BACKGROUND:Whole blood (WB) collections can occur downrange for immediate administration. An important aspect of these collections is determining when the unit is sufficiently full. This project tested a novel method for determining when a field collection is complete. METHODS:The amount of empty space at the top of WB units, destined to become LTOWB or separated into components, that were collected at blood centers or hospitals was measured by holding a WB unit off the ground and placing the top of a piece of string where the donor tubing entered the bag. The string was marked where it intersected the top of the column of blood in the bag and measured from the top. The WB units were also weighed. RESULTS:A total of 15 different bags, two of which were measured in two different filling volumes, from 15 hospitals or blood centers were measured and weighed. The most commonly used blood bag, Terumo Imuflex SP, had a median string length of 9 mm (range: 2-24 mm) and weighed a median of 565.1 g (range: 524.8-636.7 g). CONCLUSION:Pieces of string can be precut to the appropriate length depending on the type of bag before a mission where field WB collections might be required and a mark placed on the bag before the collection commences to indicate when the unit is full.

BACKGROUND:The healthy donor effect (HDE) is a selection bias caused by the health criteria blood donors must meet. It obscures investigations of beneficial/adverse health effects of blood donation and complicates the generalizability of findings from blood donor cohorts. To further characterize the HDE we investigated how self-reported health and lifestyle are associated with becoming a blood donor, lapsing, and donation intensity. Furthermore, we examined differences in mortality based on donor status.STUDY DESIGN AND METHODS:The Danish National Health Survey was linked to the Scandinavian Donations and Transfusions (SCANDAT) database and Danish register data. Logistic- and normal regression was used to compare baseline characteristics and participation. Poisson regression was used to investigate future donation choices. Donation intensity was explored by the Anderson-Gill model and Poisson regression. Mortality was investigated using Poisson regression.RESULTS:Blood donors were more likely to participate in the surveys, OR = 2.45 95% confidence interval (2.40-2.49) than non-donors. Among survey participants, better self-reported health and healthier lifestyle were associated with being or becoming a blood donor, donor retention, and to some extent donation intensity, for example, current smoking conveyed lower likelihood of becoming a donor, OR = 0.70 (0.66-0.75). We observed lower mortality for donors and survey participants, respectively, compared with non-participating non-donors.CONCLUSION:We provide evidence that blood donation is associated with increased likelihood to participate in health surveys, possibly a manifestation of the HDE. Furthermore, becoming a blood donor, donor retention, and donation intensity was associated with better self-reported health and healthier lifestyles.

BACKGROUND:At the start of the coronavirus disease 2019 (COVID-19) pandemic, widespread blood shortages were anticipated. We sought to determine how hospital blood supply and blood utilization were affected by the first wave of COVID-19. STUDY DESIGN AND METHODS:Weekly red blood cell (RBC) and platelet (PLT) inventory, transfusion, and outdate data were collected from 13 institutions in the United States, Brazil, Canada, and Denmark from March 1st to December 31st of 2020 and 2019. Data from the sites were aligned based on each site's local first peak of COVID-19 cases, and data from 2020 (pandemic year) were compared with data from the corresponding period in 2019 (pre-pandemic baseline). RESULTS:RBC inventories were 3% lower in 2020 than in 2019 (680 vs. 704, p < .001) and 5% fewer RBCs were transfused per week compared to 2019 (477 vs. 501, p < .001). However, during the first COVID-19 peak, RBC and PLT inventories were higher than normal, as reflected by deviation from par, days on hand, and percent outdated. At this time, 16% fewer inpatient beds were occupied, and 43% fewer surgeries were performed compared to 2019 (p < .001). In contrast to 2019 when there was no correlation, there was, in 2020, significant negative correlations between RBC and PLT days on hand and both percentage occupancy of inpatient beds and percentage of surgeries performed. CONCLUSION:During the COVID-19 pandemic in 2020, RBC and PLT inventories remained adequate. During the first wave of cases, significant decreases in patient care activities were associated with excess RBC and PLT supplies and increased product outdating.

Method summary Concentrations of circulating DNA in blood plasma were compared using NanoDrop, Qubit, quantitative PCR and Bioanalyzer, and DNA integrity was evaluated with the Bioanalyzer according to the time of plasma preparation.

