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Effects of the COVID-19 pandemic on supply and use of blood for transfusion
Abstract
The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. We systematically searched for relevant studies addressing the transfusion chain—from donor, through collection and processing, to patients—to provide a synthesis of the published literature and guidance during times of potential or actual shortage. A reduction in donor numbers has largely been matched by reductions in demand for transfusion. Contingency planning includes prioritisation policies for patients in the event of predicted shortage. A range of strategies maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. Sharing experience and developing expert consensus on the basis of evolving publications will help transfusion services and hospitals in countries at different stages in the pandemic.
... Such shortages also affected Catalonia (Spain) due to not only their broad spectrum of indications or manufacturing limitations but also recent critical disease outbreaks (Wörner et al., 2021). Moreover, NSIGs have been used to combat respiratory infections caused by SARS-CoV-2, SARS-CoV, or MERS-CoV (Ruiz-Antorán et al., 2010;Stanworth et al., 2020;AminJafari and Ghasemi, 2020;Vallejo Rodríguez et al., 1999). Adding to the 20% decrease in donations, the price of NSIGs has increased significantly, and the agencies have had to make a supply management plan (Spanish agency for medicines and health products, 2021; Immunodeficiency United Kingdom, 2023). ...
... Furthermore, other studies in our setting (Solís-Díez et al., 2022) have suggested a rationalization plan describing Catalan spending but created a set of prioritization categories based on pharmacy and non-European guidelines (National Blood Authority Australia, 2022; Alberta Ministry of Health Shared Health Manitoba and Saskatchewan Ministry of Health, 2018) instead of the Public Catalan Health System (SISCAT) guidelines. However, both adult and pediatric patients risk not receiving the treatment they need (Stanworth et al., 2020). Hence, it becomes paramount to shape the investments intended for indications with or without scientific evidence, what the cost of each patient means for the healthcare system, and the reasons for discontinuation of NSIGs to elucidate whether the investment has been worthwhile. ...
Background
The increasing use of non-specific immunoglobulins (NSIGs) and their current shortage show a need for NSIGs’ use prioritization. Data from a clinical perspective are necessary, mainly for pediatric patients.
Objectives
The aim of the study was to assess the level of clinical evidence (LoE) of the indications that NSIGs are used for, the reasons for discontinuation, and the costs invested.
Methods
A retrospective multicentric study was conducted on NSIG incident users between September 2019 and December 2021 retrieved from the Registry of Patients and Treatments (RPT) from Catalonia (Spain). LoE was categorized as A) authorized indications, B) unauthorized with scientific support, C) unauthorized without support, and D) unknown (UNK), following local and the United Kingdom’s guidelines as a sensitivity analysis. We also estimated overall spending and costs per patient visit.
Results
A total of 400 patients were included (17.3% pediatric), with a mean follow-up of 122.1/person-years for adults. The most frequent indications were nervous system and blood diseases. Almost all pediatric patients (56; 81.2%) were treated under A-level indications, as for 217 (65.6%) adults. In the sensitivity analysis, the A-level usage rate decreased to one-third and the B-level usage rate increased by 2–3 times. Furthermore, 37.8% (151) of individuals discontinued. This was predominantly due to remission or no response. The total costs were 868,462.6€/year, with median spending per visit amounting to 1,500€ for adults and 700€ for pediatric patients.
Conclusion
NSIGs are used in clinical practice mainly for approved indications; however, non-approved indications are still an important issue. This could represent a significant economic burden on the healthcare system, focusing on the pediatric population and those at risk for discontinuation with alternative therapeutic options.
... [1] Fears around the potential impact on blood donations, the sustainability of the blood supply and the transfusion needs of COVID-19 patients arose around the world. [2][3][4][5] The Asian Association of Transfusion Medicine, realising the potential impact of the epidemic on blood availability and utilisation very early in the pandemic, released an aide mémoire on COVID-19. [6] It included recommendations for blood services to keep in close contact with clinicians and to manage both blood stocks and blood utilisation. ...
... Several retrospective studies have evaluated the in-hospital transfusion needs of COVID-19 patients and, separately, the impact of the epidemic on blood donation. [2][3][4][5] Despite the paucity of research on how the RESEARCH epidemic affected national blood demand, utilisation and supply patterns, it is evident that the initial strict lockdown measures led to a general decrease in blood utilisation. However, the specific impact of the epidemic on blood demand at a local level remains unclear. ...
... 1,2 Many countries have taken action to close non-essential business, prohibit non-essential rallies, and limit the use of public transportation to reduce the spread of SARS-CoV-2. 3 To control the spread of COVID-19, Chinese government had implemented strict lockdown measures, which resulted in a large reduction in anthropogenic activities and found it difficult to carry out volunteer blood donation activities. Currently, little research has focused on the influence of the COVID-19 on blood donation, 4,5 and the prevalence of transfusive-transmitted infectious diseases, such like syphilis. [6][7][8] Syphilis is known to be a contagious disease caused by T. pallidum (Treponema pallidum) and can be transmitted through sexual contact, blood transfusion, or vertical transmission during pregnancy. ...
... In 2020, with the COVID-19 outbreak worldwide, the blood supply and blood donation activities were severely impacted. 4,5 As usual, the reasons for not donating blood may be concerned about sterilization of equipment, unknown fears, and feeling weakness after donation. 12 But with the outbreak of infectious diseases, people may be afraid of contracting infected diseases during blood donations, which makes blood donations more difficult than usual. ...
Background
In Shenzhen of China, the continuous increase of syphilis infections threatens the safety of blood transfusion. In 2020, COVID-19 was discovered and spread rapidly around the world, and affected the prevalence of syphilis among blood donors.
Methods
From 2013 to 2020, there were 839,161 blood samples collected in the Shenzhen Blood Center. Blood samples were screened by ELISA tests and confirmed by the TPPA (Treponema pallidum particle agglutination) tests and the TRUST (toluidine red unheated serum tests). All data was analyzed by the chi-square test.
Results
From 2013 to 2020, the positive rate of syphilis among blood donors varied significantly among individuals in different ages, educational backgrounds, regions, and blood donation histories (P<0.001). In 2020, It was the first time that there were more repeat blood donors than first-time blood donors and more blood donors with a higher education level than those with a lower education level, and the lowest reactive and positive rate of syphilis among blood donors was observed. Compared to 2019, the prevalence of syphilis among female and repeat blood donors decreased significantly in 2020 (P<0.01).
Conclusion
The prevalence of syphilis in blood donors is related to the characteristics of blood donors (in addition to gender) and the COVID-19 epidemic. COVID-19 can affect the prevalence of syphilis among blood donors by influencing the composition of blood donors and the number of syphile-positive donors in certain blood donors, including female and repeat blood donors.
... In the past 10 years, there has been increased demand for PLTs transfusions worldwide due to aging populations accompanied with advances in medical procedures/treatments [1][2][3] . However, the supply of donors has not kept pace 4,5 . In addition, patients allosensitized through PLTs transfusion or pregnancy can develop PLTs transfusion refractoriness, leaving them in need of human leukocyte antigen class I-and/or human PLTs antigen compatible donors, who can be difficult to find in cases of emergencies and rare types [5][6][7] . ...
... However, the supply of donors has not kept pace 4,5 . In addition, patients allosensitized through PLTs transfusion or pregnancy can develop PLTs transfusion refractoriness, leaving them in need of human leukocyte antigen class I-and/or human PLTs antigen compatible donors, who can be difficult to find in cases of emergencies and rare types [5][6][7] . Therefore, several groups, including ours have proposed human induced pluripotent stem cells (iPSCs) as an alternative source, but the practical ex vivo manufacturing of 200-300 billion PLTs, which is the number used for one transfusion, has not been achieved until recently [8][9][10][11][12] . ...
To complement donor-dependent platelets supplies, we previously developed an ex vivo manufacturing system using induced pluripotent stem cell (iPSC)-derived expandable immortalized megakaryocyte progenitor cell lines (imMKCLs), and a turbulent flow bioreactor to generate iPSC-derived platelets products (iPSC-PLTs). However, the tank size of the bioreactor was limited to 10 L. Here we examined the feasibility of scaling up to 50 L with reciprocal motion by two impellers. Under optimized turbulence parameters corresponding to 10 L bioreactor, 50 L bioreactor elicited iPSC-PLTs with intact in vivo hemostatic function but with less production efficiency. This insufficiency was caused by increased defective turbulent flow space. A computer simulation proposed that designing 50 L turbulent flow bioreactor with three impellers or a new bioreactor with a modified rotating impeller and unique structure reduces this space. These findings indicate that large-scale iPSC-PLTs manufacturing from cultured imMKCLs requires optimization of the tank structure in addition to optimal turbulent energy and shear stress.
... Spowodowało to szereg istotnych następstw dla krwiodawstwa i krwiolecznictwa, w tym konieczność: -wprowadzenia dodatkowych środków ostrożności w placówkach służby krwi; -wprowadzenia dodatkowych kryteriów dyskwalifikacji krwiodawców; -sprostania nowym zadaniom, związanym m.in. z przewidywanymi niedoborami składników krwi oraz koniecznością odpowiedniego planowania postępowania awaryjnego i zasad ustalania priorytetów zaopatrzenia pacjentów [40]. Z punktu widzenia krwiodawstwa i krwiolecznictwa najbardziej istotne są następujące kwestie związane z pandemią: -wpływ pandemii COVID-19 na zmniejszenie podaży składników krwi do celów klinicznych i przez to na problemy związane z odpowiednim zabezpieczeniem potrzeb krwiolecznictwa; -możliwy wpływ choroby COVID-19 na powstawanie zmian w układzie krwiotwórczym i krwi, a w konsekwencji konieczność stosowania substytucji składnikami krwi i zwiększenie zapotrzebowanie na składniki krwi; -wątpliwości i obawy dotyczące możliwości przenoszenia choroby drogą przetaczania krwi i jej składników; -zadania związane z pobieraniem i przetaczaniem osocza ozdrowieńców stosowanego u pacjentów z COVID-19 jako forma immunoterapii biernej. ...
Wstęp: Celem niniejszego opracowania było przedstawienie podstawowych aspektów działalności jednostek organizacyjnych polskiej służby krwi w 2020 roku, przy uwzględnieniu uwarunkowań związanych z trwającą pandemią COVID-19. Materiał i metody: Analiza danych dostarczonych przez Centra Krwiodawstwa i Krwiolecznictwa (CKiK). WYNIKI: W 2020 roku na terenie Polski działało 23 CKiK i 136 oddziałów terenowych (OT). Przeprowadzono 10 432 ekip wyjazdowych. Krew oddawało 569 914 osób, spośród których większość stanowili dawcy honorowi (569 566, w tym 50 012 dawców „na apel”), ponadto 25 dawców płatnych i 323 autologicznych. Najczęściej pobierano krew pełną (1 105 434 donacji), najrzadziej - koncentrat granulocytarny (82 donacje) i KKCz metodą aferezy (16 donacji). Krew pełną pobierano przede wszystkim w OT (46,84%), rzadziej w siedzibach CKiK (30,62%) i w czasie ekip wyjazdowych (22,54%). Najczęściej otrzymywane składniki krwi to KKCz (1 089 978 j.) i FFP (1 264 654 j.). Pobierano również osocze od ozdrowieńców COVID-19 (łącznie 57 708 j.). W 2020 roku otrzymano w sumie 77 485 opakowań zlewanego KKP i 52 030 opakowań KKP metodą aferezy. Dodatkowe metody preparatyki (usuwanie leukocytów, napromieniowanie) stosowano przede wszystkim w stosunku do KKP (55,47% UKKP, 44,53% NUKKP), rzadziej KKCz (21,03% UKKCz, 9,85% NUKKCz i 0,06% NKKCz). Inaktywacji czynników zakaźnych poddano łącznie około 14,21% wydanych do szpitali jednostek FFP i 11,01% opakowań KKP. W 2020 roku z różnych przyczyn zniszczono 11 430 j. KPK, 29 530 j. KKCz, 53 946 j. FFP, 1691 opakowań KKP z aferezy, 5455 opakowań zlewanego KKP oraz 1381 j. krioprecypitatu. Niemal wszystkie analizowane wskaźniki charakteryzujące działalność służby krwi w Polsce uległy w 2020 roku obniżeniu w porównaniu z latami poprzedzającymi. WNIOSKI: Przedstawione w niniejszym opracowaniu dane wskazują na znaczący wpływ pandemii COVID-19 na funkcjonowanie krwiodawstwa i krwiolecznictwa w Polsce w 2020 roku. Dane te mogą służyć jako punkt wyjścia do analizy zagadnień związanych z funkcjonowaniem jednostek organizacyjnych polskiej służby krwi, do porównania doświadczeń oraz oceny stosowanych metod działania w celu wypracowania optymalnych rozwiązań.
