bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal screening
Authors: de Haas M. , van der Schoot E.
Published: May 2013

In most countries, pregnant women are early in pregnancy typed for ABO and RhD and screened for the presence of red cell antibodies. Maternal red cell alloantibodies of IgG class are actively transported by the placenta to the fetus and destruct the fetal red cells, if these carry the involved antigen leading to haemolytic disease of the fetus and newborn, HDFN. HDFN is a disease which –if untreated– can cause perinatal mortality and morbidity, with a substantial risk for long‐term sequelae. In most cases of HDFN, alloimmunization against the RhD antigen is involved, although introduction of anti‐D immunoglobulin (Ig) prophylaxis drastically decreased anti‐D‐mediated HDFN. In the last decade, non‐invasive fetal genotyping, with cell‐free fetal DNA present in maternal plasma, for RhD, RhC, Rhc, RhE and K became a diagnostic reality. In a few countries non‐invasive fetal RhD genotyping has already been implemented to target antenatal and postnatal anti‐D Ig prophylaxis to RhD‐negative women carrying RhD‐positive fetuses. Both applications of non‐invasive fetal genotyping are summarized in this article.
Use of genomics for decision‐making in transfusion medicine: laboratory practice
Authors: Peyrard T.
Published: May 2013

Blood group antigens are classically tested through haemagglutination techniques, which show limitations that may be overcome by genomics. Numerous techniques are available for RBC genotyping, including high‐throughput devices based on microarray DNA‐chips or mass spectrometry technologies. This article aims to give an overview of the major indications of molecular testing in the immunohaematology reference laboratory, which can be summarized as follows: blood typing in recently transfused patients; prediction of blood types in patients and donors when antisera are in short supply or unavailable; blood typing in patients with a positive direct antiglobulin test; manufacturing of RBC antibody identification panels; detection of weakly expressed RBC antigens in blood donors; distinction between auto and alloantibodies; investigation of blood type discrepancies; mass screening for rare donors. Despite the limitations of DNA analysis under certain circumstances, genomics has now become a routine and essential adjunct tool to complex serological case solving in most immunohaematology reference laboratories, and is now fully considered part of the decision‐making process in transfusion medicine.
Management of complaints and product recall
Authors: Vuk T.
Published: May 2013

In the last decades, transfusion medicine has been characterized by dynamic development that resulted in considerable improvement of the quality and safety of its products and services. Unfortunately, not all risks are predictable, whereas some remain unpreventable, mainly because of the biological origin of these products, but also due to errors. Therefore, management of complaints and product recall are important segments of the quality management system. While customer complaints point to the possible drawbacks, nonconformities and failures that were unnoticed prior to the product or service issuing, product recall is aimed at preventing their unfavourable consequences. The management of complaints and product recall are well regulated by legal provisions in transfusion medicine and incorporated in the standards of quality management, professional standards and recommendations.
Defining the clinical need for rare red blood cells
Authors: Yahalom V.
Published: May 2013

Transfusion support of patients with antibodies against high frequency (HF) antigens or a combination of antibodies that is rare is challenging and requires multidisciplinary cooperation.

The treating physician should decide if there is a definitive clinical need for red blood cell (RBC) transfusion for the specific patient. According to recent clinical trials RBC transfusion is usually not indicated if the patient is haemodynamically stable and the haemoglobin (Hb) is higher than 7 g/dl. Alternative strategies for patient support might be required if rare blood is unavailable or while awaiting rare RBC unit arrival from national or international sources.
Global definitions of rare donors
Authors: Nance S. T.
Published: May 2013

Background

A basic definition of a rare donor unit is that unit not available for the patient at the time of the transfusion need. However, there are some patients who required exquisitely phenotyped, even genotyped units, for optimal survival of transfused red cells. Often, the rare phenotyped unit needed is negative for an antigen of high prevalence, sometimes the type is less than one in 10 000 donors tested or even rarer. Further complications arise with consideration of ABO/Rh type or the concomitant presence of antibodies to common antigens. Another type of rare unit is one that is negative for multiple common antigens, which in combination make the donor difficult to find.

Aims

The availability of rare donor phenotypes or genotypes can vary amongst countries, but some types, e.g. Rhnull, are difficult to provide in nearly every country. The need for an organized approach to managing rare donor information was recognized long ago, with the ISBT establishing the concept of an International Rare Donor Panel (IRDP) in 19653. In 1968, the IRDP had 300 donors listed from 10 countries. In 1985, 500 donors from 22 countries were listed, and in 1991, 3000 donors. In 1998, 4000 donors from 24 countries were listed. The ISBT Working Party on Rare Donors member countries supports the continued replenishment of rare donors and provision of their units world‐ wide by continuing to identify and submit donors to the IRDP. The aim is to ensure rare blood units are available internationally when needed.