AIMS:To assess the safety of tranexamic acid (TXA) in a large cohort of patients aged over 65 years who have sustained a hip fracture, with a focus on transfusion rates, mortality, and thromboembolic events.METHODS:This is a consecutive cohort study with prospectively collected registry data. Patients with a hip fracture in the Region of Southern Denmark were included over a two-year time period (2015 to 2017) with the first year constituting a control group. In the second year, perioperative TXA was introduced as an intervention. Outcome was transfusion frequency, 30-day and 90-day mortality, and thromboembolic events. The latter was defined as any diagnosis or death due to arterial or venous thrombosis. The results are presented as relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CIs).RESULTS:A total of 3,097 patients were included: 1,558 in the control group and 1,539 in the TXA group.31% (n = 477) of patients had transfusions in the control group compared to 27% (n = 405) in the TXA group yielding an adjusted RR of 0.83 (95% CI 0.75 to 0.91). TXA was not associated with increased 30-day mortality with an adjusted HR of 1.10 (95% CI 0.88 to 1.39) compared to the control group as well as no association with increased risk of 90-day mortality with a per protocol adjusted HR of 1.24 (95% CI 0.93 to 1.66). TXA was associated with a lower risk of thromboembolic events after 30 days (RR 0.63 (95% CI 0.42 to 0.93)) and 90 days (RR 0.72 (95% CI 0.52 to 0.99)). A subanalysis on haemoglobin demonstrated a median 17.7 g/L (interquartile range (IQR) 11.3 to 27.3) decrease in the control group compared to 17.7 g/L (IQR 9.7 to 25.8) in the per protocol TXA group (p = 0.060 on group level difference).CONCLUSION:TXA use in patients with a hip fracture, was not associated with an increased risk of mortality but was associated with lower transfusion rate and reduced thromboembolic events. Thus, we conclude that it is safe to use TXA in this patient group. Cite this article: Bone Joint J 2021;103-B(3):449-455.

: The novel coronavirus (SARS-Cov-2) that was first reported in Wuhan, China and provokes the COVID-19 disease has developed into a pandemic with hundreds of thousands of people infected. Many governments have enforced social isolation protocols on their citizens, which has led to the closure of many large public gatherings in order to limit the spread of the virus. These closures could reasonably be expected to affect blood collections, thereby presaging shortages of blood for transfusion. On the other hand, steps such as the postponement of elective surgeries and other non-urgent transfusions could mitigate against potential shortfalls in the blood supply.

The novel coronavirus (SARS-Cov-2) that was first reported in Wuhan, China and provokes the COVID-19 disease has developed into a pandemic with hundreds of thousands of people infected. Many governments have enforced social isolation protocols on their citizens, which has led to the closure of many large public gatherings in order to limit the spread of the virus. These closures could reasonably be expected to affect blood collections, thereby presaging shortages of blood for transfusion. On the other hand, steps such as the postponement of elective surgeries and other non-urgent transfusions could mitigate against potential shortfalls in the blood supply.

Abstract Identification of risk factors for contracting and developing serious illness following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of paramount interest. Here, we performed a retrospective cohort analysis of all Danish individuals tested for SARS-CoV-2 between 27 February 2020 and 30 July 2020, with a known ABO and RhD blood group, to determine the influence of common blood groups on virus susceptibility. Distribution of blood groups was compared with data from nontested individuals. Participants (29% of whom were male) included 473 654 individuals tested for SARS-CoV-2 using real-time polymerase chain reaction (7422 positive and 466 232 negative) and 2 204 742 nontested individuals, accounting for ∼38% of the total Danish population. Hospitalization and death from COVID-19, age, cardiovascular comorbidities, and job status were also collected for confirmed infected cases. ABO blood groups varied significantly between patients and the reference group, with only 38.41% (95% confidence interval [CI], 37.30-39.50) of the patients belonging to blood group O compared with 41.70% (95% CI, 41.60-41.80) in the controls, corresponding to a relative risk of 0.87 (95% CI, 0.83-0.91) for acquiring COVID-19. This study identifies ABO blood group as a risk factor for SARS-CoV-2 infection but not for hospitalization or death from COVID-19.

