Red blood cell transfusion is an important component of supportive care in selected patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). Although current guidelines emphasize restrictive transfusion thresholds, the clinical impact of transfusion delay after the hemoglobin trigger is less clear. This study examined whether delayed transfusion after a hemoglobin value≤7.0g/dL was associated with adverse in-hospital outcomes in patients with NVUGIB. We conducted a retrospective cohort study of adult patients hospitalized with NVUGIB who reached a hemoglobin trigger of≤7.0g/dL. The trigger time was defined as the index time. A 3-hour landmark design was used to classify patients into early transfusion, defined as red blood cell transfusion initiated within 3hours after the trigger, and delayed transfusion, defined as no transfusion by the 3-hour landmark. The primary outcome was a composite adverse in-hospital outcome, including in-hospital mortality, rebleeding, or intensive care unit admission. Multivariable regression models were used to estimate associations between transfusion timing and outcomes. A total of 859 patients were included, including 458 in the early transfusion group and 401 in the delayed transfusion group. Delayed transfusion was associated with higher rates of rebleeding, intensive care unit admission, composite adverse outcome, and longer hospital stay. After full adjustment, delayed transfusion remained associated with increased odds of the composite outcome (OR 2.49, 95% CI 1.82-3.39), in-hospital mortality (OR 2.38, 95% CI 1.41-4.02), rebleeding (OR 1.56, 95% CI 1.05-2.31), and intensive care unit admission (OR 3.34, 95% CI 2.31-4.84). Delayed transfusion was also associated with longer length of stay. Among patients with NVUGIB who reached a hemoglobin threshold of≤7.0g/dL, delayed transfusion was associated with worse in-hospital outcomes. These findings suggest that timely transfusion after reaching the hemoglobin trigger may be clinically important.
Post-transfusion platelet refractoriness (PTR) is a major complication in transfusion medicine. While non-immune factors are the most common cause, immune-mediated PTR, often caused by alloimmunization against human leukocyte antigens (HLA), leads to ineffective platelet transfusions, increased bleeding risks, and poorer outcomes in patients with hematologic malignancies or undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). To assess the effectiveness of platelet antibody screening, particularly anti-HLA antibody detection using mean fluorescence intensity (MFI) thresholds, in reducing the incidence of immune-mediated PTR and improving transfusion-related outcomes. This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines, involved a comprehensive search of databases including PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The outcomes include post-transfusion PTR incidence, survival rates, and transfusion-related complications. To assess the effectiveness of platelet antibody screening, relative risks (RRs) and odds ratios (ORs) were calculated, with further subgroup analyses performed based on mean fluorescence intensity (MFI) thresholds, patient populations, and screening methodologies. The final analysis included seven retrospective cohort and case-control studies, encompassing a total of 2865 patients. Patients who underwent antibody screening had a significantly lower PTR incidence (15.4 %, 95 % CI: 12.1-18.7 %) compared to unscreened patients (28.6 %, 95 % CI: 23.7-33.5 %), reflecting a 46 % reduced risk (RR: 0.54, 95 % CI: 0.41-0.71). High MFI thresholds (>10,000) showed stronger specificity for predicting PTR, while lower thresholds (>5000) demonstrated greater sensitivity. Secondary outcomes included reduced mortality, improved engraftment, and fewer transfusion-related complications in patients identified via screening who subsequently received compatible transfusions. Platelet antibody screening is an effective strategy for identifying patients at risk for immune-mediated PTR. This screening enables the implementation of targeted transfusion protocols (e.g., HLA-matched platelets), which mitigate PTR and improve clinical outcomes, particularly in high-risk populations. Standardizing MFI thresholds and protocols is essential for broader clinical application. Further prospective research is needed to validate these findings and assess cost-effectiveness.
