Journal of Blood Transfusion The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Alloimmunization in Patients with Sickle Cell Disease in French Guiana Mon, 02 Feb 2015 06:13:40 +0000 This study in French Guiana assessed the frequency of alloimmunization to red cell antigens in sickle cell disease patients over 1995–2011 and identified the most common antibodies. A retrospective analysis of the transfusion history and medical records of 302 patients showed that 29/178 transfused patients had developed alloantibodies (16%). The most frequent alloantibodies were anti-LE1, anti-MNS1, anti-LE2, and anti-FY1 and were developed after transfusion of standard red cell units. The frequency of the clinically significant antibodies in this population of SCD patients was 11% (19/178). The antibodies found on those patients who had delayed hemolytic transfusion reaction were anti-K1, anti-FY1, and anti-MNS3. The strategies used to decrease alloimmunization in French Guiana are discussed. Narcisse Elenga and Loic Niel Copyright © 2015 Narcisse Elenga and Loic Niel. All rights reserved. Blood Transfusion, Serum Ferritin, and Iron in Hemodialysis Patients in Africa Sun, 11 Jan 2015 11:31:00 +0000 Background and Objectives. There is no data analyzing the outcome of blood transfusions and oral iron therapy in patients with kidneys failure in sub-Saharan Africa. The present study aimed to fill that gap and assess the value of ferritin in the diagnosis of iron overload and deficiency. Design. From January to February 2012, we prospectively studied 85 hemodialysis patients (78% of males and 22% of females aged 20 to 79 years) attending the Gabonese National Hemodialysis Centre. Results. Correlation studies showed (a) a strong positive linear relationship between the number of blood transfusions and high serum ferritin in hemodialysis patient (Spearman ; value: 0.0001); (b) a weak association between the number of blood transfusions and serum iron concentrations (Spearman ; value: 0.04); (c) a weak association between serum ferritin and serum iron (Spearman ; value: 0.003). Also, the strength of agreement beyond chance between the levels of ferritin and iron in the serum was poor (). The prevalence of iron overload was 10.6%, whereas the prevalence of iron deficiency was 2.3%, comparing (1) patients with a maximum of one transfusion not on iron therapy; (2) patients with a maximum of one transfusion on iron therapy; (3) polytransfused patients not on iron therapy; and (4) polytransfused patients on oral iron therapy. The “Kruskal-Wallis test” showed that ferritin levels varied significantly between the groups ( value: 0.0001). Conclusion. Serum ferritin is not reliable as a marker of iron overload. For patients undergoing regular transfusion we recommend routine serum ferritin measurement and yearly measurement of LIC. Leonard Kouegnigan Rerambiah, Laurence Essola Rerambiah, Armel Mbourou Etomba, Rose Marlène Mouguiama, Phanie Brunelle Issanga, Axel Sydney Biyoghe, Batchelili Batchilili, Sylvestre Akone Assembe, and Joel Fleury Djoba Siawaya Copyright © 2015 Leonard Kouegnigan Rerambiah et al. All rights reserved. Screening Donated Blood for Transfusion Transmitted Infections by Serology along with NAT and Response Rate to Notification of Reactive Results: An Indian Experience Sun, 16 Nov 2014 09:41:21 +0000 Background. Transfusion safety begins with healthy donors. A fundamental part of preventing transfusion transmitted infections (TTIs) is to notify and counsel reactive donors. Donor notification and counselling protect the health of the donor and prevent secondary transmission of infectious diseases. Methods. 113,014 donations were screened for TTIs, namely, HIV, HBV, HCV, and syphilis, by serology and nucleic acid testing. All reactive donors were retested (wherever possible) and notified of their status by telephone or letter. All initial reactive screens were followed over six months. Results. We evaluated 2,838 (2.51%) cases with reactive screening test results (1.38% HBV, 0.54% HCV, 0.27% HIV, and 0.32% syphilis). Only 23.3% of donors (662) responded to notification. The response among voluntary donors was better as compared to the replacement donors (43.6% versus 21.2%). Only 373 (56.3%) responsive donors followed their first attendance at referral specialties. Over six months, only 176 of 662 (26.6%) reactive donors received treatment. Conclusion. Our study shed light on the importance of proper donor counselling and notification of TTI status to all reactive donors who opt to receive this information. There is also an urgent need to formulate the nationally acceptable guidelines for notification and follow-up of reactive donors. Rahul Chaurasia, Shamsuz Zaman, Bankim Das, and Kabita Chatterjee Copyright © 2014 Rahul Chaurasia et al. All rights reserved. Assessing Acceptability of Short Message Service Based Interventions towards Becoming Future Voluntary Blood Donors Mon, 10 Nov 2014 11:10:33 +0000 All blood bank services, especially those of developing countries, face a major shortfall of blood donations due to lack of voluntary blood donors. Our study aims to evaluate the acceptability of Short Message Service based interventions towards becoming voluntary blood donors among medical university students of Karachi, Pakistan. Methods. A total of 350 medical students were approached in medical universities of Karachi, Pakistan, using a nonprobability convenient sampling technique. Data collectors administered a self-made questionnaire to each participant using an interview based format. All data was recorded and analyzed on SPSS 16. Results. 