Introduction: Red blood cell (RBC) transfusions are frequently administered in the intensive care unit (ICU) and are independently associated with increased mortality. While most studies have focused on transfusion events, bleeding events that do not result in transfusion remain understudied. The validated HEME scoring system enables structured bleeding assessment but requires labor-intensive chart review, limiting scalability. We hypothesized that large language models (LLMs) could function as screening instruments to facilitate scalable chart review and support the development of curated bleeding event datasets.Methods: This retrospective cohort study included critically ill patients at high risk of bleeding. Reference data on in-ICU bleeding events were derived from prior manual review using the Hemorrhage Measurement (HEME) scoring system. For the LLM-based analysis, unstructured clinical notes were extracted from the electronic health record (EHR) for the same patient cohort. Notes were processed via structured JSON-formatted prompts using the OpenAI gpt-4o-mini model in a secure environment. Next, these bleeding events were adjudicated to come to a verified reference set.Results: In 149 patients 36 490 notes were analyzed. A total of 654 adjudicated true bleeding events were identified in the reference set. Manual review detected 66 events, while the LLM detected 647 events. Manual review identified 7 true events missed by the LLM 1.1% (7/654). The LLM identified 588 true events not captured by manual review, corresponding to an incremental detection yield of 90.1% (588/654). Among the 739 events identified by the LLM, 85 were not confirmed upon adjudication, resulting in a false-positive rate of 11.5% (85/739). The LLM correctly classified bleeding site in 42% of cases (272/654) and bleeding severity in 65% of cases (424/654).Conclusion: Use of an LLM substantially increased detection of ICU bleeding events compared with manual review. However, an 11.5% false-positive rate and limited accuracy in site and severity classification indicate that expert adjudication remains necessary.
BACKGROUND:Competency-based medical education emphasizes early clinical exposure and integration of basic and clinical sciences. We evaluated the effectiveness of an integrated anatomy and transfusion medicine workshop in improving knowledge among first-year MBBS students and laboratory technicians. METHODS:A quasi-experimental pre-post educational intervention study was conducted among first-year MBBS students and laboratory technicians attending a workshop on cubital fossa anatomy, venipuncture, bone marrow anatomy and related transfusion medicine procedures. Knowledge was assessed using an identical 11-item multiple-choice questionnaire administered immediately before and after the workshop. The primary analysis included MBBS students. Laboratory technicians attending the same workshop were analyzed separately as a descriptive subgroup. Paired t-test, Wilcoxon signed-rank test, 95% confidence intervals and Cohen's dz were used for analysis. RESULTS:Thirty-three first-year MBBS students were included in the primary analysis. Mean pre-workshop score increased from 8.09 ± 1.40 to 10.06 ± 1.09 after the workshop, with a mean paired improvement of 1.97 marks (95% CI: 1.50 to 2.44; paired t-test P<0.001; Wilcoxon P<0.001). The effect size was large (Cohen's dz=1.48). Thirty students (90.9%) improved and three (9.1%) remained unchanged; no student showed a decline. The proportion scoring at least 70% increased from 60.6% to 97.0%. Among six technicians, mean score improved from 5.17 ± 1.17 to 8.50 ± 0.84. CONCLUSION:An integrated Anatomy-Transfusion Medicine workshop produced significant significantly improved students' immediate knowledge. Such multidisciplinary, clinically focused teaching sessions can effectively supplement routine anatomy education in competency-based medical curricula.
BACKGROUND AND OBJECTIVES:The administration of anti-D immunoglobulin (RhIg) has significantly reduced the incidence of anti-D alloimmunization. However, it complicates the interpretation of antibody screening, as it is necessary to distinguish passive anti-D from early alloimmunization. Microtitration is the reference method for making this distinction. The aim of this study was to evaluate the impact of anti-D microtitration on the immuno-hematological and clinical management of RH:-1 (D-) pregnant women in the CNRHP in 2024. MATERIALS AND METHODS:This retrospective observational study included all anti-D microtitrations performed between January 1st and December 31st, 2024 in the CNRHP. The anti-D microtitration impact was analyzed in three settings: antenatal care, delivery, and fetomaternal hemorrhage (FMH). RESULTS:A total of 3281 microtitrations were performed. Antenatally, 84.6% of results matched the expected anti-D levels, while 10.5% were higher, leading to 11 diagnoses of alloimmunization. At delivery, 603 microtitrations identified two new alloimmunizations and prevented RhIg injections in 30 patients. In FMH setting 11.3% of the cases required multiple doses, with microtitration being essential for assessing neutralization. This was especially observed in massive FMH. CONCLUSION:The CNRHP's experience highlights that anti-D microtitration is an essential tool for distinguishing passive from immune anti-D, enabling early detection of alloimmunization, avoiding unnecessary monitoring and RhIg injections, and optimizing dose adjustment in cases of FMH.