Hemiarthroplasty for hip fracture is frequently associated with substantial perioperative blood loss; however, nationwide data on transfusion epidemiology and related risk factors remain limited. This study aimed (1) to assess transfusion rates and temporal trends, (2) to evaluate the use of transfusion-sparing agents, and (3) to identify risk factors of transfusion in a national cohort. Using the Korean National Health Insurance Service database, we included who underwent primary hemiarthroplasty between 2002 and 2020. The trends in transfusion and the use of transfusion-sparing agents were assessed using each procedure and drug codes. Risk factors were evaluated by multivariable logistic regression analysis. Among 220,278 hemiarthroplasties, 82.0% received transfusion with annual decrease from 86.3% to 72.2% since 2013, and mean transfusion volume decreased from 1,386mL to 1,115mL. The use of anti-fibrinolytic agents and iron supplementation increased gradually, whereas hemostatic agent use decreased. Female, old age, intertrochanteric fracture, preoperative anemia, use of closed suction drainage, hemostatic agents, and hematopoietic agents were associated with an increased transfusion risk, whereas anti-fibrinolytic agents (aOR=0.53; 95% CI 0.52-0.55; P < 0.001) and iron supplements (aOR = 0.73; 95% CI 0.71-0.76; P < 0.001) were associated with significantly decreased transfusion risk. In this nationwide cohort, transfusion after hemiarthroplasty remained common, but declined gradually over two decades. The use of anti-fibrinolytic agents and iron supplementation was associated with a decreased risk of transfusion, supporting the implementation of patient blood management (PBM) strategies for hip fracture surgery.
Blood services worldwide continue to face persistent challenges in recruiting and retaining voluntary, non-remunerated blood donors, particularly among younger populations. Over the past decade, communication strategies have shifted from traditional mass media to digital environments, where social media platforms, influencers, and online communities increasingly shape social norms, identity formation, and prosocial behaviour. These digital tools are now widely used to mobilise blood donors; however, the existing evidence base remains fragmented across disciplines, regions, and study designs. This scoping review aims to map and synthesise the available evidence on the role of social media, influencers, and online communities in blood donor recruitment and retention. It further seeks to identify key mechanisms underlying digital engagement, highlight knowledge gaps, and propose a digital sociology-informed framework to guide "next-generation" donor engagement strategies. A scoping review was conducted in accordance with PRISMA-ScR guidance. Major databases (PubMed, Scopus, Web of Science, PsycINFO, and CINAHL) and relevant grey literature were searched for publications from 2010 to March 2025. Eligible studies included empirical research and reviews examining (i) social media platforms, (ii) influencers, celebrities, or digital opinion leaders, and/or (iii) online communities or mobile and social applications used for blood donor recruitment or retention. Data were charted on study design, setting, digital platform, target population, intervention characteristics, and donor-related outcomes, and synthesised narratively. Evidence from broader eHealth and communication-intervention reviews was incorporated to contextualise social media within wider digital donor ecosystems. The body of evidence has expanded rapidly but remains methodologically and conceptually heterogeneous. Facebook's blood donation tools and associated engagement strategies were associated with modest yet consistent increases in total donations (approximately 4%) and first-time donations (around 19%) in multi-country quasi-experimental studies. Platforms such as WhatsApp, Twitter/X, and Instagram function primarily as "just-in-time" mobilisation channels, particularly in the Middle East and low- and middle-income countries, with high success in meeting urgent donation requests but limited longitudinal data on donor retention. Systematic reviews of eHealth interventions and mobile applications suggest that digital tools, including apps, SMS, and social media, can improve donation and repeat behaviour when interventions are personalised, interactive, and integrated into service workflows. Emerging literature highlights donors as digital advocates and explores how online communities foster donor identity, peer norms, and advocacy. In contrast, influencer-driven campaigns are largely documented in grey literature, and concerns persist regarding commercialisation, fear-based messaging, and misinformation. Social media and online communities have become central infrastructures for donor discovery, persuasion, and relationship-building, particularly among younger populations. However, the current evidence base is skewed toward high-income settings, single-platform interventions, and short-term outcomes. Future research should adopt theory-driven approaches, address equity and ethical concerns, and evaluate integrated, multi-platform strategies that link influencers, micro-communities, and formal blood services within coherent digital donor ecosystems.
