OBJECTIVE:Adverse transfusion reactions (ATRs) remain a major concern in transfusion medicine, impacting patient safety and clinical outcomes. Understanding the epidemiology and trends of ATRs is essential for improving transfusion practices and evaluating the impact of policy implementation. This study aimed to provide a comprehensive review of ATRs at a tertiary hospital in Thailand. Three strategies have been implemented in our center to minimize ATRs and enhance transfusion safety: leukodepleted red blood cell product to reduce febrile reaction, 100% use of platelet additive solution (PAS), and the exclusive use of leukodepleted packed red cells in thalassemia patients. METHODS:A retrospective cohort study was conducted using blood bank adverse reaction records over a 10-year period from January 2013 to December 2022. RESULTS:Among 980,596 blood transfusions, 1583 ATRs were reported, representing a rate of 1.61 per 1000 blood transfusions. A total of 184 ATR events were observed in thalassemia patients, accounting for 11.62% of all reported ATRs. Leukodepletion significantly reduced febrile nonhemolytic transfusion reactions in the general population (PRC vs. LDPRC: Odds ratio [OR] 1.94; 95% confidence interval [CI]: 1.35-2.78; P<0.001), and in thalassemia patients from 12.76% to 8.35% (95% CI: 0.84%-7.49%; P=0.017). Platelets stored in PAS reduced mild allergic reactions (61/111 vs. 44/103; 95% CI: 3.61%-24.99%; P=0.013), but not other ATRs. CONCLUSIONS:This study highlights the need for continued monitoring and targeted interventions to reduce ATRs, particularly in high-risk populations.

BACKGROUND AND OBJECTIVES:No established standards currently exist regarding the optimal interval for repeating antibody identification. Considering both transfusion safety and resource constraints, this study aimed to investigate the feasibility of extending the interval between antibody identification tests in a high-volume transfusion setting. MATERIALS AND METHODS:We retrospectively reviewed 153,526 records over a 7-year period in which antibody identification was repeated at 7-day intervals under current practice. Cases with autoantibodies, non-specific antibodies, drug-related antibodies, passive anti-D from Rhesus immunoglobulin (RhIG) or unidentified antibodies were excluded. Time intervals to newly detected antibodies (0-7, 8-14, 15-21 and 22-30 days) were analysed in transfused patients with at least one pre-existing antibody. RESULTS:A total of 5806 antibodies were detected from 4835 patients (3.15%). Of these, 217 antibodies were detected in 155 patients (3.21%) who were known to previously possess at least one antibody. Antibody development was most frequently detected at 8-14 days post transfusion (16 cases, 35.56%), followed by 22-30 days (14 cases, 31.11%), 15-21 days (10 cases, 22.22%) and 0-7 days (5 cases, 11.11%). The median time to new antibody detection was 15.5 days (interquartile range, 10-26 days). CONCLUSION:This study proposes an optimal interval for antibody identification in settings with a high prevalence of transfusion-dependent patients and resource constraints. A 14-day interval has the potential to reduce personnel workload and costs while maintaining transfusion safety.

BACKGROUND:Therapeutic plasma exchange (TPE) is a cornerstone of therapeutic apheresis across multiple subspecialties. While international registries have described global practice, nationwide data from Thailand are lacking. METHODS:We conducted a 10-year retrospective analysis of all TPE admissions reimbursed under Thailand's Universal Health Coverage scheme (2014-2023). Cases were identified using ICD-9 code 997.1. Demographics, clinical indications, complications, outcomes, and costs were extracted from discharge records. Indications were categorized according to the 2023 American Society for Apheresis (ASFA) guidelines. RESULTS:A total of 5884 admissions were identified. The mean age was 46.4 ± 20.6 years, 58.0% were male, and 13.0% were pediatric. TPE Utilization increased from the mid-200s in 2014 to nearly 900 admissions in 2023. Neurological (28.9%) and nephrological (24.4%) disorders were the leading subspecialties. Systemic lupus erythematosus (12.4%), septic shock (12.1%), and acute inflammatory demyelinating polyradiculoneuropathy (9.1%) were the most frequent disease-specific indications. Nearly three-quarters of procedures were guideline-supported (Category I: 28.6%, Category II: 31.7%), while Category III use was 28.1% in our cohort. In-hospital mortality was 51.6% overall, driven largely by septic shock and acute liver failure, whereas survival exceeded 70% in autoimmune neurologic diseases and transplant recipients. Complications included bleeding (25.5%), transfusion requirements (69.0%), and hypocalcemia (9.7%). The actual cost per admission ranged USD 4000-12000, while reimbursement covered USD 2000-7000. CONCLUSION:This first nationwide analysis of TPE in Thailand highlights increasing utilization, high-cost burden, and important differences from global practice. Strengthening registries, refining coding systems, and developing region-specific guidelines will be critical to optimize outcomes and sustainability.

