Medicine, United States
Medicine, United States

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Kiss J.E.,Institute for Transfusion Medicine | Brambilla D.,RTI | Glynn S.A.,U.S. National Institutes of Health | Spencer B.R.,Red Cross | And 3 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

Importance: Although blood donation is allowed every 8 weeks in the United States, recovery of hemoglobin to the currently accepted standard (12.5 g/dL) is frequently delayed, and some donors become anemic. Objective: To determine the effect of oral iron supplementation on hemoglobin recovery time (days to recovery of 80% of hemoglobin removed) and recovery of iron stores in iron-depleted ("low ferritin,"26 ng/mL) and iron-replete ("higher ferritin," >26 ng/mL) blood donors. Design, Setting, and Participants: Randomized, nonblinded clinical trial of blood donors stratified by ferritin level, sex, and age conducted in 4 regional blood centers in the United States in 2012. Included were 215 eligible participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months. Interventions: One tablet of ferrous gluconate (37.5mg of elemental iron) daily or no iron for 24 weeks (168 days) after donating a unit of whole blood (500 mL). Main Outcomes and Measures: Time to recovery of 80% of the postdonation decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores. Results: The mean baseline hemoglobin levels were comparable in the iron and no-iron groups and declined from a mean (SD) of 13.4 (1.1) g/dL to 12.0 (1.2) g/dL after donation in the low-ferritin group and from 14.2 (1.1) g/dL to 12.9 (1.2) g/dL in the higher-ferritin group. Compared with participants who did not receive iron supplementation, those who received iron supplementation had shortened time to 80% hemoglobin recovery in both the low-ferritin and higher-ferritin groups. Recovery of iron stores in all participants who received supplements took a median of 76 days (IQR, 20-126); for participants not taking iron, median recovery time was longer than 168 days (IQR, 147->168 days; P < .001). Without iron supplements, 67%of participants did not recover iron stores by 168 days. Conclusions and Relevance: Among blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the postdonation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL).


Triulzi D.J.,University of Pittsburgh | Triulzi D.J.,Institute for Transfusion Medicine | Yazer M.H.,University of Pittsburgh | Yazer M.H.,Institute for Transfusion Medicine
Transfusion and Apheresis Science | Year: 2010

It is indisputable that there are numerous biochemical, structural, inflammatory, and physiologic changes in stored red cells, sometimes referred to collectively as the "red cell storage lesion" It remains controversial however whether any of these changes have clinical relevance and actually impact the clinical outcomes in transfused patients. More than 25 published clinical studies have evaluated the effects of red blood cell storage on patient outcomes. The majority of studies are non-randomized observational studies with methodologic limitations described in this review. These studies do however provide equipoise to support the ethical conduct of the large, definitive randomized clinical trials which are now underway. © 2010.


Du Z.H.,Institute for Transfusion Medicine
Tissue antigens | Year: 2013

The new allele differs from MICA*008:01:01 by a single nucleotide substitution at position 591 of exon 3. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Crivello P.,University of Duisburg - Essen | Heinold A.,Institute for Transfusion Medicine | Rebmann V.,Institute for Transfusion Medicine | Ottinger H.D.,University of Duisburg - Essen | And 3 more authors.
Blood | Year: 2016

The role of HLA amino acid (AA) polymorphism for the outcome of hematopoietic cell transplantation (HCT) is controversial, in particular for HLA class II. Here, we investigated this question in nonpermissive HLA-DPB1 T-cell epitope (TCE) mismatches reflected by numerical functional distance (FD) scores, assignable to all HLA-DPB1 alleles based on the combined impact of 12 polymorphic AAs. We calculated the difference in FD scores (DFD) of mismatched HLA-DPB1 alleles in patients and their 10/10 HLA-matched unrelated donors of 379 HCTs performed at our center for acute leukemia or myelodysplastic syndrome. Receiver-operator curve-based stratification into 2 DFD subgroups showed a significantly higher percentage of nonpermissive TCE mismatches for DFD >2.665, compared with DFD £2.665 (88% vs 25%, P < .0001). In multivariate analysis, DFD >2.665 was significantly associated with overall survival (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.05-1.87; P < .021) and event-free survival (HR, 1.39; 95% CI, 1.05-1.82; P < .021), compared with DFD £2.665. These associations were stronger than those observed for TCE mismatches. There was a marked but not statistically significant increase in the hazards of relapse and nonrelapse mortality in the high DFD subgroup, whereas no differences were observed for acute and chronic graft-versus-host disease. Seven nonconservative AA substitutions in peptide-binding positions had a significantly stronger impact on DFD compared with 5 others (P 5 .0025), demonstrating qualitative differences in the relative impact of AA polymorphism in HLA-DPB1. The novel concept of DFD sheds new light onto nonpermissive HLA-DPB1 mismatches in unrelated HCT. (Blood. 2016;128(1):120-129) © 2016 by The American Society of Hematology.