Method

The ISBT Working Party on Rare Donors presented data specific to their country at the 2012 Congress Working Party meeting on the topic of: What are the most difficult phenotypes to find?

Results

Identifying donors with rare types is important for provision of blood for patients with complex antibody challenges. From the international perspective of the Working Party Members, the most difficult to provide is Rhnull, listed by 11 of 17 reporting countries (65%). D– – was listed by seven countries at 41%. Ko and U‐ were listed by 6 at 35% and Di(b‐), Ge‐, Hr/HrB‐, Lan‐ at 21%. The complete data is listed in Vox Sanguinis Science Series publication from this Regional Congress. From an international perspective, if there were more donors of these types, more patients could receive the treatments they need. While massive screening might be one way to find rare donors, it may be more effective to track the sibling of patients with rare types, and engage all that are found to be rare types to be blood donors.

Each country's rarest types should be known to all blood centers. When a patient needing this type is identified, it will be known that there might be delays or challenges in getting the blood.

The ISBT Working Party on Rare Donors works to ensure that all countries with rare donor activities have their donors listed on the IRDP, so that rare blood units are available internationally.
Donor selection for recipient safety
Authors: Goldman M.
Published: May 2013

Before the introduction of testing for transfusion transmissible agents, donor selection criteria made a critical contribution to recipient safety. Currently, for some pathogens, screening questions alone identify donors at risk, whereas for others, questions identify an at‐risk population that will undergo selective testing. For many pathogens, such as HIV, HBV and HCV, universal donor testing is done, but deferral criteria developed in the pretesting era are still in place. Ideally, the steps in the donor selection process and specific donor criteria should be evidence based, to avoid deferral of safe donors. Although obtaining evidence to assess criteria is challenging, several approaches have been taken to evaluate actual or potential changes to criteria. The donor selection process and specific criteria should be reassessed over time, as donor testing and pathogen reduction make increasingly important contributions to blood safety.
Blood Supply Management: Experience and recommendations from Australia
Authors: Caulfield J.
Published: May 2013

Background

This paper provides an overview of the Australian experience of Blood Supply Management (BSM), through analysis of each of the five steps of BSM as agreed by the ISBT BSM working group. The steps are as follows:

Assess past hospital Red Blood Cell (RBC) use for patients.

Establish Forecast for overall annual supply for Blood Establishments (BEs) and use (for hospitals).

BEs: Establish annual Blood Collection/Donor base/Supply Programme.

Weekly balancing Whole Blood (WB)/RBC use (demand) and supply in BE(s)/RBC supplier(s) and Hospitals.

Assessing and updating the patients' RBC needs and their satisfaction (self‐sufficiency/partial sufficiency/oversufficiency) from Voluntary Non Remunerated Blood Donors (VNRBD) (%).

Successes and challenges associated with this approach in the Australian context are outlined.

Results

Implementation of the Sales and Operations Planning (S&OP) framework has been key to improving BSM. S&OP provides a comprehensive continuous improvement approach to BSM that is embedded in Blood Service processes. The positive results are evident in key metrics:

8% increase in order fulfillment in the last 3 years;

Increasing productivity;

Decreasing capital investment requirements;

Decreased supply volatility;

Decreased product wastage; and

Improved efficiency.

Challenges for BSM in Australia include:

Logistics challenges posed by the geographically sparse Australian population;

Disproportionately high demand for Rhesus negative red cells comparative to the Rhesus negative members of the Australian population, requiring a donor panel that is not representative of blood type population distribution;

The time lag between a decision to take corrective action (in the form of marketing, public relations and call centre activity) by the Inventory Response Team and the observed improvement in inventory levels; and

Inability to import components from overseas, except for rare phenotypes.

Conclusion

The introduction of S&OP at the Blood Service has resulted in significant BSM improvements, including more accurate demand and supply forecasting and resulting improvements in productivity, order fulfillment, product wastage and overall efficiency.
Blood supply management – experience and recommendations from Africa
Authors: Mpuntsha L. , Reddy R.
Published: May 2013

The background is the need to understand the challenges of achieving sufficient blood supply in Africa. The aim is to show that a lot can be achieved with good systems and adequate resources applied.

The Materials & Methods is reporting on the blood supply data systems used to analyse and manage blood collection and distribution in SANBS. The results show that with use of data a good system can be developed. The conclusion reflects the need to share information accross Africa.
Update on pathogen reduction technology
Authors: Custer B.
Published: May 2013

Background

The development and adoption of pathogen reduction technology (PRT) continues. The ability to reduce transmission of a broad range of infectious and non‐infectious threats remains the primary reason PRT is attractive.

Aim

The objective of this update is to review recent findings in the development of the three most widely available PRT methods for labile blood components.

Methods

The update uses important recent publications to bring to attention new findings, current clinical studies being conducted and data from routine use in countries where regulatory approval has been obtained.

