Transfusion and Apheresis Science RSS feed: Current Issue. Transfusion and Apheresis Science (previously called Transfusion Science ) brings comprehensive and up-to-date information to physicians and health care professionals involved in the rapidly changing fields of transfusion medicine and apheresis. The journal presents original articles relating to scientific and clinical studies in the areas of immunohematology, transfusion practice and both therapeutic and donor apheresis. Topics covered include the collection and processing of blood, compatibility testing and guidelines for the use of blood products, as well as screening for and transmission of blood-borne diseases. All areas of apheresis - both therapeutic and collection - are also addressed. A major feature of the journal is the " theme " section which includes, in each issue, a group of papers designed to review a specific topic of current importance in transfusion science; basic science, current research and the clinical application of modern therapies are featured. The " Apheresis Listening Post " provides a forum for the discussion of topical issues specific to apheresis and focuses on the operators' viewpoint. Another feature section is "What's Happening" which provides informal reporting of activities in the field. In addition, brief case reports and Letters to the Editor , as well as reviews of meetings and events of general interest, and a listing of recent patents make the journal a complete source of information for practitioners of transfusion and apheresis science. Immediate dissemination of important information is ensured by the commitment of Transfusion and Apheresis Science to rapid publication of both symposia and submitted papers. http://www.trasci.com/?rss=yesElsevier Inc.en © 2012 Elsevier Ltd. All rights reserved. Transfusion and Apheresis Science1473-0502463June 2012 © 2012 Elsevier Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.trasci.com/article/PIIS1473050212000870/abstract?rss=yesEditorial board/Publication information10.1016/S1473-0502(12)00087-0Transfusion and Apheresis Science 46, 3 (2012)2012-06-01Transfusion and Apheresis Science2012-06-01463S1473-0502(12)X0004-1IFCIFChttp://www.trasci.com/article/PIIS1473050212000845/abstract?rss=yesIn this substantial issue we have an important International Forum from Turkey, a very interesting What’s Happening section, and an excellent Theme section. I am also pleased to announce that we have revived our Clinical Trials section in this issue, with a great paper contributed by Josefin-Beate Holz, MD, Study Director of the Ablynx TITAN trial, assessing the efficacy and safety of an anti-von Willebrand Factor nanobody in TTP patients.EditorialGail Rock10.1016/j.transci.2012.03.032Transfusion and Apheresis Science 46, 3 (2012)2012-04-13Transfusion and Apheresis Science2012-04-13463S1473-0502(12)X0004-1Editorial233233http://www.trasci.com/article/PIIS1473050212000833/abstract?rss=yesEarly this year, the world lost one of its senior-most figures in hematology, when Dr. Terry Hamblin, a former Senior Editor of Transfusion and Apheresis Science, died on January 8, 2012. Dr. Hamblin had an early association with the journal when working with his mentor, Dr. John Verrier Jones, the first editor of our journal.Dr. Hamblin was founder and editor of the Apheresis Bulletin, a publication which was incorporated into Plasma Therapy and Transfusion Technology in November 1988. He then became a Senior Editor of that journal, which then became the Transfusion Science journal, and ultimately evolved into the present day Transfusion and Apheresis Science, where he served as Senior Editor until 2004, when he moved on to devote his efforts to Leukaemia Research, an Elsevier publication for which he was Editor-in-Chief.Remembering Dr. Terry HamblinGail Rock10.1016/j.transci.2012.03.031Transfusion and Apheresis Science 46, 3 (2012)2012-04-13Transfusion and Apheresis Science2012-04-13463S1473-0502(12)X0004-1Obituary235235http://www.trasci.com/article/PIIS1473050212000808/abstract?rss=yes14th International Congress of the World Apheresis Association10.1016/j.transci.2012.03.028Transfusion and Apheresis Science 46, 3 (2012)2012-04-05Transfusion and Apheresis Science2012-04-05463S1473-0502(12)X0004-1International Forum237237http://www.trasci.com/article/PIIS1473050212000158/abstract?rss=yesAbstract: Background: Hematopoietic stem cells (HSC) have been characterized by CD34+ expression and an adequate dose of CD34+ cells is associated with a complete engraftment. CD133 is a more specific marker of HSC.Materials and methods: We studied the relationship between graft content of CD34+, CD133+, and CD38+ cells and trilineage engraftment after autologous stem cell transplantation in patients with different hematological disorders. Blood samples were obtained before and after mobilization with recombinant granulocyte-colony stimulating factor (G-CSF, 16μg/kg), from apheresis collections, and after transplantation.Results: Cell subsets were quantified by flow cytometry, and the dose of each population infused was correlated with success of engraftment. G-CSF induced mobilization of CD133+CD38+ cells (12.6-fold) and CD133+CD34+ cells (14.7-fold). A correlation was observed between the infused dose of CD133+CD34+ and CD133+CD38+ cells and platelet engraftment.Conclusion: CD133+CD34+ and CD133+CD38+ cells were mobilized with G-CSF and these cell subsets were correlated with platelet engraftment.CD133+CD34+ and CD133+CD38+ blood progenitor cells as predictors of platelet engraftment in patients undergoing autologous peripheral blood stem cell transplantationAlma Y. Camacho Villa, Elba Reyes Maldonado, Laura A. Montiel Cervantes, Jorge Vela Ojeda10.1016/j.transci.2012.02.002Transfusion and Apheresis Science 46, 3 (2012)2012-03-02Transfusion and Apheresis Science2012-03-02463S1473-0502(12)X0004-1Submitted Papers239244http://www.trasci.com/article/PIIS1473050212000663/abstract?rss=yesAbstract: Introduction: This study aimed to determine the effects of acute normovolemic hemodilution (ANH) using low-molecular-weight hydroxyethyl starch (LMW-HES) on intraoperative blood loss in patients who had received preoperative autologous blood donation (PABD) and had undergone sagittal split ramus osteotomy (SSRO).Methods: Patients who had undergone SSRO were analyzed. All 250 patients received PABD of 400–800mL until 2weeks before surgery. ANH was performed by withdrawing whole blood, which was replaced by the same volume of LMW-HES. ANH was performed in 197 cases for 200mL replacement (ANH-200) and in 5 cases for 400mL replacement (ANH-400); it was not performed in 48 cases (ANH-0).Results: Blood loss in ANH-200 was greater than that in ANH-0, despite no differences in hemoglobin concentrations at pre- and post-PABD, prothrombin time, activated partial thromboplastin time, fibrinogen and platelet counts between the groups before surgery. Blood loss increased as the total withdrawn blood (sum of PABD and ANH) increased.Conclusion: Increased intraoperative blood loss was associated with total withdrawn blood before the operation as well as ANH.Preoperative autologous blood donation and acute normovolemic hemodilution affect intraoperative blood loss during sagittal split ramus osteotomyYoko Iwase, Atsushi Kohjitani, Akina Tohya, Kazuna Sugiyama10.1016/j.transci.2012.03.014Transfusion and Apheresis Science 46, 3 (2012)2012-04-09Transfusion and Apheresis Science2012-04-09463S1473-0502(12)X0004-1Submitted Papers245251http://www.trasci.com/article/PIIS1473050212000651/abstract?rss=yesAbstract: Background and objectives: Occasionally there are adverse transfusion reactions in the therapeutic use of packed red blood cells. Some of those reactions are caused by the presence of white blood cells (WBCs). Both immunogenic and infectious transfusion reactions are significantly influenced by the level of white blood cell contamination.Materials and methods: The flexible in-line red cell filtration system Leucoflex LCR Diamond (Macopharma) was investigated. According to manufacturer information the system has a smaller filter surface (46cm2) than the previous filter LCR-5 (53cm2). Main difference with the previous model is the rhomboid design. The filter tube connections are not at the level of the centre edge, but at two opposite corners. Eighteen red cell concentrates were produced under Good Manufacturing Practice conditions in routine operation. To ensure the quality of the filter system every 7days metabolic parametres such as WBC count, haemoglobin content, haemolysis rate, potassium load, pH and ATP content were analysed over a storage period of 49days.Results: The mean product volume was 260.7mL after filtration. Average haemoglobin content was 51.8g per unit and WBC contamination was 0.02×106per unit. Haemolysis rate was 0.05% directly after filtration and 0.20% at the end of storage. Immediately after filtration the potassium concentration was 1.3mmol/L and the pH was 7.37. During whole storage time the ATP level was maintained above 2.0μmolperghaemoglobin.Conclusion: The tested filtration system is suitable for quality-assured production of red blood cell concentrates meeting national and international guidelines.Investigation of a new in-line leukocyte reduction filter for packed red blood cellsJ. Mönninghoff, R. Moog10.1016/j.transci.2012.03.013Transfusion