Kiss J.E.,University of Pittsburgh | Kiss J.E.,Institute for Transfusion Medicine
International Journal of Hematology | Year: 2010

Thrombotic thrombocytopenic purpura is a life-threatening multisystem disorder that represents both a diagnostic and a management challenge to clinicians. Early recognition of the condition coupled with rapid institution of plasma exchange has led to a dramatic improvement in prognosis. Studies performed over the past decade have elucidated the predominant pathophysiology, stemming from a deficiency of ADAMTS13, that accounts for the widespread microvascular deposition of platelet-von Willebrand factor in many sites, including the brain, kidney, and mesenteric vessels. However, in light of the mortality rate of 10-20%, much work remains to be done to translate advances in our understanding of pathophysiology into clinical practice. Improvements in medical management using immunosuppressive and other drugs are being actively explored in clinical trials. Agents that target ADAMTS13 autoantibody production by B-cells, such as anti-CD20 monoclonal antibodies, have the potential to shorten the duration of plasma exchange treatment, reduce relapses, and transform the management of this once enigmatic disorder. © 2010 The Japanese Society of Hematology.


Cid J.,University of Barcelona | Harm S.K.,University of Pittsburgh | Yazer M.H.,University of Pittsburgh | Yazer M.H.,Institute for Transfusion Medicine
Transfusion Medicine and Hemotherapy | Year: 2013

Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of 'high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed. © 2013 S. Karger GmbH, Freiburg.


Collins R.A.,University of Pittsburgh | Triulzi D.J.,University of Pittsburgh | Triulzi D.J.,Institute for Transfusion Medicine | Waters J.H.,University of Pittsburgh | And 3 more authors.
American Journal of Clinical Pathology | Year: 2014

Objectives: To evaluate cryoprecipitate and platelet ordering practices after the implementation of real-time clinical decision support systems (CDSSs) in a computerized physician order entry (CPOE) system. Methods: Uniform platelet and cryoprecipitate transfusion thresholds were implemented at 11 hospitals in a regional health care system with a common CPOE system. Over 6 months, a variety of information was collected on the ordering physicians and the number of alerts generated by the CDSSs when these products were ordered outside of the institutional guidelines. Results: There were 1,889 orders for platelets and 152 orders for cryoprecipitate placed in 6 months. Of these, 1,102 (58.3%) platelet and 74 (48.7%) cryoprecipitate orders triggered an alert. The proportion of orders canceled after an alert was generated ranged from 13.5% to 17.9% for platelets and 0% to 50.0% for cryoprecipitate orders. Conclusions: CDSS alerts reduce, but do not eliminate, platelet and cryoprecipitate transfusions that do not meet institutional guidelines. © American Society for Clinical Pathology.


Dunbar N.M.,Dartmouth Hitchcock Medical Center | Yazer M.H.,Institute for Transfusion Medicine | Yazer M.H.,University of Pittsburgh
Transfusion | Year: 2016