Results

TerumoBCT Mirasol™ – Recent clinical research on Mirasol‐treated platelets and plasma PRT has focused on studies that quantify the performance of white blood cell inactivation, with strong evidence of advantages over gamma irradiation. Published research on whole blood PRT currently in development provides evidence of pathogen reduction, white cell inactivation and reduction in antigen expression. Mirasol‐treated platelets are in routine use in 18 countries and plasma in routine use in 11 countries.

Macopharma Theraflex™ – Initial success in developing a novel procedure that uses short‐wave ultraviolet light (UVC) without addition of a photoactive chemical to treat platelets has been reported and is currently being evaluated for safety and efficacy. Based on haemovigilance data for methylene blue (MB)‐treated plasma, a significantly higher incidence of severe allergic reactions or other adverse events in comparison with other fresh frozen plasma types could not be confirmed. Theraflex MB‐treated plasma is in routine use in 15 countries.

Cerus Intercept™ – Efforts to understand the impact of Intercept‐treated platelets based on proteomic analyses have been reported, and the overall interpretation of proteomic findings is that although some minor changes are evident, there is no indication or evidence for a potential clinical concern for transfusion recipients. Other areas of active research focus on the inactivation of RBC concentrates using the second generation treatment process with S‐303. Intercept‐treated platelets are in routine use in 21 countries and plasma in routine use in 12 countries.

Conclusion

Both controlled clinical studies and post‐marketing surveillance are necessary to further establish the safety and effectiveness of each PRT method. Recent evidence does not suggest an obvious safety threat for any of the current PRT methods in routine use. The relative value in terms of patient health and health economics, including cost‐utility, of these methods in terms of health gains achieved by PRT remain insufficiently studied.
Application validation versus infrastructure qualification
Authors: Hulleman R.
Published: May 2013

An often used method for application validation is the “black box” approach. The functionality or application is tested against predefined protocols and the results are compared to also predefined expected results. The underlying infrastructure is automatically validated in combination with the application.

Audit Authorities and GMP regulations (Annex 11, GAMP) ask for a Qualified Infrastructure nowadays.

An IT infrastructure is a complex system of IT components working together to enable the user to “use the applications” that run on it.

To qualify an infrastructure the infrastructure has to be split up in parts; the “infrastructure components”. The process of building and changing these components has to follow strict Quality requirements.
Transformation of evidence to knowledge: a neglected task within the medical profession
Authors: Steurer J.
Published: May 2013

A common and far‐reaching fallacy among physicians is to believe that the terms evidence and knowledge mean the same thing. Evidence means the result(s) of research, whereas knowledge stands for “true justifiable belief.” This difference becomes obvious when we take a look at the results from different studies on the same issue. Results of studies on the same issue sometimes vary considerably and make it difficult for the physician to know which results are relevant for the patient sitting or lying in front of him. Two examples for illustration; within the last ten years about 600 studies evaluating the diagnostic accuracy of D‐Dimer in the diagnosis of venous thrombosis have been published and the values for the sensitivity of the test varies between 70% and 98%. Trial results reporting the effect of steroids on survival in patients with septic shock differ between no effect at all and a significant reduction of mortality. Which of these results should physicians trust?

As a consequence the transformation of evidence to knowledge, including the handling of varying and partially contradictory results, could and should be one of the main tasks of academic medicine. The transformation of evidence to knowledge makes the results from research applicable to daily practice.

An attempt to accomplish this demand is to synthesize the results of various primary studies in systematic reviews with meta‐analyses. The efforts of the Cochrane Collaboration can be mentioned favorably, but some reservations against the assembly line like production of systematic reviews are justified. It is not understandable why primary studies of low methodological quality, rated as such by the reviewers, are still included in systematic reviews. Further, the concern that results from studies with very different patient populations are pooled in systematic reviews pertains.

Two approaches to generate medical knowledge that is helpful for physicians will be presented in the lecture for further discussion; the broader utilization of consensus methods, and the derivation of probability functions. Medical knowledge can be defined as “shared experts belief” and consensus methods (Delphi technique and others) are appropriate to specify these beliefs. Beside consensus a valuable result of a carefully performed consensus process is the precise specification where and why disagreement remains. The ideal form of medical knowledge is a comprehensive set of probability functions, for the diagnostic, the prognostic and the etiognostic domain. These probability functions, stored in cyberspace can be used to calculate the probabilities about the presence of an illness, the future course of an illness and the etiology of an illness. Such probability functions can be derived from harvesting experts' knowledge – the quasi scientific method –, or from patient data – the scientific method. The emerging opportunities in computational science and information technology will make the dream – a comprehensive set of probability functions – to become reality.
The evidence base for red blood cell transfusions
Authors: Carson J. L. , Carless P.
Published: May 2013

Millions of units of red blood cells are transfused throughout the world. A systematic review of the literature as of 2011 identified 19 randomized clinical trials in 6264 patients evaluating transfusion thresholds. A restrictive transfusion strategy was associated with 39% fewer transfusions and a non significant lower 30 mortality; relative risk 0.85, 95% confidence intervals 0.70–1.03. A restrictive transfusion strategy is preferable in most patients but requires trial in patients with acute coronary syndrome.
Cord blood banking in Europe and worldwide: factors of organization and sustainability
Authors: Bart T.
Published: May 2013

Background

In the public sector, currently almost 600,000 cord blood units (CBU's) in over 150 public cord blood banks (CBB's), and an estimated 1,000,000 CBU's is stored in over 200 private CBB's.