... W 2020 roku konieczne było wprowadzenie szeregu istotnych następstw dla krwiodawstwa i krwiolecznictwa, w tym w szczególności: -wprowadzenia dodatkowych środków ostrożności w placówkach służby krwi; -wprowadzenia dodatkowych kryteriów dyskwalifikacji krwiodawców; -sprostania nowym zadaniom, związanym między innymi z przewidywanymi niedoborami składników krwi oraz koniecznością odpowiedniego planowania postępowania awaryjnego i zasad ustalania priorytetów zaopatrzenia pacjentów [41]. Wprowadzone obecnie rozwiązania mogą posłużyć w przyszłości do prawidłowego zarządzania służbą krwi w różnego rodzaju sytuacjach kryzysowych. ...
Wstęp: Celem niniejszego opracowania było przedstawienie podstawowych aspektów działalności jednostek organizacyjnych polskiej służby krwi w 2021 roku, przy uwzględnieniu uwarunkowań związanych z trwającą pandemią COVID-19. Materiały i metody: Analiza danych dostarczonych przez Centra Krwiodawstwa i Krwiolecznictwa (CKiK). WYNIKI: W 2021 roku na terenie Polski działało 23 CKiK i 136 oddziałów terenowych (OT). Przeprowadzono 11 150 ekip wyjazdowych. Krew oddawało 615 784 osób, spośród których większość stanowili dawcy honorowi (615 425, w tym 40 059 dawców „na apel”), ponadto 45 dawców płatnych i 313 autologicznych. Najczęściej pobierano krew pełną (1 248 585 donacji), najrzadziej — koncentrat granulocytarny (104 donacje) i KKCz metodą aferezy (26 donacji). Krew pełną pobierano przede wszystkim w OT (49,01%), rzadziej w siedzibach CKiK (31%) i w czasie ekip wyjazdowych (19,99%). Najczęściej otrzymywane składniki krwi to KKCz (1 231 538 j.) i FFP (1 425 640 j.). Pobierano również osocze od ozdrowieńców COVID-19 (łącznie 87 071 j.). W 2021 roku otrzymano w sumie 85 677 opakowań zlewanego KKP i 52 346 opakowań KKP metodą aferezy. Dodatkowe metody preparatyki (usuwanie leukocytów, napromieniowanie) stosowano przede wszystkim w stosunku do KKP (49,57% UKKP, 50,43% NUKKP), rzadziej KKCz (20,61% UKKCz, 10,05% NUKKCz i 0,04% NKKCz). Inaktywacji czynników zakaźnych poddano łącznie około 15,64% wydanych do szpitali jednostek FFP i 12,53% opakowań KKP. W 2021 roku z różnych przyczyn zniszczono 12 403 j. KPK, 32 866 j. KKCz, 55 058 j. FFP, 1598 opakowań KKP z aferezy, 5317 opakowań zlewanego KKP, a także 1506 j. krioprecypitatu. W 2021 roku nastąpił wzrost wartości niemal wszystkich analizowanych wskaźników charakteryzujących działalność służby krwi w Polsce w porównaniu z rokiem poprzednim. WNIOSKI: Przedstawione w niniejszym opracowaniu dane wskazują na mniejszy, niż w 2020 roku, wpływ pandemii COVID-19 na funkcjonowanie krwiodawstwa i krwiolecznictwa w Polsce w 2021 roku. Dane te mogą służyć jako punkt wyjścia do analizy zagadnień związanych z funkcjonowaniem jednostek organizacyjnych polskiej służby krwi, do porównania doświadczeń oraz oceny stosowanych metod działania w celu wypracowania optymalnych rozwiązań.
... Potential clinical consequences associated with transfusing RBC after the development of storage lesions include the risk of organ dysfunction, organ failure, infections, and death (10). These concerns contribute to the numerous potential adverse effects associated with RBC transfusion therapy; furthermore, the risk of harmful impacts increases as storage time extends (23). Experimental studies have characterized the evolution of human RBC and supernatant changes that occur during storage and form the basis for concern about the potential for harm from long-term storage of RBC. ...
Background: Impacts of red blood cell (RBC) suspension storage on outcomes in pediatric patients receiving RBC transfusions remains uncertain. Therefore, our objective is to examine the association between RBC storage duration and outcomes in pediatric patients. Methods: A retrospective study was conducted on 222 patients admitted to medical and surgical departments at our center in 2021. Primary outcomes assessed were 28-day mortality and length of hospital stays, while secondary outcomes included transfusion-related complications, total volume of RBC transfusions, number of RBC transfusions, and interval between RBC transfusions. Patients were categorized into the fresh group (≤10 days) and the old group (≥21 days) based on RBC storage time. Results: Following RBC transfusions, there was a significant improvement in post-transfusion hemoglobin, RBC counts, and hematocrit in both internal medicine and surgery departments. Among medical patients, the fresh group exhibited a shorter hospital stays compared to the old group [hazard ratio (HR) =0.677; 95% confidence interval (CI): 0.476 to 0.961; P=0.03]; however, no significant difference was observed among surgical patients. Within surgical patients, the fresh group showed longer interval between RBC transfusions (HR =2.235; 95% CI: 1.145 to 4.363; P=0.02) and required fewer number of RBC transfusions (P=0.04). No significant differences were found in hemoglobin, RBC counts, hematocrit, K + , Ca 2+ , lactate (Lac), and pH after RBC transfusions. Conclusions: RBC storage was not associated with 28-day mortality in medical and surgical pediatric patients. Fresh RBC transfusions were found to reduce the length of hospital stays by 32.3% in medical patients, extend the interval between RBC transfusions by 1.235 times and decrease the number of RBC transfusions in surgical patients.
... This highlights the fragility of the current blood bank model that relies exclusively on donation. As a result, the supply of blood was at its lowest point in a decade, resulting in the American Red Cross declaring a national emergency [3,5,6]. ...
A reliable, accessible, and high-quality blood supply is critical for the sustainment of any healthcare system. World events such as the COVID-19 pandemic have proven that maintaining the supply of blood presents a logistical challenge. The current blood supply is overseen by extensive donor programs around the world. In the United States, as in other countries, the need for blood has increased, with a decline in blood donations and increasing exclusions for blood donor qualification. While there is a need to improve blood donation participation, there is also need for new alternatives to traditional donation to ensure readiness to treat hemorrhagic shock common in the setting of trauma, as often occurs during a natural disaster or conflict. These operational medicine scenarios require significant blood availability which may tax the current blood supply chain. Aside from a walking blood bank (WBB) model for blood collection in suboptimal conditions, researchers have proposed alternatives for blood that include the manufacturing of blood from stem cell sources. Other alternatives include synthetic liquids that can carry oxygen such as Perfluoro-Chemicals (PFCs) and hemoglobin-based oxygen-carrying systems (HBCOs). Here, we review some of these alternatives to the traditional donor blood model. Researchers now have the technology that makes it feasible to develop blood alternatives that one day may supplement and help alleviate the limitations in blood supply.
... There have been no reported cases of the transmission of SARS-CoV-2 through blood transfusion, and hence the risk was considered to be minimal (2). Nevertheless, a significant reduction in the supply of blood products was reported, resulting in adverse effects on blood system activities in many countries (3). The pandemic has triggered other problems such as decreasing blood donation from the public due to travel restrictions during Movement Control Order (MCO), public fear of contracting COVID-19 infection from blood donation centres, and reduced blood donation drives during the pandemic (4,5). ...
Background: This study aimed to determine the knowledge and attitude of the Malaysian public towards blood donation during the COVID-19 pandemic. Method: This cross-sectional study utilised an online questionnaire to survey 409 Malaysians between 18 to 60 years old who were non-healthcare workers recruited via convenient snowball sampling. Data were analysed descriptively and via multiple logistic regression. Results: About half (49.2%) of the participants have good knowledge of blood donation while 71.2% of them reported a positive attitude. Gender and blood donation experience were significantly associated with knowledge of blood donation. However, only gender was associated with attitude concerning blood donation. Gender, age, income and donation experience were significantly related to the perception of blood need. No factor was identified as significantly associated with the perception of blood donation risk. The majority of the participants quoted the main reason for blood donation as to save lives. Conclusion: Most of the participants in this study showed a good knowledge and positive attitude towards blood donation. Gender, age, income and donation experience were the main associated factors. Based on these findings, future recruitment approaches for blood donors should target these identified groups, whereas promotional campaigns should be held among populations with poorer knowledge and attitudes towards blood donation, i.e. males, non-donors, younger populations and those with lower income.
... In recent years, challenges in maintaining adequate blood supply reserves have emerged due to a decline in the number of blood donors, instances of inappropriate blood use, and insufficient adherence to strict transfusion guidelines. The COVID-19 pandemic has further intensified these challenges [3]. Proactively predicting the need for PRT can improve treatment efficiency, reduce unnecessary economic burdens on patients, minimize the wastage of blood resources, and enhance patient satisfaction. ...
Background
Timely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods
From September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model’s performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts.
Results
After multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880–0.891) in the training cohort and 0.883 (95% CI: 0.875–0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit.
Conclusions
Our predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.
... One particular area of interest has been the exploration of thresholds for transfusion futility, especially after the COVID-19 pandemic exposed the fragility of blood supplies and surge capacity in times of need across global health systems. [12][13][14] The avoidance of massive resource utilization in cases where mortality is inevitable would be of great benefit. However, accurate prediction of such cases based on transfusion has proved challenging. ...
BACKGROUND
Blood shortages and utilization stewardship have motivated the trauma community to evaluate futility cutoffs during massive transfusions (MTs). Recent single-center studies have confirmed meaningful survival in ultra-MT (≥20 U) and super-MT (≥50 U), while others advocate for earlier futility cut points. We sought to evaluate whether transfusion volume and intensity cut points could predict 100% mortality in a multicenter analysis.
METHODS
A prospective, multicenter, observational cohort study was performed at seven trauma centers. Injured patients at risk for MT who required both blood transfusion and hemorrhage control procedures were enrolled. Four-hour volumes and intensities (average units per hour) were evaluated. Primary outcome of interest was 28-day mortality.
RESULTS
A total of 1,047 patients met the study inclusion with an overall mortality rate of 17% (n = 176). The median age was 35 years, 80% were male, and 62% had a penetrating mechanism, with an Injury Severity Score of 22. At 4 hours, transfusion volumes below 110 U and transfusion intensity averaging up to 21 U/h did not demonstrate futility. Total transfusion volume above 110 U was associated with 100% mortality (n = 9). Multivariable analysis noted only nonmodifiable risk factors as predictors of increased mortality (blunt mechanism, shock index).
CONCLUSION
In this study from seven Level 1 trauma centers, survival was observed at transfusion volumes up to 110 U and at transfusion velocities up to 21 U/h during the first 4 hours of resuscitation. Data are limited on transfusion volumes above 110 U in the first 4 hours. Survival can be observed in both the ultra and super-MT settings.
LEVEL OF EVIDENCE
Prospective, Multicenter, Observational Cohort Study; Level III.
... The pandemic disrupted plateletpheresis activities, leading to a significant decrease in both eligible and active plateletpheresis donors in 2020. This decline could be attributed to the sudden outbreak of COVID-19, which was consistent with global reports of decreased blood donor numbers and blood supply during the early stages of the pandemic [20][21][22][23][24][25]. At the onset of the COVID-19 outbreak, BEs primarily focused on blood safety [26] and convalescent plasma collection [27][28][29]. ...
... At the same time, the prevalence of infectious diseases such as AIDS, hepatitis B, hepatitis C, and the corona virus disease 2019 has led to a shortage of blood supply. Since the 2019 epidemic, the health status of blood donors and fear, among others, have constrained the number of blood donors leading to a lower rate of blood donation [8][9][10]. In addition, blood has a very short storage period. ...