Red blood cell (RBC) transfusions can be a life-saving intervention, particularly in critically ill patients. However, over the past two decades, their potential for harm has become increasingly evident, leading to the adoption of restrictive transfusion strategies. Current guidelines recommend a transfusion threshold of 7.0 g/dL hemoglobin (Hb) in critically ill patients. However evidence for this exact limit is lacking and there is increasing evidence that Hb-levels under 7 g/dL do not inherently lead to increased mortality or morbidity. This study aims to explore the feasibility of a more restrictive RBC transfusion threshold of 5.0 g/dL compared to the current threshold of 7.0 g/dL in the majority of critically ill patients. The study will be a prospective randomized controlled pilot trial conducted in critically ill patients (18 years or older). Participants will be randomized to be treated according to a 5.0 g/dL or a 7.0 g/dL RBC transfusion threshold. Transfusions will be administered 1 RBC unit at a time when the assigned threshold is reached. The primary endpoint is the feasibility of the intervention, expressed as protocol compliance, defined as the percentage of RBC transfusions initiated below the assigned threshold. Secondary outcomes include the SOFA score, protocol violations, incidence of major bleeding, early signs of organ hypoperfusion or organ ischemia, use of life support, acute kidney injury, 30-day mortality, ICU and hospital stay duration, readmission rates, and cost-effectiveness. This pilot study aims to determine whether employing a more restrictive transfusion threshold of 5.0 g/dL is feasible when compared to the current 7.0 g/dL threshold in critically ill patients. This study could pave the way for a future large-scale trial that may lead to more stringent transfusion policies, potentially improving patient outcomes, reducing transfusion-related risks in critically ill populations and limit the dependence on donor red blood cells. This trial was registered at highly restrictive vs normal red blood cell transfusion strategy in anemic critically ill patients - A feasibility trial | Research with human participants (identifier: NL-OMON57318) at 12th of February 2025.
Adults with hemoglobinopathies require lifelong transfusion support and long-term monitoring, which may substantially affect daily life and treatment burden. Data describing patient-reported transfusion practices in Greece remain limited. To describe transfusion practices, chelation therapy, monitoring patterns, and patient-reported daily life impact among Greek adults with hemoglobinopathies. A cross-sectional anonymous online survey was distributed to adults (≥18 years) with self-reported hemoglobinopathies living in Greece. The questionnaire collected data on demographics, disease category, transfusion frequency, chelation therapy, monitoring practices, complications, and patient-reported impact on daily life. Analyses were descriptive. Transfusion practices and chelation therapy among participants are summarized in Table 1. A total of 114 respondents (mean age 49.4 ± 9.6 years; 53.5% female) completed the survey. Most participants reported regular transfusion therapy, commonly at intervals of ≤15 days, with variable transfusion volumes per session. Chelation therapy was widely reported, although adherence varied. Monitoring practices, including imaging for iron overload, were inconsistently reported. Participants described substantial treatment-related burden, including frequent healthcare visits and concerns regarding blood availability. Greek adults with hemoglobinopathies report considerable transfusion-related treatment burden affecting daily life. These findings support the need for structured follow-up pathways and patient-centered care strategies.
The legal shelf life of platelet concentrates (PCs) has been extended from 5 to 7 days in France since 2018. Our study aimed to determine whether this increase in PC storage time has produced a significant impact on transfusion-related adverse reactions (ARs). A retrospective study was conducted in the Grand Est region of France between January 2022 and December 2023 using data from the e-FIT hemovigilance database and the record of PCs transfused held by the "Etablissement Français du Sang" (EFS). In 2022 and 2023, 270 ARs related to platelet transfusions were reported in the Grand Est region of France, 240 of which were classified as possibly, probably or certain attributable to the transfusion. The majority of these immediate ARs were allergies, febrile non-hemolytic transfusion reactions and immunological incompatibilities. We found no significant correlation of the platelet storage time (≤3 days versus 4-7 days) with the three main immediate adverse reactions (p = 0.24), or with isolated alloimmunization (p = 0.55). The storage time did not affect the incidence of ARs following transfusion of either buffy coat PC or apheresis PC (p = 0.20). Finally, no association was observed between the age of PCs and the severity of ARs (p = 0.24). Our results show that storage of platelets for 4 to 7 days has no significant effect on the occurrence or severity of ARs. Prospective studies will be necessary to assess the impact of platelet storage time on transfusion efficacy and the potential benefit of considering the age of the platelets for certain patients.
