Jolliffe E.,Wellington Blood and Cancer Center |
Flanagan P.,New Zealand Blood Service
New Zealand Medical Journal | Year: 2014
Aims In March 2013 the Australasian Society of Thrombosis and Haemostasis published an update of the Consensus Guidelines for Warfarin Reversal.3 We reviewed the prescribing practices at Capital and Coast District Health Board (CCDHB), following publication of the updated guidelines. Methods Patients were identified through multiple sources. CCDHB Medical Records identified admissions coded as “Haemorrhagic disorder due to circulating anticoagulants” or “Anticoagulants causing adverse effects in therapeutic use”. CCDHB Haematology Laboratory identified International Normalised Ratio (INR) results _4.5. Wellington Hospital Pharmacy identified patients dispensed vitamin K. New Zealand Blood Service identified recipients of Prothrombinex®-VF and Fresh Frozen Plasma (FFP). Results The management of patients with elevated INR results or bleeding on warfarin therapy was consistent with the updated guidelines in 81/149 episodes. Thirty one patients received FFP unnecessarily and 24 patients did not receive Prothrombinex®-VF when indicated. The greatest variability in management occurred in patients with bleeding complications and in patients requiring urgent warfarin reversal to allow acute surgery to proceed with only 5/31 patients and 5/21 patients having warfarin reversed as recommended. In some episodes more than one error was identified. Conclusions The audit identified the suboptimal use of Prothrombinex®-VF and the unnecessary use of FFP in the management of warfarin reversal. © NZMA.
Vickers M.A.,Scottish National Blood Transfusion Service |
Vickers M.A.,University of Aberdeen |
Wilkie G.M.,Scottish National Blood Transfusion Service |
Robinson N.,Scottish National Blood Transfusion Service |
And 12 more authors.
British Journal of Haematology | Year: 2014
Epstein-Barr virus (EBV) is associated with several malignancies, including post-transplant lymphoproliferative disorder (PTLD). Conventional treatments for PTLD are often successful, but risk organ rejection and cause significant side effects. EBV-specific cytotoxic T lymphocytes (CTLs) generated in vitro from peripheral blood lymphocytes provide an alternative treatment modality with few side effects, but autologous CTLs are difficult to use in clinical practice. Here we report the establishment and operation of a bank of EBV-specific CTLs derived from 25 blood donors with human leucocyte antigen (HLA) types found at high frequency in European populations. Since licensure, there have been enquiries about 37 patients, who shared a median of three class I and two class II HLA types with these donors. Cells have been infused into ten patients with lymphoproliferative disease, eight of whom achieved complete remission. Neither patient with refractory disease was matched for HLA class II. Both cases of EBV-associated non-haematopoietic sarcoma receiving cells failed to achieve complete remission. Thirteen patients died before any cells could be issued, emphasizing that the bank should be contacted before patients become pre-terminal. Thus, this third party donor-derived EBV-specific CTL cell bank can supply most patients with appropriately matched cells and most recipients have good outcomes. © 2014 The Authors. British Journal of Haematology published by John Wiley & Sons Ltd.
Edinur H.A.,Victoria University of Wellington |
Dunn P.P.J.,New Zealand Blood Service |
Lea R.A.,Griffith University |
Chambers G.K.,Victoria University of Wellington
International Journal of Immunogenetics | Year: 2013
Summary: In recent years, with the application of genotyping technology, there has been a substantial increase in the number of reported blood group alleles. This survey was designed to evaluate new molecular blood group genotyping methods and compile reference blood group data sets for Polynesian and Maori subjects. Subsequent analyses of these results were used to calculate probability of random match, to trace Polynesian ancestry and migration patterns and to reveal past and present episodes of genetic admixture. Genomic DNA samples from Maori and Polynesian subjects were drawn from the Victoria University of Wellington DNA Bank and genotyped using combination of commercial PCR-SSP kits, hybridization SNP assay services or sequence-based typing. This survey also involves compilation of serological ABO and Rhesus blood group data from RakaiPaaka Iwi tribal members for comparison with those generated during our molecular blood group study. We observed perfect consistency between results obtained from all molecular methods for blood group genotyping. The A, O, DCcEe, DCCee, MNs, K-k+, Jk(a+b-), Jk(a+b+), Fy(a+b-), Fy(a+b+), Di(a+b-), Co(a+b-) and Do(a-b+) were predominant blood group phenotypes in both Polynesians and Maori. Overall, our survey data show only small differences in distributions of blood group phenotypes between Polynesian and Maori groups and their subgroups. These differences might be associated with selection, population history and gene flow from Europeans. In each case, we estimate that patients with certain blood groups have a very low probability of an exact phenotypic match, even if the patients were randomly transfused with blood from donors of their own ethnicity. The best way to avoid haemolytic transfusion reaction in such cases is to perform a pretransfusion cross-match and recruit increased numbers of donors with rare phenotype profiles. The conclusion of this study is that application of molecular method covering as many known variants as possible may help to improve the accuracy blood group genotyping and potentially conserve the routine requirements of transfusion centres. © 2013 John Wiley & Sons Ltd.