Red blood cell transfusion is the main treatment to improve anemia caused by many reasons and has important clinical application value. However, the supply of red blood cells at home and abroad is currently very tight. Therefore, the utilization of stem cells to prepare erythrocytes for clinical use is expected to become a new mode of blood supply and security in the future. This review describes the process of erythropoiesis regulation in vivo, summarizes the latest research progress of in vitro erythropoiesis, and points out the current challenges of in vitro erythropoiesis, which is expected to provide a new idea for solving the problem of insufficient clinical erythropoiesis supply.
... The coronavirus disease 2019 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to significant changes in global healthcare delivery. Moreover, it has posed an unprecedented challenge to blood banking and transfusion medicine [1]. Although, SARS-CoV-2, similar to other respiratory viruses, is not transmitted through blood transfusion [2], several critical issues related to blood transfusion have emerged during the pandemic. ...
Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected both supply and demand for blood transfusion. This study aimed to investigate the prescription patterns of blood products and identify the risk factors for blood transfusion in patients with severe COVID-19. Methods: This nationwide population-based cohort study was performed in the Republic of Korea between January 2021 and December 2021. Adult patients (≥19 years) with severe COVID-19 who received oxygen therapy were examined. Data were obtained from the National Health Insurance Service database. Results: During the study period, 41,203 patients developed severe COVID-19. The overall transfusion rate was 7.11%, with 14,477 units of packed red blood cells, 4501 units of fresh frozen plasma, 20,532 units of platelet concentrates, and 1875 units of cryoprecipitate. Blood transfusion was independently associated with 90-day mortality (hazard ratio: 1.36, 95% confidence interval: 1.21–1.53, p < 0.001). Multivariate logistic regression analysis identified underlying chronic kidney disease; exposure to surgery, thrombolysis, or thrombectomy; renal replacement therapy; mechanical ventilation; and extracorporeal membrane oxygenation as significant risk factors for blood transfusion in patients with severe COVID-19. Conversely, underlying cerebrovascular diseases, a Charlson Comorbidity Index score of ≥6, admission to intensive care units, and anticoagulant use were identified as protective factors. Conclusions: This study provides an overview of blood transfusion patterns in patients with severe COVID-19. Understanding these patterns may help optimize the stockpiling of medical resources.
... Another signi cant nding was the reduction in transfusion requirements after IV iron. This is particularly relevant given the blood shortages experienced during the COVID-19 pandemic [30] and the anticipated challenges posed by the aging global population [31]. As well, as a valuable alternative to transfusions, IV iron mitigates the risks associated with transfusions such as infection, thrombosis and immunosuppression [32] -key concerns for cancer patients. ...
Purpose Intravenous (IV) iron is well-documented for treating chemotherapy-induced anemia, but data on its efficacy in a wider oncological setting are limited. Our study provides real-world experience with IV iron in both patients on active treatment and those under supportive care. Methods This retrospective study analyzed the effectiveness and safety of IV iron in cancer patients at an integrated oncology center in Hong Kong from January 2019 to August 2023. Patients who received IV iron were evaluated for changes in hemoglobin (Hb) and transfusion requirements. Results The effectiveness population comprised 283 eligible episodes, with mean Hb rising from 7.6 g/dL at baseline to 8.8 g/dL by day 28 and 9.3 g/dL by day 60 ( p < 0.001). The mean units of packed cells transfused per patient declined by 55% up to 12 weeks following IV iron ( p = 0.01). Notably, 164 (58%) patients were receiving supportive care, showing an Hb rise from 7.3 g/dL to 8.3 g/dL on day 28 ( p < 0.001) and a 62% reduction in transfusions ( p = 0.04). Baseline Hb, treatment intent and iron deficiency group significantly predicted Hb changes on day 28 in multiple linear regression. Conclusion To our knowledge, our study presents the largest dataset reported on IV iron use in cancer patients receiving supportive care. IV iron induces a meaningful Hb rise in both patients on active treatment and patients under supportive care, providing a safe alternative to blood transfusion.
... Another reason to consider bloodless medical care as an option is that, while the demand for blood and blood products is increasing in many countries, blood donations have dwindled [13,14]. While demographic trends in many Western societies have contributed to the shortage of blood supplies, the global (unmet) need for blood products intensified during the COVID-19 pandemic [15]. It is also argued that bloodless medicine (BM) significantly reduces healthcare costs and improves the quality of care [16,17]. ...
Objectives: Blood transfusions (BTs) are generally safe and potentially life-saving but come with risks. The World Health Organization advocates reducing unnecessary transfusions and using patient blood management strategies and techniques. However, providing bloodless medical care to patients who prefer to avoid blood-related treatments is a challenge. This is because healthcare professionals’ beliefs about blood transfusion may not align with those of their patients. This study delves into Polish nursing personnel’s attitudes toward bloodless medicine (BM), highlighting the potential gap between their knowledge and patient needs.
Methods: We conducted an online survey among 202 Polish nurses on non-blood management techniques, risks related to BT and BM, and nurses’ educational needs regarding BM.
Results: Although many nurses had some knowledge of BM, Polish nurses’ awareness of non-blood management techniques is relatively low: while less than half knew alternative treatment methods and drugs used in BM, many were unaware of the various risks or side effects related to BM. It also shows that more than three-quarters of nurses believed that patients should have the right to make an informed refusal of BT. While 87.1% of nurses rated their knowledge about BM insufficient or very poor, 66.3% did not feel prepared to care for patients who require non-blood management techniques.
Conclusions: This study underscores the urgent need to educate nurses on blood conservation methods, blood substitutes, and techniques of non-blood management. Incorporating these into the nursing curriculum is crucial for patients’ safety and well-being and our healthcare system's effectiveness. The potential impact of these findings on the healthcare system is significant, underlining the urgency and importance of addressing the knowledge gap in non-blood management techniques.
Public Interest Summary
Although the World Health Organization recommends using non-blood management techniques, most nurses providing bloodless medical care to patients who wish to avoid blood transfusion do not feel prepared to care for such patients. This study describes the attitudes of Polish nursing personnel toward bloodless medicine. It demonstrates that Polish nurses do not possess knowledge of non-blood management techniques, and their awareness of patient blood management methods and drugs used in bloodless medicine is low. However, it also reveals a positive aspect: Most Polish nurses are interested in broadening their knowledge of bloodless medicine. This strong motivation to improve their skills and knowledge in this area is encouraging and should be harnessed to drive positive change in the field of bloodless medicine.
... [2][3][4] Managing platelet (PLT) inventory becomes challenging due to the component's short shelf life (5-7 days), fluctuating donor recruitment, and variable clinical demand. 5,6 Blood collection centers and hospital transfusion services can adapt their collection, manufacturing, and inventory management to mitigate supply challenges. 7 In the United States, apheresis PLT units must adhere to current Food and Drug Administration (FDA) criteria, including storage in gas-permeable bags with a minimum PLT yield of 3.0 Â 10 11 platelets per unit in 90% of sampled units. ...
Background
Splitting apheresis platelet (PLT) units increase available inventory during shortages. The impact of prolonged storage in gas‐impermeable aliquot bags on PLT quality in vitro and transfusion outcomes in patients remains uncertain.
Study Design and Methods
We assessed in vitro PLT quality and thromboelastography (TEG) in PLTs stored for 8 or 24 h in aliquot bags compared with baseline (T0). Retrospective assessment of response (PLT increment and corrected count increment (CCI)) was conducted among adults (≥18 years) transfused with split platelet units from January 2021 to June 2022.
Results
No differences were observed in PLT and white blood cell (WBC) counts, mean platelet volume, or TEG parameters during storage, except for an increase in TEG R time (mean ± SD) at 24 h (6.1 ± 0.5 min) compared to T0 (4.4 ± 0.8 min), p = 0.0031 one‐way ANOVA. Eighty‐one patients were transfused 119 split units with a median [IQR] PLT yield of 2.1 × 10 ¹¹ [1.9 × 10 ¹¹ to 2.3 × 10 ¹¹ ] and storage duration of 1.6[0.7–9.1] h. The overall median PLT count increment was 6.0 × 10 ³ /uL and CCI was 5.0 × 10 ³ , correlating negatively with split unit storage duration (Spearman rho = −0.218, p = 0.017). Compared with split transfusions of pathogen‐reduced (PR) PLTs, non‐PR splits were associated with higher median platelet count increments (7.0 × 10 ³ /μL vs. 4.0 × 10 ³ /μL, p = 0.0263 Mann–Whitney U ) and higher CCIs (6.5 × 10 ³ vs. 3.9 × 10 ³ , p = 0.0116 Mann–Whitney U ) despite no differences in PLT yields (2.1 × 10 ¹¹ /μL vs. 2.1 × 10 ¹¹ /μL).
Discussion
Storing PLTs in aliquot bags for 8 or 24 h does not adversely affect their quality in vitro. Splitting apheresis PLTs are feasible for adult transfusions during shortages. It may be advisable to prioritize non‐PR PLTs for splitting given improved patient responses.
... Blood donation is a pillar of modern medicine and an essential element of health care systems across the globe. It is vital to maintain adequate supplies of blood to treat people with a range of health conditions, including major surgical procedures, cancer, blood disorders, and trauma (Shamshirian et al. 2020) Despite the significant importance of blood donation, there are ongoing challenges in securing sufficient supplies, due to both controllable factors (such as age (Romero-Dominguez et al. 2021) and country-specific cultural and social norms (Ferguson and Lawrence 2005)) and uncontrollable or disruptive factors (such was the case of the COVID-19 pandemic (Stanworth et al. 2020;Chandler et al. 2021)). ...
Blood donation is a prosocial act driven by mechanisms related to altruism. While altruism plays a significant role, the processes behind blood donation behavior are complex, with altruism being just one factor. This research aimed to investigate the influence of altruism and meaning in life on the willingness to donate blood among Romanian undergraduate medical students during the COVID-19 pandemic. The sample consisted of 319 Romanian undergraduate medical students. Structural equation modeling (PLS-SEM) was used for statistical analysis. Our findings reveal that altruism did not significantly impact the willingness to donate blood directly; however, this relationship was mediated by meaning in life. In practice, blood donation could be increased through a more substantial connection between altruism and a sense of meaning in life, especially during health crises. Utilizing social marketing campaign messages that actively encourage altruism and connect it to a sense of meaning in life may increase blood donor recruitment and retention among undergraduate medical students.
... The coping strategies adopted by different countries to maintain a safe and uninterrupted blood transfusion chain at the blood bank have provided valuable lessons for future preparedness in facing similar situations [28][29][30][31][32][33][34]. ...
Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients’ access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019–2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190–2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020–2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics.
... Por lo tanto, el manejo transfusional implica el suministro de sangre y componentes sanguíneos, así como de las terapias con las que están involucrados, a través del diseño y control de sistemas que lo hagan posible. [1][2][3][4] El enfoque utilizado para garantizar la máxima calidad de los componentes sanguíneos en el sistema de suministro de sangre es similar al utilizado en la fabricación de productos farmacéuticos, mientras que el enfoque utilizado para garantizar que los pacientes reciban la terapia transfusional de la más alta calidad incorpora algo de esto, pero también forma parte del plan de calidad general de un hospital. ...
... During this phase, clinicians must determine the minimum platelet count that patients should maintain while awaiting hematopoietic recovery [31]. Although platelet transfusion is a relatively safe prophylactic treatment, recent shortages of blood products resulting from the pandemic have raised concerns [32,33]. Additionally, frequent platelet transfusions may lead to transfusion reactions and other complications. ...
Hematopoietic stem cell transplantation (HSCT) is pivotal in treating hematologic disorders, yet it poses the risk of post-transplantation pancytopenia. Prophylactic platelet transfusions are often administered to mitigate this risk. Utilizing practical markers, such as immature platelet fraction (IPF), to predict hematopoietic recovery in advance could reduce unnecessary prophylactic transfusions. Our prospective study, involving 53 HSCT patients at Taipei Veterans General Hospital between September 2022 and May 2023, utilized the Sysmex XN analyzer to assess peripheral blood cell parameters. We investigated whether IPF could predict platelet recovery early, determined the optimal cut-off value, and compared platelet usage. Neutrophil and platelet engraftment occurred 10 (median; range: 10–12) and 15 (median; range: 15–18) days post-HSCT. Notably, 71.7% of patients exhibited an IPF increase exceeding 2% before platelet recovery. The optimal cut-off IPF on day 10 for predicting platelet recovery within five days was 2.15% (specificity 0.89, sensitivity 0.65). On average, patients received 3.89 units of post-transplantation platelet transfusion. Our results indicate that IPF serves as a predictive marker for platelet engraftment, peaking before the increase in platelet count. This insight aids clinicians in assessing the need for prophylactic platelet transfusions. Integrating reference IPF values alongside platelet counts enhances the accuracy of evaluating a patient’s hematopoietic recovery status. Anticipating the timing of platelet recovery optimizes blood product usage and mitigates transfusion reaction risks.