Aims & Methods

An overview on current international state of public and private CB Banking including an outlook on different concepts of hybrid banking (public and private CB Banking combined) is given. Possible factors influencing financial sustainability and economic viability of CB Banks, i.e. cell count TNC, and HLA haplotype distribution) are taken into consideration.

Conclusions

Banking CBU's with predominantly high TNC figures is one way to improve the business model of a public CB Bank, with regard to the establishment of financially sustainable operations. Current recruitment practices of storing low TNC count CBU's with rare HLA haplotypes for the sake of HLA diversity should be carefully scrutinized in this context.
Anthony Nolan: experiences with recruiting 16‐ and 17‐year olds as blood stem cell donors
Authors: O'Leary A.
Published: May 2013

Background

On 1 October 2012 Anthony Nolan launched a new donor recruitment policy allowing only those aged 16–30 to join the registry.

Aims

The anticipated benefits were: (1) Providing more potentially life‐saving transplants from younger donors. (2) Gradually lowering the average age of the registry, thereby providing more opportunities for potential donors to come up as a match. (3) Focusing our valuable resources on recruiting those who are most likely to be selected to donate.

Methods

To ensure a smooth changeover from the previous joining policy a programme of work took place to: (1) Prepare all documentation. (2) Revisit our donor recruitment strategy. (3) Develop a plan to communicate the change to staff, the public and key stakeholders. (4) Amend existing and prepare new communications and materials. The change was implemented on 1 October 2012 and launched with a national press release, a donor recruitment event at a post‐16 education centre and much activity on social media.

Results

Recruitment events There was concern that the recruitment rate may decrease due to the new joining policy. Though the number of large‐scale patient appeals, we have counteracted this by focusing our efforts on younger donors. Recruitment predictions have been surpassed for this period. Online The impact of the publicity surrounding the policy change was reflected immediately in activity on our website, with more than 1,000 people applying to join the registry in the first week. The weekly average previously was around 350. Social Media Social media played a key role in communicating the policy change to our target audiences. Twitter and Facebook were essential in engaging current supporters to back the change in policy and help to promote it to new audiences. On one day of high volume recruitment in January 2013, 57% of people who applied online stated that they heard about the registry through social media.

Summary / Conclusions

We are committed to engaging with younger audiences in order to recruit younger donors and improve the quality of the registry. Already the average age of those joining the registry has reduced to 21 and we know that recruiting younger donors will help us to offer the best chance of life to patients in need of a transplant.
DEHP plasticizer and blood bags: challenges ahead
Authors: Lozano M. , Cid J.
Published: May 2013

The invention of the plastic container represented a major advance in haemotherapy that opened the door to blood component preparation and transfusion. Later, it was found that the plasticizer di‐2‐ethylhexyl‐phthalate (DEHP) used in combination with polyvinylchloride (PVC), leached to the blood component contained in the plastic bag and that in the case of the red blood cells, stabilized the membrane allowing the extension of storage up to 49 days, depending on the additive solution used. This extraction of the plasticizer to the components provokes that not only the recipients of transfusions are exposed to significant levels of DEHP but also plasma and platelet apheresis donors are exposed. Although clear‐cut human toxicity has not been identified, for some the precautionary principle should be evoked and in front of the current available data, particularly in neonates and children, only DEHP‐free disposable should be used in bags containing blood components for transfusion. For platelets this has already been accomplished for most of the containers and for plasma it should not be a problem to attain it. However, for the most often transfused blood component, red blood cells concentrates, continues to be an unresolved challenge, although in recent years some new plasticizers appear to be promising safer alternatives.
Stem cell originated red blood cell cultures: status quo and outlook
Authors: Mazurier C. , Douay L.
Published: May 2013

