EDITOR’S CHOICE


Haemovigilance and parasitology: a brief look in the current literature


Focusing on elements of content in this month’s issue of The Biomedical Scientist, Brian Nation selects a small sample of related research interest to be found in the current literature.


Haemovigilance A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment. Knutson F, Osselaer J, Pierelli L et al. Vox Sang 2015; 109 (4): 343–52.


A photochemical treatment process (PCT) utilising amotosalen and UVA light (Intercept BloodSystem) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to characterise the safety profile of Intercept-treated platelet components (PCT-PLT) administered across a broad patient population. This open-label, observational


haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 hours of transfusion and for serious adverse events (SAEs) up to seven days post-transfusion. All adverse events were assessed for severity (Grade 0–4) and causal relationship to PCT-PLT transfusion. Over the course of seven years in the


study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which two were attributed to platelet transfusion


(<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion- transmitted infection or death was attributed to the transfusion of PCT-PLT. This longitudinal haemovigilance


safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.


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Targeting of blood safety measures to affected areas with ongoing local transmission of malaria.Domanovi D, Kitchen A, Politis C et al. Transfus Med 2016 May 30. doi: 10.1111/tme.12318 (Epub ahead of print).


An outbreak of locally acquired Plasmodium vivaxmalaria in Greece started in 2009 and peaked in 2011. Targeting of blood safety measures to affected areas with ongoing transmission of malaria raised questions about how to define spatial boundaries of such an area and when to trigger any specific blood safety measures, including whether and which blood donation screening strategy to apply. In order to provide scientific advice, the


European Centre for Disease Prevention and Control (ECDC) organised expert meetings in 2013. The outcomes of these consultations are expert opinions covering spatial targeting of blood safety measures to affected areas with ongoing local transmission of malaria and blood donation screening strategy for evidence of malaria infection in these areas. Opinions could help EU national blood safety authorities in developing a preventive strategy during malaria outbreaks.


Improving platelet transfusion safety: biomedical and technical considerations. Garraud O, Cognasse F, Tissot JD et al. Blood Transfus 2016; 14 (2):109–22.


Platelet concentrates account for nearly 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related to patients themselves, who may be particularly at risk of side-effects because of their underlying illness, there are aspects of platelet collection and storage that predispose to adverse events. Platelets for transfusion are strongly


activated by collection through disposal equipment, which can stress the cells, and by preservation at 22˚C with rotation or rocking, which likewise leads to platelet activation, perhaps more so than storage at 4˚C. Lastly, platelets constitutively


possess a very large number of bioactive components that may elicit pro- inflammatory reactions when infused into a patient. The review aims to describe approaches


that may be crucial to minimising side- effects while optimising safety and quality. The authors suggest that platelet transfusion is complex, in part because of the complexity of the ‘material’ itself: platelets are highly versatile cells and the transfusion process adds a myriad of variables that present many challenges for preserving basal platelet function and preventing dysfunctional activation of the platelets. The review also presents information


showing, after years of exhaustive haemovigilance, that whole blood buffy coat pooled platelet components are extremely safe compared to the gold standard (ie apheresis platelet components), both in terms of acquired infections and of immunological/inflammatory hazards.


Relative impact of a patient blood management program on utilization of all three major blood components. Thakkar RN, Lee KH, Ness PM et al. Transfusion 2016. Jul 6. doi: 10.1111/trf.13718 (Epub ahead of print).


Although patient blood management (PBM) programmes clearly reduce transfusion overuse, the relative impact on red blood cell (RBC), plasma and platelet (PLT) utilisation is unclear. A retrospective analysis of electronic


records was conducted at a medium-sized academic hospital to assess blood utilisation for all in-patients admitted during one-year periods before (n=20,531) and after (n=19,477) PBM efforts began in September 2014. Transfusion guideline compliance and overall utilisation were assessed for RBCs, plasma and PLTs. The primary PBM efforts included education on evidence-based transfusion guidelines, decision support in the computerised provider order entry system, and distribution of provider-specific reports showing comparison to peers for guideline compliance. Cost avoidance was determined by two methods (acquisition cost and activity-based cost), and clinical outcomes were compared during the two periods.


AUGUST 2016 THE BIOMEDICAL SCIENTIST


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