bluuebunny/crossref_metadata_2025_split huggingface dataset:
Handling low haemoglobin and iron deficiency in a blood donor population
Authors: Magnussen K. , Ladelund S. 
Published: January 2016

BackgroundBlood donors with low haemoglobin concentration (Hb) and iron deficiency are well‐known challenges in any blood bank setting. The handling of such donors is complex, and although iron deficiency is a frequent cause of anaemia, there are differential diagnoses.AimsThe primary aims were to standardize and optimize the handling of blood donors with Hb below the limit for donation. Secondary aims were to deal with all issues related to high or low either Hb or ferritin in blood donors.MethodsThe problem was approached by centralizing measurement of Hb, initiating ferritin measurements and establishing Centre for Donor Haemoglobin and Iron. An algorithm was created, taking Hb and ferritin into account. The donors were mainly contacted by post, but when Hb was low or when there was insufficient effect of previously given iron supplementation, the donors were contacted by phone to improve compliance. Hb was measured on Sysmex‐XE2100D at every donation. Ferritin was measured once in all donors, at every 10th donation and repeated when outside 60–300 μg/l or Hb low at the previous donation.ResultsFebruary 1st 2012–February 1st 2015, 71 450 donors (53·5%women/46·5%men) donated 281 814 units of whole blood. Due to changes in calibration, Hb changes could only be monitored over the first 24 months. Mean Hb increased in the female and male donors (P < 0·0001). Percentage of donors with low Hb decreased (women OR/month = 0·98; P < 0·0001; men OR/month = 0·97; P < 0·0001).Summary/conclusionsThe program of iron supplementation restricted only to those that would benefit has led to an increase in Hb and a reduction in the number of donors with low Hb.
New additive solutions for red cells
Authors: de Korte D. 
Published: January 2016

Shortly after the introduction of component therapy in the 1960s, the first additives for red cell concentrates (RCC) were introduced. This development resulted in prolongation of RCC shelf life from 21 to 35 or 42 days. Over the years, some new solutions were developed, but still SAGM (Europe) and AS‐1 (United States) are the standard, nearly exclusive in combination with CPD as anticoagulant. Most of these new solutions were minor variations on SAGM or AS‐1, with limited improvement of in vitro quality of erythrocytes. Development of new concepts, resulting in improved quality of RCC, was in first instance focused on achieving longer storage time. However, as a result from the concern about possible negative side effects caused by transfusion of older units, the research on new additive solutions is more focused on having a better quality during the currently accepted maximum storage time of 35–42 days. Around 1990, Meryman developed the concept of the so‐called chloride shift. Through replacement of chloride by impermeable solutes, it is possible to manipulate the intracellular pH of erythrocytes, resulting in high 2,3‐DPG and/or ATP values throughout storage. During the past 15–20 years, several research groups, with the group of Greenwalt and Hess as pioneers, developed new additive solutions based on the Meryman concept. Recently, the first commercial product from these studies was launched, with an improved in vitro quality parameter profile and improved in vivo recovery data. Finally, some recent developments are discussed with respect to alkaline additive solutions and anaerobic storage of erythrocyte concentrates.
The air they breathe
Authors: Dzik W. 
Published: January 2016

BackgroundWhile all living creatures share Earth's atmosphere, they have adapted respiration to unique environments with the capacity to outperform anything humanly possible.AimsTo describe tissue oxygenation strategies used by different animal species.MethodsPublished research on the respiratory physiology of deep‐diving mammals and high‐flying migratory birds.ResultsThe oxygen‐binding characteristics of haemoglobin are relatively constant across broad species of animals on Earth, but available oxygen is remarkably different in different environments. Deep‐diving marine mammals reach depths of 1 mile where pressures are 200 times greater than at sea level and can hold their breath for up to 1 h. They oxygenate muscles using wilful control of heart rate and blood flow collectively. They avoid nitrogen narcosis by emptying their lungs of air prior to dives. Myoglobin plays an important role in tissue oxygenation. Deep‐diving mammals are the finest anaerobic athletes on the planet. In contrast, birds breathe in a manner entirely different from mammals and oxygenate their blood during both inspiration and expiration. This remarkable process results in a far more efficient method of blood oxygenation than can be achieved in mammals (including humans), making birds the finest aerobic athletes on Earth.SummaryFrom the perspective of oxygen delivery to tissues, athletic capacity and adaptation to environmental stress, certain non‐human species demonstrate superior performance. A better understanding of the how other creatures use the same air that we breathe may lead to greater respect for species diversity and animal life.
Assessing the risk of transfusion‐transmitted emerging infections
Authors: Domanović D. 
Published: January 2016