The present paper reports the various obstacles cleared during the past decade with the view of generating red blood cells in vitro from various sources of stem cells, for transfusion purposes. We also consider the next developments to be performed for achieving this goal. Starting from the natural source, the haematopoietic stem cells, the major advance resides in the establishment of the proof of principle for transfusion in human, by showing a normal life span of cultured Red blood cells compared to their native counterpart. The best available source of highly proliferative adult stem cells is cord blood, with the capacity of generating the equivalent of 100 units of packed RBC from one average unit. It is, however, a limited source in terms of haematopoietic stem cells and remains dependent on donations as observed from conventional blood supply. Critical advances have allowed the in vitro production of functional RBC from pluripotent human stem cells, embryonic and induced pluripotent stem cells, in the past 5 years. Because induced pluripotent stem cells (iPS) can proliferate indefinitely and be selected for a phenotype of interest, they appear the most favourable source of stem cells. Proof of concept of the generation of RBC from iPS has been made, but still needs to be optimized. We also discuss the key points that remain to be resolved to achieve an application for clinical transfusion. Several crucial points remain to be resolved notably to ensure the safety of iPS of clinical grade, the optimization of the erythrocyte differentiation and cellular amplification, and finally, the definition of GMP conditions for industrial production.
Dealing with donor issues in therapeutic cell donation
Authors: Buser A. , Halter J.
Published: May 2013

The number of allogeneic stem cell transplantations increases annually and hence does the need for therapeutic cell donations in parallel. These donation procedures harbour immediate, short‐term and late adverse reactions. Most of these events are mild to moderate; however, fatalities have been reported. Avoiding as many adverse events as possible is paramount. Donor follow up as proposed by the Worldwide Network for Blood and Marrow Transplantation and the development of donor eligibility criteria for all donors are important measures to better understand the risk of therapeutic cell donation and to increase donor safety.
Harnessing CD1d‐restricted iNKT cells to design novel vaccination strategies
Authors: Salio M. , Cerundolo V.
Published: May 2013

The success of vaccination strategies depends on the efficient generation of appropriate antigen‐specific T‐ and B‐cell responses. The unique position of invariant natural killer T (iNKT) cells at the interface of the innate and adaptive immune systems and their ability to direct the maturation of dendritic cells and B cells offer the possibility of harnessing them to ‘jump‐start’ the antigen‐specific immune response to both microbial pathogen and tumour antigens. In this brief review, the biology and activation of iNKT cells is discussed, with particular emphasis on the development of pharmacological agents to be used as adjuvants to antigenic proteins, to achieve an iNKT cell‐dependent augmentation of antigen‐specific T‐ and B‐cell responses. In addition, we discuss the future directions and challenges in translating these findings from experimental data obtained in mice to use in the clinic.
The mechanisms of action of IVIG in autoimmune and inflammatory diseases
Authors: Patil V. , Kaveri S. V.
Published: May 2013

Human intravenous immunoglobulin (IVIg) is constituted by pooled immunoglobulin (IgG) from several thousand healthy donors. IVIg consists of antibodies to external antigens and naturally occurring autoantibodies (NAbs) with germline or close to germline configurations. The NAbs are independent of deliberate immunization with cognate antigens. It is well established that NAbs play an important role in maintaining tissue and immune homeostasis. It is therefore logical to attribute the therapeutic beneficial effects of IVIg to NAbs. Apart from immunodeficiency conditions, IVIg is indicated for the treatment of a variety of autoimmune and inflammatory conditions. Despite its use in a wide range of autoimmune and inflammatory conditions, the mechanisms underlying the beneficial effects have not been fully elucidated. Understanding the mechanisms by which IVIg operates under different clinical settings is of critical significance. In this review, we summarize the current status of the mechanisms of action of IVIg in autoimmunity and the recent advances in IVIg therapy.
Metagenomics in virus discovery
Authors: Jazaeri Farsani S. M. , Oude Munnink B. B. , Deijs M. , Canuti M. , van der Hoek L.
Published: May 2013

Virus infections are a continuous threat to the human population. Apart from infections with known viruses, there is a world of yet unknown viruses which may cause new emerging diseases, or cause known infectious diseases. Discovery of unknown viruses requires serious efforts since there is no universal viral genomic sequence to amplify an unknown viral genome, as is the case for bacteria for which 16S rRNA sequences can be used. In the last decennium, next generation sequencing allowed new approaches for virus discovery. Our virus discovery method is based on cDNA‐AFLP (AFLP: Amplified Fragment Length Polymorphism) combined with next generation sequencing techniques (VIDISCA‐454). The method supplies thousands of sequence reads with which any RNA or DNA virus in patient samples can be detected.
Clinical trials on platelet transfusion: successes and failures
Authors: Heddle N. M.
Published: May 2013