350 participants, having a mean age of 21.47 ± 1.36, were included in our study with 30.6% (107/350) being males and 69.4% (243/350) being females. 93.4% (327/350) of participants agreed that donating blood was healthy, but only 26% had donated blood in the past with 79.1% donating voluntarily. 65.7% (230/350) of the participants agreed to take part in Short Message Service based behavioral interventions to become voluntary blood donors with 69.7% (244/350) also agreeing that Short Message Service reminders will promote them to donate blood more often. Conclusion. With university students willing to become voluntary blood donors, Pakistani blood banks can carry out Short Message Service based interventions to encourage them to donate blood. Sana Saleem, Anum Wasim, Sidra Sabih, Ayisha Farooq Khan, Madiha Hasan Rizvi, Umaima Ayesha Jillani, Mujtaba Jamal Syed, Madiha Mumtaz, Yasmeen Mumtaz, Abdul Moid Shehzad, Om Dawani, Saima Khan, Sheheryar Munir, Nava Asad, and Abdul Nafey Kazi Copyright © 2014 Sana Saleem et al. All rights reserved. Factors Associated with Intention to Donate Blood: Sociodemographic and Past Experience Variables Wed, 05 Nov 2014 08:45:17 +0000 Background and Objectives. This study was conducted to assess the level of intention of the general public towards blood donation and the factors associated with it. Methods. A descriptive cross-sectional study was conducted in South-East Botswana amongst participants aged 21–65 years. An interviewer-administered questionnaire was completed for 384 participants. Results. Of the 384 participants, 104 (27.1%) reported that they had donated blood in the past and 269 (70.1%) stated that they were willing to donate blood in the future. Thirteen out of the 104 past donors (12.5%) reported that they had donated blood in the 12 months preceding the survey and only 10 (9.6%) participants reported that they have been regular donors. In the backward logistic regression analysis, the variables that remained significant predictors of the intention to donate blood were secondary education (adjusted odds ratio (AOR) (95% confidence interval (CI)): 2.92 (1.48, 5.77)), tertiary education (AOR (95% CI): 3.83 (1.52, 9.62)), and knowing a family member who had ever donated blood (AOR (95% CI): 2.84 (1.58, 5.12)). Conclusion. Being informed about blood transfusion and its life-saving benefits through either the education system or the experience made people more likely to intend to donate blood. Evidence-based interventions to retain blood donors as regular donors are recommended. Pule Ishmael Pule, Boitshwarelo Rachaba, Mgaywa Gilbert Mjungu Damas Magafu, and Dereje Habte Copyright © 2014 Pule Ishmael Pule et al. All rights reserved. Testing for Partial RhD with a D-Screen Diagast Kit in Moroccan Blood Donors with Weak D Expression Tue, 28 Oct 2014 09:45:43 +0000 The aim of this study was to search for the partial D phenotype in Moroccan blood donors with weak D expression. The study included 32 samples with weak D phenotype, and partial D category red blood cells were detected with the D-Screen Diagast kit, which consists in 9 monoclonal anti-D antibodies specific for the most common categories of partial D. Among the 32 samples studied, we identified 13 specific reactions to a partial D antigen (3 DVI, 2 DVa, 2 D, and 6 DVII), with 8 reactions suggesting a weak D and 11 reactions providing no formal argument in favor of a partial D antigen. This work can be used to validate the performance of the anti-D reagent and to improve the safety of transfusion of red blood cells from donors expressing the partial D antigen by integrating the finding into the recipient file with a recommendation concerning the appropriate care. Z. Kabiri, M. Benajiba, K. Hajjout, N. Dakka, and H. Bellaoui Copyright © 2014 Z. Kabiri et al. All rights reserved. How to Motivate Whole Blood Donors to Become Plasma Donors Tue, 28 Oct 2014 07:50:15 +0000 This study tested the efficacy of interventions to recruit new plasma donors among whole blood donors. A sample of 924 donors was randomized to one of three conditions: control; information only by nurse; and information plus self-positive image message by nurse (SPI). Participants in the control condition only received a leaflet describing the plasma donation procedure. In the two experimental conditions the leaflet was explained face-to-face by a nurse. The dependent variables were the proportion of new plasma donors and the number of donations at six months. Overall, 141 (15.3%) new plasma donors were recruited at six months. There were higher proportions of new plasma donors in the two experimental conditions compared to the control condition (); the two experimental conditions did not differ. Also, compared to the control condition, those