and Apheresis Science 46, 3 (2012)2012-04-04Transfusion and Apheresis Science2012-04-04463S1473-0502(12)X0004-1Submitted Papers253256http://www.trasci.com/article/PIIS1473050212000638/abstract?rss=yesAbstract: Background: CXCR4 receptor antagonist plerixafor is used to mobilize hematopoietic stem cells. No detailed data regarding the effects of plerixafor on other blood cell components have been published but may be of importance in regard to graft composition collected after plerixafor injection.Patients and methods: The study included thirty-nine patients with non-Hodgkin lymphoma (NHL) mobilized with chemotherapy plus G-CSF. Plerixafor was given pre-emptively in twenty patients due to poor mobilization or low collection yield. Nineteen NHL patients served as controls. We evaluated CD34+ counts and WBC counts and differential from the morning of the first plerixafor injection and 8h after the plerixafor injection. From the control patients the corresponding values were evaluated on the morning of the first apheresis and 24h before it.Results: The first plerixafor dose increased CD34+ counts and number of leukocytes, neutrophils, lymphocytes, eosinophils and monocytes. Leukocyte, neutrophil, lymphocyte, monocyte and eosinophil counts were higher after plerixafor injection compared to the control group at the time of the first apheresis. Minimal graft (⩾2×106/kg CD34+ cells) was collected in 85% of plerixafor treated patients, with a single apheresis in 45% of the patients.Discussion: Plerixafor significantly increases B-CD34+ cell counts on the next morning making effective blood stem cell collection possible in the majority of the patients mobilizing poorly. It also influences other blood cell components but impact of this observation in regard to graft content and post-transplant course needs to be assessed in further studies.Pre-emptive plerixafor injection increases blood neutrophil, lymphocyte and monocyte counts in addition to CD34+ counts in patients with non-Hodgkin lymphoma mobilizing poorly with chemotherapy plus G-CSF: Potential implications for apheresis and graft compositionV. Varmavuo, P. Mäntymaa, T. Kuittinen, T. Nousiainen, E. Jantunen10.1016/j.transci.2012.03.011Transfusion and Apheresis Science 46, 3 (2012)2012-04-05Transfusion and Apheresis Science2012-04-05463S1473-0502(12)X0004-1Submitted Papers257262http://www.trasci.com/article/PIIS147305021200064X/abstract?rss=yesAbstract: Complications caused by elevated white blood cell count in pediatric patients with CML could be a presenting feature of the disease. Here, we present two adolescents, aged 16 and 17years, who were admitted for investigation of extremely elevated leukocytes and complications of leucostasis. Initial manifestations were priapism and blurred vision, respectively. Diagnosis of chronic phase of chronic myeloid leukemia is established, and conventional measures for leucoreduction began. However, since there were no improvements, a leukapheresis procedure was initiated. After undergoing 3 daily procedures the leukocyte count declined for each patient, with resolution of pripaism and ophtalmological disturbances. Leukapheresis is safe and effective therapeutic option for patients with complications of hyperleucocytosis. If started in a timely manner, permanent organ damage or death could be avoided.Leukapheresis in management hyperleucocytosis induced complications in two pediatric patients with chronic myelogenous leukemiaDobrila Veljković, Milos Kuzmanović, Dragan Mićić, Olivera Šerbić-Nonković10.1016/j.transci.2012.03.012Transfusion and Apheresis Science 46, 3 (2012)2012-04-05Transfusion and Apheresis Science2012-04-05463S1473-0502(12)X0004-1Submitted Papers263267http://www.trasci.com/article/PIIS1473050212000602/abstract?rss=yesAbstract: Malaria was expected to be a major problem during blood donation in Turkey due to existence of malaria cases in southeastern region of Turkey. The present study aimed for the first time, to investigate malaria in “donors deferred for malaria risk” and to determine the regional rates of malaria deferral in Turkey. Blood samples were collected from several Blood Banks of southeastern provinces where local malaria cases still exist and from Blood Bank of Ege University Medical School (EUMS) located in western Turkey where malaria is eradicated decades ago. Plasmodium spp. and specific antibodies were investigated by stained smears, antigen detection, PCR and ELISA. Among the donors deferred for malaria risk, Plasmodium spp. were not detected by microscopy, PCR or antigen detection. Seroprevalances were 2% and 3.92% in western and southeastern regions, respectively. Rate