... Indeed, these measures are widely practiced in clinical and military rescue scenarios [29]. However, the demand for natural blood often outpaces supply [30,31]. Natural blood has a limited preservation period (< 42 d), requires special storage and transportation conditions [32], and is susceptible to damage and adverse reactions when infused [33,34]. ...
Oxygen is necessary for life and plays a key pivotal in maintaining normal physiological functions and treat of diseases. Hemoglobin-based oxygen carriers (HBOCs) have been studied and developed as a replacement for red blood cells (RBCs) in oxygen transport due to their similar oxygen-carrying capacities. However, applications of HBOCs are hindered by vasoactivity, oxidative toxicity, and a relatively short circulatory half-life. With advancements in nanotechnology, Hb encapsulation, absorption, bioconjugation, entrapment, and attachment to nanomaterials have been used to prepare nanomaterial-related HBOCs to address these challenges and pend their application in several biomedical and therapeutic contexts. This review focuses on the progress of this class of nanomaterial-related HBOCs in the fields of hemorrhagic shock, ischemic stroke, cancer, and wound healing, and speculates on future research directions. The advancements in nanomaterial-related HBOCs are expected to lead significant breakthroughs in blood substitutes, enabling their widespread use in the treatment of clinical diseases.
Graphical Abstract
... Although the Director-General of the WHO declared the end of the COVID-19 public health emergency on May 5, 2023, post-vaccination syndrome (PVS), caused by genetic vaccines that have been promoted worldwide and have been given to billions of people, has become a major global problem [19,21,27,30] requiring a reasonable harm-benefit assessment of the global use of genetic vaccines [27,[31][32][33]. Since the beginning of the coronavirus pandemic and genetic vaccination, there has been much debate about the safety of blood products and their use in transfusions [34][35][36][37][38][39]. However, because the pathology of SARS-CoV-2 was not fully understood at the beginning, there was no specific discussion based on data or analysis of what was a problem and what could be a risk; only concerns were expressed, and no clear conclusions or policies were drawn. ...
The coronavirus pandemic was declared by the World Health Organization (WHO) in 2020, and a global genetic vaccination program has been rapidly implemented as a fundamental solution. However, many countries around the world have reported that so-called genetic vaccines, such as those using modified mRNA encoding the spike protein and lipid nanoparticles as the drug delivery system, have resulted in post-vaccination thrombosis and subsequent cardiovascular damage, as well as a wide variety of diseases involving all organs and systems, including the nervous system. In this article, based on these circumstances and the volume of evidence that has recently come to light, we call the attention of medical professionals to the various risks associated with blood transfusions using blood products derived from people who have suffered from long COVID and from genetic vaccine recipients, including those who have received mRNA vaccines, and we make proposals regarding specific tests, testing methods, and regulations to deal with these risks. We expect that this proposal will serve as a basis for discussion on how to address post-vaccination syndrome and its consequences following these genetic vaccination programs.
... Despite the current clinical experience regarding the efficacy of chemotherapy plus plasmapheresis, most studies were conducted before new drugs, such as bortezomib, and were almost inseparable from using fresh frozen plasma [9][10][11]. Plasma, as a nonrenewable resource, can only be obtained from volunteer blood donors [12]. In addition, massive plasma transfusions are associated with a high risk of adverse immune side effects, such as transfusion-related immune modulation and latent viral infections, further endangering the antitumor function and health of patients with MM [13,14]. ...
As no unified treatment protocol or evidence yet exists for plasmapheresis without plasma, this study explored the outcomes of using 4% human albumin (ALB) solution as a replacement solution in patients undergoing plasma exchange for multiple myeloma (MM) patients with acute kidney injury (AKI). This study was prospectively registered (ChiCTR2000030640 and NCT05251896). Bortezomib-based chemotherapy plus therapeutic plasmapheresis (TPP) with 4% human ALB solution was assessed for three years in patients with MM aged >18 years, with AKI according to the Kidney Disease Improving Global Outcomes criteria, and without previous renal impairment from other causes. The primary endpoints were changes in renal function over 18 weeks and survival outcomes at 36 months. The secondary endpoints were the incidence of adverse reactions and symptom improvement. Among the 119 patients included in the analysis, 108 experienced renal reactions. The M protein (absolute changes: median −12.12%, interquartile ranges (IQRs) −18.62 to −5.626) and creatine (median −46.91 μmol/L, IQR −64.70 to −29.12) levels decreased, whereas the estimated glomerular filtration rate (eGFR) increased (median 20.66 mL/(min·1.73 m²), IQR 16.03–25.29). Regarding patient survival, 68.1% and 35.3% of patients survived for >12 and >36 months, respectively. The three symptoms with the greatest relief were urine foam, poor appetite, and blurred vision. All 11 patients (7.6%) who experienced mild adverse reactions achieved remission. In conclusion, in MM patients with AKI, plasma-free plasmapheresis with 4% human ALB solution and bortezomib-based chemotherapy effectively alleviated light chain damage to kidney function while improving patient quality of life.
... HGRH is a busy SA regional hospital with a traditionally high trauma patient burden. [15,16] RCC was selected because it is the most commonly used blood product and was expected to provide the clearest signal. We measured RCC issued by SANBS, as data for units transfused was not available. ...
Background. Blood products, though potentially lifesaving, are a scarce and costly resource. Trauma injuries, which contribute to the demand for these resources, increase in proportion to alcohol consumption. South Africa’s COVID-19 lockdown measures included a ban on alcohol sales and curfews.Objective. To investigate the effect of these societal measures on blood product usage. Methods. We retrospectively compared medical patient data from the South African National Blood Service database of red cell concentrate (RCC) usage in four disciplines during the COVID-19 period with data from the 3 years preceding the pandemic. We also examined trauma case patterns using an institutional database from the Harry Gwala Regional Hospital (HGRH) Emergency Department during the same periods. Results. In total, 16 922 RCCs at HGRH and 528 734 RCCs in KwaZulu-Natal were issued across the four disciplines, from March 2017 - March 2021. RCC usage significantly decreased among trauma patients at institutional and provincial levels during the COVID-19 period (provincial pre-lockdown mean 10.99 units per day; SD 6.89, 95% CI 10.63 - 11.35 v. lockdown 7.46 units per day; SD 5.42, 95% CI 6.14 - 8.79; p<0.01). Further, RCC usage significantly increased during the weekend immediately following the lifting of the first alcohol ban, along with a significant decrease in the number of trauma patients seen during hard lockdown periods. Conclusions. Societal restrictions, including curfews and banning alcohol consumption, decreased the use of RCCs in trauma patients. Government policies aimed at reducing alcohol-related traumatic injuries would likely have a significant impact on RCC usage.
... MSBOS was introduced in the 1970s 25,26 , and was found to reduce unnecessary cross-matching, enhance patient safety and be cost-effective 3,27 . Although, several strategies can be used to calculate MSBOS 3,5,24,28 . MSBOS was calculated using Mead's criteria in this present study (MSBOS=1.5xTi) ...
Objective: This study aimed to evaluate the pattern of blood transfusion requests and utilization in non-coronavirus disease (COVID) patients having undergone elective surgeries during the COVID-19 pandemic. Material and Methods: The pattern of blood transfusion requests and utilization for elective surgical procedures in six departments of a University Hospital; between January 2020 and December 2021, were retrospectively evaluated. The cross-match-to transfusion (C/T) ratio, transfusion probability (%T), transfusion index (Ti), and maximum surgical blood order schedule (MSBOS) were calculated. Results: A total of 15,030 patients underwent elective surgery. Among the 14,426 units of blood requested, 12,776 (89%) units were cross-matched preoperatively for 5,799 (39%) patients, and an additional 1,650 (11%) units were requested for 394 (2.6%) patients intraoperatively. Among these, 4,588 (32%) units were transfused to 1,710 (11.4%) patients. The overall C/T ratio, %T, and Ti were 2.78, 29.5%, and 0.79, respectively. Blood utilization indices for each department varied substantially according to the type of surgery, with blood utilization indices being unfavorable for 68 (80%) of the 85 procedures. The MSBOS was 0 for 32 procedures. Conclusion: Over-ordering of blood units for elective surgical procedures remained common during the COVID-19 pandemic. The blood utilization indices showed substantial variations according to the type of surgical procedures. The MSBOS has been formulated to assist in future decision-making.
... Therefore, the use of Cell Saver can reduce the use of valuable resources while avoiding the risks of allogenic blood transfusions. Interestingly, recent studies looking at the effects of the COVID-19 pandemic on the blood supply chain have found that the combination of a reduction in donor numbers and reduced staff availability to collect and process blood results in blood bank shortages [18] . Therefore, alternatives to allogenic transfusion at times of blood shortages should be actively pursued. ...
Introduction
The use of autologous blood transfusions in oncologic surgeries is somewhat controversial due to the potential risk of disease dissemination through the salvage process. On the other hand, autologous blood transfusion can prevent the potential negative effects of allogenic blood transfusions and reduce use of valuable resources.
Methods
This study included 106 adult patients who underwent oncologic liver surgery at our institution between December 2015 and June 2019. The patients were divided into two groups: the Cell Saver® group (operated between January 2018 and June 2019) and the control group (operated between December 2015 and December 2017). The Cell Saver® device was present in the operating room for the Cell Saver® group, and blood was re-transfused if a certain amount of blood loss occurred. Data analysis focused on outcomes such as blood transfusion requirements, overall survival, recurrence-free survival, hemoglobin levels, hospital stay, and complications. Patient records provided relevant information on demographics, surgery details, pathology, and outcomes for both groups.
Results
Autologous blood transfusion was found to reduce the amount of blood units needed (4.0 units (control group) versus 0.4 units (Cell Saver® group) P =0.029. Kaplan-Meier curves showed no difference for both overall survival 471.6 days (Cell Saver® group) versus 468.3 days (control group) ( P =0.219) and 488.9 days (Cell Saver® group) versus 487.2 days (control group) ( P =0.993) and disease-free survival ( P =0.553) and ( P =0.735) for primary hepatic tumours and hepatic metastasis respectively between the Cell Saver® and control groups. Overall survival regardless of the type of tumour was similar to the control group (485.4 d vs. 481.9 d) ( P =0.503). Survival was significantly lower for minor hepatectomies (516.0 d vs. 517.4 d) ( P =0.050) in the Cell Saver® group, major hepatectomies showed no difference in overall survival (470.2 d vs. 466.4 d) ( P =0.868). No impact on disease recurrence was found between patients who received autologous blood transfusions versus those who did not.
Conclusion
The use of Cell Saver® should not be avoided in oncologic surgeries of the liver. Use of Cell Saver® for major hepatectomies might be more beneficial as OS was significantly lower for the Cell Saver® group for patients who underwent minor hepactomies. Further research is needed to explain this conflicting result. Nonetheless, the use of Cell Saver® in autologous blood transfusions can reduce the use of valuable resources and the risks associated with allogenic blood transfusions.
Background: Anemia is common in cancer patients receiving palliative care, causing significant symptom burden and transfusion requirement. While intravenous (IV) iron is recognized for its role in chemotherapy-induced anemia, its efficacy in broader palliative oncology settings is underexplored. Our study provides real-world experience with IV iron in cancer patients, particularly those receiving supportive care alone. Methods: This retrospective study was conducted at an integrated oncology center in Hong Kong from January 2019 to August 2023. Patients who received IV iron were evaluated for changes in hemoglobin (Hb) and transfusion requirements. Results: Among 283 eligible episodes, mean Hb increased from 7.6 g/dL at baseline to 8.8 g/dL and 9.3 g/dL by days 28 and 60, respectively (ps < 0.001). Mean units of packed cells transfused per patient declined by 55% within to 12 weeks following IV iron ( P = 0.01). Among 164 (58%) patients receiving supportive care alone, Hb rose from 7.3 g/dL to 8.3 g/dL on day 28 ( P < 0.001), with a 62% reduction in transfusions ( P = 0.04). Adverse reactions were observed in 4 patients (1.1%), none with significant consequences. Baseline Hb, treatment intent and iron deficiency group significantly predicted Hb change on day 28 in multiple linear regression. Conclusion: IV iron significantly improved anemia and reduced transfusion requirements in cancer patients with anemia, including those receiving supportive care. To our knowledge, this study presents the largest dataset on IV iron use in cancer patients receiving supportive care to date. Future studies should explore its effect on symptoms management, quality of life and health-economic benefits.