in the experimental conditions (all ) gave plasma more often (information only by nurse:  ; SPI: ); the SPI intervention significantly outperformed () the information only by nurse condition. The results suggest that references to feelings of SPI such as feeling good and being proud and that giving plasma is a rewarding personal experience favor a higher frequency of plasma donation. Gaston Godin and Marc Germain Copyright © 2014 Gaston Godin and Marc Germain. All rights reserved. Phenotypic Profile of Rh and Kell Blood Group Systems among Blood Donors in Cote d’Ivoire, West Africa Wed, 24 Sep 2014 00:00:00 +0000 Few countries in sub-Saharan Africa make systematic searches for antigens C, c, E, and e of the Rh and Kell system antigens in the donor and recipient, thereby exposing transfused patients. Purpose and Objectives. In this paper, we propose to determine the red cell Rh and Kell blood groups among blood donors from traditional techniques to improve medical care of transfused patients. This study will allow us to assess the frequency of blood group antigens in these systems. Study Design and Methods. We carried out a study on the red cell typing in the blood donor population of the National Blood Transfusion Center in Abidjan. This study was performed on 651 blood donors. Results. For the Rh system, the antigen frequencies of D, c, e, C, and E are, respectively, 92.93%, 99.85%, 99.85%, 21.97%, and 13.82%. K antigen is found in 0.77% of donors. Discussion and Conclusion. Although the frequencies of the most immunogenic antigens are lower than in the white race, lack of preventive measures makes the immunological risk high in Africa. Furthermore, Africa is full of specificities that are important to note for a better care of our patients. L. Siransy Bogui, B. Dembele, Y. Sekongo, S. Abisse, S. Konaté, and M. Sombo Copyright © 2014 L. Siransy Bogui et al. All rights reserved. Massive Transfusion Protocol Activation Does Not Result in Preferential Use of Older Red Blood Cells Wed, 10 Sep 2014 06:44:48 +0000 Widespread, anecdotal belief exists that patients receiving massive transfusion, particularly those for whom a massive transfusion protocol (MTP) is activated, are more likely to receive older red blood cells (RBCs). Retrospective review of blood bank records from calendar year 2011 identified 131 patients emergently issued ≥10 RBC units (emergency release (ER)) prior to obtaining a type and screen. This cohort was subclassified based on whether there was MTP activation. For comparison, 176 identified patients transfused with ≥10 RBC units in a routine fashion over 24 hours represented the nonemergency release (nER) cohort. Though the median age of ER RBCs was 5 days older than nER RBCs (ER 20, nER 15 days, ), both fell within the third week of storage. Regardless of MTP activation, transfused ER RBCs had the same median age (MTP 20, no-MTP 20 days, ). In the ER cohort, transition to type-specific blood components increased the median age of transfused RBC units from 17 to 36 days (). These data refute the anecdotal belief that MTP activation results in transfusion of older RBCs. However, upon transition to type-specific blood components, the age of RBCs enters a range in which it is hypothesized that there may be a significant effect of storage age on clinical outcomes. Lauren M. McDaniel, Darrell J. Triulzi, James Cramer, Brian S. Zuckerbraun, Jason L. Sperry, Andrew B. Peitzman, Jay S. Raval, and Matthew D. Neal Copyright © 2014 Lauren M. McDaniel et al. All rights reserved. Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center Tue, 02 Sep 2014 12:33:47 +0000 Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of  mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures. Babatunde O. Akinbami and Bisola Onajin-Obembe Copyright © 2014 Babatunde O. Akinbami and Bisola Onajin-Obembe. All rights reserved. Transfusion Strategy: Impact of Haemodynamics and the Challenge of Haemodilution Wed, 06 Aug 2014 06:18:12 +0000 Blood transfusion is associated with increased morbidity and mortality and numerous reports have emphasised the need for reduction. Following this there is increased attention to the concept of patient blood management. However, bleeding is relatively common following cardiac surgery and is further enhanced by the continued antiplatelet therapy policy. Another important issue is that cardiopulmonary bypass leads to haemodilution and a potential blood loss. The basic role of blood is oxygen transport to the organs. The determining factors of oxygen delivery are cardiac output, haemoglobin, and saturation. If oxygen delivery/consumption is out of balance, the compensation mechanisms are simple, as a decrease in one factor results in an increase in one or two other factors. Patients with coexisting cardiac diseases may be of particular risk, but studies indicate that patients with coexisting cardiac diseases tolerate moderate anaemia and may even benefit from a restrictive transfusion regimen. Further it has been shown that patients with reduced left ventricular function are able to compensate with increased cardiac output in response to bleeding and haemodilution if normovolaemia is