of donor deferral for malaria risk was 0.9% in EUMS and deferrals were exclusively because of travel to southeastern Turkey. In southeastern provinces, deferrals were mainly due to malaria like fever history. The present study first time assessed regional rates of donor deferral due to malaria risk in Turkey. Previously, malaria was expected to be a major problem during blood donation in Turkey due to existence of malaria cases in southeastern region of Turkey. The results of the study showed that 97% of the deferrals were unnecessary. In conclusion, to reduce unnecessary donor deferrals in Turkey, in addition to comprehensive questioning for malaria history, the usage of a malaria antibody screening method should be initiated prior to deferral decision.Action plan to regain unnecessary deferred blood donors due to malaria risk in TurkeyAysu Değirmenci, Mert Döşkaya, Ayşe Caner, Şebnem Nergis, Kadri Gül, Yeşim Aydınok, Tufan Ertop, Nurten Aksoy, Metin Korkmaz, Mehmet Ziya Alkan, Ahmet Üner, Yüksel Gürüz10.1016/j.transci.2012.03.008Transfusion and Apheresis Science 46, 3 (2012)2012-03-30Transfusion and Apheresis Science2012-03-30463S1473-0502(12)X0004-1Submitted Papers269275http://www.trasci.com/article/PIIS1473050212000675/abstract?rss=yes Manager of Transfusion Medicine, Hematology and Tissue Typing/DNA Laboratories at The Ottawa Hospital, three site tertiary care facility, since 2001. In this position she provides technical and operational support for Transfusion Services to additional 16 regional hospitals part of the Eastern Ontario Laboratory Association (EORLA).Brief biography: Doris Neurath, BScPharm, ART, MBADoris Neurath10.1016/j.transci.2012.03.015Transfusion and Apheresis Science 46, 3 (2012)2012-04-05Transfusion and Apheresis Science2012-04-05463S1473-0502(12)X0004-1Theme Section277277http://www.trasci.com/article/PIIS1473050212000687/abstract?rss=yesI am delighted and honoured to have the opportunity to serve as a guest editor of this theme section, on issues related to the patients who require blood transfusion. My intent is to provide examples of various transfusion practices that would be useful in both the large tertiary care institutions and in the smaller community hospitals.Transfusion practicesDoris Neurath10.1016/j.transci.2012.03.016Transfusion and Apheresis Science 46, 3 (2012)2012-04-05Transfusion and Apheresis Science2012-04-05463S1473-0502(12)X0004-1Theme Section279279http://www.trasci.com/article/PIIS1473050212000699/abstract?rss=yesAbstract: Pretransfusion testing encompasses much more than testing a patient’s sample in the laboratory. All aspects pertaining to this testing will be reviewed, from the clinician’s order to the final step of when the blood product is ready to be issued to the clinical side from the laboratory. The importance of patient safety and positive outcomes will be stressed through discussion of positive patient identification and appropriate labelling in order to get the right product to the right patient at the right dose. Transfusion service does not stop in the laboratory; it is imperative that all who are involved in this service appreciate the significance of performing tasks accordingly to standards and regulations.A primer in pretransfusion testingDenise Evanovitch10.1016/j.transci.2012.03.017Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Theme Section281286http://www.trasci.com/article/PIIS1473050212000705/abstract?rss=yesAbstract: Solid Phase Red Cell Adherence Assay (SPRCA) is one of the two tubeless methods developed to improve sensitivity and specificity in blood group serology. The SPRCA (solid phase) and the column agglutination (gel) technology have gained wide acceptance following successful adaptation to fully automated platforms, The purpose of this paper is to discuss the development, principle, procedures as well as laboratory and clinical applications of the SPRCA in transfusion medicine.Solid Phase Red Cell Adherence Assay: A tubeless method for pretransfusion testing and other applications in transfusion scienceEric Ching10.1016/j.transci.2012.03.018Transfusion and Apheresis Science 46, 3 (2012)2012-04-04Transfusion and Apheresis Science2012-04-04463S1473-0502(12)X0004-1Theme Section287291http://www.trasci.com/article/PIIS1473050212000717/abstract?rss=yesAbstract: Frozen plasma is a commonly used blood product. The primary indication for frozen plasma is the treatment and prevention of bleeding in patients with prolonged coagulation tests. Unfortunately, there is a lack of well conducted clinical trials to determine the appropriate indications for frozen plasma and, as a result, a large proportion of frozen plasma transfusions