Background and ObjectivesThe risk from established blood‐borne infections is not eliminated, and newly emergent pathogens in the era of mass international travel and climate change are posing a continuous threat to blood safety. This is an overview of risk assessment methodologies, frameworks used in response to threats posed by transfusion‐transmitted emerging infectious diseases (TT EIDs), and approaches and tools developed by the European Centre for Disease Prevention and Control (ECDC) aiming to provide EU Member States and the EU Commission with the best advice available concerning infectious risks of donations and human use of substances of human origin (SoHO).Materials and MethodsComprehensive literature searches were conducted in PubMed, Medline and EMBASE for articles published in English. In addition, the EU Commission's reports and ECDC's technical documents were used to retrieve relevant data.ResultsThe risk assessment is a part of the risk management process that comprises preparatory activities, risk analysis and risk evaluation. International efforts have been taken to identify, prioritize and develop fact sheets, toolkits and frameworks for assessing the threat of emerging infections and their impact on blood safety and availability. ECDC developed a European Up‐Front Risk Assessment Tool to allow member states to assess the risk of TT EDIs. ECDC's interactive maps inform the competent authorities for blood about areas with ongoing transmission of West Nile virus to humans to support their implementation of screening and blood safety legislation. ECDC has identified and prioritized eleven arthropod‐borne diseases that may pose a threat to the safety of SoHO. A priority list was the basis for developing a comprehensive, review‐based risk assessment and defining preventive interventions of their transmission through SoHO.ConclusionRisk assessment determines the necessity, urgency and magnitude of response to threats posed by TT EIDs. In order to timely assess the risk, it is important to be vigilant and to identify the infectious threat to the blood safety as soon as possible. The manner in which the risk assessment is applied is dependent on uncertainties manifested by EID, a specific context of blood transfusion practice and a framework within which the risk is managed.
Engaging ethnic minority blood donors
Authors: Charbonneau J. , Daigneault S. 
Published: January 2016

Background and ObjectivesTargeting ethnic minorities is consistent with the objective of ensuring better access to rare phenotypes. The number of blood donors is generally lower among these groups. This article seeks to present the solutions Héma‐Québec has developed to address this challenge.Materials and MethodsIn 2010–2011, the organization conducted 53 awareness‐raising activities targeting black communities. In 2009–2010, 83 interviews were conducted with donors and leaders of diverse ethnic groups in Montreal. Employees’ perceptions were also explored. Based on research findings, a training seminar was developed and provided to 69 front‐line managers. Its most important elements were integrated into basic training for all employees.ResultsThe number of black community donors climbed from 170 in 2009 to 1582 in 2012. However, experiences with ethnic associations and donors have raised many concerns among staff. The 2‐day training helped planning services develop better recruitment strategies and bolster employees’ self‐confidence with regard to their interactions with ethnic minorities.ConclusionNew strategies are dependent on the specific characteristics of each country's ethnic diversity, the availability of empirical data on minorities, and the clearly expressed will of management in blood products supply organizations.
A randomized controlled trial comparing the outcome of critically ill adults who received fresher vs. older red cells units
Authors: Lacroix J. , Hébert P. C. , Fergusson D. A. , Tinmouth A. , Walsh T. , Stanworth S. , Campbell H. , Boyd J. , Burrows H. , Hemmatapour S. ,   the Canadian Critical Care Trials Group
Published: January 2016

