Article
Peer reviewed
Background
Plasma transfusion is a critical treatment in managing bleeding patients. In an effort to make plasma immediately available in spite of the limited amount of AB plasma, providers have ...begun using A plasma in life‐threatening emergencies. As this practice becomes widely adopted it is important to evaluate safety. Hemolytic transfusions reactions are underreported, and hemolysis may be subclinical.
Study Design and Methods
A retrospective study was performed at the University of Florida/Shands Hospital of B and AB patients who received 1 unit or more of A plasma. Patient charts were reviewed and data collected included age; sex; mortality; intensive care unit (ICU) length of stay; and laboratory tests used in identifying hemolysis including direct antiglobulin test, lactate dehydrogenase, haptoglobin, indirect bilirubin, aspartate aminotransferase, urinalysis, hemoglobin, and hematocrit. The primary end points of the study were immune mediated hemolysis, mortality, and length of ICU stay.
Results
Ninety‐three patients were identified as eligible for the study. One patient suffered a delayed hemolytic transfusion reaction determined to be due to an anti‐Jka. No evidence of hemolysis due to ABO‐incompatible plasma transfusion was identified. The volume of A plasma transfused was found to be weakly related to mortality and ICU stay.
Conclusion
No evidence of ABO immune‐mediated hemolysis was observed in the patient population. The results of the study support the safety of A plasma transfusion in B and AB patients. We hypothesize the relationship observed between A plasma volume and mortality/ICU stay may be from collinearity with disease severity.
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3.
P123 Anti-A titer method comparison Passwater, Michael; Ross, Bonnie; Rebellato, Lorita M.
Human immunology,
October 2018, 2018-10-00, Volume:
79
Journal Article
Peer reviewed
To determine an appropriate testing method to evaluate the anti-A titer in blood group B renal transplant waitlist patients to qualify for consideration of blood group A2 (A subgroup) donors. UNOS ...has established a maximum anti-A titer of 8 to qualify for an A to B kidney.
A review of methods in use at transplant centers performing ABO incompatible kidney transplants identified four categories of method variation. The four categories were:•Dithiothreitol (DTT) treatment of serum vs. no DTT treatment•Direct agglutination vs. Indirect agglutination (anti-human globulin enhancement)∘Direct = Room Temperature Test Tube or MTS-Gel buffer card∘Indirect = Anti-IgG Test Tube or MTS-Gel anti-IgG card•Test Tube method vs. MTS-Gel microcolumn method•A1 target cells vs. A2 target cellsStandard commercial blood bank reagents were used for all testing. The same technologist performed all testing. Ten blood group B patients from the kidney transplant waitlist were tested using 8 different methods. After choosing the preferred variable for each of the first three categories, 15 group B potential recipients were tested comparing A1 vs. A2 target cells.
▪The categories of Test Tube vs. MTS-Gel and Direct vs. Indirect agglutination had little impact on titers. Pretreatment of serum with DTT provided qualifying titers for three times as many patients as using serum not treated with DTT. DTT pretreatment of serum was chosen along with the indirect agglutination method to optimize detection of IgG anti-A. Using the DTT – Indirect – MTS Gel titer method, comparing A1 vs. A2 target cells with 15 samples showed the choice of target cells also impacted titers. 8 of 15 patients had a 3-fold or greater titer increase using A1 cells compared to A2 cells. 11 of 15 patients (73%) had a qualifying titer with A1cells, compared to 100% with A2 cells.
Use of DTT treated serum and A2 cells were associated with the lowest anti-A titers. Efforts to establish acceptable method specific titer limits are encouraged.
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BACKGROUND
Use of universally ABO‐compatible group AB plasma for trauma resuscitation can be challenging due to supply limitations. Many centers are now using group A plasma during the initial ...resuscitation of traumatically injured patients. This study was undertaken to evaluate the impact of this practice on mortality and hospital length of stay (LOS).
STUDY DESIGN AND METHODS
Seventeen trauma centers using group A plasma in trauma patients of unknown ABO group participated in this study. Eligible patients were group A, B, and AB trauma patients who received at least 1 unit of group A plasma. Data collected included patient sex, age, mechanism of injury, Trauma Injury Severity Score (TRISS) probability of survival, and number of blood products transfused. The main outcome of this study was in‐hospital mortality differences between group B and AB patients compared to group A patients. Data on early mortality (≤24 hr) and hospital LOS were also collected.