are inappropriate according to current guidelines. As an alternative approach to foster improved transfusion practice, we outline a recently described paradigm for the use of frozen plasma to prevent and treat bleeding: (1) prolonged coagulation tests increase the risk of bleeding, (2) frozen plasma will correct abnormal coagulations and (3) correcting abnormal coagulation with frozen plasma transfusions will reduce bleeding. However, the evidence does not support either of the first two tenets, which suggests that transfusing frozen plasma will not reduce bleeding in some situations. Targeting these situations may allow an opportunity to improve current utilization of frozen plasma.Evidence for a rationale use of frozen plasma for the treatment and prevention of bleedingAlan Tinmouth10.1016/j.transci.2012.03.019Transfusion and Apheresis Science 46, 3 (2012)2012-04-23Transfusion and Apheresis Science2012-04-23463S1473-0502(12)X0004-1Theme Section293298http://www.trasci.com/article/PIIS1473050212000729/abstract?rss=yesAbstract: Hemophilia is an X-linked bleeding disorder caused by a deficiency of factor VIII or IX activity. We will review the use of blood products, including plasma derived and recombinant coagulation factor concentrates (CFCs), and other hemostatic agents central to the management of bleeding, surgical procedures, prophylaxis and inhibitors. However, management of hemophilia is more than just giving CFCs. Attention to the physical and psychosocial health of persons with hemophilia to improve their quality of life must be the goal. These goals can best be met by comprehensive care hemophilia (bleeding disorders) clinics designed to provide clinical service and education to persons with hemophilia and their families, and to conduct research to improve hemophilia care.Hemophilia management in transfusion medicineMan-Chiu Poon, Robert Card10.1016/j.transci.2012.03.020Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Theme Section299307http://www.trasci.com/article/PIIS1473050212000730/abstract?rss=yesAbstract: Background: Octaplex®, a six factor prothrombin complex concentrate (PCC), has recently been approved for use in Canada. The optimal dose of Octaplex has yet to be established and our study was designed to monitor the efficacy of a low standard dose.Study design and methods: Patients on warfarin treatment in need of urgent reversal for bleeding, invasive procedures or surgery were given a standard dose of 40ml (1000IU FIX, 14IU/kg). We conducted a retrospective chart review of 231 patients.Results: Patients given concurrent frozen plasma (FP) for reversal were eliminated from the study. Overall, 150 patients were reviewed and divided into three groups: (1) non-CNS bleeders, (2) CNS bleeders, and (3) non-bleeders. Correction of INR to 1.5 or less was achieved to the same extent in each group. Patients with active bleeding had the least successful bleeding cessation and patients with intracranial bleeding had the most dismal outcome compared to non-intracranial bleeders.Conclusions: Our data suggests that Octaplex, when given as a low standard dose is effective at INR reversal with 76% of our patients correcting to an INR of 1.5 or less. It appears that this dose is sufficient for non-bleeding patients. Bleeding patients may benefit most from a dose increase to achieve more complete reversal and patients with intracranial bleeding should achieve more complete reversal within 2h of presentation.Prothrombin complex concentrate for the urgent reversal of warfarin. Assessment of a standard dosing protocolMiranda Wozniak, Adrian Kruit, Ruth Padmore, Antonio Giulivi, Janis Bormanis10.1016/j.transci.2012.03.021Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Theme Section309314http://www.trasci.com/article/PIIS1473050212000742/abstract?rss=yesAbstract: The most frequently encountered patients with primary immunodeficiency disease (PID) are those with antibody deficiencies. These patients require life-long immunoglobulin (IgG) replacement therapy to prevent severe and reoccurring infections. IgG is traditionally administered intravenously (IVIG) on an outpatient basis, although in some Scandinavian countries subcutaneous administration of IgG (SCIG) as home self-infusion has become the predominant mode of delivery. Compared with IVIG, SCIG therapy leads to a more physiologic IgG profile since the large variations between peak and trough levels of serum IgG are blunted by slow absorption and maintenance of closer equilibrium between intra- and extravascular compartments. SCIG therapy has been shown to be as effective as IVIG in preventing infections and has a better safety profile, with