maintained. In conclusion the evidence supports that each institution establishes its own patient blood management strategy to both conserve blood products and maximise outcome. Carl-Johan Jakobsen Copyright © 2014 Carl-Johan Jakobsen. All rights reserved. Prevalence and Incidence of Syphilis among Volunteer Blood Donors in Israel Tue, 22 Apr 2014 07:12:28 +0000 Data of 1,290,222 volunteer blood donors, in a 5-year period, was analyzed for prevalence and incidence of syphilis. Subsequent testing of donations positive in Treponema pallidum hemagglutination assay included Venereal Disease Research Laboratory and fluorescent Treponemal antibody absorption. Stepwise logistic regression model was used to identify positive syphilis serology. Prevalence of syphilis was 47 : 100,000, similar in men and women and increased significantly with age (). Native Israelis had the lowest prevalence rate of syphilis (21 : 100,000), while a significantly higher prevalence was found among immigrants from Africa, Eastern Europe, and South America (odds ratios of 19.0, 10.8, and 7.3, resp., for each). About 33.2% of the seropositive donors had evidence of recent infection, and 66.8% had past infections. Incidence rate reached 8 : 100,000 person-years. Coinfection with HIV, HCV, and HBV was calculated as 8%, 1.88%, and 0.37% for positive donations, respectively. The data support the need to continue screening blood donors in Israel for syphilis and employ preventive measures to populations at risk, in order to improve public health, blood safety, and quality. A subsequent study to assess blood donors’ knowledge, attitude, and behavior is planned. In times of global migration this information may be useful to blood services worldwide. Leibovici Vera, Donchin Milka, Strauss-Liviatan Nurith, and Shinar Eilat Copyright © 2014 Leibovici Vera et al. All rights reserved. Frequencies and Specificities of “Enzyme-Only” Detected Erythrocyte Alloantibodies in Patients Hospitalized in Austria: Is an Enzyme Test Required for Routine Red Blood Cell Antibody Screening? Tue, 25 Mar 2014 12:52:58 +0000 The aim of this study was to determine the frequencies and specificities of “enzyme-only” detected red blood cell (RBC) alloantibodies in the routine antibody screening and antibody identification in patients hospitalized in Austria. Routine blood samples of 2420 patients were investigated. The antibody screening was performed with a 3-cell panel in the low-ionic strength saline- (LISS-) indirect antiglobulin test (IAT) and with an enzyme-pretreated (papain) 3-cell panel fully automated on the ORTHO AutoVue Innova System. The antibody identification was carried out manually with an 11-cell panel in the LISS-IAT and with an enzyme-pretreated (papain) 11-cell panel. In total 4.05% () of all patients () had a positive RBC antibody screening result. Of them 25.51% (25/98) showed “enzyme-only” detected specific or nonspecific RBC alloantibodies. Rhesus and Lewis system antibodies were found the only specificities of “enzyme-only” RBC alloantibodies: all in all 4.8% (4/98) were detected with anti-E, 3.06% (3/98) with anti-, 3.06% (3/98) with anti-D after anti-D prophylaxis and 1.02% (1/98) with anti-e. In total, 14.29% (14/98) showed a nonspecific RBC alloantibody result with the enzyme test. The results of the present study demonstrate that a high number of unwanted positive reactions with the enzyme technique overshadows the detection of “enzyme-only” RBC alloantibodies. (Trial Registration: K-37-13). Dietmar Enko, Claudia Habres, Franz Wallner, Barbara Mayr, and Gabriele Halwachs-Baumann Copyright © 2014 Dietmar Enko et al. All rights reserved. Mapping Rare Erythrocyte Phenotypes in Morocco: A Tool to Overcome Transfusion Challenges Wed, 12 Mar 2014 06:57:33 +0000 The aim of this research is to search for the distribution of blood groups in all the regions of Morocco. This study, done for the first time, aimed to provide the frequency of the Rhesus system and Kell (K) in more than 55000 blood donors from nine different regions around the country. In addition, the frequency of the Cellano, Duffy, Kidd, and MNS blood antigens was searched for 500 blood donors from the Rabat’s region. Frequency of blood donors with rare blood groups was characterized for the first time in the country and compared to results found from other populations. A. Benahadi, S. Boulahdid, B. Adouani, A. Laouina, A. Mokhtari, A. Soulaymani, K. Hajjout, M. Benajiba, and R. Alami Copyright © 2014 A. Benahadi et al. All rights reserved. Blood Requisition and Utilization Practice in Surgical Patients at University of Gondar Hospital, Northwest Ethiopia Thu, 28 Nov 2013 18:01:46 +0000 Background. Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence based estimates. Overordering with minimal utilization squanders technical time, reagent and imposes extra expenses on patients. This study was conducted to assess blood utilization practices. Methods. Cross-sectional study was conducted in Gondar Hospital. Five-month data were collected from all discharged surgical patients and blood bank registries. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (%T), and transfusion index (TI) indices. Results. A total of 982 patients were requested to prepare 1,072 crossmatched units. Of these, 468 units were transfused for 286 patients. The overall ratios of C/T, %T, and TI index were 2.3, 47%, and 0.77, respectively. Blood transfusion from the units crossmatched was 43.6%. Moreover, the highest C/T ratio was observed in elective surgical patients. Conclusions. The overall blood utilization was encouraging, but excessive crossmatching with minimal transfusion practice was observed in elective surgical patients. Blood ordering pattern for elective procedures needs to be revised and overordering of blood should be minimized. Moreover, the hospital with blood transfusion committee should formulate maximum surgical blood ordering policies for elective surgical procedures and conduct regular auditing. Tadesse Belayneh, Gashaw Messele, Zewditu Abdissa, and Birehanemeskel Tegene Copyright © 2013 Tadesse Belayneh et al. All rights reserved. Knowledge, Attitude, and Practice of Voluntary Blood Donation among Healthcare Workers at the University of Benin Teaching Hospital, Benin City, Nigeria Wed, 09 Oct 2013 15:58:23 +0000 Introduction. Adequate and safe blood supply has remained a challenge in developing countries like ours. There is a high dependency on family replacement and remunerated blood donors in our environment which carries an attendant increased risk of transfusion transmissible infection. Objectives. The objectives of this study were to assess the knowledge, attitude, and practice of voluntary blood donation among healthcare workers (nonphysicians) and to identify and recruit potential voluntary blood donors. Methodology. This was a cross-sectional descriptive study carried out at the University of Benin Teaching Hospital, Benin City. A total of 163 staffs were recruited. Pretest questionnaires were used to assess their knowledge, attitude, and practice of voluntary blood donation. Statistical Analysis. The responses were collated and analyzed with the Statistical Package for Social Sciences (SPSS) 16. The association between blood donation practice and gender of respondents, category of staff, and level of education was tested using Chi-square and Fisher’s tests where appropriate. were considered statistically significant. Results. The median age of the respondents was 32 years (18–56) with females accounting for 55.6% (90). A total of 74.8% (122) attained tertiary education, and 55.8% (91) of respondents were senior staffs. The majority has good knowledge and positive attitude towards donation; however, only 22.1% (36) have donated blood with 41.7% (15) of these being voluntary. Male workers were more likely to donate (). There is no significant association between blood donation and level of education. Conclusion. There is a strong disparity between the knowledge, attitude, and practice of voluntary donation amongst healthcare workers. Benedict Nwogoh, Usimenahon Aigberadion, and Alexander Ikenna Nwannadi Copyright © 2013 Benedict Nwogoh et al. All rights reserved. A Comparison Study of the Blood Component Quality of Whole Blood Held Overnight at 4°C or Room Temperature Thu, 05 Sep 2013 09:12:41 +0000 Background. The use of plasma frozen within 24 hrs is likely to increase. Whole blood (WB) and buffy coats (BCs) can be held for a few hrs or overnight before processing. Methods. Twenty-four bags of WB for plasma and 12 bags for platelet (PLT) concentrates were collected. The fresh frozen plasma (FFP) was prepared within 6 hrs. I-FP24 and II-FP24 samples were prepared either from leukodepleted WB that was held overnight or from WB that was held overnight before leukodepletion. The PLT concentrates (PCs) were prepared from BCs within 6 hrs (PC1) and within 18 to 24 hrs (PC2). The typical coagulation factors and some biochemical parameters were determined. Results. Compared to the FFP samples, the levels of FVII and FVIII in the I-FP24 and II-FP24 samples decreased significantly. The pH, Na+, LDH, and FHb levels differed significantly between II-FP24 and FFP. Compared to PC1, PC2 exhibited lower pH, pO2, and Na+ levels, a higher PLT count, and increased pCO2, K+, Lac, and CD62P expression levels. Conclusion. FP24 is best prepared from WB that was stored overnight at 4°C and then leukodepleted and separated within 24 hrs. PCs are best produced from BCs derived from WB that was held overnight at room temperature. Shichun Wang, Tiantian Wang, Yahan Fan, Shan Huang, Zhongmei Yi, Ruiqing Li, and Shuming Zhao Copyright © 2013 Shichun Wang et al. All rights reserved. Comprehensive Look at Blood Transfusion Utilization in Total Joint Arthroplasty at a Single Academic Medical Center under a Single Surgeon Tue, 16 Jul 2013 11:40:36 +0000 The utilization of autologous and allogeneic transfusions in total joint arthroplasties was to characterize patients who may benefit from giving preoperative blood donations. We conducted a retrospective chart review of 525 patients to document preoperative hematocrit, estimated blood loss, length of stay, transfusions, and medical comorbidities. Results of our review showed that total hip arthroplasty revision (THA-R) had the highest prevalence of transfusions (60%) followed by total hip