Background
The administration of blood components and their alternatives can be lifesaving. Anaemia, bleeding and transfusion are all associated with poor peri‐operative outcomes. Considerable changes in the approaches to optimal use of blood components and their alternatives, driven by the findings of large randomised controlled trials and improved haemovigilance, have become apparent over the past decade. The aim of these updated guidelines is to provide an evidence‐based set of recommendations so that anaesthetists and peri‐operative physicians might provide high‐quality care.
Methods
An expert multidisciplinary, multi‐society working party conducted targeted literature reviews, followed by a three‐round Delphi process to produce these guidelines.
Results
We agreed on 12 key recommendations. Overall, these highlight the importance of organisational factors for safe transfusion and timely provision of blood components; the need for protocols that are targeted to different clinical contexts of major bleeding; and strategies to avoid the need for transfusion, minimise bleeding and manage anticoagulant therapy.
Conclusions
All anaesthetists involved in the care of patients at risk of major bleeding and peri‐operative transfusion should be aware of the treatment options and approaches that are available to them. These contemporary guidelines aim to provide recommendations across a range of clinical situations.
Background
During the height of the COVID‐19 pandemic (2020–2021), people were urged to minimize movements. Nevertheless, the Netherlands observed a huge increase in new donor registrations in early 2020. It is unclear whether such “pandemic” donors are willing to become repeat donors. The aim of this study was to analyze the donation behavior of these “pandemic” donors during 2 years after registration.
Methods
All donors registered in weeks 11–20 of 2020 were followed for 2 years and their turnout for the new donor screening (NDS), their first‐time donation (FTD), their donation(s) in the follow‐up period, and their availability at the end of the follow‐up period was compared with donors registered in weeks 11–20 of the previous years, 2017–2019.
Results
Totally 26,463 donors registered during week 11–20 in 2020; more than double as in the same period in previous years. Their turnout for the NDS (80%) and FTD (60%) was like donors registered in 2017–2019. On the longer term, we saw lower donor availability with a shift in number of whole blood and plasma donations.
Discussion
During the first phase of the pandemic, more people registered than usual. Their show rates for the NDS and the FTD were comparable with previous years, suggesting that “pandemic” donors show identical behavior as regular donors. On the long term, however, donation behavior differed (lower return rates and shift in donation types). Further research is needed to disentangle impacts of the pandemic especially on the long‐term changes as they happened simultaneously with policy and recruitment changes.
The history of blood transfusion has been dominated by the search for compatibility for species specificity, the search for how to transfer blood from one individual into another, or infuse. Safety has become a major issue since it became clear that blood was not only able to allow mystical miracles to take place but also could transmit infectious diseases. The science behind these ideas reflects observation, a thinking and exchange of knowledge and skills, originally documented in reports or case studies of what has happened and was observed, and peer presented—knowledge economy.
Background
Blood product constraints have increased the focus on inventory management as blood banks have faced challenges that impact supply chains and donor availability. Solutions often include a reduction in transfusion volumes through multidisciplinary improvements, but this is often coupled with a reduction in blood bank inventory to match reduced demand. We sought to improve inventory availability within the blood bank without modification of transfusion rates through solutions that prevented unnecessary RBC orders and crossmatching.
Study Design and Methods
Improvements were focused on reduction of duplicate orders, preoperative blood orders, excess volume of blood orders, and crossmatching in advance of perioperative needs. The study monitored the improvement of the crossmatch to transfusion ratio as the primary outcome and days of shelf life until expiration as a secondary outcome.
Results
The CT ratio of RBCs decreased from 2.03 (16,044/7922) pre‐implementation to 1.67 (12,321/7375) post‐implementation ( p < 0.05). Our inventory was managed more efficiently following our interventions as demonstrated through the day of shelf life of RBCs issued. Pre‐implementation, RBCs were issued an average of 17.5 days before expiration, which increased to 20.4 days post‐implementation ( p < 0.05).
Conclusion
Modification of preoperative order sets and education of clinical staff to ensure appropriate blood product ordering can significantly impact available inventory. Although this was also identified within our study, we found that the largest impact comes from a change in crossmatching workflow to reduce unnecessary reserving of RBCs. These changes can be implemented without significant impact to turnaround time.
Uvod: Održavanje stabilnih rezervi krvnih komponenti je kompleksan proces, na koje utiče kako adekvatna upotreba krvi, tako i stopa odbačenih jedinica krvi (“stopa rasipanja”) kao jedan od najznačajnih indikatora kvaliteta transfuzijske službe.
Cilj rada: utvrditi razloge za odbacivanje zamrznute sveže plazme (ZSP) kao i količinu odbačene ZSP u Zavodu za transfuziju krvi Vojvodine (ZZTKV) na osnovu kojih bi mogli da se uvedu protokoli koji će pomoći da se minimizira odbacivanje
krvnih komponenti.
Materijal i metode: Retrospektivnom studijom je analiziran period od januara do
decembra 2021. godine u ZZTKV, najvećem distributeru krvi i krvnih produkata u Vojvodini (za 8 bolničkih banki krvi i 19 bolnica). Relevantni podaci su dobijeni iz informacionog sistema ZZTKV. Statistička analiza podataka je radjena testom Analizeom varijanse (ANOVA) grupisanjem podataka po razlozima odbacivanja jedinica zamrznute sveže plazme (ZSP) i upoređivanjem prosečnih vrednosti za
različite kategorije odbacivanja, sa ciljem da utvrdimo da li postoji statistički značajna razlika u prosečnom broju odbačenih jedinica među ovim grupama. Rezultati: Od ukupnog broja prikupljenih jedinica (43073 jedinica krvi) napravljena je 34831 (80,86%) jedinica ZSP. Za terapijsku upotrebu je iskorišćeno 19556/34831 (56,14%), dok je 15275/34831 (43,86%) bilo odbačenih produkata. Glavni razlozi za odbacivanje ZSP bili su: lipemični produkti 8974/34831 (25,76%), tehničke greške 5759/34831 (16,05%), pozitivni rezultati testiranja na transmisivne bolesti 139/34831 (0,40%), istekao rok trajanja 56/34831 (0,16%) i ostali razlozi 403/34831 (1,16%). Zaključak: Zavod za transfuziju krvi Vojvodinе je 2021. godine napravio 34831 (80,86%) jedinicu zamrznute sveže plazme ZSP. Za terapijsku upotrebu je iskorišćeno samo 56,14%, dok je ostalih 43,86% odbačeno, najviše zbog lipemičnih produkata (25,76%). Odbačene lipemične plazme 8974 produkata su činile više od pola (58,75%) odbačenih produkata ZSP. Glavni razlog povećanog broja donacija lipemične plazme predstavlja činjenica da se u Vojvodini konzumira tradicionalna hrana bogata masnoćama a učestvuje i genetski faktor za hiperlipoproteinemije.
Edukacija davalaca krvi može da podstakne da se stvore zdravije navike ishrane. Smanjen broj tehničkih greški može se postići boljom opremom (centrifuge, separatori), kao i pažljivim rukovanjem napravljenim produktima krvi.
There is no multi-country/multi-language study testing a-priori multivariable associations between non-modifiable/modifiable factors and validated wellbeing/multidimensional mental health outcomes before/during the COVID-19 pandemic. Moreover, studies during COVID-19 pandemic generally do not report on representative/weighted non-probability samples. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is a multi-country/multi-language survey conducting multivariable/LASSO-regularized regression models and network analyses to identify modifiable/non-modifiable factors associated with wellbeing (WHO-5)/composite psychopathology (P-score) change. It enrolled general population-representative/weighted-non-probability samples (26/04/2020-19/06/2022). Participants included 121,066 adults (age=42±15.9 years, females=64 %, representative sample=29 %) WHO-5/P-score worsened (SMD=0.53/SMD=0.74), especially initially during the pandemic. We identified 15 modifiable/nine non-modifiable risk and 13 modifiable/three non-modifiable protective factors for WHO-5, 16 modifiable/11 non-modifiable risk and 10 modifiable/six non-modifiable protective factors for P-score. The 12 shared risk/protective factors with highest centrality (network-analysis) were, for non-modifiable factors, country income, ethnicity, age, gender, education, mental disorder history, COVID-19-related restrictions, urbanicity, physical disorder history, household room numbers and green space, and socioeconomic status. For modifiable factors, we identified medications, learning, internet, pet-ownership, working and religion as coping strategies, plus pre-pandemic levels of stress, fear, TV, social media or reading time, and COVID-19 information. In multivariable models, for WHO-5, additional non-modifiable factors with |B|>1 were income loss, COVID-19 deaths. For modifiable factors we identified pre-pandemic levels of social functioning, hobbies, frustration and loneliness, and social interactions as coping strategy. For P-scores, additional non-modifiable/modifiable factors were income loss, pre-pandemic infection fear, and social interactions as coping strategy. COH-FIT identified vulnerable sub-populations and actionable individual/environmental factors to protect well-being/mental health during crisis times. Results inform public health policies, and clinical practice.
The reduction in the blood supply following the 2019 coronavirus pandemic has been exacerbated by the increased use of balanced resuscitation with blood components including whole blood in urban trauma centers. This reduction of the blood supply has diminished the ability of blood banks to maintain a constant supply to meet the demands associated with periodic surges of urban trauma resuscitation. This scarcity has highlighted the need for increased vigilance through blood product stewardship, particularly among severely bleeding trauma patients (SBTPs). This stewardship can be enhanced by the identification of reliable clinical and laboratory parameters which accurately indicate when massive transfusion is futile. Consequently, there has been a recent attempt to develop scoring systems in the prehospital and emergency department settings which include clinical, laboratory, and physiologic parameters and blood products per hour transfused as predictors of futile resuscitation. Defining futility in SBTPs, however, remains unclear, and there is only nascent literature which defines those criteria which reliably predict futility in SBTPs. The purpose of this review is to provide a focused examination of the literature in order to define reliable parameters of futility in SBTPs. The knowledge of these reliable parameters of futility may help define a foundation for drawing conclusions which will provide a clear roadmap for traumatologists when confronted with SBTPs who are candidates for the declaration of futility. Therefore, we systematically reviewed the literature regarding the definition of futile resuscitation for patients with trauma-induced hemorrhagic shock, and we propose a concise roadmap for clinicians to help them use well-defined clinical, laboratory, and viscoelastic parameters which can define futility.
Background
Blood components are costly and scarce. The Blood Stocks Management Scheme (BSMS) was established in the United Kingdom (UK) to support hospital transfusion services and national blood services through collection, analysis, and monthly feedback of data on blood component inventory and wastage management. There is a growing evidence base on how best to deliver feedback for quality improvement. We assessed the quality and utility of the monthly BSMS component reports.
Methods
We assessed the content of BSMS reports issued in March 2023 against established criteria for effective feedback. Two researchers independently rated whether criteria spanning the five domains of goal setting, data collection, feedback content, feedback display and feedback delivery were fully, partially or not met. Disagreements were resolved through discussion. We conducted an online questionnaire survey of recipients of BSMS reports during March 2023 to assess their use of reports and seek suggestions for improvement.
Results
Five out of 20 criteria for effective feedback were fully met. Areas for improvement included placing more emphasis in the feedback on positive change, linking data and summary messages, and including specific suggestions for action. Respondents highlighted the value of benchmarked comparisons with other hospital transfusion services.
Conclusion
There is scope for enhancing the effectiveness and utility of BSMS feedback reports and hence reducing wastage of blood components. This methodology for evaluation of feedback could be utilized to improve other areas of transfusion practice.