BACKGROUND:Chimeric antigen receptor (CAR) T-cell therapy is frequently complicated by prolonged cytopenias requiring transfusion. Comparative real-world data on transfusion burden across commercial CAR-T products and post-therapy alloimmunization risk remain limited. METHODS:We retrospectively reviewed 102 patients treated with idecabtagene vicleucel (Abecma), ciltacabtagene autoleucel (Carvykti), lisocabtagene maraleucel (Breyanzi), axicabtagene ciloleucel (Yescarta), or brexucabtagene autoleucel (Tecartus) at a single center. Red blood cell (RBC) and platelet transfusions were quantified over 0-30, 30-90, and 90-180days post-infusion. Kruskal-Wallis tests and negative binomial regression with disease-stratified interpretation were used to estimate incidence rate ratios with 95% confidence intervals. Alloimmunization was assessed through routine, clinically driven antibody screening. RESULTS:Adjusted exploratory models detected no product-specific differences in RBC support. Platelet transfusion distributions varied by product and disease group, but these findings were based on small absolute counts and were driven by a minority of high-need patients; therefore, they should be interpreted as hypothesis-generating rather than definitive product-level differences. No new RBC alloantibodies were detected through routine clinical antibody screening. CONCLUSION:Transfusion needs after CAR-T therapy were concentrated in the first 30days and were modest overall, with most patients transfusion-free thereafter. This real-world descriptive analysis helps fill a current gap in understanding transfusion-support patterns across commercial CAR-T products and disease groups. Apparent product- and disease-related differences were driven by a minority of high-need patients and should be considered hypothesis-generating. No new RBC alloantibodies were detected through routine clinical screening, although standardized antibody surveillance was not performed.
BACKGROUND AND OBJECTIVES:Rapid freezing is thought to better preserve labile coagulation factors in fresh frozen plasma (FFP). This pilot study compared contact shock freezing (CSF) with conventional freezing (CF) to assess their effectiveness in maintaining post-thaw coagulation factor levels. Although the ABO blood group may influence plasma characteristics, its role was not a primary objective and was only noted for preliminary observation during the comparison of the two freezing methods. MATERIALS AND METHODS:In a prospective pilot study, plasma from 75 donors (balanced by ABO group) was divided into matched aliquots and subjected to either CSF (30min at -30°C) or CF (7-8hours at -30°C). Post-thaw analyses of PT, aPTT, fibrinogen, factor V, factor VIII, and factor IX were performed. Non-parametric statistics (Wilcoxon Signed-Rank tests and Aligned Ranks Transform ANOVA) were used for analysis. RESULTS:Study data suggested a trend towards superior preservation with CSF, yielding lower median PT and aPTT and higher median activities of fibrinogen, factor V, and factor VIII. Notably, statistically significant interaction effects between the freezing method and ABO group were observed for fibrinogen (P=0.033), factor VIII (P=0.012), and factor IX (P=0.003). Post-hoc analysis indicated that the potential benefit of CSF for fibrinogen may be most pronounced in group AB, and for factor VIII in group B, while CF might better preserve factor IX in group A. CONCLUSION:This in vitro pilot study demonstrates that contact shock freezing is superior to conventional freezing in preserving the coagulation integrity of fresh frozen plasma across all major parameters. The observed ABO-related differences emerged as incidental exploratory findings and should be interpreted with caution. The clinical significance of these biochemical improvements requires further investigation in well-designed clinical outcome studies.