RESULTS
There were 354 B and AB patients and 809 A patients. The two study groups were comparable in terms of age, sex, TRISS probability of survival, and total number of blood products transfused. The use of group A plasma during the initial resuscitation of traumatically injured patients of unknown ABO group was not associated with increased in‐hospital mortality, early mortality, or hospital LOS for group B and AB patients compared to group A patients.
CONCLUSION
These results support the practice of issuing thawed group A plasma for the initial resuscitation of trauma patients of unknown ABO group.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract
Objectives
Transfusions remain a complicated procedure involving many disciplines performing various steps. Pretransfusion specimen identification errors remain a concern. Over the past two ...decades, system changes have been made and minimal improvements in the error rates have been seen. Wrong blood in tube (WBIT) events may lead to mistransfusions of components with life-threatening complications.
Methods
A continuous quality improvement effort involving the introduction of electronic patient identification at the point of pretransfusion specimen collection (an automated system improvement), manual independent dual verification, and periodic education (human process system improvements) were implemented.
Results
Both automated and human system process improvements resulted in greater than 10-fold reduction in WBIT events and a 47% reduction in mislabeled specimens.
Conclusions
Diligent improvement and implementation of combination automated system processes and human protocols with continuous monitoring led to great reductions in WBIT error rates and labeling discrepancies, leading to an increase in system safety. These combinations of improvement can lead to more decreased error rates if applied to other critical process steps in the transfusion process.
To determine the appropriate target cell for assessment of anti-A titer in blood group B kidney transplant patients waiting for a deceased donor and qualify for blood group A2 (A subgroup) donors ...according to OPTN/UNOS guidelines.
248 sera samples collected from 57 blood group B candidates (56% male, 79% African American) and tested after DTT treatment. Titers were done using A1 and A2 reagent target cells using the MTS Gel anti-IgG card method. Standard commercial blood bank reagents were used for all testing (2 donors per lot of A1 or A2 cells). The same technologist performed all titers. The titer for eligibility is ⩽ 8.
37 patients were eligible (titer ⩽ 8) with either A1 or A2 cells. 20 patients (35%) shown below had titers from 16 up to 128 with A1 cells. 2(4%) patients had a titer >8 with A2 cells. Of these 20 patients, the cPRA varied from 0–100% and was not correlated with anti-A titer. Sex and race was also not correlated with an anti-A titer ⩾ 8.▪
Patient eligibility may vary considerably depending on the target cell used. Additional clinical studies will be required to determine the optimum approach.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
BACKGROUND
Culturing residual blood components after suspected septic transfusion reactions guides management of patients and cocomponents. Current practice, accuracy of provider vital sign ...assessment, and performance of the AABB culture criteria are unknown. A multicenter international study was undertaken to investigate these issues and develop improved culture criteria.
STUDY DESIGN AND METHODS
Retrospective data for all transfusion reactions resulting in residual blood component culture in 2016 were collected from participating hospitals. The performance of the AABB culture criteria were assessed for detection of positive culture results. Modifications to the AABB criteria including 1) recommending culturing in the setting of isolated high fevers, 2) defining hypotension and tachycardia using objective parameters, and 3) incorporating antipyretic use were tested to determine if modifications improved performance. Modifications associated with improvement were incorporate into the BEST criteria. The AABB and the BEST criteria were then tested against a data set enriched for positive culture results to determine which criteria were superior.
RESULTS
Data were collected from 20 centers encompassing 779,143 transfusions, 3,187 reported transfusion reactions, and 1,104 cultured components. There was marked variation in reaction reporting and culturing rates (0.0%‐100.0%). Of 35 total positive component cultures, only one of 35 (2.9%) had concordant patient cultures; 12 of 34 (35.3%) did not have patient cultures performed. The BEST criteria had better sensitivity for detection of a positive culture result compared to the AABB criteria (74% vs. 41%), although specificity decreased (45% vs. 65%).
CONCLUSION
Compared to the AABB criteria, the BEST criteria have improved sensitivity for positive culture detection.
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