Cryoprecipitate, a cost-effective fibrinogen replacement, remains vital in managing coagulopathies, particularly in resource-limited settings. There is a wide variation of cryoprecipitate transfusion practices worldwide, even though it is widely transfused in various clinical settings. This prospective observational study investigated cryoprecipitate utilization patterns in a tertiary care center in Northern India, focusing on Haemato-Oncology patients. This study was conducted over a period of one year, analyzing 350 transfusion events across 286 patients. Data on patient demographics, clinical and laboratory parameters, and transfusion indications were collected and evaluated for adherence to established guidelines. Cryoprecipitate accounted for 2.1 % of blood component requests, predominantly from the Haemato-Oncology department (73 %). Among the transfusion events, 65.7 % were deemed appropriate based on guidelines, with the majority (85.6 %) occurring in Haemato-Oncology patients. Pre- and post-transfusion fibrinogen levels were documented in 45.4 % of events, revealing a mean fibrinogen increase of 0.71 g/L per dose. However, 34.3 % of events were inappropriate, largely due to transfusions without pre-transfusion fibrinogen measurements. Key findings include hypofibrinogenemia as the leading indication for cryoprecipitate transfusion (74.3%) and significant differences in transfusion practices between Haemato-Oncology and non-Haemato-Oncology population cohorts. The study highlights the need for periodic utilization audits and continuous training of stakeholders to ensure adherence to evidence-based guidelines and reduce empirical transfusion practices. Future multi-center studies are recommended to establish standardized cryoprecipitate administration protocols and assess clinical outcomes.
Pathogen reduction treatment (PRT) of platelet concentrates (PC) is one of the most recent advances in improving blood safety and lowering the risk of transfusion-transmitted diseases. The characteristics of PR-treated PC differ slightly from those of untreated PC and may affect transfusion outcomes. We established how effective PRT methods, (INTERCEPT™ Blood System) PC are when transfused to cardiac surgery patients. This study examined the influence of PRT using amotosalen and UVA light in a population of cardiac surgery patients. We analysed bleeding and platelet drop following cardiopulmonary bypass (CPB) surgery. We selected 73 patients after considering the medical exclusion criteria: 46 patients transfused with untreated platelet concentrate versus 27 patients transfused with PRT-treated platelet concentrate. Data analysis concerns the readout after the first platelet concentrate transfusion. The decrease in patient platelet count between pre-operative and H0 [Intensive Care Unit (ICU) admission], and pre-operative and H6 post-surgery did not differ significantly with or without PRT. The volume of postoperative bleeding after CPB surgery did not differ significantly regardless of whether the patient was transfused with PRT-PC or untreated PC. No difference was documented between the groups in terms of postoperative pulmonary infection rate. Regardless of the use of platelet PRT, among the factors associated with bleeding, only Fg level was independently and significantly associated. A 1mg/L increase in fibrinogen (pre-operative) is associated with a 159mL decrease in bleeding 24hours post-surgery. In postoperative cardiac surgery, the use of platelets treated with amotosalen/UVA for pathogen reduction does not appear to affect transfusion effectiveness and postoperative bleeding.