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).

Mie Topholm Bruun, Mark H. Yazer, Philip C. Spinella, Kjell Titlestad, Miquel Lozano , Meghan Delaney, Hana Lejdarov a, Dana E. Pavlova, Pavel Trakhtman, Nikolay Starostin, Eugene Zhiburt, Marian G. J. van Kraaij, Elise Huisman, Jose M. Kutner, Araci M. Sakashita, Ana P. H. Yokoyama, Josune Zubicaray, Juli an Sevilla, Hitoshi Okazaki, Mitsuteru Hiwatari, Yutaka Nagura, Paola Maria Manzini , Giuseppina Facco, Costantino Avdis, Lakhvinder Singh, Rekha Hans, Ratti Ram Sharma , Praveen Kumar, Agneta Wikman , Em€ oke Deschmann, Hartirathpal Kaur, Joyce Lam Ching Mei, Selina Ho Kah Ying, Koh Pei Lin, Helen V. New, Rachel Moss, Anne Kinmonth, Mary Comande, Helen Savoia, Gemma Crighton, Joanne Yacobovich, Vered Yahalom & Wendy Lau

Vox SanguinisVolume 114, Issue 5 p. 523-530 International Forum Vox Sanguinis International Forum on paediatric indications for blood component transfusion: Summary Mie Topholm Bruun, Mie Topholm Bruun mie.topholm.bruun@rsyd.dk Department of Clinical Immunology, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorMark H. Yazer, Mark H. Yazer myazer@itxm.org The Institute for Transfusion Medicine, Pittsburgh, PA, USASearch for more papers by this authorPhilip C. Spinella, Philip C. Spinella pspinella@wustl.edu Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, MO, USASearch for more papers by this authorKjell Titlestad, Kjell Titlestad kjell.titlestad@rsyd.dk Department of Clinical Immunology, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorMiquel Lozano, Miquel Lozano mlozano@clinic.cat orcid.org/0000-0003-2593-833X Department of Hemotherapy and Hemostasis, Hospital Clinic, Barcelona, SpainSearch for more papers by this authorMeghan Delaney, Meghan DelaneySearch for more papers by this authorHana Lejdarová, Hana LejdarováSearch for more papers by this authorDana E. Pavlova, Dana E. PavlovaSearch for more papers by this authorPavel Trakhtman, Pavel TrakhtmanSearch for more papers by this authorNikolay Starostin, Nikolay StarostinSearch for more papers by this authorEugene Zhiburt, Eugene ZhiburtSearch for more papers by this authorMarian G. J. van Kraaij, Marian G. J. van KraaijSearch for more papers by this authorElise Huisman, Elise HuismanSearch for more papers by this authorJose M. Kutner, Jose M. KutnerSearch for more papers by this authorAraci M. Sakashita, Araci M. SakashitaSearch for more papers by this authorAna P. H. Yokoyama, Ana P. H. YokoyamaSearch for more papers by this authorJosune Zubicaray, Josune ZubicaraySearch for more papers by this authorJulián Sevilla, Julián SevillaSearch for more papers by this authorHitoshi Okazaki, Hitoshi OkazakiSearch for more papers by this authorMitsuteru Hiwatari, Mitsuteru HiwatariSearch for more papers by this authorYutaka Nagura, Yutaka NaguraSearch for more papers by this authorPaola Maria Manzini, Paola Maria Manzini orcid.org/0000-0002-0385-9123 Search for more papers by this authorGiuseppina Facco, Giuseppina FaccoSearch for more papers by this authorCostantino Avdis, Costantino AvdisSearch for more papers by this authorLakhvinder Singh, Lakhvinder SinghSearch for more papers by this authorRekha Hans, Rekha HansSearch for more papers by this authorRatti Ram Sharma, Ratti Ram Sharma orcid.org/0000-0002-7415-4665 Search for more papers by this authorPraveen Kumar, Praveen KumarSearch for more papers by this authorAgneta Wikman, Agneta Wikman orcid.org/0000-0002-8810-7974 Search for more papers by this authorEmöke Deschmann, Emöke DeschmannSearch for more papers by this authorHartirathpal Kaur, Hartirathpal KaurSearch for more papers by this authorJoyce Lam Ching Mei, Joyce Lam Ching MeiSearch for more papers by this authorSelina Ho Kah Ying, Selina Ho Kah YingSearch for more papers by this authorKoh Pei Lin, Koh Pei LinSearch for more papers by this authorHelen V. New, Helen V. NewSearch for more papers by this authorRachel Moss, Rachel MossSearch for more papers by this authorAnne Kinmonth, Anne KinmonthSearch for more papers by this authorMary Comande, Mary ComandeSearch for more papers by this authorHelen Savoia, Helen SavoiaSearch for more papers by this authorGemma Crighton, Gemma CrightonSearch for more papers by this authorJoanne Yacobovich, Joanne YacobovichSearch for more papers by this authorVered Yahalom, Vered YahalomSearch for more papers by this authorWendy Lau, Wendy LauSearch for more papers by this author Mie Topholm Bruun, Mie Topholm Bruun mie.topholm.bruun@rsyd.dk Department of Clinical Immunology, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorMark H. Yazer, Mark H. Yazer myazer@itxm.org The Institute for Transfusion Medicine, Pittsburgh, PA, USASearch for more papers by this authorPhilip C. Spinella, Philip C. Spinella pspinella@wustl.edu Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, MO, USASearch for more papers by this authorKjell Titlestad, Kjell Titlestad kjell.titlestad@rsyd.dk Department of Clinical