BACKGROUND:Hemoglobin (Hb) assessment is crucial to prevent blood donation from anemic donors. Most measurements are invasive and painful; however, an alternative, non-invasive hemoglobin measurement is available. This study aimed to compare non-invasive and point-of-care invasive hemoglobin test results with those from an automated blood analyzer in blood donors. METHODS:Qualified blood donors were enrolled at a tertiary care hospital in Bangkok, Thailand. Hemoglobin was initially measured by the non-invasive device (Rad-67 Pulse CO-Oximeter) and a point-of-care invasive hemoglobin screening device (Mission HemoPro). Participants with point-of-care invasive hemoglobin ≥ 12.5 g/dL were eligible to donate, and during donation, standard hemoglobin measurements were obtained using an automated analyzer, XN-550. Those who were ineligible with point-of-care invasive hemoglobin < 12.5 g/dL underwent additional blood sampling for hemoglobin measurement by an automated analyzer. Correlation and agreement between non-invasive, point-of-care, and automated hemoglobin measurements were assessed with Intraclass Correlation Coefficient (ICC) and Bland-Altman plots, while satisfaction was evaluated using a Likert scale. RESULTS:Of 300 participants, 295 had complete data. Of these, 169 were male (57.28%). Average non-invasive, point-of-care, and automated hemoglobin levels were 14.38 ± 1.12 g/dL, 13.65 ± 0.70 g/dL, and 13.90 ± 1.16 g/dL, respectively. The ICC between non-invasive, point-of-care, and automated hemoglobin measurement was 0.600 (95% CI: 0.522-0.668) and 0.897 (95% CI: 0.872-0.957). The sensitivity of the non-invasive Hb measurement was poor for detecting anemic donors when the Hb cut-off was set at 12.5 g/dL. This method received significantly higher satisfaction than the routinely used invasive device. CONCLUSION:The non-invasive Hb measurement in blood donors showed moderate agreement with the standard test, but the sensitivity was poor when the cut-off hemoglobin was set at 12.5 g/dl. Since donor satisfaction was higher, this method may be used as an alternative screening tool, provided a higher Hb cut-off value is used.

BACKGROUND:ABO discrepancies, inconclusive results between forward and reverse typing, are one of the significant challenges encountered in transfusion medicine. Their frequency and etiologies can vary among ethnicities. This study aimed to characterize ABO discrepancies in a Thai population. METHODS:We conducted a retrospective review of 285,450 donor and 258,780 patient samples for ABO discrepancies, which were categorized into five groups, as described below. The serological ABO grouping was performed using an automated system, and further serological techniques were used in the discrepancy cases. Additionally, sequencing was used to examine the genetic background of the B(A) phenotype detected during the retrospective review. RESULTS:ABO discrepancies were identified in 396 patients (0.15 %) and 74 blood donors (0.03 %). Among the patients, the most frequent cause was ABO mismatch stem cell transplantation (198; 50 %). The remaining 198 discrepancy cases (198/258,780; 0.08 %) were categorized into five groups: weak/missing red cell reactivity, extra red cell reactivity, mixed-field, weak/missing serum reactivity, and extra serum reactivity, accounting for 17.17 %, 0.51 %, 29.29 %, 28.79 %, and 24.24 %, respectively. For the blood donors, the percentages were 48.65 %, 2.70 %, 2.70 %, 37.84 %, and 8.11 %, respectively. We also identified the B(A) phenotype in one patient and two blood donors. The sequencing study identified allele variants of c.467 C>T, c.796 C>A, c.803 G>C, and c.930 G>A in exon 7, which was a novel allele. CONCLUSION:ABO discrepancies were distinct between donors and patients even in the same ethnicity. This finding highlighted the influence of the patient's conditions and therapy on the anomalous ABO typing. Additionally, the B(A) individuals identified in this study carried identical genetic alterations that differed from all antecedent alleles of the B(A) phenotype.