fewer systemic side effects. While local tissue reactions are common with SCIG, they are usually mild, tend to improve over time and typically do not interfere with therapy. Switching to SCIG therapy from IVIG can lead to significant improvements in health-related quality of life, appears to be more convenient for the patient, and can make it easier for the patient to travel. In those patients with difficult vascular access and intolerable side-effects with IVIG therapy, SCIG therapy may be the only treatment option. Selected patients can be expected to benefit greatly from SCIG therapy, although implementation of a successful home-treatment program requires proper education, training, and supportive care.Home therapy with subcutaneous immunoglobulins for patients with primary immunodeficiency diseasesÉlie Haddad, David Barnes, Ayman Kafal10.1016/j.transci.2012.03.022Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Theme Section315321http://www.trasci.com/article/PIIS1473050212000754/abstract?rss=yesAbstract: Hospital transfusion committees can be instrumental in ensuring appropriate blood utilization and that best practice standards are followed. In Ontario, Canada, the provincial Ministry of Health and Long-Term Care Blood Programs Coordinating Office has implemented several initiatives to support these multi-disciplinary hospital committees to fulfill their mandate. The primary goal is to improve patient safety and the secondary goal is to reinforce the importance of appropriate use of blood components and blood products. Recognizing the challenges in developing a fully functional hospital transfusion committee, several initiatives have been launched to provide educational resources and tools to achieve a successful outcome. The number of hospital transfusion committees in Ontario has increased over the past 5years. Attendance at the annual educational forum for transfusion committees continues to be high. The majority of hospitals are using the resources and tools being provided. More work is needed to achieve the success of this strategy.Building better hospital transfusion committees for OntarioW. Owens, K. Gagliardi, D. Lauzon10.1016/j.transci.2012.03.023Transfusion and Apheresis Science 46, 3 (2012)2012-04-03Transfusion and Apheresis Science2012-04-03463S1473-0502(12)X0004-1Theme Section323327http://www.trasci.com/article/PIIS1473050212000766/abstract?rss=yesAbstract: Hemovigilance systems are important programs for: monitoring trends of known risks; evaluating effectiveness of steps taken to reduce risks; providing data to support recommendations for change and guideline development; and contributing overall to the safety of transfusion. The Transfusion Transmitted Injury Surveillance System is the hemovigilance system implemented in Canada. It evolved in 1999 as a pilot program and expanded across Canada in 2005. Each province reports their adverse reactions to the transfusion of blood products and plasma proteins to the Public Health Agency of Canada (PHAC) at predetermined intervals. PHAC reconciles, summarizes the data and publishes a report approximately 2years after the data are collected. This is considered a passive reporting system but in spite of the delays, the program provides useful information to address a variety of questions. Examples include: assessing the impact of a provincial patient transfusion history registry in Québec on reporting of hemolytic transfusion reactions; identifying trends of bacterial contamination of blood products and assessing the impact of interventions on these events; and the impact of male-only plasma on the incidence of Transfusion Related Acute Lung Injury. Although hemovigilance data has been successfully used to improve blood safety, we must continue to explore ways to utilize such data to improve and implement safe transfusion practices.The Canadian Transfusion Surveillance System: What is it and how can the data be used?Julie Ditomasso, Yang Liu, Nancy M. Heddle10.1016/j.transci.2012.03.024Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Theme Section329335http://www.trasci.com/article/PIIS1473050212000778/abstract?rss=yesAbstract: Background: Although the National blood system in Canada reduces the risk of inventory shortages the possibility of a blood supply shortage still exists. The Ontario Ministry of Health and Long-Term Care developed a provincial plan to manage blood transfusion needs and inventory in the event of a National blood shortage. The Ontario plan was developed to align with the National plan as well as other provincial plans in order to ensure consistency in blood management strategies across the country. The Ontario plan