Platelet transfusions are a commonly used medical therapy to prevent bleeding (prophylactic use), or to treat patients who are actively bleeding (therapeutic use). The most frequent use of prophylactic platelet transfusions occurs in patients with chemotherapy induced thrombocytopenia, although prophylactic platelet transfusions are also used in other thrombocytopenic patient populations prior to a surgical intervention. Therapeutic platelet transfusions used by many different patient populations with acute hemorrhage including: medical and surgical patients; trauma patients, patients with intraventricular hemorrhage and gastrointestinal bleeds. Randomized controlled trials designed to determine the optimal trigger, optimal dose, efficacy of a therapeutic only platelet transfusion strategy, and efficacy of pathogen reduced platelets have contributed to an evidence based approach for platelet transfusions over the past 15 years. Although we have learned a lot from these clinical trials, generalizability is limited with most trials have been conducted in adults with chemotherapy induced thrombocytopenia. There is a paucity of evidence to inform transfusion therapy in other patient populations. Methodological challenges associated with many of these studies have hampered the overall acceptance of the results; hence, knowledge uptake has been slow raising the question: why evidence based platelet transfusion changes occur so slowing even when RCT data are available? The answer to this question is complex but may include: research design limitations; the lack of generalizability of data from hematology/oncology patients to other patient populations; and, methodological limitations including clinical relevance and/or challenges with measuring the outcome.

Information generated through clinical research related to platelet transfusion has provided some guidance to inform the practice of evidence based platelet transfusion therapy; however, along that path we have also recognized the flaws and limitations of the clinical research methodology used which has limited practice change. The question for transfusion researchers today is –how do we move forward from here to ensure that research resources are best spent to inform evidence based practices that will benefit our patients? In this presentation what we know about evidence based transfusion practices will be reviewed with emphasis on the potential limitations associated with clinical research as explanations for the lack of practice change. Activities underway to overcome some of these limitations will also be discussed.
Challenges for developing sustainable blood transfusion services in the Caribbean
Authors: Duits A. J.
Published: May 2013

Blood transfusion services are an essential part of health care. Timely availability of safe blood is a major challenge in developing countries. The Caribbean region faces interesting challenges in achieving a sustainable blood transfusion program. Several key issues need to be addressed in order to achieve a sustainable program. The use of replacement donors is widely spread with achieving complete coverage by non‐remunerated voluntary donors still far away. With support of external agencies several important documents and training efforts have been produced. However it should be mentioned that economies of scale, resources and local culture still provide major challenges for achieving the goals set by the different countries in the region as mentioned in their regional plan of action.

Interestingly these efforts have also provided a unique compilation of relevant data for the Caribbean region. These data provide information on the situation in all the countries regarding essential/key areas needed to be addressed like national programs, self sufficiency, regulations and legislation, quality systems and human resources. Special attention is given to development of a reliable hemovigilance system.

Further governmental commitment, improvement of horizontal collaboration and continued support by external agencies like the PAHO, WHO and AABB is necessary to achieve sustainability of quality blood transfusion services.
Blood collection and donor motivation in Germany
Authors: Weidmann C. , Klüter H.
Published: May 2013

Altruism is often reported by repeat donors to be their major motivation. It is, however, unclear whether altruism is relevant for both non‐remunerated and remunerated blood donors. To describe donor motivation of non‐remunerated and remunerated German first‐time donors as well as donor return, we conducted a retrospective analysis of two donor surveys of 3,077 non‐remunerated and 738 remunerated first‐time donors. We compared sociodemographic characteristics (age, sex, education) and self‐reported motivation of remunerated and non‐remunerated blood donors. Finally, the proportion of active donors among non‐remunerated and remunerated donors after two years and after four years was calculated. Both remunerated and non‐remunerated donors mentioned that they initially were activated by the intention to help others. Over half of the remunerated donors further reported that the remuneration was important or very important for their first donation. In the twenty‐four months following the initial donation, remunerated donors were more likely to return for further donation. The long‐term commitment, however, appears to be higher among non‐remunerated first‐time donors. Blood donor recruiting campaigns should therefore continue to appeal to altruism to recruit first‐time donors that are likely to donate on a routine basis.
Molecular DNA‐based testing for blood group antigens: recipient–donor focus
Authors: Westhoff C. M.
Published: May 2013

DNA‐based testing for blood group antigens has become commonplace in a number of clinical situations to improve transfusion therapy for blood transfusion recipients. These include typing for antigens in patients who are multiply transfused to determine which blood group antibodies may be present, typing when the red blood cells (RBCs) are coated with immunoglobulin, and typing for uncommon antigens, especially when no serologic reagent is available. Other clinical applications include resolving ABO typing discrepancies for patients awaiting transplant, or determination of the original type of a bone marrow transplant recipient, or confirmation of an ABO subgroup in a kidney donor. Testing for the specific mutation associated with depressed Kell system antigens in McLeod syndrome may also have value because different mutations appear to be associated with prognosis.

Applications in prenatal medicine include discrimination between weak D and partial D to determine if a pregnant woman is a candidate for Rh immune prophylaxis, and assessing the risk for hemolytic disease of the fetus or newborn and neonatal thrombocytopenia. Assessing risk includes testing the paternal sample for the target antigen, and if positive testing for gene copy number (zygosity) and testing the fetus from amniocentesis or non‐invasive maternal plasma sample.