Background
Current procedures for thawing and issuing of cryopreserved platelets (CPPs) are laborious and have remained challenging in emergency settings such as blood banks and military operations. In this prospective study, a novel processing method designed to facilitate the rapid issuance of CPPs with no postthaw handling required was developed and functionally characterized in parallel with standard CPPs manufactured.
Study Design and Methods
Double‐dose plateletpheresis units ( n = 42) were cryopreserved at −80°C in 5%–6% dimethyl sulfoxide to produce matched pairs thawed successively over a 27‐month period for comparison between two processing arms. In contrast to the standard CPPs manufactured as standalone units, platelets were frozen in tandem with resuspending plasma in a distinct partition as a single unit in the novel method, herein referred to as tandem CPPs. Postthaw (PT) CPPs from both arms were assessed at PT0‐, 12‐, and 24‐h to measure platelet recovery, R‐time (time to clot initiation; min), and maximum amplitude (MA; clot strength; mm) using thromboelastography.
Results
In the overall dataset, mean platelet recovery was higher ( p < .0005) for tandem CPPs (83.9%) compared with standard CPPs (73.3%) at PT0; mean R‐times were faster ( p < .0005) for tandem CPPs (2.5–3.6 min) compared with standard CPPs (3.0–3.8 min); mean MA was higher for tandem CPPs (57.8–59.5 mm) compared with standard CPPs (52.1–55.8 mm) at each postthaw time point ( p < .05).
Conclusion
Robust temporal dynamics of superior hemostatic functionality were established for tandem CPPs over extended cryopreservation up to 27 months and 24 h of postthaw storage.
Uncontrollable bleeding is recognized as the leading cause of preventable death among trauma patients. Early transfusion of blood products, especially plasma replacing crystalloid and colloid solutions, has been shown to increase survival of severely injured patients. However, the requirements for cold storage and thawing processes prior to transfusion present significant logistical challenges in prehospital and remote areas, resulting in a considerable delay in receiving thawed or liquid plasma, even in hospitals. In contrast, freeze- or spray-dried plasma, which can be massively produced, stockpiled, and stored at room temperature, is easily carried and can be reconstituted for transfusion in minutes, provides a promising alternative. Drawn from history, this paper provides a review of different forms of dried plasma with a focus on in vitro characterization of hemostatic properties, to assess the effects of the drying process, storage conditions in dry form and after reconstitution, their distinct safety and/or efficacy profiles currently in different phases of development, and to discuss the current expectations of these products in the context of recent preclinical and clinical trials. Future research directions are presented as well.
Objectives:
The aims of this study were to describe the baseline estimated blood loss (EBL) in surgery and transfusion rate in patients undergoing cytoreductive surgeries for ovarian malignancy, and identify perioperative variables associated with blood loss and transfusion.
Methods:
A retrospective cohort study at a single institution was performed that included patients with known or suspected ovarian malignancy undergoing cytoreductive surgery between 2016 and 2021. t tests, χ2 tests, and multiple logistic regression analyses were used.
Results:
Among 44 patients meeting inclusion criteria, 61% received perioperative blood transfusion. There were significant differences in EBL and preoperative hemoglobin levels between patients who did and did not receive transfusion (EBL 442.6 vs 236.8 mL, P = 0.0008; preoperative hemoglobin 10.2 vs 11.2 g/dL, P = 0.049). After adjusting for preoperative hemoglobin, the risk of transfusion increased for each additional 200 mL of EBL (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.5-9.5). Stratified by race, the association between EBL and transfusion risk remained statistically significant only for non-Latinx White patients (OR 6.1, 95% CI 1.7-21.9), who made up 77% of the study population, but not for patients of other races and ethnicities (OR 1.0, 95% CI 0.16-6.42).
Conclusions:
Perioperative blood transfusion is common in patients undergoing cytoreductive surgery. In this study, EBL and preoperative hemoglobin levels were significantly associated with transfusion receipt. Clinicians should optimize hemoglobin levels and intraoperative blood conservation strategies to reduce the need for transfusion. The results also highlight the importance of considering racial and ethnic differences when developing strategies to reduce transfusion risk.
Berzuini et al report the observation that nearly half of patients with COVID-19 tested at their blood center had a positive direct antiglobulin test (DAT). However, eluates did not react with any test cells but did react with red cells from other patients with COVID-19 that were DAT negative. This suggests that COVID-19 may modulate the red cell membrane and present novel antigenic epitopes.
Background
There is considerable variation in disease behavior among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19). Genomewide association analysis may allow for the identification of potential genetic factors involved in the development of Covid-19.
Methods
We conducted a genomewide association study involving 1980 patients with Covid-19 and severe disease (defined as respiratory failure) at seven hospitals in the Italian and Spanish epicenters of the SARS-CoV-2 pandemic in Europe. After quality control and the exclusion of population outliers, 835 patients and 1255 control participants from Italy and 775 patients and 950 control participants from Spain were included in the final analysis. In total, we analyzed 8,582,968 single-nucleotide polymorphisms and conducted a meta-analysis of the two case–control panels.
Results
We detected cross-replicating associations with rs11385942 at locus 3p21.31 and with rs657152 at locus 9q34.2, which were significant at the genomewide level (P<5×10⁻⁸) in the meta-analysis of the two case–control panels (odds ratio, 1.77; 95% confidence interval [CI], 1.48 to 2.11; P=1.15×10⁻¹⁰; and odds ratio, 1.32; 95% CI, 1.20 to 1.47; P=4.95×10⁻⁸, respectively). At locus 3p21.31, the association signal spanned the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 and XCR1. The association signal at locus 9q34.2 coincided with the ABO blood group locus; in this cohort, a blood-group–specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95% CI, 1.20 to 1.75; P=1.48×10⁻⁴) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95% CI, 0.53 to 0.79; P=1.06×10⁻⁵).
Conclusions
We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.)
The emerging COVID‐19 pandemic has overwhelmed healthcare resources worldwide, and for transfusion services this could potentially result in rapid imbalance between supply and demand due to a severe shortage of blood donors. This may result in insufficient blood components to meet every patient's needs resulting in difficult decisions about which patients with major bleeding do and do not receive active transfusion support. This document, which was prepared on behalf of the National Blood Transfusion Committee in England, provides a framework and triage tool to guide the allocation of blood for patients with massive haemorrhage during severe blood shortage. Its goal is to provide blood transfusions in an ethical, fair, and transparent way to ensure that the greatest number of life years are saved. It is based on an evidence‐ and ethics‐based Canadian framework, and would become operational where demand for blood greatly exceeds supply, and where all measures to manage supply and demand have been exhausted. The guidance complements existing national shortage plans for red cells and platelets.
The new coronavirus SARS-CoV-2 has rapidly spread over the world causing the disease by WHO called COVID-19. This pandemic poses unprecedented stress on the health care system including programs performing allogeneic and autologous hematopoietic cell transplantation (HCT) and cellular therapy such as with CAR T cells. Risk factors for severe disease include age and predisposing conditions such as cancer. The true impact on stem cell transplant and CAR T-cell recipients in unknown. The European Society for Blood and Marrow Transplantation (EBMT) has therefore developed recommendations for transplant programs and physicians caring for these patients. These guidelines were developed by experts from the Infectious Diseases Working Party and have been endorsed by EBMT’s scientific council and board. This work intends to provide guidelines for transplant centers, management of transplant candidates and recipients, and donor issues until the COVID-19 pandemic has passed.
As COVID‐19 disease escalates globally, optimising patient outcome during this catastrophic health care crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and health care authorities with information regarding how to apply established principles of patient blood management during the COVID‐19 pandemic. In particular, this review considers the impact of the COVID‐19 pandemic on the blood supply and specifies important aspects of donor management. We further discuss how preventative and control measures implemented during the COVID‐19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID‐19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID‐19. Finally, we address special considerations pertaining to supply‐demand and cost‐benefit issues of patient blood management during the COVID‐19 pandemic.
With the developing COVID‐19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self‐isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life‐saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID‐19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID‐19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID‐19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.
Infection with SARS-CoV-2, the cause of coronavirus infectious disease–19 (COVID-19), has caused a pandemic with >850,000 cases worldwide and increasing. Several studies report outcomes of COVID-19 in predominately well persons. There are also some data on COVID-19 in persons with predominately solid cancer but controversy whether these persons have the same outcomes. We conducted a cohort study at two centres in Wuhan, China, of 128 hospitalised subjects with haematological cancers, 13 (10%) of whom developed COVID-19. We also studied 226 health care providers, 16 of whom developed COVID-19 and 11 of whom were hospitalised. Co-variates were compared with the 115 subjects with haematological cancers without COVID-19 and with 11 hospitalised health care providers with COVID-19. There were no significant differences in baseline co-variates between subjects with haematological cancers developing or not developing COVID-19. Case rates for COVID-19 in hospitalised subjects with haematological cancers was 10% (95% Confidence Interval [CI], 6, 17%) compared with 7% (4, 12%; P = 0.322) in health care providers. However, the 13 subjects with haematological cancers had more severe COVID-19 and more deaths compared with hospitalised health care providers with COVID-19. Case fatality rates were 62% (32, 85%) and 0 (0, 32%; P = 0.002). Hospitalised persons with haematological cancers have a similar case rate of COVID-19 compared with normal health care providers but have more severe disease and a higher case fatality rate. Because we were unable to identify specific risk factors for COVID-19 in hospitalised persons with haematological cancers, we suggest increased surveillance and possible protective isolation.
Background:
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by novel coronavirus (SARS-CoV-2), and first reported in Wuhan, China, in December 2019. Since the severe acute respiratory syndrome (SARS) outbreak in 2003, Tan Tock Seng Hospital (TTSH) in Singapore has routinely fit-tested staff for high filtration N95 respirators, and established web-based staff surveillance systems. The routine systems were enhanced in response to Singapore's first imported COVID-19 case on January 23,2020.
Methods:
We conducted a cross-sectional study, from January 23,2020 to February 23,2020, among healthcare workers to evaluate the effectiveness of the staff protection and surveillance strategy in TTSH, a 1600-bed multidisciplinary acute-care hospital co-located with the 330-bed National Centre for Infectious Diseases (NCID). As of February 23,2020, TTSH/NCID has managed 76% of confirmed COVID-19 cases in Singapore. The hospital adopted a multi-pronged approach to protect and monitor staff with potential COVID-19 exposures:(1) Risk-based personal protective equipment, (2) Staff fever and sickness surveillance, and (3) Enhanced medical surveillance of unwell staff.
Results:
A total of 10,583 staff were placed on hospital-wide fever and sickness surveillance, with 1,524 frontline staff working in COVID-19 areas under close surveillance. Among frontline staff, a median of eight staff illness episodes was seen per day, and almost 10% (n=29) resulted in hospitalization. None of the staff was found to be infected with COVID-19.
Conclusions:
A robust staff protection and health surveillance system that is routinely implemented during non-outbreak periods and enhanced during the COVID-19 outbreak is effective in protecting frontline staff from the infection.
BACKGROUND
Increasing numbers of emergency medical service agencies and hospitals are developing the capability to administer blood products to patients with hemorrhagic shock. Cold‐stored whole blood (WB) is the only single product available to prehospital providers who aim to deliver a balanced resuscitation strategy. However, there are no data on the safety and in vitro characteristics of prehospital stored WB. This study aimed to describe the effects on in vitro quality of storing WB at remote helicopter bases in thermal insulating containers.
STUDY DESIGN AND METHODS
We conducted a two‐armed single‐center study. Twenty units (test) were stored in airtight thermal insulating containers, and 20 units (controls) were stored according to routine procedures in the Haukeland University Hospital Blood Bank. Storage conditions were continuously monitored during emergency medical services missions and throughout remote and blood bank storage. Hematologic and metabolic variables, viscoelastic properties, and platelet (PLT) aggregation were measured on Days 1, 8, 14, and 21.
RESULTS
Storage conditions complied with the EU guidelines throughout remote and in‐hospital storage for 21 days. There were no significant differences in PLT aggregation, viscoelastic properties, and hematology variables between the two groups. Minor significantly lower pH, glucose, and base excess and higher lactate were observed after storage in airtight containers.
CONCLUSION
Forward cold storage of WB is safe and complies with EU standards. No difference is observed in hemostatic properties. Minor differences in metabolic variables may be related to the anaerobic conditions within the thermal box.