Red blood cell (RBC) exchanges (RCE) are particularly efficient to treat and prevent complications in patients with sickle cell anemia (SCA). However, the low weight of young children is a barrier to their use. Spectra Optia is a therapeutic apheresis platform that enables automatic priming to prevent hemodynamic complications in low-weight children. The easiest method is to use albumin for priming, which is allowed by the software. We conducted a retrospective monocenter analysis of the feasibility, safety, and efficacy of albumin priming during RCE (RCE/Alb-primed) in 19 children weighing 12 to 23 kg for a total of 153 sessions. They were treated either on an emergency basis (8 children, 8 sessions), before surgery (2 children, 4 sessions) or as part of a RCE program (9 children, 141 sessions). Indications of RCE/Alb-primed sessions included: (i) an extracorporeal volume of the kit equal to 15% of the child's total blood volume, (ii) a weight of less than 20 kg, or (iii) a weight between 20 and 25 kg with a hematocrit (Hct) of 20% or less. We monitored Grade 2 adverse events (AEs) during the sessions, in extenso decreased blood pressure, increased heart rate and fatigue. Post-apheresis hematocrit and the fraction of cell remaining (FCR) values after RCE were compared to the expected ones. A low incidence of complications was observed in the 153 RCE/Alb-primed sessions with only 1 episodes of transient Grade 2 AEs. Post-apheresis Hct and FCR reached expected values with the RCE/Alb-primed method. In conclusion, RCE/Alb-primed seems to be safe and efficient in young SCA children and should be proposed systematically for curative RCE or prophylactic programs.
Poor collection of hematopoietic stem cells during insufficient mobilization for autologous stem cell transplantation has been widely described. However, only isolated cases of insufficient stem cell collection despite adequate mobilization prior to autologous transplantation have been reported. Over a 5-year period, French apheresis teams reported 31 cases of highly disastrous HSC collection (1.0±0.9 × 106 CD34+ cells/kg, median 0.65) (using a continuous collection method), despite adequate levels of circulating CD34+ cells (79 ± 49/μL, median 79/μL) during the processing of 3 blood volumes. Collection efficiency is the main indicator for assessing the ability to collect cells during cytapheresis. These collections were characterized by disastrous collection efficiencies (CE2), considered very low below 20% (8/31 patients) and catastrophic below 10% (23/31 patients). The teams attempted to find solutions to compensate for these disastrous and unexpected collections. Changes to the collection parameters led only to minor improvements in collection efficiency (CE2=8 ± 5 vs 5 ± 2%) and the amount of hematopoietic stem cells collected (1.46 ± 1.39 vs 0.56 ± 0.45 × 106 CD34+ cells/kg), while switching from a continuous collection technique to a discontinuous technique resulted in a significant improvement in collection efficiencies (39 ± 20 vs 8 ± 6%) and the amount of hematopoietic stem cells collected (4.64 ± 3.39 vs 1.09 ± 0.88 × 106 CD34+ cells/kg). Our work highlights the importance of switching from a continuous collection technique to a discontinuous technique in cases of catastrophic collection despite appropriate hematopoietic stem cell mobilization.
BACKGROUND:Thrombocytopenia is prevalent in living donor liver transplantation (LDLT), resulting from underlying liver disease and perioperative factors. Although platelet transfusions are frequently required, their response is variable and may be associated with adverse outcomes. This study evaluated the prevalence and severity of thrombocytopenia, platelet transfusion practices, assessed post-transfusion response using corrected count increment (CCI), and predictors of poor CCI in adult LDLT recipients. STUDY DESIGN & METHODS:This prospective observational study was conducted at a quaternary care center after ethical committee approval. Adult LDLT recipients were enrolled, and clinical, biochemical, intraoperative, and transfusion data were collected. Platelet transfusion response was assessed using CCI post-transfusion; CCI <5,000 was considered a poor response. RESULTS:Among 100 LDLT recipients (median age 52 years; 88% male), preoperative thrombocytopenia was observed in 91% of patients (17% severe). Intraoperative platelet transfusions were administered in 18% of cases. Postoperatively, 66 platelet transfusions were given to 23 patients, with a mean CCI of 9.0×109/L. Poor CCI was observed in 10 patients and was associated with higher bilirubin levels, prolonged INR, longer ICU stay, and increased 30-day mortality. Early allograft dysfunction (EAD) at postoperative day 7 was an independent predictor of poor CCI (OR 10.2, 95% CI 2.4-43.1). An absolute platelet count ≤71,000/mm3 on day 7 predicted EAD with 85% sensitivity (AUC 0.79). CONCLUSIONS:Thrombocytopenia is highly prevalent in LDLT recipients. Poor CCI is associated with graft dysfunction and adverse outcomes, suggesting that CCI monitoring may help to prognosticate and anticipate worser outcomes.
