Effective measures for preventing Vasovagal reaction (VVR) have not yet been developed on apheresis donations.
This study investigated the potential to predict VVR from fluctuations in peripheral blood flow measured by laser Doppler flowmetry. Data were collected from 354 individuals who donated platelets. To calculate the level for issuing VVR alert, the percent decrease in blood flow (DBF) was calculated. The time from alert to VVR was estimated for three DBF levels, and the detection performance of each alert level was calculated.
Mean maximum DBF in the VVR group was 64.7±13.7%, which was significantly higher than the 25.6±11.7% in the non-VVR group. At a maximum DBF threshold of 45%, sensitivity for discriminating between VVR and non-VVR donors was 93.3% and accuracy was 94.4%. When 45% DBF was used as the alert level, alerts were issued for 44 donors, including 25 in the VVR group. Mean time from alert to diagnosis in the VVR group was 4.04±4.35 minutes, and accuracy of the alert was 56.8%.
We found that it is possible to predict VVR early enough before onset to intervene by monitoring DBF in real time during blood collection using laser Doppler flowmetry.
The number of platelets in refrigerated platelet concentrate (PC) decreases due to the formation of clumps. However, when suspended in Platelet Additive Solution (PAS) as PAS-PC, the number of platelets can be maintained for long periods. Furthermore, the CD42b-positive rate reportedly decreases when refrigerated PC is re-warmed to 37°C. It is unknown whether a similar phenomenon occurs with PAS-PC. Here, we evaluated the quality of PAS-PC (65% T-PAS+/35% plasma) stored at 4°C for 21 days.
The CD62P-positive rate and annexin-V binding rate were significantly higher in refrigerated PAS-PC than PC stored at room temperature until the expiration date. The number of platelets did not significantly decrease in refrigerated PAS-PC until after 14 days and platelet aggregation was maintained for 21 days. Moreover, the mean fluorescence intensity (MFI) of CD42b and ristocetin-induced aggregation were better maintained in PAS-PC warmed after storage at 4°C than in PC stored at room temperature.
Our findings indicate that PAS-PC stored at 4°C for approximately 14 days may be clinically useful, albeit slightly activated.
Factors triggering the onset of transfusion-associated circulatory overload (TACO), a type of heart failure associated with blood transfusion, depend on patient characteristics. We analyzed the clinical features of patients who developed TACO and patients who only developed high blood pressure, which is a diagnostic characteristic of TACO, in our hospital. We found that monitoring blood pressure was important for identifying patients with early stage TACO. The patients with increased blood pressure and risk factors for TACO tended to have moderate to severe hypertension. In contrast, the patient with TACO, who had both risk factors for heart disease and age older than 80 years, tended to show a mild increase followed by a decrease in blood pressure. In addition, tachycardia was observed in the patients with TACO before transfusion, suggesting that it is important to perform pulse monitoring in patients with TACO. Fever is also considered a warning symptom for TACO in patients with pneumonia and septicemia. The time of onset for fever ranged from 30 minutes to 5.5 hours after starting blood transfusion, suggesting that observations for blood transfusion reactions should be carefully performed for at least 6 hours after transfusion.
Background: Spectra Optia® is an apheresis system that enables peripheral blood stem cell collection (PBSCC) to be easily conducted due to its unique automated interface management system. We retrospectively analyzed the number for CD34-positive cells in collected products and the collection efficiency for CD34-positive cells between the Spectra Optia® MNC mode (MNC group) and CMNC mode (CMNC group) for PBSCC.
Methods: We retrospectively analyzed 233 cases of PBSCC (autologous PBSCC: 103 cases, allogeneic PBSCC: 130 cases), which were performed in our institution between August 2013 and February 2018.
Results: In autologous PBSCC, there was no significant difference in the number of CD34-positive cells in collected products or the collection efficiency for CD34-positive cells between the two groups. In allogeneic PBSCC, the number of CD34-positive cells in collected products and the collection efficiency for CD34-positive cells in the CMNC group were significantly higher than those in the MNC group. Peripheral blood platelet count and hemoglobin concentration were identified as the factors influencing the collection efficiency for CD34-positive cells.
Conclusion: In autologous PBSCC, the number and collection efficiency for CD34-positive cells were not significantly different between the two modes, whereas in allogeneic PBSCC, the CMNC mode was more efficient for PBSCC than the MNC mode.