Donor centers are now able to screen large numbers of donors to label antigen‐negative RBC products. DNA typing will change transfusion practice by allowing patients facing chronic transfusion therapy to have a more comprehensive blood group antigen profile performed, and to receive donor units antigen‐matched for more than ABO and RhD to reduce alloimmunization. A patient who makes an alloantibody to a RBC antigen is forever at risk for his or her lifetime; for a serious transfusion reaction if ever requiring transfusion in an emergency, and also for a high risk pregnancy if a woman of child bearing age. Prevention of alloimmunization is an important advance in transfusion safety and is now possible with electronic patient medical records and testing and labeling of blood products for additional blood group antigens.
The cellular pathophysiology of immune thrombocytopenia
Authors: Semple J. W.
Published: May 2013

Background

Immune thrombocytopenia (ITP) is a bleeding disorder with circulating platelet counts of <100 9 109/l, in the absence of any other resultant cause or disorder. This disease is primarily mediated by two major immune mechanisms. The predominant response occurs when immunoglobulin G (IgG) autoantibodies are produced against platelet self‐antigens resulting in platelet opsonization and increased Fc‐receptor‐mediated phagocytosis and destruction by macrophages within the spleen. In addition, these IgG autoantibodies can also mediate megakaryocyte inhibition/destruction within the bone marrow. The second immune response concerns T‐cell‐mediated platelet destruction in the periphery and megakaryocyte destruction/inhibition in the bone marrow. One or both of these mechanisms of immune mediated thrombocytopenia may lead to reduced levels of platelets.

Results

It appears that ITP is associated with many varied defects at the level of antigen presenting cells, T cells and B cells. The primary defect in active disease appears to be an expansion of pro‐inflammatory Th17 cells with a concomitant deficiency in T and B regulatory cells.

Conclusion

This article will summarize the role of cellular autoreactive mechanisms associated with ITP to gain a greater understanding of the pathophysiology of this autoimmune bleeding disorder.
Haemoglobinopathies: genetic and clinical aspects with an impact on blood transfusion
Authors: Politis C.
Published: May 2013

The haemoglobinopathies are autosomal recessive genetic disorders resulting in qualitative or quantitative change in the haemoglobin (Hb) molecule. HbS, the most widespread structural haemoglobin variant, hinders microcirculation by causing a sickle shape of red cells. In sickle cell disease, blood transfusion should be done only for strict indications. In thalassaemias, Hb synthesis is impeded by defective production of globin chains. The commonest types of clinical importance are α‐, βδ‐ and β‐thalassaemia. Compound heterozygotes for thalassaemia and Hb variants may have varying clinical impact.

Morbidity is related to the anaemia, complications of blood transfusions including iron overload and transfusion transmissible infections, and splenectomy.

Treatment of homozygous β‐thalassaemia is based on regular blood transfusion from early childhood, placing a major workload for blood transfusion services. Stringent quality measures are necessary to ensure that the transfused product meets requirements.

Greece's national registry records 4,506 thalassaemia major and intermedia, “Η” haemoglobinopathy and sickle cell disease patients. Thalassaemia patients consume 18% of total RBC supply. Incidence of transfusion associated adverse reactions is 250:100 000 units of RBCs. Allergic (87.6:100 000) and NHFTR (89.9:100 000) are most common. One sickle thalassaemia patient died of hyperhaemolysis syndrome. Eight patients died of HCV hepatocellular carcinoma. HIV was transmitted to one patient during the window period.
CANINE MENINGEAL DISEASE: ASSOCIATIONS BETWEEN MAGNETIC RESONANCE IMAGING SIGNS AND HISTOLOGIC FINDINGS
Authors: Keenihan E.K. , Summers B.A. , David F.H. , Lamb C.R.
Published: May 2013

In order to compare the accuracy of MR sequences for diagnosis of meningeal disease, MR images of the brain, and histopathologic specimens including the meninges of 60 dogs were reviewed retrospectively by independent observers in a cross‐sectional study. MR images included T1‐weighted pre‐ and postgadolinium images, subtraction images, T2‐weighted images, and T2‐weighted fluid‐attenuated inversion‐recovery (FLAIR) images. Pathologic changes affected the pachymeninges in 16 dogs, leptomeninges in 35 dogs, and brain in 38 dogs. The meninges were normal in 12 dogs. Meninges were classified histopathologically as normal (grade 0), slightly or inconsistently affected (grade 1), or markedly affected (grade 2). When applying relaxed pathologic criteria (grades 0 and 1 considered normal), the results of ROC analysis (area under curve, AUC) were: T1‐weighted postcontrast images 0.74; subtraction images 0.7; T2‐weighted images 0.68; FLAIR images 0.56. The difference in AUC between T1‐weighted postgadolinium images and FLAIR images was significant (P = 0.04). AUC for FLAIR images was not significantly different from 0.5. When applying strict pathologic criteria (only grade 0 considered normal), none of the MR sequences had AUC significantly different from 0.5. On the basis of T1‐weighted postgadolinium images and subtraction images, correct anatomic classification of lesions occurred more often for pachymeningeal than leptomeningeal lesions (P < 0.001). Overall, MR imaging had low sensitivity for diagnosis of meningeal pathology in dogs, particularly for changes affecting the leptomeninges. Subtraction images had similar accuracy to T1‐weighted postgadolinium images for meningeal lesions in dogs. T2‐weighted FLAIR images appear to have limited diagnostic utility for meningeal lesions.
Investigation of Low Temperature Combustion Regimes of Biodiesel With N-Butanol Injected in the Intake Manifold of a Compression Ignition Engine
Authors: Soloiu Valentin , Duggan Marvin , Ochieng Henry , Williams David , Molina Gustavo , Vlcek Brian
Published: May 2013