BACKGROUND AND OBJECTIVES:Frequent platelet apheresis donations can lead to iron depletion. Serum ferritin is traditionally measured to assess iron status in donors. Reticulocyte haemoglobin (RET-He) has emerged as a rapid, convenient and cost-effective alternative. This study aimed to determine the prevalence of iron depletion among regular platelet apheresis donors and to evaluate the sensitivity and specificity of RET-He compared to serum ferritin in diagnosing iron depletion. MATERIALS AND METHODS:This cross-sectional study involved 100 healthy, regular platelet apheresis donors aged 18-60 years who donated at least once a month. RET-He, serum ferritin and complete blood count results were analysed. The sensitivity and specificity of RET-He were calculated against serum ferritin. RESULTS:Of the 100 donors, 13.00% (13 out of 100 donors) had serum ferritin levels <15 ng/mL, indicating iron depletion. RET-He showed a sensitivity of 76.92% (95% confidence interval [95% CI]: 46.19%-94.96%) and specificity of 44.83% (95% CI: 34.15%-55.87%) in detecting iron depletion. Significant differences in RET-He levels, donation frequency, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, white blood cell count and red cell distribution width were detected between the iron-depleted and non-iron-depleted groups (p = 0.045, 0.032, 0.053, 0.026, 0.069 and 0.027, respectively). CONCLUSION:Frequent platelet donations increase the risk of iron depletion; therefore, iron supplementation is recommended for regular donors. While RET-He testing is convenient, cost effective and fast, it cannot replace serum ferritin testing because of insufficient sensitivity and specificity.

Anti-CD19 chimeric antigen receptor (CAR)-T cell therapy has evolved as a standard of care for various forms of relapsed/refractory B cell malignancies in major developed countries. However, access to industry-driven CAR-T cell therapy is limited in developing countries, partly due to the centralized manufacturing system. Here, we demonstrated the feasibility of the point-of-care (POC) manufacturing of anti-CD19 CAR-T cells from heavily pretreated patients and healthy graft donors at an academic medical center in Thailand using a closed semi-automated production platform, CliniMACS Prodigy, and established in-process quality control and release testing to ensure their identity, purity, sterility, safety, and potency. Nine out of the nine products manufactured were used in a pilot study (ISRCTN17901467). However, we did observe that starting T cells with CD4/CD8 ratios of less than one-third had a high chance of manufacturing failure, which could be minimized by serum supplementation. Further analysis of T cell phenotypes in the infused versus circulating CAR-T cells revealed the differentiation from early memory subtypes toward effector cells in vivo. The POC manufacturing and quality control settings herein could be applied to other CAR-T cell products and may benefit other academics, especially those in developing countries, making CAR-T cells more accessible.

Introduction: DEL is known to be one of the weakest D variants, which can be detected by the adsorption-elution technique or by molecular study. Currently, in Thailand, we do not routinely test for DEL variants serologically or genetically among serologic RhD-negative blood donors. Case Presentation: We reported 2 cases of alloimmunization after transfused with Rh DEL, RHD*DEL1 allele, in the Thai population. The first case was a 73-year-old male with anemia who presented with post-cardiac arrest and septic shock. The patient was group B, RhD-negative, and was transfused with RhD-negative red blood cells (RBCs). Antibody screening and identification found that the patient developed anti-D and anti-Mi(a) during the admission course. The second case was a 38-year-old woman with pseudomyxoma peritonei who developed anti-D after receiving four units of RhD-negative RBCs during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Both patients did not receive anti-D immunoglobulin and had no previous history of anti-D detection. We retrospectively investigated and found two units of RHD*DEL1 among the RBCs transfused to these patients. Discussion: Previous reports of several cases of anti-D alloimmunization in RhD-negative recipients transfused by RHD*DEL1, an Asian-type DEL, are limited only to East Asia. We first identified 2 patients with anti-D alloimmunization after receiving the RHD*DEL1 RBCs in the Thai population. This raises concern about Rh DEL screening among D-negative Thai blood donors and whether to remove DEL units from the D-negative inventory to improve patient safety.