Background and ObjectivesRed blood cell (RBC) units are stored up to 42 days postcollection. The standard policy is to deliver the oldest units in order to limit blood wastage. The hypothesis of the ‘Age of Blood Evaluation’ (ABLE) study was that the outcomes of adults transfused in intensive care units (ICU) with RBC units stored ≤7 days will be better than controls who received the oldest RBC units.Materials and MethodsThe ABLE study is a double‐blind randomized controlled trial. The primary outcome measure was all‐cause 90‐day mortality postrandomization. Secondary outcomes included 28‐day, ICU and hospital mortality, acquired infections, length of ICU and hospital stay, and length of treatments. Statistical analyses were performed using an intention‐to‐treat approach.ResultsFrom 2009 to 2014, 1211 patients were allocated to the fresh arm, 1219 to the control arm (length of storage: 6·1 ± 4·9 and 22·0 ± 8·4 days, P < 0·001). There were 448 deaths (37·0%) in the fresh arm 90‐day postrandomization, and 430 (35·3%) in the control arm (absolute risk difference: 1·7%; 95% CI: −2·1% to 5·5%). A survival analysis revealed that the hazard ratio of deaths 90 days postrandomization was 1·1% in the fresh‐blood group (95% CI: 0·9% and 1·2%). The same trend against the fresh arm intervention was observed with all but one secondary outcome measure.ConclusionThe transfusion of RBC units stored ≤7 days does not improve the outcome of critically ill adults compared to the transfusion of units stored about 3 weeks (ISRCTN44878718).
Signalling mechanisms involved in C‐peptide‐mediated inhibition of low O2‐induced ATP release from human erythrocytes
Authors: Richards J. P. , Bowles E. A. , Ellsworth M. L. , Stephenson A. H. , Sprague R. S. 
Published: January 2016

Background and objectivesIn vivo, insulin is released with connecting peptide (C‐peptide) which has recently been shown to have biological activity. When erythrocytes are exposed to reduced oxygen (O2) tension, they release O2 as well as the vasodilator ATP enabling them to participate in the appropriate distribution of vascular perfusion and, thereby, O2 supply. Low O2‐induced ATP release is absent in erythrocytes of humans with type 2 diabetes (DM2), but this response is restored by co‐administration of physiological concentrations of insulin and C‐peptide. However, either C‐peptide or insulin, when administered alone, inhibits low O2‐induced ATP release from healthy human erythrocytes. Here, we investigated the mechanism(s) by which C‐peptide inhibits this physiological ATP release from human erythrocytes.MethodsErythrocytes from healthy humans (n = 21) or humans with DM2 (n = 4) were incubated with C‐peptide in the absence or presence of inhibitors of either protein kinase C alpha (PKCα) or soluble guanylyl cyclase (sGC). Erythrocytes were then exposed to low O2, and ATP release was determined.ResultsIn healthy human erythrocytes, C‐peptide inhibited ATP release in response to low O2. Preincubation with either Gö6976, a PKCα inhibitor, or ODQ, a sGC inhibitor, prevented this effect of C‐peptide. In addition, C‐peptide alone did not rescue low O2‐induced ATP release from DM2 erythrocytes.ConclusionAdministration of C‐peptide in excess of levels present under physiological conditions or the combination of C‐peptide and insulin at ratios that exceed those observed physiologically to insulin‐deficient individuals can be detrimental for low O2‐induced ATP release from human erythrocytes and could, consequently, interfere with optimal O2 delivery to skeletal muscle.
Managing the patient with haemoglobinopathy and multiple red cell antibodies
Authors: Politis C. , Hassapopoulou E. , Halkia P. , Kourakli A. , Mougiou A. , Zervou E. , Kleronomos E. , Sfyridaki K. , Pappa C. , Tsoumari I. , Lafiatis I. , Kavallierou L. , Parara M. , Richardson C. 
Published: January 2016

