Journal of Blood Transfusion The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Quality and Safety of Blood Products Thu, 29 Dec 2016 08:31:57 +0000 Sandra Ramirez-Arcos, Denese C. Marks, Jason P. Acker, and William P. Sheffield Copyright © 2016 Sandra Ramirez-Arcos et al. All rights reserved. Knowledge, Attitudes, Practices, and Factors Associated with Voluntary Blood Donation among University Students in Kilimanjaro, Tanzania Wed, 14 Dec 2016 13:38:10 +0000 Background. Understanding the knowledge and awareness of blood donation among potential blood donors in the population, like young people, and the associated attitudes and practices is important. Methodology. This was a cross-sectional study whereby a self-administered questionnaire was used to collect information from the consenting participants. Results. A total of 422 participants were enrolled. Their mean age was 24.2 (SD 3.6) years. Of the 422, 30% have ever donated blood. 55% of those who had ever donated were repeated blood donors. Majority of the participants (93%) had positive attitudes towards blood donation and 88% were willing to donate in the future. Factors that were significantly associated with ever donating blood were male gender, knowing a person who has donated blood, knowledge of the amount of blood donated, willingness to donate in the future, and not expecting any postdonation reward. Discussion. High awareness, positive attitude, and high intention to donate in the future should be used to underscore the need to educate the young people on the value of blood donation in saving lives and to give them correct information on overall requirements for blood donation. Elionora Elias, Wilhellmuss Mauka, Rune N. Philemon, Damian J. Damian, Michael J. Mahande, and Sia E. Msuya Copyright © 2016 Elionora Elias et al. All rights reserved. Quality Assessment of Established and Emerging Blood Components for Transfusion Wed, 14 Dec 2016 06:03:28 +0000 Blood is donated either as whole blood, with subsequent component processing, or through the use of apheresis devices that extract one or more components and return the rest of the donation to the donor. Blood component therapy supplanted whole blood transfusion in industrialized countries in the middle of the twentieth century and remains the standard of care for the majority of patients receiving a transfusion. Traditionally, blood has been processed into three main blood products: red blood cell concentrates; platelet concentrates; and transfusable plasma. Ensuring that these products are of high quality and that they deliver their intended benefits to patients throughout their shelf-life is a complex task. Further complexity has been added with the development of products stored under nonstandard conditions or subjected to additional manufacturing steps (e.g., cryopreserved platelets, irradiated red cells, and lyophilized plasma). Here we review established and emerging methodologies for assessing blood product quality and address controversies and uncertainties in this thriving and active field of investigation. Jason P. Acker, Denese C. Marks, and William P. Sheffield Copyright © 2016 Jason P. Acker et al. All rights reserved. Could Microparticles Be the Universal Quality Indicator for Platelet Viability and Function? Thu, 08 Dec 2016 07:55:44 +0000 High quality means good fitness for the intended use. Research activity regarding quality measures for platelet transfusions has focused on platelet storage and platelet storage lesion. Thus, platelet quality is judged from the manufacturer’s point of view and regulated to ensure consistency and stability of the manufacturing process. Assuming that fresh product is always superior to aged product, maintaining in vitro characteristics should preserve high quality. However, despite the highest in vitro quality standards, platelets often fail in vivo. This suggests we may need different quality measures to predict platelet performance after transfusion. Adding to this complexity, platelets are used clinically for very different purposes: platelets need to circulate when given as prophylaxis to cancer patients and to stop bleeding when given to surgery or trauma patients. In addition, the emerging application of platelet-rich plasma injections exploits the immunological functions of platelets. Requirements for