Cancer-related anemia is associated with poorer quality of life and cancer progression. Red blood cell (RBC) transfusion might have an impact on perioperative outcomes after major oncologic surgery. We performed a systematic review and meta-analysis to evaluate whether RBC transfusion exposure (yes/no) and whether RBC transfusion strategies ('liberal' vs. 'restrictive') may impact on postoperative outcomes for patients admitted to an intensive care unit (ICU) following oncologic surgery. We searched Pubmed, Embase and Cochrane Library to identify eligible articles published between 1st January 2000 to 31st December 2023. We included clinical trials and observational studies that evaluated RBC transfusion exposure and all studies that compared 'liberal' vs. 'restrictive' transfusion strategies, in adult critically ill patients admitted to ICU after oncologic surgery. Ten observational studies that compared transfused vs. non-transfused patients, and three comparative transfusion strategy studies (two randomized-controlled trials [RCTs] and one non-randomized) were included. In the observational studies, non-transfused patients had a better survival (OR 0.24 [0.06-0.92], p = 0.04; I2 = 78 %), as well as reduced risks of sepsis (OR 0.37 [0.14-0.97], p = 0.04; I2 = 91 %), acute kidney injury (OR 0.37 [0.21-0.65], p = 0.0005; I2 = 83 %) and pneumonia (OR 0.32 [0.19-0.52], p < 0.00001; I2 = 59 %). Hospital length-of-stay was also lower for non-transfused patients: mean difference -4.7 days [-7.13 to -2.26], p = 0.0002 (I2 = 94 %). In the two RCTs, no difference was found between 'liberal' and 'restrictive' transfusion strategies on main outcomes. However, the strength of evidence was 'very low' to 'low' quality for the two RCTs. After major oncologic surgery, perioperative anemia requiring transfusion therapy may impact adversely on postoperative outcomes. Our meta-analysis revealed high heterogeneity in observational studies and low strength of evidence in the transfusion strategy RCTs. Further high-quality comparative studies are needed to investigate RBC transfusion in this setting.
Single donor plateletpheresis (SDP) though considered safe is associated with adverse donor reactions (ADRs) in 2.7-19% of cases in reported studies. The primary source of ADRs is passive reporting by the donor though such reporting has the disadvantage of underestimating the actual quantum of ADRs especially in low middle income countries due to limitation of donor understanding of the procedure. Unidentified and missed ADRs compromise donor care and retention. The study thus explored the utility of donor education and active reporting to assess correct incidence of ADRs. This prospective interventional study included consenting male SDP donors. Control arm (n=300) received standard written information about ADRs. Intervention arm (n=300) received pre-procedure symptom education and were actively monitored during procedure. Donor and procedure details were documented; ADRs were graded using AABB's Severity Grading Tool. Data were analysed using IBM SPSS v29.0. Intervention arm reported a significantly higher ADR (28 donors, 9.3%) compared to control arm (7 donors, 2.3%). ADR severity was grade-I in all donors in intervention arm when compared to control arm where 42.8% of ADR were grade-II to III. The odds of severe ADRs were 98% lower in intervention arm than in control arm (OR=0.02; 95% CI: 0-0.51). Donor and procedural parameters were comparable between arms. Enhanced donor education and active symptom surveillance led to increased detection of grade-I ADRs and reduced progression to grade-II or III reactions. This strategy improves procedural safety and enhances donor experience, supporting its integration into routine apheresis practice.
Although transfusion medicine is a relatively recent addition to everyday clinical practice, the current understanding of blood as a therapeutic compound does not solely result from a single century of research, but rather from the culmination of millennia of observations, experimentations and interpretations. Early conceptions about blood have largely been transmitted through myths and mythology where blood is deeply connected to themes such as strength, power, life, heritage, wellbeing, holiness, suffering and death. Interestingly, this perception appears to be universal, transcending geographical and cultural boundaries. Most medical textbooks overlook this aspect which is crucial because these symbols and archetypes acted as a cultural substratum from which the modern understanding of transfusion gradually emerged, thereby carrying with it emotional and symbolic forces that still today shape the patient's experience and perception of blood transfusion. This review article traces the origins of transfusion medicine back to its most ancient foundations. It examines how early civilizations perceived blood, the symbols associated with it, how these ideas have influenced modern science thereby transforming ancestral beliefs associated with blood into a scientifically grounded medical practice. Tracing and recognizing this intellectual lineage underscore that medicine is not isolated from culture. Itconverts blood transfusion from a purely technical act into a humanistic gesture and provide physicians with deeper understanding why certain taboos, fears, or ethical debates persists around blood transfusion and help them to better empathize with patients who may have cultural or religious concerns about transfusion.