Immunology, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorMiquel Lozano, Miquel Lozano mlozano@clinic.cat orcid.org/0000-0003-2593-833X Department of Hemotherapy and Hemostasis, Hospital Clinic, Barcelona, SpainSearch for more papers by this authorMeghan Delaney, Meghan DelaneySearch for more papers by this authorHana Lejdarová, Hana LejdarováSearch for more papers by this authorDana E. Pavlova, Dana E. PavlovaSearch for more papers by this authorPavel Trakhtman, Pavel TrakhtmanSearch for more papers by this authorNikolay Starostin, Nikolay StarostinSearch for more papers by this authorEugene Zhiburt, Eugene ZhiburtSearch for more papers by this authorMarian G. J. van Kraaij, Marian G. J. van KraaijSearch for more papers by this authorElise Huisman, Elise HuismanSearch for more papers by this authorJose M. Kutner, Jose M. KutnerSearch for more papers by this authorAraci M. Sakashita, Araci M. SakashitaSearch for more papers by this authorAna P. H. Yokoyama, Ana P. H. YokoyamaSearch for more papers by this authorJosune Zubicaray, Josune ZubicaraySearch for more papers by this authorJulián Sevilla, Julián SevillaSearch for more papers by this authorHitoshi Okazaki, Hitoshi OkazakiSearch for more papers by this authorMitsuteru Hiwatari, Mitsuteru HiwatariSearch for more papers by this authorYutaka Nagura, Yutaka NaguraSearch for more papers by this authorPaola Maria Manzini, Paola Maria Manzini orcid.org/0000-0002-0385-9123 Search for more papers by this authorGiuseppina Facco, Giuseppina FaccoSearch for more papers by this authorCostantino Avdis, Costantino AvdisSearch for more papers by this authorLakhvinder Singh, Lakhvinder SinghSearch for more papers by this authorRekha Hans, Rekha HansSearch for more papers by this authorRatti Ram Sharma, Ratti Ram Sharma orcid.org/0000-0002-7415-4665 Search for more papers by this authorPraveen Kumar, Praveen KumarSearch for more papers by this authorAgneta Wikman, Agneta Wikman orcid.org/0000-0002-8810-7974 Search for more papers by this authorEmöke Deschmann, Emöke DeschmannSearch for more papers by this authorHartirathpal Kaur, Hartirathpal KaurSearch for more papers by this authorJoyce Lam Ching Mei, Joyce Lam Ching MeiSearch for more papers by this authorSelina Ho Kah Ying, Selina Ho Kah YingSearch for more papers by this authorKoh Pei Lin, Koh Pei LinSearch for more papers by this authorHelen V. New, Helen V. NewSearch for more papers by this authorRachel Moss, Rachel MossSearch for more papers by this authorAnne Kinmonth, Anne KinmonthSearch for more papers by this authorMary Comande, Mary ComandeSearch for more papers by this authorHelen Savoia, Helen SavoiaSearch for more papers by this authorGemma Crighton, Gemma CrightonSearch for more papers by this authorJoanne Yacobovich, Joanne YacobovichSearch for more papers by this authorVered Yahalom, Vered YahalomSearch for more papers by this authorWendy Lau, Wendy LauSearch for more papers by this author First published: 13 May 2019 https://doi.org/10.1111/vox.12763Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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BACKGROUND: Pneumatic transportation systems (PTSs) are increasingly used for transportation of blood samples to the core laboratory. Many studies have investigated the impact of these systems on different types of analyses, but to elucidate whether PTSs in general are safe for transportation of blood samples, existing literature on the subject was systematically assessed. METHODS: A systematic literature review was conducted following the preferred reporting items for systematic reviews and metaanalyses (PRISMA) Statement guidelines to gather studies investigating the impact of PTS on analyses in blood samples. Studies were extracted from PubMed and Embase. The search period ended November 2016. RESULTS: A total of 39 studies were retrieved. Of these, only 12 studies were conducted on inpatients, mainly intensive care unit patients. Blood gases, hematology, and clinical chemistry were well investigated, whereas coagulation, rotational thromboelastometry, and platelet function in acutely ill patients were addressed by only 1 study each. Only a few parameters were affected in a clinically significant way (clotting time parameter in extrinsic system thromboelastometry, pO(2) in blood gas, multiplate analysis, and the hemolysis index). CONCLUSIONS: Owing to their high degree of heterogeneity, the retrieved studies were unable to supply evidence for the safety of using PTSs for blood sample transportation. In consequence, laboratories need to measure and document the actual acceleration forces in their existing PTS, instituting quality target thresholds for these measurements such as acceleration vector sums. Computer modeling might be applied to the evaluation of future PTS installations. With the increasing use of PTS, a har-monized, international recommendation on this topic is warranted. (c) 2017 American Association for Clinical Chemistry