quality of platelets intended to prevent bleeding, stop bleeding, or promote wound healing are potentially very different. Can a single measurable characteristic describe platelet quality for all uses? Here we present microparticle measurement in platelet samples, and its potential to become the universal quality characteristic for platelet production, storage, viability, function, and compatibility. Elisabeth Maurer-Spurej and Kate Chipperfield Copyright © 2016 Elisabeth Maurer-Spurej and Kate Chipperfield. All rights reserved. Effectiveness of Provider Education Followed by Computerized Provider Order Entry Alerts in Reducing Inappropriate Red Blood Cell Transfusion Mon, 05 Dec 2016 06:02:22 +0000 To reduce the rate of inappropriate red blood cell transfusion, a provider education program, followed by alerts in the computerized provider order entry system (CPOE), was established to encourage AABB transfusion guidelines. Metrics were established for nonemergent inpatient transfusions. Service lines with high order volume were targeted with formal education regarding AABB 2012 transfusion guidelines. Transfusion orders were reviewed in real time with email communications sent to ordering providers falling outside of AABB recommendations. After 12 months of provider education, alerts were activated in CPOE. With provider education alone, the incidence of pretransfusion hemoglobin levels greater than 8 g/dL decreased from 16.64% to 6.36%, posttransfusion hemoglobin levels greater than 10 g/dL from 14.03% to 3.78%, and number of nonemergent two-unit red blood cell orders from 45.26% to 22.66%. Red blood cell utilization decreased by 13%. No additional significant reduction in nonemergent two-unit orders was observed with CPOE alerts. Provider education, an effective and low-cost method, should be considered as a first-line method for reducing inappropriate red blood cell transfusion rates in stable adult inpatients. Alerts in the computerized order entry system did not significantly lower the percentage of two-unit red blood cells orders but may help to maintain educational efforts. Vijay M. Patel, Anna W. Rains, and Christopher T. Clark Copyright © 2016 Vijay M. Patel et al. All rights reserved. Stability of Thawed Apheresis Fresh-Frozen Plasma Stored for up to 120 Hours at 1°C to 6°C Thu, 24 Nov 2016 08:33:30 +0000 Regulations concerning the storage of transfusable plasma differ internationally. In Canada, plasma obtained from whole blood donations and frozen within 24 hours of phlebotomy (frozen plasma, FP) may be thawed and transfused within 120 hours of refrigerated storage. However, plasma frozen within 8 hours of phlebotomy following apheresis donation (FFPA) must be transfused within 24 hours of thawing and refrigeration. Our objectives were to measure coagulation factors (F) V, VII, and VIII, fibrinogen activities, and the prothrombin time (PT) in thawed refrigerated FFPA at 0, 24, and 120 hours of storage and to compare these values to those in thawed refrigerated FP. Fibrinogen activity remained unchanged over time, while mean factor levels in 28 FFPA units declined by 17% (FV), 19.7% (FVII), and 54.6% (FVIII) over 120 hours, while PT values rose to 7.6%. Factor activities were significantly higher in FFPA than FP after 120 hours of refrigerated storage. Residual FVIII activities in thawed FFPA met predefined noninferiority criteria compared to thawed FP after 120 hours. These results support a change in Canadian regulations to permit transfusion of thawed FFPA made in a closed system and refrigerated for up to 120 hours, one that could reduce wastage of transfusable plasma. William P. Sheffield, Varsha Bhakta, Qi-Long Yi, and Craig Jenkins Copyright © 2016 William P. Sheffield et al. All rights reserved. Mitigating the Risk of Transfusion-Transmitted Dengue in Australia Sun, 13 Nov 2016 11:20:21 +0000 Dengue viruses (DENV 1–4) are a risk to transfusion safety, with several transfusion-transmitted (TT) cases reported globally. DENV 1–4 are endemic in over 100 countries, with seasonal outbreaks occurring in northeastern Australia. To mitigate TT-DENV risk in Australia, fresh blood components are not manufactured from donors returning from any area (domestic/overseas) with known dengue transmission. Alternatively, TT-DENV risk may be mitigated using an appropriate blood