BACKGROUND Although evidence supporting this practice is limited, some centers use thawed group A plasma for the initial resuscitation of trauma patients. STUDY DESIGN AND METHODS To better understand the current use of plasma in trauma resuscitation, a survey was developed, validated, and distributed via e-mail to 121 American trauma centers. RESULTS A total of 61 responses were received. Most were from Level 1 trauma centers (56/61, 92%) in urban settings (47/61, 77%). Virtually all centers reported maintaining A thawed plasma inventory (59/61, 97%). Among the 56 Level 1 trauma center respondents, most keep thawed A immediately available (49/56, 88%) and many use group A plasma for trauma recipients of unknown ABO group (34/49, 69%). Half of the surveyed centers implemented this practice within the past year. The majority do not limit the amount of A plasma that can be administered to a patients of unknown ABO group (21/34, 62%), and most do not titer for anti-B (27/34, 79%). CONCLUSION The majority of Level 1 trauma centers maintain thawed plasma inventories and use group A plasma for trauma recipients of unknown ABO group. Most centers do not limit the amount of group A plasma used in this situation or titer the anti-B. © 2015 AABB.


Narick C.,Allegheny General Hospital | Narick C.,University of Pittsburgh | Narick C.,Institute for Transfusion Medicine | Triulzi D.J.,Allegheny General Hospital | And 5 more authors.
Transfusion | Year: 2012

BACKGROUND: In 2010, transfusion-associated circulatory overload (TACO) was the second most common cause of transfusion-related mortality reported to the Food and Drug Administration. We sought to determine the rate of TACO caused by plasma transfusion. STUDY DESIGN AND METHODS: This study was conducted in two parts: 1) A retrospective analysis to determine the prevalence of TACO reactions caused by plasma at a tertiary care hospital from 2003 to 2010 was performed by analyzing the blood bank's electronic transfusion reaction records and 2) active surveillance of plasma recipients to determine if unreported TACO reactions had occurred over a 1-month period at the same hospital. RESULTS: Eighty-seven reactions to plasma had been reported to the blood bank from 2003 through 2010. Of these reactions 23% (20/87) were TACO. The historical prevalence rate of TACO was 1 in 1566 (95% confidence interval [CI], 1:2564-1:1014). During the prospective 1-month surveillance period, 84 patients received a total of 272 units of plasma, and four TACO reactions in separate patients (4.8%) were identified, none of which were reported to the blood bank. The prevalence rate of TACO in the prospective study was 1 in 68 (95% CI, 1:250-1:27). In total, most patients (14/24) were in the intensive care unit when they experienced TACO and on average they had received 4.0 ± 2.3 units of plasma at an average rate of 647 ± 315 mL/hr before the TACO reaction. CONCLUSIONS: Passive reporting of TACO grossly underestimates its actual prevalence. Educational efforts are needed to enhance physician recognition of TACO reactions. © 2011 American Association of Blood Banks.


Wang R.R.,Institute for Transfusion Medicine | Triulzi D.J.,Institute for Transfusion Medicine | Triulzi D.J.,University of Pittsburgh | Qu L.,Institute for Transfusion Medicine | Qu L.,University of Pittsburgh
American Journal of Clinical Pathology | Year: 2012

The purpose of this study was to assess the incidence of febrile nonhemolytic transfusion reactions (FNHTRs) to concurrent transfusions of prestorage-leukoreduced (PreSLR) pooled platelets, poststorage-leukoreduced (PostSLR) pooled platelets, nonleukoreduced (NonLR) pooled platelets, and apheresis single-donor platelets (SDPs) to compare the rates of FNHTRs to PreSLR vs PostSLR pooled platelets. Reported transfusion reactions to platelets at 15 hospitals for a period of 45 months were retrospectively reviewed. Reaction rates to different types of platelet products were calculated and compared. During the study period, 70,015 platelet transfusions were administered. Among these, 152 (0.22%) FNHTRs and 111 (0.16%) allergic transfusion reactions were seen. Reported rates of FNHTRs were 0.07% (SDP), 0.16% (PreSLR), 0.30% (PostSLR), and 0.20% (NonLR) (P < .05 for PreSLR vs PostSLR). Rates of allergic reactions were 0.16% (SDP), 0.17% (PreSLR), 0.18% (PostSLR), and 0.11% (NonLR) (P > .05). The rates of reported FNHTRs were low for all types of platelet transfusions. SDPs and PreSLR pooled platelets were associated with a slightly lower rate of FNHTR compared with PostSLR pooled platelets. Copyright© by the American Society for Clinical Pathology.

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