BACKGROUND:The prevalence of iron depletion is high among premenopausal women who donate blood frequently. Studies in nondonor populations indicate that iron deficiency anemia is associated with an increased risk of low birth weight. This prompts concerns that iron deficiency induced by frequent blood donation might impair subsequent fetal development. STUDY DESIGN AND METHODS:The aim of this study was to assess whether prepregnancy donation intensity affects the birth weight of singletons born at term (gestational week 38 or later) to nulliparous female donors in Denmark. We identified 293,897 first live singleton births to Danish women between 1997 and 2012 with complete information on gestational age, birth weight, child sex, parental age, maternal smoking status during pregnancy, and parental education length and annual income. Linear regression analysis was applied, with birth weight as outcome, number of donations within the 3 years before pregnancy as the explanatory variable, and confounding variables as described. RESULTS:Birth weight among children of low-intensity donors (n = 22,120) was 12.6 g (95% confidence interval, 6.7-18.6) higher than nondonors (n = 268,253) after controlling for the above-mentioned factors. The higher birth weight among low-intensity donors can be explained by the healthy donor effect. In fully adjusted analyses, birth weight among children of high-intensity donors (n = 3,524) was 20.2 g (95% confidence interval, 5.1-35.3 g) lower compared with low-intensity donors. This reduced birth weight among high-intensity donors compared to low-intensity donors may reflect blood donation-induced iron deficiency. CONCLUSIONS:Our results show that high prepregnancy donation intensity is inversely associated with birth weight of singletons born at term to nulliparous women.