BACKGROUND:Transfusion-related acute lung injury (TRALI) is a severe complication of blood transfusion, but its molecular mechanisms remain poorly understood. This study aimed to investigate the role of Toll-like receptor 4 (TLR4) and its downstream signaling cascade in the pathogenesis of TRALI. METHODS:Lipopolysaccharide (LPS)-treated PAEC cells and BALB/c mice were used as a model of TRALI. Relative mRNA expression was evaluated via quantitative RT-PCR. Protein abundance in cells/tissues and cell culture supernatant/serum was detected using western blot and ELISA, respectively. Lung tissue injury was evaluated by hematoxylin and eosin staining, and protein expression in lung tissues was analyzed by immunohistochemistry. RESULTS:Expressions of TLR2, TLR4 and myeloid differentiation 2 (MD-2) were significantly elevated in the cellular TRALI model and accompanied by an increase in c-Jun, c-Fos, and P65 phosphorylation and increased expression and secretion of IL-1β, IL-6, IL-8, and TNF-α. The TLR4 inhibitor TAK-242 or MD-2 siRNAs effectively suppressed the molecular alterations induced by LPS in the cellular TRALI model. TAK-242 significantly reduced mortality and lung tissue injury in the TRALI mouse model, decreased TLR2, TLR4 and MD-2 expression, inhibited c-Jun, c-Fos, and p65 phosphorylation, and downregulated IL-1β, IL-6, IL-8, and TNF-α expression. CONCLUSIONS:In this animal model of TRALI, the highly expressed TLR4/MD-2 complex promotes the pathogenesis of TRALI through the activation of the activator protein-1(AP-1) and nuclear factor-κB (NF-κB) signaling pathways and the release of inflammatory mediators. One limitation is the positive study in rodent model but not in humans.
BACKGROUND:Detection of neutrophil antigen is not routinely performed in transfusion medicine. The gold standard for antigen detection is a serological test; nonetheless, lack of antibody to white cell antigens is one of its limitations. OBJECTIVE:This research aimed to identify human neutrophil antigen-3 (HNA-3) genotypes in Southern Thai blood donors using high-resolution melting (HRM) analysis. Allele frequencies of HNA-3 were also compared to other populations. MATERIALS AND METHODS:DNA from 443 blood donors from Southern Thailand was amplified by two-step PCR and then genotypically classified by HRM analysis. Allele frequencies of solute carrier family 44 member 2 (SLC44A2) gene and distribution of HNA-3 genotypes were compared with other populations. Forty-seven samples were subsequently sequenced to generate concordance date between HRM and Sanger sequencing. RESULTS:Frequencies of SLC44A2*01 and SLC44A2*02 were 0.812 and 0.188, respectively. HNA-3a/3a homozygous was the most common genotype at 62.3%, followed by 37.7% of HNA-3a/3b heterozygous, whereas HNA-3b/3b homozygous genotype was not observed. Distribution of genotype frequencies in the present study was significantly different from other populations worldwide including other parts of Thailand but matched to the same population reported previously by multiplex PCR. HRM genotyping was strong agreement with sequencing method (Kappa score=0.87). CONCLUSION:This report identified three genotypes of HNA-3 in Thailand using PCR-HRM. PCR-HRM is a rapid, sensitive, and cost-effective genotyping tool suitable for large-scale donor screening.
BACKGROUND/OBJECTIVES:Hemiarthroplasty for hip fracture is frequently associated with substantial perioperative blood loss; however, nationwide data on transfusion epidemiology and related risk factors remain limited. This study aimed: (1) to assess transfusion rates and temporal trends; (2) to evaluate the use of transfusion-sparing agents; and (3) to identify risk factors of transfusion in a national cohort. METHODS:Using the Korean National Health Insurance Service database, we included who underwent primary hemiarthroplasty between 2002 and 2020. The trends in transfusion and the use of transfusion-sparing agents were assessed using each procedure and drug codes. Risk factors were evaluated by multivariable logistic regression analysis. RESULTS:Among 220,278 hemiarthroplasties, 82.0% received transfusion with annual decrease from 86.3 to 72.2% since 2013, and mean transfusion volume decreased from 1386 to 1115mL. The use of anti-fibrinolytic agents and iron supplementation increased gradually, whereas hemostatic agent use decreased. Female, old age, intertrochanteric fracture, preoperative anemia, use of closed suction drainage, hemostatic agents, and hematopoietic agents were associated with an increased transfusion risk, whereas anti-fibrinolytic agents (aOR=0.53; 95% CI 0.52-0.55; P<0.001) and iron supplements (aOR=0.73; 95% CI 0.71-0.76; P<0.001) were associated with significantly decreased transfusion risk. CONCLUSION:In this nationwide cohort, transfusion after hemiarthroplasty remained common, but declined gradually over two decades. The use of anti-fibrinolytic agents and iron supplementation was associated with a decreased risk of transfusion, supporting the implementation of patient blood management (PBM) strategies for hip fracture surgery.