arthroplasty (THA, 53%), total knee arthroplasty-revision (TKA-R, 33%), and total knee arthroplasty (TKA, 23%). There was significant waste of autologous donations: 92% of TKA patients, 64% of THA, and 33% of THA-R patients wasted on average 1.527, 1.321, and 1.5 autologous units, respectively. Pre-operative hematocrit was the strongest predictor of future transfusion need across all procedures, and primary THA had additional predictors in age and gender. Sean Robinson, Owen McGonigle, Sam Volin, Yung-Chi Sung, Matthew Moore, Charles Cassidy, and Eric Smith Copyright © 2013 Sean Robinson et al. All rights reserved. Process Improvement by Eliminating Mixing of Whole Blood Units after an Overnight Hold Prior to Component Production Using the Buffy Coat Method Wed, 05 Jun 2013 15:23:27 +0000 The elimination of a thorough manual mixing of whole blood (WB) which takes place following the overnight hold, but before the first centrifugation step, during buffy coat component production at Canadian Blood Services (CBS) was investigated. WB was pooled after donation and split. Pairs of platelet, red blood cell (RBC), and plasma components were produced, with half using the standard method and half using a method in which the mixing step was eliminated. Quality assessments included yield, pH, CD62P expression and morphology for platelets, hemoglobin, hematocrit, hemolysis, and supernatant K+ for RBCs, and volume and factor VIII activity levels for plasma. All components, produced using either method, met CBS quality control criteria. There were no significant differences in platelet yield between components produced with and without mixing. A significant difference was seen for RBC hemolysis at expiry (), but for both groups, levels met quality control requirements. Noninferiority of components produced without mixing was confirmed for all parameters. Manual mixing is laborious and has a risk of repetitive strain for production staff and its significance is unclear. Elimination of this step will improve process efficiencies without compromising quality. Cherie Mastronardi, Peter Schubert, Elena Levin, Varsha Bhakta, Qi-Long Yi, Adele Hansen, Tamiko Stewart, Craig Jenkins, Wanda Lefresne, William Sheffield, and Jason P. Acker Copyright © 2013 Cherie Mastronardi et al. All rights reserved. An Efficient Apparatus for Rapid Deoxygenation of Erythrocyte Concentrates for Alternative Banking Strategies Sun, 10 Mar 2013 08:23:42 +0000 Erythrocyte concentrates (ECs) stored for transfusion purposes still represent a lifesaving solution in a wide series of clinically occurring circumstances, especially for traumatized and perioperative patients. However, concerns still arise and persist as to whether current criteria for collection and storage of ECs might actually represent the best case scenario or there might rather be still room for improvement. In particular, the prolonged storage of EC has been associated with the accumulation of a wide series of storage lesions, either reversible (metabolism) or irreversible (protein and morphology). Independent laboratories have contributed to propose alternative strategies, among which is the introduction of oxygen removal treatments to ECs. Convincing biochemical and preliminary clinical evidences have been produced about the benefits derived from the introduction of this practice. We, hereby, propose a rapid, efficient, and time-effective strategy for blood deoxygenation which might fit in current EC production chain. The proposed strategy resulted in the complete deoxygenation of red blood cell hemoglobin ( mmHg). A preliminary small-scale study about the application of the present method resulted in reduced hemolysis, decreased vesiculation, and limited alterations to the red blood cell morphology, as gleaned from flow cytometry and scanning electron microscopic analyses. Further in-depth and larger-scale investigations are encouraged. Lello Zolla and Angelo D'Alessandro Copyright © 2013 Lello Zolla and Angelo D'Alessandro. All rights reserved. Potential Application of Cord Blood-Derived Stromal Cells in Cellular Therapy and Regenerative Medicine Tue, 04 Dec 2012 13:14:46 +0000 Neonatal stromal cells from umbilical cord blood (CB) are promising alternatives to bone marrow- (BM-) derived multipotent stromal cells (MSCs). In comparison to BM-MSC, the less mature CB-derived stromal cells have been described as a cell population with higher differentiation and proliferation potential that might be of potential interest for clinical application in regenerative medicine. Recently, it has become clear that cord blood contains different stromal cell populations, and as of today, a clear distinction between unrestricted somatic stromal cells (USSCs) and CB-MSC has been established. This classification is based on the expression of DLK-1, HOX, and CD146, as well as functional examination of the adipogenic differentiation potential and the capacity to support haematopoiesis in vitro and in vivo. However, a marker enabling a prospective isolation of the rare cell populations directly out of cord blood is yet to be found. Further analysis may help to reveal even more subpopulations with different