Severe acute respiratory syndrome coronavirus 2, also known as COVID‐19, has spread to 184 countries with almost 1.5 million cases as of mid‐April 2020 since first reported (1). The clinical features of this disease are not completely understood, however severe illness is thought to predominantly occur in adults with advanced age and those with underlying comorbidities (2). Sickle cell disease (SCD), an immunocompromised condition, puts patients at higher risk for respiratory infections and subsequent pulmonary complications such as acute chest syndrome (ACS) (3).
Objective
To evaluate viral loads at different stages of disease progression in patients infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first four months of the epidemic in Zhejiang province, China.
Design
Retrospective cohort study.
Setting
A designated hospital for patients with covid-19 in Zhejiang province, China.
Participants
96 consecutively admitted patients with laboratory confirmed SARS-CoV-2 infection: 22 with mild disease and 74 with severe disease. Data were collected from 19 January 2020 to 20 March 2020.
Main outcome measures
Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed.
Results
3497 respiratory, stool, serum, and urine samples were collected from patients after admission and evaluated for SARS-CoV-2 RNA viral load. Infection was confirmed in all patients by testing sputum and saliva samples. RNA was detected in the stool of 55 (59%) patients and in the serum of 39 (41%) patients. The urine sample from one patient was positive for SARS-CoV-2. The median duration of virus in stool (22 days, interquartile range 17-31 days) was significantly longer than in respiratory (18 days, 13-29 days; P=0.02) and serum samples (16 days, 11-21 days; P<0.001). The median duration of virus in the respiratory samples of patients with severe disease (21 days, 14-30 days) was significantly longer than in patients with mild disease (14 days, 10-21 days; P=0.04). In the mild group, the viral loads peaked in respiratory samples in the second week from disease onset, whereas viral load continued to be high during the third week in the severe group. Virus duration was longer in patients older than 60 years and in male patients.
Conclusion
The duration of SARS-CoV-2 is significantly longer in stool samples than in respiratory and serum samples, highlighting the need to strengthen the management of stool samples in the prevention and control of the epidemic, and the virus persists longer with higher load and peaks later in the respiratory tissue of patients with severe disease.
We present a putative link between maternal COVID19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS‐CoV‐2 has already resulted in high numbers of critically ill patients and deaths in the non‐pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP syndrome, and thus knowledge of the COVID19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D‐dimers, prothrombin time, and platelet count in all patients presenting with COVID19 as per ISTH guidance, monitoring of APTT and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS‐CoV‐2‐positive pregnant women are vital, as their derangement may signal a more severe COVID19 infection, and may warrant pre‐emptive admission and consideration of delivery to achieve maternal stabilization.
An 80‐year‐old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever and critically low O2 saturation and definitive chest CT scan findings in favor of COVID‐19 and positive PCR results in 48 h. He received antiviral treatment plus recombinant human Erythropoietin(rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the SARS‐CoV‐2 virus through multiple mechanisms including cytokine modulation, anti‐apoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus.
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Currently, there are no approved specific antiviral agents for novel coronavirus disease 2019 (COVID-19). In this study, 10 severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 d after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 d. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 d. Several parameters tended to improve as compared to pretransfusion, including increased lymphocyte counts (0.65 × 10 ⁹ /L vs. 0.76 × 10 ⁹ /L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesions within 7 d. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in larger well-controlled trials.
Because of high rates of 2019 novel coronavirus disease in Wuhan, China, Wuhan Blood Center began screening for severe acute respiratory syndrome coronavirus 2 RNA on January 25, 2020. We screened donations in real-time and retrospectively and found plasma samples positive for viral RNA from 4 asymptomatic donors.
Coronaviruses are enveloped single‐stranded RNA viruses belonging to the family of Coronaviridae. While initial research focused on their ability to cause enzootic infections, infections which have emerged in the past two decades demonstrate their ability to cross the species barrier and infect humans [1,2]. The ensuing epidemics have included Severe Acute Respiratory Syndrome (SARS) in 2002 and the more recent Middle East Respiratory Syndrome (MERS) in 2012, and have resulted in severe disease burden, mortality and economic disruption [3]. A novel flu‐like coronavirus, emerging towards the end of 2019 and subsequently named SARS‐CoV‐2, has been associated with an epidemic initially focused in Wuhan, China.
Plasma provided by COVID‐19 convalescent patients may provide therapeutic relief as the number CODID‐19 cases escalate steeply world‐wide. Prior findings in various viral respiratory diseases including SARS‐CoV related pneumonia suggest that convalescent plasma can reduce mortality, although formal proof of efficacy is still lacking. By reducing viral spread early on, such an approach may possibly downplay subsequent immunopathology. Identifying, collecting, qualifying and preparing plasma from convalescent patients with adequate SARS‐CoV‐2 neutralizing Ab titers in an acute crisis setting may be challenging, although well within the remit of most blood establishments. Careful clinical evaluation should allow to quickly establish whether such passive immunotherapy, administered at early phases of the disease in patients at high risk of deleterious evolution may reduce the frequency of patient deterioration, and thereby COVID‐19 mortality.
The World Health Organization (WHO) has declared Coronavirus Disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Global health care now faces unprecedented challenges with widespread and rapid human-to-human transmission of SARS-CoV-2 and high morbidity and mortality with COVID-19 worldwide. Across the world, the medical care is hampered by a critical shortage of not only hand sanitizers, personal protective equipment, ventilators and hospital beds, but also impediments to the blood supply. Blood donation centers in many areas around the globe have mostly closed. Donors, practicing social distancing, some either with illness or undergoing self-quarantine, are quickly diminishing. Drastic public health initiatives have focused on containment and "flattening the curve" while invaluable resources are being depleted. In some countries, the point is reached at which demand for such resources, including donor blood outstrips supply. Questions as to the safety of blood persist. Although it does not appear very likely that the virus can be transmitted through allogeneic blood transfusion, this still remains to be fully determined. As options dwindle, we must enact regional and national shortage plans worldwide, and more vitally disseminate the knowledge of and immediately implement Patient Blood Management (PBM). PBM is an evidence-based bundle of care to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This multinational and diverse group of authors issue this "Call to Action" underscoring "The Essential Role of Patient Blood Management in the Management of Pandemics" and urging all stakeholders and providers to implement the practical and common-sense principles of PBM and its multi-professional and multimodality approaches.
(Abstracted from Am J Obstet Gynecol 2020;223:36–41)
The presence of coronavirus disease 2019 (COVID-19) in pregnant patients raises concerns for adverse outcomes. The goal of this study was to collect information on mothers and neonates with COVID-19 and shed light on delivery timing and mode of delivery.
Question 1
Demographics:
a. Beer Yaakov, Israel.
b. Large academic medical center.
c. 956 beds.
d. 9034 RBC units issued in 2019, approximately 9000.
e. 4831 confirmed SARS‐CoV‐2 cases and 17 deaths (March 31, 2020, 12:40 pm, data from the Israeli Ministry of Health).
f. 9,136,000 inhabitants.
g. The spread of SARS‐CoV‐2 in Israel is still increasing, but as of yesterday the rate of increase is declining sharply (from almost 30% of samples tested per day at the peak to 12% yesterday).
Purpose:
Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection.
Methods:
All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respiratory distress syndrome (ARDS) due to COVID-19 between March 3rd and 31st 2020 were included. Medical history, symptoms, biological data and imaging were prospectively collected. Propensity score matching was performed to analyze the occurrence of thromboembolic events between non-COVID-19 ARDS and COVID-19 ARDS patients.
Results:
150 COVID-19 patients were included (122 men, median age 63 [53; 71] years, SAPSII 49 [37; 64] points). Sixty-four clinically relevant thrombotic complications were diagnosed in 150 patients, mainly pulmonary embolisms (16.7%). 28/29 patients (96.6%) receiving continuous renal replacement therapy experienced circuit clotting. Three thrombotic occlusions (in 2 patients) of centrifugal pump occurred in 12 patients (8%) supported by ECMO. Most patients (> 95%) had elevated D-dimer and fibrinogen. No patient developed disseminated intravascular coagulation. Von Willebrand (vWF) activity, vWF antigen and FVIII were considerably increased, and 50/57 tested patients (87.7%) had positive lupus anticoagulant. Comparison with non-COVID-19 ARDS patients (n = 145) confirmed that COVID-19 ARDS patients (n = 77) developed significantly more thrombotic complications, mainly pulmonary embolisms (11.7 vs. 2.1%, p < 0.008). Coagulation parameters significantly differed between the two groups.
Conclusion:
Despite anticoagulation, a high number of patients with ARDS secondary to COVID-19 developed life-threatening thrombotic complications. Higher anticoagulation targets than in usual critically ill patients should therefore probably be suggested.
Introduction
Prehospital care in the combat environment has always been of great importance to the U.S. military, and trauma resuscitation has remained a cornerstone. More evidence continues to demonstrate the advantages of intervention with early transfusion of blood products at the point of injury. The military has recognized these benefits; as such, the Department of Defense Joint Trauma System and the Committee on Tactical Combat Casualty Care have developed new advanced resuscitation guidelines, which now encourage the use of whole blood (WB) in the prehospital setting.
Materials and Methods
This general review of peer-reviewed journal articles was performed through an extensive electronic search from the databases of PubMed Central (MEDLINE) and the Cochrane Library.
Results
Based on this literature search, the current evidence suggests that transfusion with WB is safe and efficacious. Additionally, soldier function is preserved after donating fresh WB in the field. Currently, the collection and implementation of WB is accomplished through several different protocol-driven techniques.
Conclusion
WB has become the favored transfusion product as it provides all of the components of blood in a convenient package that is easy to store and transport. Specifically, group O WB containing low titers of anti-A and -B antibodies has become the transfusion product of choice, offering the ability to universally fluid resuscitate patients despite not knowing their blood group. This new ability to obtain low titer group O WB has transformed the approach to the management of hemorrhagic shock in the prehospital combat environment.
Background and Objectives
A worldwide pandemic of coronavirus disease 2019 (COVID‐19) has affected millions of people. A ‘closed‐off management’ protocol has been launched nationwide in China to cope with this major public health emergency. However, these procedures may cause a crisis for blood donation and blood supply. In this study, we assessed the impact of the COVID‐19 pandemic on blood donation and supply in Zhejiang province, which could provide reference and insight for developing countermeasures in other countries.
Materials and Methods
Blood donor and supply information from 38 blood centres during the Spring Festival of 2019 and 2020 were reviewed. A self‐administered questionnaire was carried out.
Results
Due to the COVID‐19 pandemic, the number of whole blood donors dropped by 67%. The success rate of recruitment for donations dropped by 60%. Most respondents (81·2%) were worried about the ‘possibility of acquiring COVID‐19 during blood donation’. The total amount of RBCs supply dropped by 65%. In the first week of the outbreak, the weekly amount of issued RBC units (10171·5 u) was almost six times higher than the collected units (1347·5 u). The mean haemoglobin value for RBCs transfusion was about 6·3 g/dl. About 4% of RBCs and 2·8% of frozen plasma were used in COVID‐19 patients.
Conclusion
The secondary consequences of the COVID‐19 pandemic are blood shortages caused by the unavailability of blood donors, and this is likely to be replicated in many countries with high burdens of COVID‐19. Practical actions to broaden sources and reduce use for the global crisis must be taken proactively.
The SARS-CoV-2 coronavirus (COVID-19) induced infection can be associated with a coagulopathy, findings consistent with infection induced inflammatory changes as observed in patients with disseminated intravascular coagulopathy (DIC). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding management of the complications that arise in the course of this viral illness. The lungs are the target organ for COVID-19; patients develop acute lung injury which can progress to respiratory failure, although multiorgan failure can also occur. The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested. COVID-19 associated coagulopathy should be managed as it would be for any critically ill patient, following the established practice of using thromboembolic prophylaxis for critically ill hospitalized patients, and standard supportive care measures for those with sepsis-induced coagulopathy or DIC. Although D-dimer, sepsis physiology, and consumptive coagulopathy are indicators of mortality, current data do not suggest the use of full intensity anticoagulation doses unless otherwise clinically indicated. Even though there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with DIC, have not been reported. If bleeding does occur, standard guidelines for the management of DIC and bleeding should be followed.