Dickson M.,New Zealand Blood Service |
Dinesh D.,Wellington Regional Hospital
New Zealand Medical Journal | Year: 2013
Aims To identify the rate of bacterial contamination of platelet concentrates in New Zealand and compare with other countries who use the BacT/ALERT screening system. To report on septic transfusion reactions associated with platelet transfusion in New Zealand. Methods Six mL of platelet concentrate is inoculated into a BacT/ALERT BPA (aerobic culture) bottle on Day 2 post-collection. Bottles that are flagged as positive are sent to the microbiology laboratory, with the associated unit, for confirmatory testing. Platelet units that have expired are sampled again. Results from the four blood processing sites in New Zealand were reviewed. Results 59,461 (65%) platelet components were sampled on Day 2 and 15,560 (17%) were re-sampled post-expiry, between December 2003 and September 2011. The rate of confirmed bacterial contamination was 0.04% for Day 2 sampling and 0.04% for post-expiry sampling. The rate in the published literature ranges from 0.01-0.74% and is lower (0.01-0.18%) when diversion of the initial flow of blood is utilised. There were five bacterial transfusion transmitted infections associated with platelet transfusion reported during the study period. Conclusions: BacT/ALERT screening reduces the transfusion of bacterially contaminated platelet concentrates. Day 2 sampling does not identify all contaminated units. © NZMA.
Carter M.C.,Scottish National Blood Transfusion Service |
Wilson J.,Scottish National Blood Transfusion Service |
Redpath G.S.,Scottish National Blood Transfusion Service |
Hayes P.,New Zealand Blood Service |
Mitchell C.,Canadian Blood Services
Transfusion and Apheresis Science | Year: 2011
The first decade of the millennium has seen a fundamental shift in global sufficiency. In many developing countries the major challenge remains the need to collect sufficient, safe blood from volunteer non-remunerated blood donors to support developing health care needs. However, in the developed world the current challenges faced by blood services are more complex and constantly changing. This article will explore the impact of these challenges and consider the implications for blood services in the next decade in donor management and recruitment.The authors discuss the major strategic challenges of:. maintaining an adequate donor base with the correct blood group mix; intelligent inventory control; improving efficiency in the face of the current global economic climate; redesigning the donor experience;The paper discusses donor recruitment and retention strategies and provides case studies from the SNBTS marketing strategy. The paper discusses options to rethink the traditional supply and demand models.In conclusion, consider the potential challenges and opportunities of the next decade, considering: demographic changes and influences; impact of new technologies; demand trends; donor expectation. © 2011.
Badami K.G.,New Zealand Blood Service |
Sesun M.,New Zealand Blood Service |
Basu A.,University of Canterbury |
Absalom N.,New Zealand Blood Service
Journal of Clinical Apheresis | Year: 2012
We studied the demographic, laboratory, and operational parameters that might influence individual, as well as average, plateletpheresis yields. Multivariate linear regression analyses showed that 25.4% and 11.6% of variability, among males and females, respectively, in individual yields was explained by the platelet count prior to that donation and 55% of the variation in mean platelet yields (PYs) was explained by the pre-first donation platelet count, the first donation PY and the body mass index (BMI). Logistic regression analysis showed that donors with first donation PYs higher, compared to those with lower yields, than the median of all mean PYs were more likely to be relatively high platelet yielders over the long term. A statistically significant, although clinically insignificant, decline in predonation platelet counts is seen in all donors regardless of the total number of donations or interdonation interval. Donors with high pre-first donation platelet counts, first donation yields, and BMI are likely to be consistent good platelet yielders. J. Clin. Apheresis 27:247-254, 2012. © 2012 Wiley Periodicals, Inc.