donor screening assay. We aimed to determine the rate of dengue infection in donors during dengue outbreaks in Australia. Plasma samples were collected from blood donors during local dengue outbreaks. All samples were tested for the presence of DENV RNA and selected samples were tested for DENV antigen (nonstructural protein 1, NS1) with two assays. No donors residing in high risk areas had detectable levels of DENV RNA or NS1 and no cases of DENV viremia were detected in blood donors residing in areas of Australia experiencing DENV outbreaks. Definitive conclusions could not be drawn from this study; however, the lack of detection of DENV RNA or antigen in donations suggests that the current risk of TT-DENV is low and maintaining the fresh component restriction for “at-risk” donors is appropriate. Kelly Rooks, Clive R. Seed, Jesse J. Fryk, Catherine A. Hyland, Robert J. Harley, Jerry A. Holmberg, Denese C. Marks, Robert L. P. Flower, and Helen M. Faddy Copyright © 2016 Kelly Rooks et al. All rights reserved. A Comparative Study of Assay Performance of Commercial Hepatitis E Virus Enzyme-Linked Immunosorbent Assay Kits in Australian Blood Donor Samples Mon, 07 Nov 2016 10:32:14 +0000 Hepatitis E virus (HEV) is transfusion-transmissible and therefore poses a risk to blood transfusion safety. Seroprevalence studies are useful for estimating disease burden and determining risk factors. Considerable variability in the sensitivity of HEV antibody detection assays exists. This study aimed to compare the performances of commercially available HEV enzyme-linked immunosorbent assays (ELISA) in Australian blood donor samples. Plasma samples that tested positive () or negative () for HEV IgG (Wantai HEV IgG ELISA) were selected. Of the 194 HEV IgG positive samples, 4 were positive for HEV IgM (Wantai HEV IgM ELISA). All samples were tested with the MP Diagnostics: HEV IgG ELISA, total (IgG, IgM, and IgA) HEV antibody ELISA, and HEV IgM ELISA. Of the 194 Wantai HEV IgG positive samples, 92 (47%) tested positive with the MP Diagnostics HEV IgG ELISA () and 126 (65%) with MP Diagnostics total HEV antibody assay (). There was poor agreement between Wantai and MP Diagnostics HEV IgM assays. This study demonstrated poor agreement between the assays tested. These observations are consistent with previous reports demonstrating significant variability between HEV ELISAs, highlighting that results of HEV serology should be interpreted with caution. Ashish C. Shrestha, Robert L. P. Flower, Clive R. Seed, Susan L. Stramer, and Helen M. Faddy Copyright © 2016 Ashish C. Shrestha et al. All rights reserved. A New Proof of Concept in Bacterial Reduction: Antimicrobial Action of Violet-Blue Light (405 nm) in Ex Vivo Stored Plasma Wed, 28 Sep 2016 10:18:56 +0000 Bacterial contamination of injectable stored biological fluids such as blood plasma and platelet concentrates preserved in plasma at room temperature is a major health risk. Current pathogen reduction technologies (PRT) rely on the use of chemicals and/or ultraviolet light, which affects product quality and can be associated with adverse events in recipients. 405 nm violet-blue light is antibacterial without the use of photosensitizers and can be applied at levels safe for human exposure, making it of potential interest for decontamination of biological fluids such as plasma. As a pilot study to test whether 405 nm light is capable of inactivating bacteria in biological fluids, rabbit plasma and human plasma were seeded with bacteria and treated with a 405 nm light emitting diode (LED) exposure system (patent pending). Inactivation was achieved in all tested samples, ranging from low volumes to prebagged plasma. 