An estimated 20% of allogeneic blood transfusions in the United States are associated with cardiac surgery. It is estimated that 11% of red cell resources were used for transfusion support of ...patients undergoing coronary artery bypass grafting (CABG) with a documented wide variability in transfusion rate (7.8 to 92.8%). To address the issue of unnecessary transfusions within the CABG population, we developed a model to predict which patients are at low risk of bleeding for whom transfusion treatment might be considered unnecessary. Herein we present our "SHOULD-NOT-BLEED-SCORE" application developed for the Windows® software platform which is based on our previous research.
This study is aimed to develop a user-friendly application that stratifies patients with respect to bleeding risk. The statistical model we used in our previous research was focused on detection of CABG patients at low risk of bleeding. The rationale behind such an approach was to identify a CABG patient subgroup at low risk of bleeding. By identifying patients at low risk of bleeding we can define a subgroup of patients for whom transfusion treatment might be considered unnecessary. We developed a Windows platform application based on risk modelling which we previously calculated for 1426 patients undergoing elective CABG from January 2010 to January 2018.
The SHOULD-NOT-BLEED-SCORE risk score is developed for the Windows software platform. A mathematical model that is based on multivariate analysis was used for app development. The variables that entered the scoring system were: Age; Body Mass Index; Chronic Renal Failure; Preoperative Clopidogrel Exposure; Preoperative Red Blood Cells Count; Preoperative Fibrinogen Level; Preoperative Multiplate ASPI test area under the curve (AUC) units. The SHOULD-NOT-BLEED-SCORE identifies/predicts patients without a risk for excessive bleeding with strong discriminatory performance (Receiver Operating Curve (ROC) analysis AUC 72.3%, p < 0.001).
The SHOULD-NOT-BLEED risk scoring application may be useful in the preoperative risk screening process. The clinical and economic burden associated with unnecessary transfusions may be adequately addressed by a preoperative scoring system detecting patients at low risk of bleeding for whom transfusion treatment might be considered unnecessary.
BackgroundPatients with hematological diseases are polytransfused and often immunocompromised, therefore susceptible to transfusion reactions (TR). This study aims to document the incidence of TRs in ...adult hematological patients and assess the effect of changes in the production of blood components and transfusion practice on their occurrence.Study design and methodsRetrospective observational analysis of TRs reported from 1993 to 2019 was performed. For the analysis of the effect of changes on the incidence of TRs, the evaluated time was divided into two periods: the 1st period before the introduction of changes in production, when leukoreduced blood components were used only selectively, and the 2nd period, when semi‐automated method of production and universal leukoreduction was introduced.ResultsThe decrease in the incidence of TRs was observed for both red blood cell (RBC) and platelet concentrate (PC) transfusions in the 2nd period. Since platelet additive solution has been used, a further decrease in the incidence was reported. The decrease in incidence was also observed for delayed hemolytic/serological transfusion reactions and for transfusion‐transmitted bacterial infections. Four cases of incorrect blood transfusions were uniquely related to the hematological patients, caused by antigen loss and transfusion ordering after ABO‐incompatible hematopoietic stem cell transplantation.DiscussionOur results provided evidence that the introduction of tools offered by modern transfusion medicine: universal leukodepletion, plasma replacement with additive solutions, sensitive laboratory techniques, prophylactic antigen matching policy, informatization, and automatization, decreased the incidence of TRs and improved transfusion safety.
Autoimmune haemolytic anaemia (AIHA) is a rare autoimmune disease characterised by haemolysis associated with the presence of immunoglobulins and/or components of the complement system on red blood ...cells (RBCs). It is classified into warm or cold antibody-mediated AIHA according to the temperature at which autoantibodies bind optimally to RBCs. Clinicians should be familiar with the procedural tests used for a complete laboratory investigation of AIHA. Good collaboration between clinicians and laboratory specialists with correct sample handling and an exact diagnostic work-up is extremely important for the correct classification and proper therapeutic management of AIHA. Specialised serological test procedures are very complex. Problems with serological testing may be excluded with the molecular testing, which has now become a gold standard to predict a patient’s phenotype in order to secure the right antigen-matched blood for AIHA patients. More recently, genotyping has been used instead of serological typing and complex adsorption tests. This paper offers a description of various tests for differentiating between types of AIHA. A diagnostic algorithm and the problems of laboratory investigation are also presented, and an application of molecular methods for the blood group typing in AIHA is elaborated.