In this study, the in-cylinder soot and NOx trade off was investigated in a compression engine by implementing premixed charge compression ignition (PCCI) coupled with low temperature combustion (LTC) for selected regimes of 1–3 bars IMEP. In order to achieve that, an omnivorous (multifuel) single cylinder diesel engine was developed by injecting n-butanol in the intake port while being fueled with biodiesel by direct injection in the combustion chamber. By applying this methodology, the in-cylinder pressure decreased by 25% and peak pressure was delayed in the power stroke by about 8 CAD for the cycles in which the n-butanol was injected in the intake manifold at the engine speed of 800 rpm and low engine loads, corresponding to 1–3 bars IMEP. Compared with the baseline taken with ultra-low sulfur diesel no. 2 (USLD#2), the heat release presented a more complex shape. t 1–2 bars IMEP, the premixed charge stage of the combustion totally disappeared and a prolonged diffusion stage was found instead. At 3 bars IMEP, an early low temperature heat release was present that started 6 deg (1.25 ms) earlier than the diesel reference heat release with a peak at 350 CAD corresponding to 1200 K. Heat losses from radiation of burned gas in the combustion chamber decreased by 10–50% while the soot emissions showed a significant decrease of about 98%, concomitantly with a 98% NOx reduction at 1 IMEP, and 77% at 3 IMEP, by controlling the combustion phases. Gaseous emissions were measured using an AVL SESAM FTIR and showed that there were high increases in CO, HC and NMHC emissions as a result of PCCI/LTC strategy; nevertheless, the technology is still under development. The results of this work indicate that n-butanol an be a very promising fuel alternative including for LTC regimes.
Wind Turbine Condition and Power Quality Monitoring by the Approach of Fast Individual Harmonic Extraction
Authors: Yang Wenxian , Ng Chong H. , Jiang Jiesheng
Published: May 2013

Increasing deployment of wind turbines requires efficient condition monitoring to ensure the safety and availability of these machines. Grid code also requests the operator to enhance the monitoring of the quality of the power generated by the wind turbine. Most commercially available wind turbine condition monitoring systems are supported by a number of vibration transducers. They consequently are complex in hardware, expensive in price, but inefficient in computation and particularly lack of power quality monitoring ability. In view of this, an innovative electrical signal analysis-based wind turbine condition and power quality monitoring technique is developed in this paper by the approach of individual harmonic extraction. The proposed technique has been verified in the lab by applying to detecting both the mechanical and electrical faults emulated on a specially designed wind turbine condition monitoring test rig. Experiments show that the proposed technique is not only sensitive to the faults, but alert to the degradation of power quality.
An Enabling Study of Low Temperature Combustion With Ethanol in a Diesel Engine
Authors: Gao Tongyang , Divekar Prasad , Asad Usman , Han Xiaoye , Reader Graham T. , Wang Meiping , Zheng Ming , Tjong Jimi
Published: May 2013

Previous research indicates that the low temperature combustion (LTC) is capable of producing ultra-low nitrogen oxides (NOx) and soot emissions. The LTC in diesel engines can be enabled by the use of heavy exhaust gas recirculation (EGR) at moderate engine loads. However, when operating at higher engine loads, elevated demands of both intake boost and EGR levels to ensure ultra-low emissions make engine controllability a challenging task. In this work, a multifuel combustion strategy is implemented to improve the emission performance and engine controllability at higher engine loads. The port fueling of ethanol is ignited by the direct injection of diesel fuel. The ethanol impacts on the engine emissions, ignition delay, heat-release shaping, and cylinder-charge cooling have been empirically analyzed with the sweeps of different ethanol-to-diesel ratios. Zero-dimensional phenomenological engine cycle simulations have been conducted to supplement the empirical work. The multifuel combustion of ethanol and diesel produces lower emissions of NOx and soot while maintaining the engine efficiency. The experimental setup and study cases are described, and the potential for the application of an ethanol-to-diesel multifuel system at higher loads has been proposed and discussed.