99.9% reduction of low density bacterial populations (≤103 CFU mL−1), selected to represent typical “natural” contamination levels, was achieved using doses of 144 Jcm−2. The penetrability of 405 nm light, permitting decontamination of prebagged plasma, and the nonrequirement for photosensitizing agents provide a new proof of concept in bacterial reduction in biological fluids, especially injectable fluids relevant to transfusion medicine. Michelle Maclean, John G. Anderson, Scott J. MacGregor, Tracy White, and Chintamani D. Atreya Copyright © 2016 Michelle Maclean et al. All rights reserved. Quantification of Cell-Free DNA in Red Blood Cell Units in Different Whole Blood Processing Methods Tue, 27 Sep 2016 13:38:06 +0000 Background. Whole blood donations in Canada are processed by either the red cell filtration (RCF) or whole blood filtration (WBF) methods, where leukoreduction is potentially delayed in WBF. Fresh WBF red blood cells (RBCs) have been associated with increased in-hospital mortality after transfusion. Cell-free DNA (cfDNA) is released by neutrophils prior to leukoreduction, degraded during RBC storage, and is associated with adverse patient outcomes. We explored cfDNA levels in RBCs prepared by RCF and WBF and different storage durations. Methods. Equal numbers of fresh (stored ≤14 days) and older RBCs were sampled. cfDNA was quantified by spectrophotometry and PicoGreen. Separate regression models determined the association with processing method and storage duration and their interaction on cfDNA. Results. cfDNA in 120 RBC units (73 RCF, 47 WBF) were measured. Using PicoGreen, WBF units overall had higher cfDNA than RCF units (); fresh WBF units had higher cfDNA than fresh RCF units (). Using spectrophotometry, fresh RBC units overall had higher cfDNA than older units (); fresh WBF RBCs had higher cfDNA than older RCF RBCs (). Conclusion. Higher cfDNA in fresh WBF was observed compared to older RCF blood. Further study is required for association with patient outcomes. Andrew W. Shih, Vinai C. Bhagirath, Nancy M. Heddle, Jason P. Acker, Yang Liu, John W. Eikelboom, and Patricia C. Liaw Copyright © 2016 Andrew W. Shih et al. All rights reserved. Epidemiology of Transfusion Transmitted Infection among Patients with β-Thalassaemia Major in Pakistan Sun, 31 Jul 2016 07:27:17 +0000 Introduction. Transfusion Transmitted Infections (TTIs) continue to be a major risk in transfusions in many parts of the world. The transfusion-dependent β-thalassaemia patients are particularly at risk of acquiring TTIs. The current study was undertaken to estimate the prevalence of TTIs in transfusion-dependent β-thalassaemia patients. Material and Methods. A cross-sectional study of 1253 multitransfused thalassaemia major patients was conducted in five different centres of Islamabad, Rawalpindi, and Karachi. The study subjects were screened for HIV, HCV, and HBV. The screening was performed at two centres: Department of Pathology, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, and Blood Transfusion Services, Jinnah Postgraduate Medical Centre, from July to December 2015. The confirmatory screening was performed by Chemiluminescent Immunoassay (CLIA). Results. Out of the 1253 multiple transfused patients, 317 (25.3%) were infected with TTIs. HCV was positive in 273 cases (21.7%), HBV in 38 cases (3.0%), and HIV in 6 cases (0.5%). Conclusion. HCV was the leading TTI in multitransfused thalassaemia major patients in the study. Presence of HIV in thalassaemia patients is a recent disturbing development in Pakistan. Improved regulation of blood banks including use of internationally or nationally evaluated kits will bring down the incidence of TTIs in transfusion-dependent β-thalassaemia patients. More stringent behavioral and serological pretransfusion screening of blood for TTIs must be implemented in blood banks. Rizwan Ahmed Kiani, Muhammad Anwar, Usman Waheed, Muhammad Javaid Asad, Saleem Abbasi, and Hasan Abbas Zaheer Copyright © 2016 Rizwan Ahmed Kiani et al. All rights reserved. Knowledge, Attitude, and Practice of Adult Population towards Blood Donation in Gondar Town, Northwest Ethiopia: A Community Based Cross-Sectional Study Tue, 19 Jul 2016 13:09:18 +0000 Background. Though World Health Organization recommends 100% voluntary blood donation, the percentage of blood collected from voluntary blood donors and the average annual blood collection rate are extremely low in Ethiopia. The role of adults is crucial to meet the demand of safe blood. Thus, this study aimed to assess knowledge, attitude, and practice of adult population towards blood donation in Gondar town, Northwest Ethiopia. Method. A community based cross-sectional study was conducted among 768 adults. Multistage sampling technique together with simple random and systematic random sampling technique was employed. Bivariate and multivariate logistic regression analysis and bivariate correlation analysis were done. Result. About 436 (56.8%), 630 (82%), and 141 (18.4%) study participants had adequate knowledge, good attitude, and experience of blood donation, respectively. Secondary and higher educational statuses were significantly associated with adequate knowledge towards blood donation. Participants who were protestant by religion were more likely to have good attitude towards blood donation. Age, self-perceived health status, and religion were significantly associated with blood donation practice. Conclusion. Knowledge and attitude towards blood donation are high. However, the level of practice is low. District and national blood banks and transfusion agency should design strategies that promote and motivate the communities to donate blood. Mulugeta Melku, Betelihem Terefe, Fikir Asrie, Bamlaku Enawgaw, Tadele Melak, Yakob Gebregziabher Tsegay, Mohamedamin Areba, and Elias Shiferaw Copyright © 2016 Mulugeta Melku et al. All rights reserved. Motivating Factors and Potential Deterrents to Blood Donation in High School Aged Blood Donors Sun, 15 May 2016 11:47:27 +0000 Background. To ensure an adequate supply of blood, collection centers must design campaigns that successfully recruit and maintain an active donor pool. Understanding factors that motivate and deter individuals from donating may help centers develop targeted recruitment campaigns. These factors among high school aged blood donors have not yet been fully investigated. Study Design and Methods. A voluntary, anonymous survey was administered to student donors at high school mobile blood drives. The survey instrument asked the students to rate several potential motivating factors in their importance in the decision to donate blood and several potential deterring factors in their future decision whether or not to donate blood again. The survey also asked the students to rate the desirability of several potential incentives. Results. Motivating factors that reflected prosocial, empathetic, and altruistic thoughts and beliefs were rated highly by students. Pain from phlebotomy was most commonly chosen as potential deterrent. Movie tickets and cookies/snacks at the drive were rated as the most attractive incentives. Conclusion. High school aged blood donors are similar to other donor groups in their expressed motives for donating blood. This group may be unique in the factors that deter them from donating and in their preferences for different incentives. Rachel Finck, Alyssa Ziman, Matthew Hoffman, Michelle Phan-Tang, and Shan Yuan Copyright © 2016 Rachel Finck et al. All rights reserved. Association between Perioperative Blood Transfusions and Clinical Outcomes in Patients Undergoing Bladder Cancer Surgery: A Systematic Review and Meta-Analysis Study Sun, 31 Jan 2016 13:01:27 +0000 Background. Perioperative blood transfusions are associated with poor survival in patients with solid tumors including bladder cancer. Objective. To investigate the impact of perioperative blood transfusions on oncological outcomes after radical cystectomy. Design. Systematic review and meta-analysis. Setting and Participants. Adult patients who underwent radical cystectomy for bladder cancer. Intervention. Packed red blood cells transfusion during or after radical cystectomy for bladder cancer. Outcome Measurements and Statistical Analysis. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). We calculated the pooled hazard ratio (HR) estimates and 95% confidence intervals by random and fixed effects models. Results and Limitation. Eight, seven, and five studies were included in the OS, CSS, and RFS analysis, respectively. Blood transfusions were associated with 27%, 29%, and 12% reduction in OS, CSS, and RFS, respectively. A sensitivity analysis supported the association. This study has several limitations; however the main problem is that it included only retrospective studies. Conclusions. Perioperative BT may be associated with reduced RFS, CSS, and OS in patients undergoing RC for BC. A randomized controlled study is needed to determine the causality between the administration of blood transfusions and bladder cancer recurrence. Juan P. Cata, Javier Lasala, Greg Pratt, Lei Feng, and Jay B. Shah Copyright © 2016 Juan P. Cata et al. All rights reserved. Factors Associated with Repeat Blood Donation at the Northern Zone Blood Transfusion Centre in Tanzania Sun, 13 Dec 2015 12:14:44 +0000 Background and Objective. The aim of this study was to determine factors associated with repeat blood donation. Methods. This was a cross-sectional study carried out among blood donors aged 18–65 years in northern Tanzania. The questionnaire was administered among 454 participants through the phone. Results. Of the 454 participants, the proportion of repeat donation was 63.9%. In the backward logistic regression analysis, the significant predictors were living in Arusha which had lower odds of repeat donation compared to those living in Kilimanjaro. Knowledge of time interval between donations increased odds of repeating donations. High intention increased odds of repeat donation compared to low intention. Altruistic score had minor effect on increasing odds of repeating donation. Conclusion. Repeat blood donation is affected by proximity of donating site, awareness of the blood donation interval, intention to donate, and experience on previous donation. We recommend continuous education concerning blood donors and donation among health workers and society as a whole; this will create awareness on motivational factors for repeat donations. Wilhellmuss I. Mauka, Michael J. Mahande, Sia E. Msuya, and Rune N. Philemon Copyright © 2015 Wilhellmuss I. Mauka et al. All rights reserved. Low Dose Perioperative Intravenous Tranexamic Acid in Patients Undergoing Total Knee Arthroplasty: A Double-Blind Randomized Placebo Controlled Clinical Trial Sun, 06 Dec 2015 09:31:39 +0000 Background and Objectives. The null hypothesis of this study was that TA has no effect on postsurgical bleeding in patients undergoing TKA. Methods. This study was a double-blind randomized trial. In the first group (T) patients received 500 mg of intravenous Tranexamic acid (TA) twice (once preoperatively and once 3 hours postoperatively) and in the second group (P) they received slow infusion of normal saline as placebo. The primary outcome of the study was the level of Hb 48 hours after surgery. Results. Hb levels 48 hours after surgery as the primary outcome were and  (g/dL) in groups T and P, respectively, and the difference was statistically significant (). Statistically significant differences were also observed in Hb levels 6 and 24 hours after surgery, the drain output 48 hours after surgery, and the number of units of packed cells transfused between study groups (). There was no significant difference in duration of hospitalization between the study groups ( = n.s.). Conclusions. The low dose perioperative intravenous TA significantly reduces blood loss, requirement for blood transfusion, and drain output in patients undergoing TKA. However, duration of hospitalization did not change significantly. Mahdi Motififard, Mohammad Ali Tahririan, Mehdi Saneie, Sajad Badiei, and Amin Nemati Copyright © 2015 Mahdi Motififard et al. All rights reserved. The Value of Tranexamic Acid in Reducing Blood Loss following Hip Reconstruction in Children with Cerebral Palsy Tue, 17 Nov 2015 12:54:35 +0000 This is a retrospective study of 51 consecutive hip reconstructions in children with cerebral palsy performed between 2011 and 2013. Tranexamic acid (TXA) was used in 14 hip reconstructions only. Transfusion rate was higher, postoperative Hb was lower, and patients stayed longer in the TXA group. This did not reach a statistical significance ( = 0.75, 0.5, and 0.71, resp.). More than half of the patients who had TXA underwent bilateral hip reconstructions in comparison with 27% only in the non-TXA group. Bilateral hip reconstructions mean more surgery, more blood loss, and more blood transfusion. The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels. Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated. Ideally this should be explored further in an adequately powered, randomised controlled trial where risk of bias is minimized. I. Majid, S. Alshryda, B. Somanchi, E. Morakis, and A. Foster Copyright © 2015 I. Majid et al. All rights reserved. Estimating the Risk of ABO Hemolytic Disease of the Newborn in Lagos Thu, 17 Sep 2015 11:52:30 +0000 Background. ABO hemolytic disease of the newborn is the most common hemolytic consequence of maternofetal blood group incompatibility restricted mostly to non-group-O babies of group O mothers with immune anti-A or anti-B antibodies. Aim. We estimated the risk of ABO HDN with view to determining need for routine screening for ABO incompatibility between mother and fetus. Materials and Methods. Prevalence of ABO blood group phenotypes in blood donors at the donor clinic of the Lagos University Teaching Hospital and arithmetic methods were used to determine population prevalence of ABO genes. We then estimated proportion of pregnancies of group O mothers carrying a non-group-O baby and the risk that maternofetal ABO incompatibility will cause clinical ABO HDN. Results. Blood from 9138 donors was ABO typed. 