Alloimmunization is a known risk of transfusion therapy caused by exposure to foreign RBC antigens. However, alloimmunization is not observed in all transfused patients. Human leukocyte antigen (HLA) ...molecules may contribute to the recognition and presentation of foreign antigens and to the potency of immune responses that result in the production of antibodies. The aim of this study was to determine the association of HLA-DR and HLA-DQ polymorphisms with alloimunization to Fy
antigen in Croatian patients.
The study was conducted on 70 alloimmunized patients to Fy
antigen and two control groups: 165 healthy Croatian individuals (Control 1) and 45 Fy
antigen-negative nonimmunized patients exposed to Fy
antigen (Control 2). Phenotype frequencies for HLA-DRB1 and HLA-DQB1 alleles were compared between the cases and control groups.
Statistically significant differences in phenotype frequencies between cases and controls were found for DRB1*04 (odds ratios ORs, 10.5 and 18.7 for Control 1 and Control 2, respectively), DRB1*15 (ORs, 8.0 and 6.9), and DQB1*02 alleles (ORs, 0.2 and 0.03); and DRB1*04-DQB1*03:01 (ORs, 7.9 and 17.6), DRB1*04-DQB1*03:02 (ORs, 5.5 and 7.6), DRB1*15-DQB1*06:02 (ORs, 7.3 and 5.5), DRB1*03-DQB1*02:01 (OR, 0.1), and DRB1*07-DQB1*02:02 (OR, 0.3) haplotypes.
Several HLA-DRB1 and HLA-DQB1 alleles and haplotypes were proved to contribute to and protect from alloimmunization to Fy
antigens. Alleles DRB1*04 and DRB1*15, as well as haplotypes DRB1*04-DQB1*03:02 and DRB1*15-DQB1*06:02 can be considered as risk factors, while allele DQB1*02 and haplotype DRB1*03-DQB1*02:01 have a protective role in Fy
alloimmunization.
Background
Patients with hematological diseases are polytransfused and often immunocompromised, therefore susceptible to transfusion reactions (TR). This study aims to document the incidence of TRs ...in adult hematological patients and assess the effect of changes in the production of blood components and transfusion practice on their occurrence.
Study design and methods
Retrospective observational analysis of TRs reported from 1993 to 2019 was performed. For the analysis of the effect of changes on the incidence of TRs, the evaluated time was divided into two periods: the 1st period before the introduction of changes in production, when leukoreduced blood components were used only selectively, and the 2nd period, when semi‐automated method of production and universal leukoreduction was introduced.
Results
The decrease in the incidence of TRs was observed for both red blood cell (RBC) and platelet concentrate (PC) transfusions in the 2nd period. Since platelet additive solution has been used, a further decrease in the incidence was reported. The decrease in incidence was also observed for delayed hemolytic/serological transfusion reactions and for transfusion‐transmitted bacterial infections. Four cases of incorrect blood transfusions were uniquely related to the hematological patients, caused by antigen loss and transfusion ordering after ABO‐incompatible hematopoietic stem cell transplantation.
Discussion
Our results provided evidence that the introduction of tools offered by modern transfusion medicine: universal leukodepletion, plasma replacement with additive solutions, sensitive laboratory techniques, prophylactic antigen matching policy, informatization, and automatization, decreased the incidence of TRs and improved transfusion safety.
BACKGROUND
Alloimmunization is a known risk of transfusion therapy caused by exposure to foreign RBC antigens. However, alloimmunization is not observed in all transfused patients. Human leukocyte ...antigen (HLA) molecules may contribute to the recognition and presentation of foreign antigens and to the potency of immune responses that result in the production of antibodies. The aim of this study was to determine the association of HLA‐DR and HLA‐DQ polymorphisms with alloimunization to Fya antigen in Croatian patients.