Platelet refractoriness is a frequent and challenging problem in thrombocytopenic patients who require long-term platelet transfusions. However, real-world practice in diagnosing and managing refractoriness remains variable with no inclusive guidelines. This study aimed to address this variability by means of conducting a survey. We conducted an anonymous, web-based survey of U.S. hematology and oncology practitioners in 2024-2025 to capture current approaches to platelet refractoriness. The 20-item survey explored diagnostic thresholds, use of HLA antibody testing, application of calculated panel reactive antibody (cPRA) in clinical decision-making, strategies for selecting specialty platelets, and platelet transfusion thresholds across clinical scenarios. Responses were analyzed descriptively. 28 practitioners responded, most of whom were attending hematologists at academic centers. Awareness of the technical platform for HLA antibody testing was limited, with nearly 90% of respondents unable to identify the assay used at their center. Few institutions reported a defined cPRA threshold to trigger specialized platelet support. For prophylaxis, most adhered to a 10 × 103/µL threshold in inpatients, while outpatient thresholds varied more widely. This national survey highlights marked heterogeneity in the recognition and management of platelet refractoriness among hematology and oncology practitioners. Development of targeted guidelines addressing immune-mediated refractoriness could help standardize practice and optimize patient care.
Neonatal hyperbilirubinemia remains a common neonatal condition. While Rh immunoprophylaxis and phototherapy have dramatically reduced exchange transfusion (ET) use in high-income countries, ET remains essential in selected cases, particularly in transitioning healthcare systems. Comprehensive data from Southeast Europe are limited. To evaluate 23-year trends in neonatal ET use, indications, and outcomes at a Serbian tertiary referral center. This retrospective cohort study (2001-2023) included all neonates undergoing ET at the University Clinical Center of Serbia. Data were collected from medical, transfusion, and laboratory records. Primary outcome was ET rate trend; secondary outcomes included indications and complications. Among 145,702 deliveries, 243 ETs were performed in 206 neonates. ET rates declined significantly from 6.4 to 0 per 1000 deliveries (p < 0.001), mirroring trends observed in high-income countries. Hemolytic disease of the newborn accounted for 67 % of cases, primarily due to anti-D alloimmunization (65.9 %), a profile characteristic of settings with Rh prophylaxis gaps. Non-immune indications included anemia (36.7 %), infections (28.3 %), and other causes (35.0 %). Most procedures were double-volume ET (61.3 %). No ET-related mortality occurred; complications were transient. RhD-negative mothers showed high sensitization rates (82.1 %). The significant decline in ET rates in Serbia reflects successful perinatal care improvements, yet the persistent burden of anti-D alloimmunization underscores challenges shared with many transitioning health systems. Strengthening Rh immunoprophylaxis programs and expanding access to bilirubin monitoring are essential public health strategies to further reduce ET need in similar healthcare settings worldwide.
Transfusion-related acute lung injury (TRALI) is a severe complication of blood transfusion, but its molecular mechanisms remain poorly understood. This study aimed to investigate the role of Toll-like receptor 4 (TLR4) and its downstream signaling cascade in the pathogenesis of TRALI. Lipopolysaccharide (LPS)-treated PAEC cells and BALB/c mice were used as a model of TRALI. Relative mRNA expression was evaluated via quantitative RT-PCR. Protein abundance in cells/tissues and cell culture supernatant/serum was detected using western blot and ELISA, respectively. Lung tissue injury was evaluated by hematoxylin and eosin staining, and protein expression in lung tissues was analyzed by immunohistochemistry. Expressions of TLR2, TLR4 and myeloid differentiation 2 (MD-2) were significantly elevated in the cellular TRALI model and accompanied by an increase in c-Jun, c-Fos, and P65 phosphorylation and increased expression and secretion of IL-1β, IL-6, IL-8, and TNF-α. The TLR4 inhibitor TAK-242 or MD-2 siRNAs effectively suppressed the molecular alterations induced by LPS in the cellular TRALI model. TAK-242 significantly reduced mortality and lung tissue injury in the TRALI mouse model, decreased TLR2, TLR4 and MD-2 expression, inhibited c-Jun, c-Fos, and p65 phosphorylation, and downregulated IL-1β, IL-6, IL-8, and TNF-α expression. In this animal model of TRALI, the highly expressed TLR4/MD-2 complex promotes the pathogenesis of TRALI through the activation of the activator protein-1(AP-1) and nuclear factor-κB (NF-κB) signaling pathways and the release of inflammatory mediators. One limitation is the positive study in rodent model but not in humans.