54.3%, 23%, 19.4%, and 3.3% were blood groups O, A, B, and AB, respectively. Calculated gene frequencies were 0.1416, 0.1209, and 0.7375 for A, B, and O genes, respectively. It was estimated that 14.3% of deliveries will result in a blood group O woman giving birth to a child who is non-group-O. Approximately 4.3% of deliveries are likely to suffer ABO HDN with 2.7% prone to suffer from moderately severe to severe hemolysis. Alani Sulaimon Akanmu, Olufemi Abiola Oyedeji, Titilope Adenike Adeyemo, and Ann Abiola Ogbenna Copyright © 2015 Alani Sulaimon Akanmu et al. All rights reserved. Postoperative Autologous Reinfusion in Total Knee Replacement Wed, 09 Sep 2015 07:39:25 +0000 Surgeries for total knee replacement (TKR) are increasing and in this context there is a need to develop new protocols for management and use of blood transfusion therapy. Autologous blood reduces the need for allogeneic blood transfusion and the aim of the present study was to verify the safety and the clinical efficacy. An observational retrospective study has been conducted on 124 patients, undergoing cemented total knee prosthesis replacement. Observed population was stratified into two groups: the first group received reinfusion of autologous blood collected in the postoperative surgery and the second group did not receive autologous blood reinfusion. Analysis of data shows that patients undergoing autologous blood reinfusion received less homologous blood bags (10.6% versus 30%; ) and reduced days of hospitalization (7.88 ± 0.7 days versus 8.96 ± 2.47 days for the control group; ). Microbiological tests were negative in all postoperatively salvaged and reinfused units. Our results emphasize the effectiveness of this procedure and have the characteristics of simplicity, low cost (€97.53 versus €103.79; ), and easy reproducibility. Use of autologous drainage system postoperatively is a procedure that allows reducing transfusion of homologous blood bags in patients undergoing TKR. A. Crescibene, F. Martire, P. Gigliotti, A. Rende, and M. Candela Copyright © 2015 A. Crescibene et al. All rights reserved. CRASH-2 Study of Tranexamic Acid to Treat Bleeding in Trauma Patients: A Controversy Fueled by Science and Social Media Mon, 07 Sep 2015 06:33:36 +0000 This paper reviews the application of tranexamic acid, an antifibrinolytic, to trauma. CRASH-2, a large randomized controlled trial, was the first to show a reduction in mortality and recommend tranexamic acid use in bleeding trauma patients. However, this paper was not without controversy. Its patient recruitment, methodology, and conductance in moderate-to-low income countries cast doubt on its ability to be applied to trauma protocols in countries with mature trauma networks. In addition to traditional vetting in scientific, peer-reviewed journals, CRASH-2 came about at a time when advances in communication technology allowed debate and influence to be leveraged in new forms, specifically through the use of multimedia campaigns, social media, and Internet blogs. This paper presents a comprehensive view of tranexamic acid utilization in trauma from peer-reviewed evidence to novel multimedia influences. Sophia Binz, Jonathon McCollester, Scott Thomas, Joseph Miller, Timothy Pohlman, Dan Waxman, Faisal Shariff, Rebecca Tracy, and Mark Walsh Copyright © 2015 Sophia Binz et al. All rights reserved. Assessment of Vascular Endothelial Growth Factor in Fresh versus Frozen Platelet Rich Plasma Sun, 02 Aug 2015 13:48:49 +0000 Platelet rich plasma (PRP) is hemoconcentration with platelets concentration above baseline values and high concentration of many growth factors. The aim of this study was to assess freezing effect on vascular endothelial growth factor (VEGF) release from PRP using two different activation methods