STUDY DESIGN AND METHODS
The study was conducted on 70 alloimmunized patients to Fya antigen and two control groups: 165 healthy Croatian individuals (Control 1) and 45 Fya antigen‐negative nonimmunized patients exposed to Fya antigen (Control 2). Phenotype frequencies for HLA‐DRB1 and HLA‐DQB1 alleles were compared between the cases and control groups.
RESULTS
Statistically significant differences in phenotype frequencies between cases and controls were found for DRB1*04 (odds ratios ORs, 10.5 and 18.7 for Control 1 and Control 2, respectively), DRB1*15 (ORs, 8.0 and 6.9), and DQB1*02 alleles (ORs, 0.2 and 0.03); and DRB1*04‐DQB1*03:01 (ORs, 7.9 and 17.6), DRB1*04‐DQB1*03:02 (ORs, 5.5 and 7.6), DRB1*15‐DQB1*06:02 (ORs, 7.3 and 5.5), DRB1*03‐DQB1*02:01 (OR, 0.1), and DRB1*07‐DQB1*02:02 (OR, 0.3) haplotypes.
CONCLUSION
Several HLA‐DRB1 and HLA‐DQB1 alleles and haplotypes were proved to contribute to and protect from alloimmunization to Fya antigens. Alleles DRB1*04 and DRB1*15, as well as haplotypes DRB1*04‐DQB1*03:02 and DRB1*15‐DQB1*06:02 can be considered as risk factors, while allele DQB1*02 and haplotype DRB1*03‐DQB1*02:01 have a protective role in Fya alloimmunization.
SAŽETAK
Autoimunosna hemolitička anemija je rijetka bolest imunosnog sustava koju karakterizira hemoliza vlastitih eritrocita uzrokovana autoprotutijelima i/ili aktiviranim komponentama komplementa. ...Ovisno o osnovnoj bolesti, autoimunosna hemolitička anemija može biti primarna ili sekundarna, a prema serološkim karakteristikama autoprotutijela dijeli se na toplu, hladnu i miješanu. Dijagnoza bolesti postavlja se na temelju pozitivnog rezultata direktnoga antiglobulinskog testa, anemije i prisutnih laboratorijskih pokazatelja hemolize. U vrlo rijetkim slučajevima mogući su oblici autoimunosnih hemolitičkih anemija s negativnim direktnim antiglobulinskim testom. Uz preciznu imunohematološku dijagnostiku potrebnu za razlikovanje pojedinih vrsta autoimunosnih anemija, za pravilno liječenje nužna je i dijagnostika osnovne bolesti. U liječenju toplih autoimunosnih hemolitičkih anemija najčešće se primjenjuju kortikosteroidi, a u težim slučajevima i rituksimab. Kod hladnih autoimunosnih hemolitičkih anemija važno je utopliti bolesnika i izbjegavanje hladnoće, a medikamentozno liječenje rituksimabom s bendamustinom ili bez njega potrebno je u težim slučajevima. U refraktornim slučajevima paroksizmalne hladne hemoglobinurije uz rituksimab se primjenjuju imunosupresivni lijekovi. Za miješanu autoimunosnu hemolitičku anemiju uz kortikosteroide se preporučuje rano primijeniti rituksimab. U liječenju simptomatske anemije primjenjuje se transfuzijsko liječenje, a za liječenje životno ugroženog bolesnika moguće je primijeniti intravenske imunoglobuline, plazmaferezu, a u rijetkim slučajevima retikulocitopenije i eritropoetin. Novi lijekovi, koji su trenutno u kliničkim istraživanjima, obećavajući su za liječenje teških oblika autoimunosnih hemolitičkih anemija, kao što su komplementom posredovane autoimunosne hemolitičke anemije ili refraktorni oblici hladnih autoimunosnih hemolitičkih anemija. Za praćenje terapijskog učinka autoimunosnih hemolitičkih anemija važno je poznavati kriterije kojima se definira odgovor na terapiju i ishod bolesti. Cilj ovoga preglednog rada jest prikazati aktualna saznanja o dijagnostici i liječenju te praćenju učinka terapije autoimunosnih hemolitičkih anemija.
PDF