Dickson M.,New Zealand Blood Service
The New Zealand medical journal | Year: 2013
To identify the rate of bacterial contamination of platelet concentrates in New Zealand and compare with other countries who use the BacT/ALERT screening system. To report on septic transfusion reactions associated with platelet transfusion in New Zealand. Six mL of platelet concentrate is inoculated into a BacT/ALERT BPA (aerobic culture) bottle on Day 2 post-collection. Bottles that are flagged as positive are sent to the microbiology laboratory, with the associated unit, for confirmatory testing. Platelet units that have expired are sampled again. Results from the four blood processing sites in New Zealand were reviewed. 59,461 (65%) platelet components were sampled on Day 2 and 15,560 (17%) were re-sampled post-expiry, between December 2003 and September 2011. The rate of confirmed bacterial contamination was 0.04% for Day 2 sampling and 0.04% for post-expiry sampling. The rate in the published literature ranges from 0.01-0.74% and is lower (0.01-0.18%) when diversion of the initial flow of blood is utilised. There were five bacterial transfusion transmitted infections associated with platelet transfusion reported during the study period. BacT/ALERT screening reduces the transfusion of bacterially contaminated platelet concentrates. Day 2 sampling does not identify all contaminated units.
Badami K.G.,New Zealand Blood Service
Medical Hypotheses | Year: 2015
Antibodies to red blood cell (RBC), platelet, and neutrophil antigens, and IgA may cause serious clinical problems. With a few exceptions, preventing these conditions is a matter of limiting exposure to the foreign antigen while treatment consists of managing the consequences. Might immune tolerance induction (ITI) be possible and beneficial in these situations?Neonatal exposure to antigens is known to induce central tolerance. However central tolerance may not be absolute. Factors that determine whether an antibody will be produced in response to an antigen are not well understood but include the appropriate expression of major histocompatibility complex-class II and/or co-stimulatory molecules on dendritic cells, the presence or absence of adjuvants and whether or not the antigen is presented together with agonists for the toll-like receptor. Modifying these may prevent alloimmunization. Peripheral tolerance, in sensitized individuals, as routinely used in patients with allergic/anaphylactic reactions, those with haemophilia A or B with inhibitors and acquired haemophilia, may also be possible. Briefly, monitored, graded, increasing exposure to the antigen of interest with or without additional immunosuppression is used.Neither central nor peripheral ITI has been tried or suggested for individuals sensitizable or sensitised to RBC, platelet, and neutrophil antigens, or IgA. Theoretically, this is possible and may be of benefit. © 2015 Elsevier Ltd.
Badami K.G.,New Zealand Blood Service |
Joliffe E.,New Zealand Blood Service |
Stephens M.,New Zealand Blood Service
Vox Sanguinis | Year: 2015
New Zealand Blood Service Haemovigilance uses International Society of Blood Transfusion/International Haemovigilance Network definitions to categorize transfusion reactions (TR). Transfusion-associated dyspnoea (TAD) is a category for TR with respiratory features (TRRF) that do not fit definitive entities. TRRF, including TAD, are clinically significant. TR classified as TAD were reviewed. We found that many TAD may have been transfusion-associated circulatory overload. Better information in TR reports and refining TR diagnostic criteria may result in less misclassification of TRRF. TAD may represent mild, atypical or overlap entities, and there may be a residuum of cases with currently unexplained pathophysiology. © 2015 International Society of Blood Transfusion.
Charlewood R.,New Zealand Blood Service |
Flanagan P.,New Zealand Blood Service
Vox Sanguinis | Year: 2013
Background The low, fluctuating levels of DNA characteristic of occult hepatitis B infection make its detection by nucleic acid testing (NAT) a challenge. Methods Four year's routine use of the Ultrio and Ultrio Plus assays in blood donations in New Zealand was analysed. Results 0·09% of donations tested with Ultrio and Ultrio Plus assays showed reactivity in the multiplex assay, but non-reactivity in all three discriminatory assays and relevant mandatory serological assays (anti-HIV, anti-HCV, HBsAg). These donations were more likely to be anti-HBc reactive (Ultrio, 13%; Ultrio Plus, 57%; random donors, 6·8%). Thirty-four per cent of these anti-HBc-reactive donations were also reactive in either an alternate NAT assay or on repeat multiplex testing. Thirteen per cent of the donors of the discriminatory-negative, anti-HBc-reactive donations who had given other Ultrio- or Ultrio Plus-tested donations had at least one other multiplex reactive donation. Conclusion These findings suggest that their HBV DNA levels are around the assay's limit of detection, that false reactivity cannot be presumed when a donor fails to discriminate and that caution should be applied when deciding whether to continue accepting donations from such donors. © 2012 The Author(s). Vox Sanguinis © 2012 International Society of Blood Transfusion.