Red blood cell (RBC) alloimmunization continues to challenge the foundational promise of transfusion therapy: to provide safe and universally effective support. Although most transfused individuals remain tolerant, a vulnerable minority develop alloantibodies that complicate care and increase the risk of delayed hemolytic transfusion reactions (DHTRs). While high-income nations increasingly mitigate this risk through molecular genotyping, low- and middle-income countries (LMICs) face a distinct landscape defined by antigenic mismatch and resource scarcity. This critical review evaluates alloimmunization not merely as a technical failure, but as a phenomenon driven by the collision of immunobiological susceptibility and structural health determinants. A structured literature review informed by PRISMA reporting recommendations was conducted to synthesize immunobiological and health-systems evidence across diverse epidemiological settings. We synthesize evidence on immune responsiveness alongside the economic realities of LMICs, where competing health priorities often necessitate trade-offs in laboratory capacity. By critically examining compatibility strategies through the lenses of feasibility and cost-effectiveness, we propose a risk-adapted, tiered framework for antigen matching. This approach challenges one-size-fits-all paradigms, suggesting that transfusion safety can be optimized by aligning biological risk with available resources rather than relying solely on inaccessible technologies.
Reports on the changes in plasma fibrinogen levels in patients receiving cryoprecipitates synthesized using different methods are lacking. Therefore, we investigated these changes in patients who underwent cardiovascular surgery. We included 309 patients who underwent cardiovascular surgery and received 12 cryoprecipitate units between February 2020 and March 2024 and 204 patients were selected by propensity score matching. The cryoprecipitates were prepared using two methods. Fresh frozen plasma (FFP) was thawed at 2 to 6 °C for 24 h and centrifuged to remove the supernatant in the one-step method, whereas FFP was thawed, refrozen at -20 °C, and subsequently rethawed in the two-step method. We investigated the association between different cryoprecipitate preparation methods and ICU admission for ≥1 week, with in-hospital mortality considered as a competing risk in the analysis. In addition, we evaluated the changes in plasma fibrinogen levels before and after cryoprecipitate administration. Baseline plasma fibrinogen levels were significantly higher in the two-step method group than in the one-step method group. Differences in cryoprecipitate preparation methods were not significantly associated with ICU admission for ≥1 week, in the analysis that considered in-hospital mortality as a competing risk (P = 0.93). The increase in plasma fibrinogen levels after cryoprecipitate administration was significantly higher with the two-step method than with the one-step method (36 mg/dL vs. 51 mg/dL, P = 0.020). The cryoprecipitates synthesized using the two-step method showed a higher increase in plasma fibrinogen levels than those prepared using the one-step method. These findings may help guide appropriate transfusion protocols by confirming intraoperative plasma fibrinogen levels.
Thrombocytopenia is prevalent in living donor liver transplantation (LDLT), resulting from underlying liver disease and perioperative factors. Although platelet transfusions are frequently required, their response is variable and may be associated with adverse outcomes. This study evaluated the prevalence and severity of thrombocytopenia, platelet transfusion practices, assessed post-transfusion response using corrected count increment (CCI), and predictors of poor CCI in adult LDLT recipients. This prospective observational study was conducted at a quaternary care center after ethical approval. Adult LDLT recipients were enrolled, and clinical, biochemical, intraoperative, and transfusion data were collected. Platelet transfusion response was assessed using CCI post-transfusion; CCI <5,000 was considered a poor response. Among 100 LDLT recipients (median age 52 years; 88% male), preoperative thrombocytopenia was observed in 91% of patients (17% severe). Intraoperative platelet transfusions were administered in 18% of cases. Postoperatively, 66 platelet transfusions were given to 23 patients, with a mean CCI of 9.0 × 10⁹/L. Poor CCI was observed in 10 patients and was associated with higher bilirubin levels, prolonged INR, longer ICU stay, and increased 30-day mortality. Early allograft dysfunction (EAD) at postoperative day 7 was an independent predictor of poor CCI (OR 10.2, 95% CI 2.4-43.1). A platelet count ≤71,000/mm³ on day 7 predicted EAD with 85% sensitivity (AUC 0.79). Thrombocytopenia is highly prevalent in LDLT recipients. Poor CCI is associated with graft dysfunction and adverse outcomes, suggesting that CCI monitoring may help guide transfusion strategies after liver transplantation.