We investigated the actual use of transfusion blood products and plasma fractionation products in medical facilities throughout the country in 2017. At the same time, we investigated the current status of blood transfusion control. In this questionnaire survey, responses were obtained from 5,092 facilities, and the response rate was 50.75%. The total blood product volume including total used blood volume and total waste amount was 14,257,594 units, which was 80.2% of the blood product for blood transfusion supplied by the Japanese Red Cross Society blood center. By counting the number of transfusion-enforced patients and questionnaire response rates by facility size and calculating the number of predictive blood transfusion cases when the response rate was 100%, the number of predictive patients for allogeneic blood transfusion was 974,963, It was less than one million people. As a result of investigating the trend in the amount of the preparation used per hospital bed since 2012, the red blood cell product increased by 7.7%, the platelet product decreased by 5.6%, the plasma product decreased by 9.6%, the albumin preparation decreased by 12.4%, the immunoglobulin preparation increased by 31.5%. In 696 facilities with more than 300 beds, 654 facilities corresponding to 94.0% were acquiring the percentage of facilities that acquired blood transfusion control fee I or II. In addition, the proportion of institutions that acquired proper blood transfusion addition has increased from 30.8% last year to 31.2%. In the development status relating to the transfusion management system, facilities with more than 300 beds with five requirements of unified management of blood transfusion work; appointment of blood transfusion responsible doctors, placement of laboratory technicians responsible for transfusion, a 24-hour system of blood transfusion testing, and establishment of transfusion therapy committee, was filled with 90% or more of. It is considered necessary to review the significance of the implementation of an infectious disease test after transfusion, as the facility that stores patient specimens before transfusion has reached 99% at more than 300 beds.
We experienced a case of dermatitis derived from extravasation of the right upper extremity after preoperative and intraoperative autologous blood transfusion in laparoscopic myomectomy. After the operation, we strived to better understand the situation and treated the patient's anxiety and discomfort. Dermatitis was completely resolved after 62 days. Although autologous blood transfusion is generally considered safe, closer attention shoud be paid to the potential occurrence of dermatitis due to extravasation after rapid induction.
Patients with hemophilia A often experience various bleeding episodes, especially in severe cases (FVIII concentration [FVIII: C] less than 1%). We encountered a patient with moderate hemophilia A who developed perirenal hemorrhage after renal biopsy. A 27-year-old patient had had proteinuria for several years. He was diagnosed with moderate hemophilia A as a 1-year-old. He had unknown spontaneous retroperitoneal bleeding at 22 years of age. He underwent left renal biopsy with administration of recombinant FVIII (rurioctocog alfa) 2,000 IU i.v. to obtain a target FVIII peak of 60-70% (height: 171 cm, body weight: 54.7 kg), and was diagnosed with IgA nephropathy. After a 1-hour renal biopsy, he received rhFVIII 2,000 IU i.v. Despite sufficient FVIII: C, he developed a large perirenal hematoma the day after renal biopsy. He was administered rhFVIII (octocog alfa) 2,000 IU/day from day 1 to day 44 after bleeding, and the hematoma was diminished. For the purpose of prophylaxis for bleeding, we performed population pharmacokinetics (PK) (myPKFIT® Baxalta) and started regular supplementation of FVIII with rurioctocog alfa 1,500 IU/day three times a week. He has not experienced hemorrhagic episodes for two years. Advancements in hemostatic treatments in recent years have increased the lifespan of hemophilia patients. For good control of bleeding in hemophilia patients, population PK should be performed on a case by case basis.
There are few reports on hemolytic transfusion reactions due to anti-Kpc antibodies against low-incidence red blood cell (RBC) antigens (Kpc) in Japan and abroad. Here, we report an extremely rare case of hemolysis after a homologous blood transfusion that was subsequently shown to be caused by anti-Kpc antibodies. A 50-year-old male with chronic kidney disease for 27 years received 4 units of RBCs during hemodialysis. The next day, the patient developed a fever and dyspnea, and had a marked decrease in blood pressure. Hemolysis was suggested based on biochemical data. The Japanese Red Cross Tokyo Blood Center was asked to perform a detailed examination. The resulting report indicated that there were anti-Kpc antibodies in the patient's blood and confirmed that a unit of blood transfused to him was Kpc-Ag-positive. Generally, antibodies against low-incidence antigens are considered clinically insignificant because they react below 37°C; however, such antibodies reportedly induce hemolytic disease in fetuses and newborns. In conclusion, while transfusion-related adverse reactions due to antibodies against low-incidence antigens are extremely rare, it is important to note that these antibodies can induce serious hemolysis.