properties, which could be useful for the directed application of these cells in preclinical models. Simone Maria Kluth, Teja Falk Radke, and Gesine Kogler Copyright © 2012 Simone Maria Kluth et al. All rights reserved. Anemia and Blood Transfusions in Critically Ill Patients Mon, 22 Oct 2012 11:45:21 +0000 Anemia is common in critically ill patients. As a consequence packed red blood cell (PRBC) transfusions are frequent in the critically ill. Over the past two decades a growing body of literature has emerged, linking PRBC transfusion to infections, immunosuppression, organ dysfunction, and a higher mortality rate. However, despite growing evidence that risk of PRBC transfusion outweighs its benefit, significant numbers of critically ill patients still receive PRBC transfusion during their intensive care unit (ICU) stay. In this paper, we summarize the current literature concerning the impact of anemia on outcomes in critically ill patients and the potential complications of PRBC transfusions. M. Kamran Athar, Nitin Puri, and David R. Gerber Copyright © 2012 M. Kamran Athar et al. All rights reserved. High Rates of Hepatitis B and C and HIV Infections among Blood Donors in Cameroon: A Proposed Blood Screening Algorithm for Blood Donors in Resource-Limited Settings Wed, 10 Oct 2012 13:27:18 +0000 Background. Infections with human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C virus (HCV) are currently major public health problems. Methods. A retrospective study was conducted from January to June 2008 at the Blood Bank of the Central Hospital, Yaoundé (Cameroon). The objective was to study the prevalence of HIV, HBV, and HCV and their coinfections among blood donors. Results. A total of 4650 donors were identified, and the sex ratio (male/female) was 14/1. The median age of donors was 28 years (range: 16 to 69 years). Among blood donors, HBV, HIV, and HCV infection prevalences were 12.14%   , 4.44%  , and 1.44%  , respectively. Coinfection with HIV and HBV was observed among 0.77% donors, followed by hepatitis B and C co-infection (0.21%) and HIV and HCV coinfection (0.06%). Co-infection with HIV-HBV-HCV was encountered in 2 donors. The HIV, HBV, and HCV infections lead to a destruction of one out of six sets of blood collected. Conclusion. There is a need to review policies for blood collection from donors, by modifying the algorithm of blood donors testing. Pretesting potential donors using rapid tests could help to avoid collection and destruction of (infected) blood. Florent Fouelifack Ymele, Basile Keugoung, Jeanne Hortense Fouedjio, Nadege Kouam, Sandrine Mendibi, and Jacqueline Dongtsa Mabou Copyright © 2012 Florent Fouelifack Ymele et al. All rights reserved. State of the Art in Stem Cell Research: Human Embryonic Stem Cells, Induced Pluripotent Stem Cells, and Transdifferentiation Thu, 05 Jul 2012 09:49:20 +0000 Stem cells divide by asymmetric division and display different degrees of potency, or ability to differentiate into various specialized cell types. Owing to their unique regenerative capacity, stem cells have generated great enthusiasm worldwide and represent an invaluable tool with unprecedented potential for biomedical research and therapeutic applications. Stem cells play a central role in the understanding of molecular mechanisms regulating tissue development and regeneration in normal and pathological conditions and open large possibilities for the discovery of innovative pharmaceuticals to treat the most devastating diseases of our time. Not least, their intrinsic characteristics allow the engineering of functional tissues for replacement therapies that promise to revolutionize the medical practice in the near future. In this paper, the authors present the characteristics of pluripotent stem cells and new developments of transdifferentiation technologies and explore some of the biomedical applications that this emerging technology is expected to empower. Giuseppe Maria de Peppo and Darja Marolt Copyright © 2012 Giuseppe Maria de Peppo and Darja Marolt. All rights reserved. Potential Uses of Cord Blood in Cardiac Surgery Wed, 07 Mar 2012 14:23:41 +0000 Despite advances in the fields of prevention, medical intervention and surgical therapy, cardiovascular disease remains a major public healthcare issue. A promising area of research is the potential application of regenerative therapies with pluripotential stem cells to reduce the burden of heart disease and its sequelae. Umbilical cord blood, a rich source of multiple populations of nonembryonic stem cells, will be a valuable resource and has the potential to advance therapeutic options for patients with acquired and congenital heart disease. Ralph S. Mosca Copyright © 2012 Ralph S. Mosca. All rights reserved. Epidemiological Profiles of Foreign-Born and US-Born Hispanic Blood Donors in a Major Metropolitan Area in the United States Mon, 06 Feb 2012 19:09:55 +0000 Background. The explosive growth of Hispanics in the US makes this population a significant and untapped source for blood donation. Methods. A cross-sectional study was performed to evaluate blood donation behaviors and demographics of foreign-born and US-born Hispanic donors between 2006 and 2009 in metropolitan Atlanta, GA, USA. Bivariate analyses and multivariate logistic regression were used to assess factors associated with foreign-born donors. Results. 