to simplify its use in different clinical applications. PRP was prepared using two-centrifugation steps method from 12 qualified blood donors. VEGF concentrations were measured in fresh PRP and after freezing/thawing for one and three weeks with two methods of activation using (i) calcium gluconate and (ii) calcium gluconate and thrombin. Platelets count was significantly increased compared to baseline whole blood values in all fresh and frozen PRP samples (p value was <0.05). No significant difference was found between VEGF concentrations after activating fresh and frozen-thawed PRP samples for one and three weeks by calcium alone or calcium with thrombin, and also no significant difference was found when freezing period was extended from one to three weeks. Our results showed that platelets count does not correlate with variable levels of VEGF. PRP could be prepared once and preserved frozen for at least three weeks for the next treatment sessions and activation with thrombin addition to calcium will not augment the growth factor release. Nada Hosny, Fikry Goubran, Basma BadrEldin Hasan, and Noha Kamel Copyright © 2015 Nada Hosny et al. All rights reserved. Motivational Differences between Whole Blood and Apheresis Donors in Quebec, Canada: A Questionnaire-Based Survey in a Voluntary Nonremunerated Context Wed, 29 Jul 2015 13:54:00 +0000 Background. Finding ways to recruit apheresis donors is crucial. The aim of this study was to provide a quantitative analysis of the motivations of regular plasma/platelets donors (PPDs) in comparison with those of regular whole blood donors (WBDs), in a voluntary and nonremunerated context. Study Design and Methods. Motives to donate blood and demographic characteristics were collected through questionnaires completed by 795 WBDs and 473 PPDs. Chi-square tests were completed to determine which motivations stand out across the two blood donor groups. Results. The motivator selected by the highest percentage was “my blood can save lives.” Comparison of WBDs and PPDs showed that 12 out of 23 items were statistically significantly different from one group to another. Conclusion. The belief that helping others is in their nature is more prevalent among PPDs. In this sense, their profile is unique. Four other motivators distinguish this group from the WBDs: “I think there is a strong need for blood products,” “it gives me a sense of pride,” “I like to have goals,” and “I receive telephone reminders.” These motivators point to the role the ongoing support provided by blood collection agencies (BCAs) plays with PPDs. Johanne Charbonneau, Marie-Soleil Cloutier, and Élianne Carrier Copyright © 2015 Johanne Charbonneau et al. All rights reserved. Infiltration of Autologous Growth Factors in Chronic Tendinopathies Mon, 15 Jun 2015 11:36:49 +0000 Achilles tendinopathy and patellar tendinopathy are among the most frequent diagnoses in sports medicine. Therapeutic treatment of the disease is difficult, particularly in chronic cases. In literature, several studies suggest the employment of Platelet-Rich Plasma as a therapeutic alternative in tendinopathies. The choice of employing this method is based on the activity of growth factors contained in platelets which activate, amplify, and optimize the healing process. We selected 14 patients affected by Achilles tendinopathy and 7 patients affected by patellar tendinopathy, with a two-year final follow-up. These patients underwent a cycle of three tendinous infiltrations, after clinical and instrumental evaluation carried out by means of specific questionnaires and repeated ultrasound scans. Ultrasound scans of 18 patients showed signs of reduction in insertional irregularities. The result is confirmed by complete functional recovery of the patients, with painful symptomatology disappearing. The patients showed a clear pain reduction, along with an enhanced VISA score after the 24-month follow-up, equal to 84.2 points on a scale of 0 to 100. In conclusion, the present study provides evidence to suggest that PRP infiltration is a valid option to patients with chronic tendinopathy who did not benefit from other treatments. Antonio Crescibene, Marcello Napolitano, Raffaella Sbano, Enrico Costabile, and Hesham Almolla Copyright © 2015 Antonio Crescibene et al. 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.