The precautionary principle is, according to Wikipedia, “a strategy for approaching issues of potential harm when extensive scientific knowledge on the matter is lacking.” The evidence base on the efficacy and acceptability of the different types of face mask in preventing respiratory infections during epidemics is sparse and contested (1,2). But covid-19 is a serious illness that currently has no known treatment or vaccine and is spreading in an immune naive population. Deaths are rising steeply, and health systems are under strain. This raises an ethical question: should policy makers apply the precautionary principle now and encourage people to wear face masks on the grounds that we have little to lose and potentially something to gain from this measure? (3) We believe they should.
Endothelial cell infection and endotheliitis in COVID-19
Background
Few observations exist with respect to the pro‐coagulant profile of patients with COVID‐19 acute respiratory distress syndrome (ARDS). Reports of thromboembolic complications are scarce but suggestive for a clinical relevance of the problem.
Objectives
Prospective observational study aimed to characterize the coagulation profile of COVID‐19 ARDS patients with standard and viscoelastic coagulation tests, and to evaluate their changes after establishment of an aggressive thromboprophylaxis.
Methods
Sixteen patients with COVID‐19 ARDS received a complete coagulation profile at the admission in the intensive care unit. Ten patients were followed in the subsequent 7 days, after increasing the dose of low molecular weight heparin, antithrombin levels correction, and clopidogrel in selected cases.
Results
At baseline, the patients showed a pro‐coagulant profile characterized by an increased clot strength (CS, median 55 hPa, 95% interquartile range 35‐63), platelet contribution to CS (PCS, 43 hPa, interquartile range 24‐45), fibrinogen contribution to CS (FCS, 12 hPa, interquartile range 6‐13.5 elevated D‐dimer levels (5.5 μg/mL, interquartile range 2.5‐6.5), hyperfibrinogenemia (794 mg/dL, interquartile range 583‐933). Fibrinogen levels were associated (R²=0.506, P=0.003) with interleukin‐6 values. After increasing the thromboprophylaxis, there was a significant (P=0.001) time‐related decrease of fibrinogen levels, D‐dimers (P=0.017), CS (P=0.013), PCS (P=0.035) and FCS (P=0.038).
Conclusion
The pro‐coagulant pattern of these patients may justify the clinical reports of thromboembolic complications (pulmonary embolism) during the course of the disease. Further studies are needed to assess the best prophylaxis and treatment of this condition.
Background
The severe inflammatory state secondary to Covid‐19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D‐dimer as well as low fibrinogen.
Aims
Whole blood from 24 patients admitted at the intensive care unit because of Covid‐19 was collected and evaluated with thromboelastography by the TEG point‐of‐care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis.
Results
TEG parameters are consistent with a state of hypercoagulability as shown by decreased R and K values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal). Fibrinogen was increased and D‐dimer was dramatically increased. C‐reactive protein was increased. Factor VIII and von Willebrand factor (n=11) were increased. Antithrombin (n=11) was marginally decreased and protein C (n=11) was increased.
Conclusion
The results of this cohort of patients with Covid‐19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/treatment. Clinical trials are urgently needed to establish the type of drug, dosage and optimal duration of prophylaxis.
Background
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which causes novel coronavirus disease 2019 (COVID‐19), is spreading rapidly around the world. Thrombocytopenia in patients with COVID‐19 has not been fully studied.
Objective
To describe thrombocytopenia in patients with COVID‐19.
Methods
For each of 1476 consecutive patients with COVID‐19 from Jinyintan Hospital, Wuhan, China, nadir platelet count during hospitalization was retrospectively collected and categorized into (0, 50], (50, 100], (100 ‐ 150] or (150 ‐ ) group after taking the unit (× 109/L) away from the report of nadir platelet count. Nadir platelet counts and in‐hospital mortality were analyzed.
Results
Among all patients, 238 (16.1%) patients deceased and 306 (20.7%) had thrombocytopenia. Compared with survivors, non‐survivors were older, were more likely to have thrombocytopenia and had lower nadir platelet counts. The in‐hospital mortality was 92.1%, 61.2%, 17.5% and 4.7% for (0, 50], (50, 100], (100 ‐ 150] and (150 ‐ ) group, respectively. With (150 ‐ ) as the reference, nadir platelet counts of (100 ‐ 150], (50, 100] and (0, 50] group had a relative risk of 3.42 (95% CI 2.36 ‐ 4.96), 9.99 (95% CI 7.16 ‐ 13.94) and 13.68 (95% CI 9.89 ‐ 18.92), respectively.
Conclusions
Thrombocytopenia is common in patients with COVID‐19, and it is associated with increased risk of in‐hospital mortality. The lower the platelet count is, the higher the mortality becomes
Objective
to conduct a systematic review of the outcomes reported for pregnant patients with COVID 19.
Data sources
we searched electronically Pubmed, Cinahl, Scopus using combination of keywords “Coronavirus and/ or pregnancy”; “COVID and/or pregnancy”; “COVID disease and/or pregnancy”; “COVID pneumonia and/or pregnancy. There were no restriction of languages in order to collect as much cases as possible.
Study eligibility criteria
all pregnant women, with a COVID19 diagnosed with acid nucleic test, with reported data about pregnancy and, in case of delivery, reported outcomes.
Study appraisal and synthesis methods
all the studies included have been evaluated according the tool for evaluating the methodological quality of case reports and case series described by Murad et al.
Results
6 studies including 51 women were eligible for the systematic review. Three pregnancies were ongoing at the time of the report; of the remaining 48, 46 were delivered with a cesarean section and 2 vaginally; there was 1 stillbirth and 1 neonatal death.
Conclusions
although vertical transmission of SARS-Cov2 has been excluded thus far and the outcome for mothers and fetuses has been generally good, the high rate of preterm cesarean delivery is a reason for concern. These interventions were typically elective, and it is reasonable to question whether they were warranted or not. COVID-19 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.
The rapid evolution of the novel coronavirus pneumonia (COVID‐19) from Wuhan, Hebei, China to a global pandemic has caused significant impact to healthcare systems worldwide and disruption to daily lives. Every country has been putting in numerous measures and efforts to control the disease spread and manage all the patients that need treatment. By mid‐April, the number of confirmed cases have reached 1.9 million and over 123,000 deaths are reported 1. However, it has yet to be seen when the pandemic could be under control and treatment becomes effective.
Introduction
COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available.
Methods
We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital.
Results
We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications.
Conclusion
The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
Background:
Since 3 months ago, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, and spread rapidly around the world. Severe novel coronavirus pneumonia (NCP) patients have abnormal blood coagulation function, but their venous thromboembolism(VTE) prevalence is still rarely mentioned.
Objectives:
To determine the incidence of VTE in patients with severe NCP.
Methods:
In this study, 81 severe NCP patients in the Intensive Care Unit (ICU) of Union Hospital (Wuhan, China) were enrolled. The results of conventional coagulation parameters and lower limb vein ultrasonography of these patients were retrospectively collected and analyzed.
Results:
The incidence of VTE in these patients was 25%(20/81), of which 8 patients with VTE events died. VTE group was different from non-VTE group in age, lymphocytes counts, activated partial thromboplastin time (APTT), D-dimer, etc. If 1.5 µg/mL was used as the D-dimer cut-off value to predicting VTE, the sensitivity was 85.0%, the specificity was 88.5% and the negative predictive value (NPV) was 94.7%.
Conclusions:
The incidence of VTE in patients with severe NCP is 25% (20/81), which may be related to poor prognosis. The significant increase of D-dimer in severe NCP patients is a good index for identifying high-risk groups of VTE.
The novel coronavirus 2019, or COVID-19, infection has rapidly spread through the New York metropolitan area since the first reported case in the state on March 1, 2020. New York currently represents an epicenter for COVID-19 infection in the United States, with 84,735 cases reported as of April 2, 2020. We previously presented an early experience with seven COVID-positive patients in pregnancy, including two women who were diagnosed with COVID-19 following an asymptomatic initial presentation. We now describe a series of 43 test-confirmed cases of COVID-19 presenting to a pair of affiliated New York City hospitals over two weeks from March 13 to 27, 2020. Fourteen (32.6%) patients presented without any COVID-associated viral symptoms, and were identified either after developing symptoms during admission or following the implementation of universal testing for all obstetrical admissions on March 22. Of these, 10/14 (71.4%) developed symptoms or signs of COVID-19 infection over the course of their delivery admission or early after postpartum discharge. Of the other 29 (67.4%) patients who presented with symptomatic COVID-19 infection, three women ultimately required antenatal admission for viral symptoms, and an additional patient represented six days postpartum after a successful labor induction with worsening respiratory status that required oxygen supplementation. There were no confirmed cases of COVID-19 detected in neonates upon initial testing on the first day of life. Applying COVID-19 disease severity characteristics as described by Wu et al, 37 (86%) women possessed mild disease, four (9.3%) exhibited severe disease, and two (4.7%) developed critical disease; these percentages are similar to those described for non-pregnant adults with COVID-19 infections (about 80% mild, 15% severe, and 5% critical disease).
According to the World Health Organization (00:00CET 19 March 2020), coronavirus disease 2019 (COVID‐19), has invaded up to 150 countries/territories. With 17,361 confirmed cases and 1135 deaths, after China and Italy, Iran is the 3rd most affected country in the world and the first one in the Eastern Mediterranean Region [1].
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease (COVID-19), has spurred a global health crisis. To date, there are no proven options for prophylaxis for those who have been exposed to SARS-CoV-2, nor therapy for those who develop COVID-19. Immune (i.e. "convalescent") plasma refers to plasma that is collected from individuals, following resolution of infection and development of antibodies. Passive antibody administration through transfusion of convalescent plasma may offer the only short-term strategy to confer immediate immunity to susceptible individuals. There are numerous examples, where convalescent plasma has been used successfully as post-exposure prophylaxis and/or treatment of infectious diseases, including other outbreaks of coronaviruses (e.g., SARS-1, Middle East Respiratory Syndrome [MERS]). Convalescent plasma has also been used in the COVID-19 pandemic; limited data from China suggest clinical benefit, including radiological resolution, reduction in viral loads and improved survival. Globally, blood centers have robust infrastructure to undertake collections and construct inventories of convalescent plasma to meet the growing demand. Nonetheless, there are nuanced challenges, both regulatory and logistical, spanning donor eligibility, donor recruitment, collections and transfusion itself. Data from rigorously controlled clinical trials of convalescent plasma are also few, underscoring the need to evaluate its use objectively for a range of indications (e.g., prevention vs treatment) and patient populations (e.g., age, comorbid disease). We provide an overview of convalescent plasma, from evidence of benefit, regulatory considerations, logistical work flow and proposed clinical trials, as scale up is brought underway to mobilize this critical resource. .
The coronavirus disease 19 (COVID‐19) outbreak, which was characterized as a pandemic on 11 March 2020 by the WHO, started in December 2019 with the emergence of pneumonia cases of unknown cause in Wuhan, Hubei, China [1]. SARS‐CoV‐2, the causative agent of COVID‐19, are enveloped, non‐segmented, single stranded positive sense RNA viruses and are classified as a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS‐CoVs) of the species Severe acute respiratory syndrome‐related coronavirus [2]. So far, no respiratory virus, including SARS‐CoV and the Middle East Respiratory Syndrome (MERS)‐CoV, has been confirmed as transfusion‐transmissible [3,4].
The novel coronavirus (2019-nCoV) is an emerging pathogen that was first described in late December 2019 and causes a severe respiratory infection in humans. Since the outbreak of COVID-19, international attention has raised to develop treatment and control options such as types of immunotherapies.
The immunotherapy is an effective method for fighting against similar viral infections such as SARS-CoV, and MERS-CoV. These methods include several types of vaccines, monoclonal antibody candidates, and etc.
This systematic review article was designed to evaluate the existing evidence and experience related to immunotherapy for 2019-nCoV. Web of Science (ISI), PubMed, and Scopus databases were used to search for suitable keywords such as 2019-nCoV, novel coronavirus, Immunotherapy, interleukin, vaccine and the related words for relevant publications up to 24.3.2020. The present systematic review was performed based on PRISMA protocol. Data extraction and quality valuation of articles were performed by two reviewers. 51 articles were the results of the search and based on the inclusions and exclusions criteria, 7 articles were included in the final review.
As a conclusion of these studies demonstrated that although no serious research has been done on this subject at the time of writing this article, similar studies on the related viruses showed notable results. So immunotherapy for this virus can also be a suitable option.