BACKGROUND AND OBJECTIVE:The mainstay of management for thalassemia is regular blood transfusions. However, gaps and unmet needs of blood services for thalassemia are still not clearly identified and addressed in Thailand, a country prevalent with thalassemia. What can be a collaborative implementation framework that helps advance practices and policies relating to blood management for thalassemia?METHODS:The first Blood & Beyond Roundtable Discussion was held in July 2022 to gather the current situation, gaps, and unmet needs of blood services for thalassemia from multidisciplinary experts and thalassemic patients. The Implementation Guide as suggested by the Centre for Effective Services was applied as a tool to consolidate information from the discussions and construct the collaborative implementation framework.RESULTS:The National Blood Center and hospitals in Thailand followed the missions specified in the National Blood Policy and the standard guidelines to ensure the best practice of blood management for thalassemia. However, there were six gaps and unmet needs identified from the discussions. After all discussion points were mapped onto the framework, an implementation plan comprised of five specific activities became clear and actionable.CONCLUSION:Without the complete information from both experts and patients, the implementation plan would not have been successfully constructed. The method that we employed to translate all information into the framework can be adapted by other countries to develop their own specific framework efficiently.

SARS-CoV-2 virus infection has imposed a significant healthcare burden globally. To contain its spread and decrease infection-related mortality, several vaccines have been deployed worldwide in the past 3 years. We conducted a cross-sectional seroprevalence study to assess the immune response against the virus among blood donors at a tertiary care hospital, Bangkok, Thailand. From December 2021 to March 2022, total of 1,520 participants were enrolled, and their past history of SARS-CoV-2 infection and vaccination was recorded. Two serology test, namely, quantitative IgG spike protein (IgGSP) and qualitative IgG nucleocapsid antibody (IgGNC) were performed. The median age of study participants was 40 years (IQR 30-48) and 833 (54.8%) were men. Vaccine uptake was reported in 1,500 donors (98.7%) and 84 (5.5%) reported the past infection history. IgGNC was detected in 46/84 donors with the past infection history (54.8%) and in 36 out of the rest 1,436 (2.5%) with no past history. IgGSP positivity was observed in 1484 donors (97.6%). When compared to unvaccinated donors (n = 20), IgGSP level was higher in the donors who had received one vaccine dose (p< 0.001) and these antibody levels increased significantly among those with 3rd and 4th vaccine doses. Factors associated with low IgGSP (lowest quartile) by multivariate analysis included: no past infection history, homologous vaccination, < 3 vaccine doses, and > 90 days duration since last vaccination. In conclusion, vaccine uptake among our study donors was high (98.7%) and IgGSP antibody was observed in nearly all the vaccinated donors (97.6%). Previous SARS-CoV-2 infection, use of heterologous vaccination, vaccines ≥ 3 doses, and duration of the last vaccination >90 days affected IgGSP levels. Use of serological assays were found beneficial in the evaluation and differentiation of immune response to vaccination, and natural infection including the identification of previous asymptomatic infections.

Background Transfusion of blood from glucose-6-phosphate dehydrogenase (G6PD) enzyme deficient donors could cause a potentially unfavorable outcome, especially in newborns and those with hemoglobinopathies. Aims To determine the prevalence of G6PD deficiency in Thai blood donors, the characteristics of G6PD deficient blood, and the efficacy of fluorescent spot test (FST) to screen for G6PD deficiency in a hospital blood bank setting. Methods Blood samples were obtained from 514 Thai blood donors who donated blood at Siriraj Hospital (Bangkok, Thailand) during December 2020-February 2021. G6PD deficiency status was screened using FST, and in vitro hemolysis of red blood cell parameters of G6PD deficient blood units was compared with those of normal control units at different time points during 35 days of refrigerated storage. Results The prevalence of G6PD deficiency was 7.59% (35 [8.73%] males, 4 [3.54%] females). The sensitivity of FST was 100% (95% confidence interval [CI]: 90.97-100%), and the specificity was 99.58% (95%CI: 98.49-99.95%). In vitro hemolysis was not significantly different between G6PD deficiency and normal controls. Conclusion The prevalence of G6PD deficiency in this study was 7.59%. FST was demonstrated to be an effective and reliable method for G6PD deficiency screening among Thai blood donors in a hospital blood bank setting.