was released in 2008, along with a toolkit to aid hospitals in developing their facility specific plans. In the Champlain region of Ontario, a group of 16 hospitals worked collaboratively to develop a regional blood shortage plan. A provincial blood shortage simulation exercise was held in 2010 to test out these plans.Method: The Director of Transfusion Medicine of the largest facility in the group of 16 hospitals (The Ottawa Hospital) took the lead in the development of the regional blood shortage management plan. Working groups from all 16 sites contributed to the plan development. The proposed plan was presented to the Medical Advisory Committee for approval.Results: The plan consists of activities relating to the severity of the supply shortage as defined by Amber, Red, Recovery and Green phases. The plan includes a communication plan for notifying stakeholders including patients whose treatment may be affected. Inventory management and triage guidelines are provided to reduce the demand for blood and to conserve inventory for those patients whose need is prioritized as highest. The regional blood shortage management plan was tested successfully during the provincial simulation exercise.Conclusion: Where regional hospitals work together to provide healthcare, it is beneficial to develop a standardized plan to provide guidance to hospital personnel in response to a blood supply shortage. A consistent plan will ensure patient care is provided in a consistent manner across a health region. Mock or simulation exercises can aid in testing plans and raising the awareness of stakeholders.Contingency plan implementationD. Neurath, N. Cober, W. Owens, A. Giulivi10.1016/j.transci.2012.03.025Transfusion and Apheresis Science 46, 3 (2012)2012-04-05Transfusion and Apheresis Science2012-04-05463S1473-0502(12)X0004-1Theme Section337340http://www.trasci.com/article/PIIS147305021200078X/abstract?rss=yesAbstract: In most countries whole blood transfusions have been replaced by component therapy. This has allowed for both better usage of the blood donations and better quality during storage. While this strategy was initially motivated by the commercial need for plasma the plasma reduction also reduced the levels of low grade proteases and sialidase, hence minimizing the cellular storage lesion/microvesiculation during prolonged storage. Plasma reduction also reduces transfusion reactions associated with plasma. During special military conditions, however, blood transfusion is urgently needed without corresponding access to blood components, in particular platelets. Accordingly, new focus on whole blood has aroused and added a new challenge to the blood transfusion services. This special issue of “what is happening” highlights the planed efforts by Swedish and Norwegian groups in the developments of military walking blood bank, which is applicable to civil blood services.Military walking blood bank and the civilian blood serviceOlle Berséus, Tor Hervig, Jerard Seghatchian10.1016/j.transci.2012.03.026Transfusion and Apheresis Science 46, 3 (2012)2012-04-04Transfusion and Apheresis Science2012-04-04463S1473-0502(12)X0004-1What's Happening341342http://www.trasci.com/article/PIIS1473050212000791/abstract?rss=yesAbstract: The Phase II TITAN trial is designed to assess the efficacy and safety of an anti-von Willebrand factor (vWF) Nanobody in patients with acquired thrombotic thrombocytopenic purpura (TTP). Nanobodies are a novel class of therapeutic proteins and are based on the smallest functional fragments of single-chain antibodies that occur naturally in the Camelidae family (Nanobody® and Nanobodies® are registered trademarks of Ablynx NV). With vWF implicated in the thrombotic process underlying TTP, an anti-vWF Nanobody may hold significant promise as adjunctive therapy to plasma exchange. Recruitment is currently ongoing, and aims to include a total of 110 patients from countries in Europe, the Middle East, Australia and Northern America.The TITAN trial – Assessing the efficacy and safety of an anti-von Willebrand factor Nanobody in patients with acquired thrombotic thrombocytopenic purpuraJosefin-Beate Holz10.1016/j.transci.2012.03.027Transfusion and Apheresis Science 46, 3 (2012)2012-04-04Transfusion and Apheresis Science2012-04-04463S1473-0502(12)X0004-1Clinical Trials Section343346http://www.trasci.com/article/PIIS147305021200081X/abstract?rss=yesTransfusion associated graft versus host disease (TaGVHD) is a potential complication of transfusion of any blood component containing viable T-lymphocytes when there is disparity in the histocompatibility antigens between donor and recipient. This immunological assault is