Background and ObjectivesSickle cell disease (SCD) and thalassaemia, particularly the β‐type, represent major sources of morbidity. Recommended treatment includes regular blood transfusion following highly uniform strategies across thalassaemia units and monitoring related complications including alloimmunization. This complex problem depends on donor–recipient antigenic diversity, the patient's immune status and specific circumstances such as pregnancy.Materials and MethodsWe examined alloimmunization against RBC antigens and autoimmunization in 983 patients with thalassaemia and SCD in Greece, in relation to applied RBC antigen matching policies and other factors possibly relevant in reducing the rate of alloimmunization and delayed haemolytic transfusion reaction (DHTR).ResultsUp to 2010, 11.6% of all patients had history of alloimmunization and 7.3% of autoimmunization. Frequency was highest in thalassaemia intermedia followed by sickle–thalassaemia and thalassaemia major. New alloimmunization was low at 1.4% after 2010, corresponding to a risk of 1:9405 units of RBCs transfused. Despite the very high transfusion burden in the chronically transfused patients, the use of extended matched donor blood is proven effective in reducing the rate of alloimmunization.ConclusionMultiple RBC alloantibodies represent a small but difficult to manage risk for responders prone to combination with autoimmunization. DHTR with hyperhaemolysis is a major clinical problem in haemoglobinopathies, especially during the gestational period and delivery in patients who escape expert medical follow‐up. Progress in the safety and quality of blood transfused in these patients is expected to contribute to prolongation of their life expectancy and to reproduction. Investigation of HLA and other antibodies in patients prone to developing RBC antibodies is suggested.
Preventing bacterial infection in blood components
Authors: Schmidt M. , Seifried E. 
Published: January 2016

BackgroundThe prevention of bacterial infections by blood components can be classified into general procedures and blood component‐specific procedures.General proceduresDonor selection programmes with a temporary deferral of blood donors are sufficient measures to prevent bacterial contaminations of blood components. Secondly, an efficient donor arm disinfection is important to reduce the resident skin flora to a minimum. Since the beginning of this century, all countries have implemented the predonation sampling with the diversion of the first 30–40 ml.Blood components specific proceduresMany countries have already implemented methods of detecting bacteria in platelets using culture methods. A residual risk for culture methods, however, is the occurrence of sample errors by collecting the test volume within the first 24 h. Some countries have implemented rapid bacterial detection systems like Bactiflow or NAT systems. Different pathogen reduction methods were developed for platelets, plasma and packed red cells. The advantage of these methods is the reduction of all bacteria and potential new pathogens. A disadvantage might be their high cost and limited efficiency in detecting bacteria spores.ConclusionGeneral procedures are not sufficient to prevent all bacterial transmissions. Culture methods and pathogen reduction methods that have focused on the prevention of bacterial contamination in platelets are currently in development for erythrocytes and whole‐blood components and might not be feasible for stem cell components. Therefore, the world is still waiting for a new general procedure that will be an addendum to existing systems – such a system is eagerly awaited.
Different sensitivities to calcineurin inhibitors between B cells responding to blood group A and B antigens
Authors: Yamashita M. , Tanaka Y. , Tazawa H. , Sakai H. , Ohdan H. 
Published: January 2016

Background and ObjectivesWe evaluated the phenotypic and functional distinction between B cells with receptors for human blood group A and B determinants in α‐galactosyltransferase‐deficient (GalT−/−) mice.Materials and MethodsGalT−/− mice were immunized with human blood group A or B red blood cells (RBCs), and the anti‐A or B anti‐bodies (Abs) were determined in their sera. B cells with receptors for group A and B epitopes were identified by the use of synthetic A and B determinants.ResultsThe anti‐A and anti‐B Ab levels were comparably elevated in the sera of GalT−/− mice after the immunization with A/B‐RBCs. B cells bearing receptors recognizing B epitopes exhibited the CD5dim/− CD11b+ B‐1b‐cell phenotype, whereas those with receptors for A epitopes showed the CD5+CD11b+ B‐1a‐cell phenotype. Myeloid differentiation factor 88 (MyD88) levels increased in B cells with anti‐B receptors, indicating a contribution of Toll‐like receptor (TLR) signalling, whereas no such elevation was detected in B cells with anti‐A receptors. Calcineurin inhibitor (CNI) treatment prevented the elevation of anti‐A Ab levels after immunization, but did not affect anti‐B Ab levels.ConclusionsThese findings indicate different sensitivities of B cells with blood group A and B antigens in the response to CNIs.
Culturing red blood cells from stem cells: a solution to present and future challenges of transfusion medicine?
Authors: Rousseau G. F. , Mazurier C. , Douay L. 
Published: January 2016