Efficient workflow in blood donation centers is crucial for timely collections, donor safety, and effective staff utilization. However, issues such as redundant documentation, inefficient layouts, communication interruptions, and inventory disruptions often lead to increased donor waiting times and decreased satisfaction. To address these inefficiencies, a study was conducted employing Lean Six Sigma (LSS) methodology to identify and reduce non-value-added activities (NVA) in the donor area. Utilizing the DMAIC (Define-Measure-Analyze-Improve-Control) framework over seven months, the study involved baseline observations, time-motion studies, staff interviews, and spaghetti diagrams to uncover bottlenecks. Targeted interventions included workflow zoning, digital registration, inventory dashboards, structured communication protocols, and role delegation. The quantitative outcomes were measured pre- and post-intervention (October-December 2024 vs. January-April 2025) were performed using SPSS software (version 29). The results demonstrated a statistically significant improvement in post-intervention: donor registration time reduced by 52.7 %, waiting times decreased by 49.6 %, and NVA activities dropped from 20 % to 9 % of staff time. Documentation errors fell by 65 %, inventory disruptions decreased to under 10 min per day, and staff movement dropped by over 40 %. Additionally, donor throughput increased by 25 %, and satisfaction scores improved from 61 % to 86 %, while communication delays were reduced from over 90 min to 25-30 min daily demonstrating a significant large-sized effect with meaningful difference. The application of LSS significantly enhanced workflow efficiency, documentation accuracy, and service delivery, presenting a scalable and sustainable model for quality improvement in healthcare settings.
The stability of red cell concentrates (RCCs) during storage is routinely assessed by measuring haemolysis, which must remain below 0.8 % in Europe and 1.0 % in the USA. Haemolysis during storage is influenced by both technical factors (e.g., additive solutions, leukoreduction) and donor-related characteristics, such as age and gender. To investigate the influence of donor age, gender, donation frequency and collection time on haemolysis in RCCs during storage. A retrospective study was conducted on 768 RCCs prepared at the Croatian Institute of Transfusion Medicine over a 13-year period (2011-2023). Haemolysis was assessed on day 35 of storage. Haematological parameters were measured using an Abbott Cell-Dyn Ruby analyser, and free haemoglobin levels using a Plasma/Low Hb photometer, with subsequent calculation of haemolysis percentage. Donor demographic data (age, gender, donation frequency) were retrieved from the blood bank software e-Delphyn. Statistical analyses, including independent-samples t-tests, ANOVA, and correlation analysis, were performed using IBM SPSS Statistics software. A total of 768 RCC units were analysed. Male donors exhibited significantly higher haemolysis levels compared to female donors (P < 0.001), particularly among younger age groups. In female donors older than 50 years, the median of haemolysis was significantly higher than in those under 50 years (P = 0.022). A weak but statistically significant correlation was observed between haemolysis and donation frequency (rho = 0.163; P < 0.001). However, donation frequency and collection time were not major contributors to haemolysis in regression analysis. Donor gender and age significantly influence the level of haemolysis in stored RCCs, with higher haemolysis observed in male and older donors. Donation frequency and collection time were not identified as major contributors to haemolysis in regression analysis. These findings support previous research and highlight the importance of considering donor-related factors when aiming to optimize RCC quality and storage outcomes.