manifested clinically by dysfunction of the skin, liver, gastrointestinal tract and bone marrow, seen 4–30days after transfusion. Treatment is rarely effective and death is the usual outcome . By inactivating immunologically competent cells using gamma irradiation, TaGVHD can be prevented. Guidelines exist for the use of irradiated products for specific clinical indications in order to prevent the development of TaGVHD (British Committee for Standards in Haematology Blood Transfusion Task Force, 2010). Interestingly, only one case of TaGvHD was reported to our national haemovigilance scheme since the introduction of universal leukodepletion in 1999 . No report of TaGVHD has been received since 2001 and this is despite a large number of clinical incidents every year where non-irradiated components were given in error. This implies that prestorage leukodepletion has significantly reduced, if not abolished, the risk of TaGVHD.A simple screening tool allowing a zero tolerance approach to blood transfusion requests with incomplete special requirement information following a series of incidentsA. Billen, S. Idris, M. Pooley, M.J.W. Lewin, M.W. Besser10.1016/j.transci.2012.03.029Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Letters to the Editor347348http://www.trasci.com/article/PIIS1473050212000821/abstract?rss=yesIntravenous immunoglobulin (IVIG) is a fractionated blood product consisting of concentrated immunoglobulin derived from pooled human plasma. Originally developed for use in primary immunodeficiency , its uses now encompass a number of conditions for which there are varying degrees of evidence. It is currently licensed by Health Canada for primary and secondary immunodeficiencies, allogeneic bone marrow transplantation, chronic lymphocytic leukemia (CLL), primary immune thrombocytopenia, and pediatric human immunodeficiency virus infection, however, its growing use has been primarily for off-label indications . Tripling of IVIG use in the last decade has resulted in Canada having the highest per capita use in the world .Trimming the fat with an IVIG approval processSigny Chow, Giselle Salmasi, Jeannie L. Callum, Yulia Lin10.1016/j.transci.2012.03.030Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Letters to the Editor349352http://www.trasci.com/article/PIIS1473050211001856/abstract?rss=yesI have read with great interest the interesting case report (Therapeutic plasma exchange in amitriptyline intoxication) presented by Sari et al. published in your journal . They managed a comatose case (Glasgow Coma Score=4) of amitriptyline intoxication who presented with sinus tachycardia and weak respiratory efforts. She was seizure-free and did not have hypotension, QRS widening, and/or dysrhythmias. After being intubated and performance of gastric lavage, charcoal and sodium bicarbonate infusion were administered. It seems that plasma exchange has been initiated for the patient with respiratory depression and coma as the criteria for the decision to perform exchange. After the first session of plasma exchange, her GCS increased to 14. Interestingly, the second session has been performed for the patient while she has had a GCS of 14. I have two major questions regarding the management of this patient; firstly, what was the indication for the initiation of sodium bicarbonate therapy in this patient? As you know, alkalinization and sodium loading with sodium bicarbonate along with controlled ventilation should be administered to all cyclic antidepressant overdosed patients presenting with major cardiovascular toxicity and altered mental status . This is while their patient has had no major cardiovascular toxicity. She only had a sinus tachycardia. Secondly, as I have noted, if their sole criteria for exchange was coma and respiratory depression, why would they have to re-exchange the patient when the patient had re-gained consciousness (GCS=14)? Do the authors believe that the benefit of performance of such extracorporeal technique overweighed its risk of probable complications in the similar cases? Thanks for the presentation of this interesting case.Regarding “Therapeutic plasma exchange in amitriptyline intoxication: Case report and review of the literature”Hossein Sanaei-Zadeh10.1016/j.transci.2011.10.023Transfusion and Apheresis Science 46, 3 (2012)2012-06-01Transfusion and Apheresis Science2012-06-01463S1473-0502(12)X0004-1Letters to the Editor353353http://www.trasci.com/article/PIIS1473050212000857/abstract?rss=yesUpcoming Events10.1016/j.transci.2012.03.033Transfusion and Apheresis Science 46, 3 (2012)2012-04-16Transfusion and Apheresis Science2012-04-16463S1473-0502(12)X0004-1Upcoming Events355356