5,119 foreign-born and 11,841 US-born Hispanics donated blood. Foreign-born Hispanic donors were more likely than US-born donors to be blood group O (57.6% versus 52.0%; P<.001) and more frequent donors (2.2 versus 2.0; P<.001). Cuban-born donors had the highest rates of return donation (63.2%). In contrast, Mexicans, the most prevalent subpopulation among foreign-born Hispanic donors (31.8%), had the lowest rates of return donation (42.0%). Conclusions. The heterogeneity found among Hispanic donors in this study is valuable for the design of recruitment strategies to increase blood donations. Adelbert B. James, Cassandra D. Josephson, Marta I. Castillejo, George B. Schreiber, and John D. Roback Copyright © 2012 Adelbert B. James et al. All rights reserved. Comparative Efficacy of Three Forms of Parenteral Iron Thu, 19 Jan 2012 10:19:44 +0000 Intravenous iron therapy is a useful treatment for the rapid correction of iron deficiency anaemia and can be used to avoid or reduce the requirement for allogeneic blood transfusion. Several intravenous iron preparations are available commercially which differ in cost, mode of administration and side effect profile. There are few data directly comparing the efficacy of these preparations. In this retrospective single-centre study, we present the results from two hundred and eight patients treated using three different iron preparations (iron dextran, iron sucrose and ferric carboxymaltose) and compare the effect on haemoglobin levels and other measures of iron deficiency six weeks after treatment. Within the limitations of our study design, we show a statistically and clinically significant difference in efficacy between these preparations. Richard Dillon, Ibrahim Momoh, Yvonne Francis, Laura Cameron, Claire N. Harrison, and Deepti Radia Copyright © 2012 Richard Dillon et al. All rights reserved. Ethical Aspects of Blood Donors and the Recipients of Their Blood Thu, 19 Jan 2012 10:18:59 +0000 To date medical care is inextricable based on blood donors and blood products. The continuing increase and intensification of tests and guidelines also results in a change in deferral and abnormal test results. Donors and recipients of their blood are faced with this information and are confronted with a kaleidoscope of thoughts and emotions. The discussion with respect to paid versus nonpaid donation is not new, but other aspects are less often discussed. We describe these other aspects for donors and recipients of their blood and hope to open the ethical discussion; if and to what extent we should have limits? P. J. M. van den Burg and K. Magnussen Copyright © 2012 P. J. M. van den Burg and K. Magnussen. All rights reserved. Using Basic Ethical Principles to Evaluate Safety Efforts in Transfusion Medicine Thu, 19 Jan 2012 10:13:12 +0000 Pursuit of pharmaceutical purity of the blood in the bag has led to a shrinking donor base and a significantly more expensive product. Decisions regarding new infectious marker testing and donor deferrals have typically been made emphasizing decreasing one specific risk without considering the effect the intervention will have on the overall safety and availability of blood transfusion. Regulations have been formulated by governmental agencies with limited input from the medical community. The decision making process has lacked risk benefit analyses and has not had the robustness associated with spirited discussions. Policies made in this manner may result in certain risks being decreased but can also have adverse unintended consequences. Being guided by the ethical principles of nonmaleficence, beneficence, autonomy, and justice, we need to evaluate our actions in the context of overall blood safety rather than narrowly focusing on any one area. Jay P. Brooks Copyright © 2012 Jay P. Brooks. All rights reserved. Quality of Red Blood Cells Isolated from Umbilical Cord Blood Stored at Room Temperature Thu, 19 Jan 2012 10:11:29 +0000 Red blood cells (RBCs) from cord blood contain fetal hemoglobin that is predominant in newborns and, therefore, may be more appropriate for neonatal transfusions than currently transfused adult RBCs. Post-collection, cord blood can be stored at room temperature for several days before it is processed for stem cells isolation, with little known about how these conditions affect currently discarded RBCs. The present study examined the effect of the duration cord blood spent at room temperature and other cord blood characteristics on cord RBC quality. RBCs were tested immediately after their isolation from cord blood using a broad panel of quality assays. No significant decrease in cord RBC quality was observed during the first 65 hours of storage at room temperature. The ratio of cord blood to anticoagulant was associated with RBC quality and needs to be optimized in future. This knowledge will assist in future development of cord RBC transfusion product. Mariia Zhurova, John Akabutu, and Jason Acker Copyright © 2012 Mariia Zhurova et al. All rights reserved.