Transfusion needs are diversely fulfilled globally. Besides, with population ageing, the various problems faced by healthcare systems will become more and more prominent. As a consequence, the current model of blood supply has to be strengthened, and new sources of red blood cells (RBC) are welcome. A cell therapy approach, in which so‐called ‘culturedRBC’ (cRBC) are generatedin vitro,might be a solution. We report here on the various obstacles that were overcome during the past decade to generatecRBCfrom various sources of stem cells (SC) and also discuss the next developments which will be required to achieve this goal. To date, the culmination point in the field has been the proof of principle of transfusion ofcRBCinto human, produced from autologous haematopoietic stem and progenitor cells (HSPC), which allowed to demonstrate a favourable life span ofcRBCwhen compared with their native counterpart. The best available source of highly proliferative adultSCis cord blood (CB), which could allow to produce tens ofRBCconcentrates (RBCC) from one averageCB. However, this source is quantitatively limited in number, and more research onHSPCisolated from peripheral blood (PB) is needed. In parallel, critical advances have allowedin vitroproduction of functionalRBCfrom human pluripotentSC, either embryonic (ESC) or induced (iPS). AsiPScan proliferate indefinitely and can be selected for a specific patient phenotype, they appear to be the most favourableSCsource, but the protocols still need to be optimized. Most recently, erythroid cell lines have also been envisaged to produceRBC. The major challenges remaining today are economic and technological in order to lead to a cost‐effective process for large‐scale production.
Nursing Practice Guidelines in China do Need Reform: A Critical Appraisal Using the AGREE II Instrument
Authors: Jin Yinghui , Wang Yunyun , Zhang Yao , Ma Yue , Li Yan , Lu Cui , Wang Wei , Li Ge , Shang Hongcai 
Published: January 2016

ABSTRACTBackgroundAn increasing number of nursing practice guidelines (NPGs) of varying methodological and reporting quality have been issued and published in international journals. Currently, the quality of NPGs in mainland China has not been explored.ObjectiveTo assess the quality of NPGs in China mainland using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument.MethodsThe authors searched the electronic databases of Chinese Biomedical Literature Database, China National Knowledge Infrastructure, The VIP Database, Wan Fang Database, Chinese Master's Theses Full‐Text Database, China Doctor Dissertation Full‐Text Database, and China Proceedings of Conference Full‐Text Database and the web of China Guideline Clearinghouse for NPGs in China published from the inception of databases to December, 2013. Four independent assessors rated the quality of each guideline using AGREE II. The authors classified NPGs into two types: evidence‐based NPG (EB‐NPG) and consensus‐based NPG (CB‐NPG), and compared their quality. The authors also considered whether the quality of NPGs changed over time.ResultsForty‐two NPGs were appraised. Methodological rigor and reporting of NPGs were poor. Across all guidelines, the appraisers assigned the highest scores to the domain “scope and purpose,” and the lowest scored to the domain of “editorial independence.” EB‐NPGs were significantly superior to the CB‐NPGs in the domains of “stakeholder involvement,” “rigor of development,” and “editorial independence.” There was no improvement over time for all domains.Linking Evidence to ActionThis research found an absence of a systematic guideline development methodology and a tendency to rely on expert opinion in the process of developing NPGs. The readers should consider these flaws and limitations when using recommendations in those NPGs.