BACKGROUND:Randomized controlled trials have demonstrated that a restrictive red blood cell (RBC) transfusion strategy lowers transfusion frequency without affecting mortality. However, the external validity of these trials has not been tested in a large cohort. The purpose was to estimate the effect of introducing a National Clinical Guideline (NCG) for a restrictive hemoglobin transfusion threshold on transfusion frequency and mortality in hip fracture patients > 65 years old. METHODS:A consecutive cohort study of hip fracture patients > 65 years old residing in the southern region of Denmark was conducted using prospectively gathered data from registers during two separate 1-year time periods. The first period from October 1, 2012, to September 30, 2013, included 1494 patients and used a liberal transfusion threshold, whereas the second period from October 1, 2015, to September 30, 2016, including 1414 participants used a restrictive threshold from the NCG. Participant data for age, sex, body mass index, Charlson Comorbidity Index, time to surgery, and death were retrieved from the Danish Interdisciplinary Registry of Hip Fractures and were merged with RBC transfusion and medication data extracted from the Danish Transfusion and Odense Pharmacoepidemiological Databases, respectively. Cox proportional hazards models were used to test relative mortality risk for the restrictive group compared with the liberal group at 30 and 90 days. RESULTS:Overall RBC transfusions decreased from 42 to 30% (p < 0.001). The 30-day mortality rate (95% CI) was 9% (8;11) in the restrictive group and 13% (11;14) in the liberal group (p < 0.008), whereas the adjusted relative mortality risk was 0.72 (0.57;0.91). The 90-day mortality rate was 15% (13;17) in the restrictive group and 19% (17;21) in the liberal group, whereas the adjusted relative mortality risk was 0.78 (0.65;0.94). CONCLUSION:These data suggest that the introduction of an NCG on restrictive blood transfusion leads to lower transfusion frequency in hip fracture patients > 65 years old. Even though this reduction is associated with decreased mortality at both 30 and 90 days, it may be explained by other issues than restrictive transfusion strategy. There has been an improvement in the mortality of hip fracture patients in Denmark, and we suggest that a restrictive transfusion strategy does not lead to increased mortality.

The long preclinical phase of rheumatoid arthritis (RA), where some factors involved in RA pathogenesis circulate peripherally, raises concern of RA transmissibility through blood transfusion.1 Specifically, this possibility is suggested by murine RA models in which anticitrullinated peptide/protein antibodies may induce and enhance arthritis, and precursors of the RA-fibroblast-like synoviocyte cells may aggravate and spread the disease between joints.2 3 We used a large Danish–Swedish population-based research donations and transfusions database (SCANDAT2) with health register information on 1.5 million blood donors and 2.1 million recipients of their blood to investigate (1) RA occurrence in recipients of blood from donors who later developed RA and (2) clustering of RA among recipients of blood from individual donors, regardless of the donor’s RA status.4–6 We used two different approaches to analyse RA transmission. First, we identified all donors who developed RA after blood donation. For each of these index donors, we identified up to 10 donors matched on age, sex, county, date of first donation, number of donations and ABO blood group, who were free of RA at the date …

Pneumatic transportation systems (PTSs) are increasingly used for transportation of blood samples to the core laboratory. Many studies have investigated the impact of these systems on different types of analyses, but to elucidate whether PTSs in general are safe for transportation of blood samples, existing literature on the subject was systematically assessed.A systematic literature review was conducted following the preferred reporting items for systematic reviews and metaanalyses (PRISMA) Statement guidelines to gather studies investigating the impact of PTS on analyses in blood samples. Studies were extracted from PubMed and Embase. The search period ended November 2016.A total of 39 studies were retrieved. Of these, only 12 studies were conducted on inpatients, mainly intensive care unit patients. Blood gases, hematology, and clinical chemistry were well investigated, whereas coagulation, rotational thromboelastometry, and platelet function in acutely ill patients were addressed by only 1 study each. Only a few parameters were affected in a clinically significant way (clotting time parameter in extrinsic system thromboelastometry, pO2 in blood gas, multiplate analysis, and the hemolysis index).Owing to their high degree of heterogeneity, the retrieved studies were unable to supply evidence for the safety of using PTSs for blood sample transportation. In consequence, laboratories need to measure and document the actual acceleration forces in their existing PTS, instituting quality target thresholds for these measurements such as acceleration vector sums. Computer modeling might be applied to the evaluation of future PTS installations. With the increasing use of PTS, a harmonized, international recommendation on this topic is warranted.