Objective: To evaluate the effectiveness of viscoelastic hemostatic assay (VHA)-guided therapy for assessing and managing trauma-related bleeding using a multidisciplinary team approach at a level 1 trauma center.Materials and Methods: This retrospective pilot study included trauma-related hemorrhagic patients who underwent rotational thromboelastometry (ROTEM) during September 2019-May 2020. ROTEM trace results were compared with those of conventional coagulation tests (CCT).Results: Thirteen patients (median age: 29.1 years; male: 76.92%) were included. The median (range) days of ventilator support, ICU length of stay, and hospital length of stay was 4 [0-65], 5 [1-65], and 6 [1-83], respectively. ROTEM-guided therapy was applied 26 times, and was repeated in 7 cases. Of those, four cases were repeated to correct coagulopathy. The median time-to-confirmed hemostasis for ROTEM was substantially shorter than for CCT (92 minutes [70-110] vs. 287 minutes [204-354], respectively). The coagulation results from 26 ROTEM tests were also compared between those requiring and not requiring a massive transfusion protocol (MTP). MTP with ROTEM-guided therapy was activated in 6/13 cases. Following the resuscitation endpoints in traumatic shock, four of those had their median serum lactate levels decreased from 10.9 d/L (2.1-16.8) to 3.9 d/L (1.7-17.7). ROTEM traces detected cases with low fibrinogen that only required cryoprecipitate transfusion, and red blood cell and fresh frozen plasma use was less in ROTEM than in conventional MTP.Conclusion: VHA-guided therapy was shown to effectively facilitate goal-directed hemostatic resuscitation and efficient blood product use during resuscitation, definitive treatment, and postoperative intensive care.

Dengue virus (DENV) infection is a major public health problem worldwide. Dengue clinical manifestations may range from asymptomatic, to mild symptomatic, and to a life-threatening shock syndrome. In endemic countries including Thailand blood donations from asymptomatic dengue infected persons pose a risk for DENV transmission. We investigated the prevalence of dengue viremia and dengue immunity among Thai blood donors (n = 400) from August 2015 to March 2016 using nested RT-PCR and anti-DENV IgM/IgG capture ELISA. Only one donor was positive for dengue virus serotype 2 (DENV2) viremia as revealed by RT-quantitative PCR and virus isolation. After a two-month follow up, the donor did not develop symptoms related to DENV infection and anti-DENV IgG and IgM levels remained just above and below cut-off values, respectively and were unchanged from the day of blood donation. In dengue serological studies, anti-DENV antibody ELISA was positive for IgG in 246 (61%) and both IgG and IgM in 24 (6%) of blood donors, respectively. In conclusion, the prevalence of detectable dengue (DENV2) viremia in blood donors in Bangkok was 0.25% but there still exists concern in dengue endemic regions of a finite risk of infection from blood transfusions. Further studies with a larger sample size will be required to evaluate the cost-benefit of an additional measure to detect dengue viremia in blood donations in Thailand.

AIM:The aims of this study were to estimate human leukocyte antigen (HLA)-B allele frequency, to identify alleles associated with ankylosing spondylitis (AS), and to explore manifestations in various HLA-B*27 in Thai AS patients.METHODS:This was a cross-sectional study. Thai patients older than 18 years with diagnosed AS according to modified New York criteria who visited Siriraj Hospital (Bangkok, Thailand) were consecutively enrolled. HLA-B alleles were determined by reverse sequence-specific oligonucleotide assays, and were assigned at a 4-digit resolution. HLA-B alleles of 334 unrelated healthy Thai donors who participated in a previous phase 2b dengue vaccine clinical trial were included as controls. Odds ratio (OR) and Fisher's exact test were used to estimate association between allele and AS. The P value significance threshold was calculated according to Bonferroni.RESULTS:Among the 88 patients who were recruited, 34 HLA-B alleles were identified, and all patients were heterozygous. The prevalence of HLA-B*27 was 89.8%, and 4 alleles of HLA-B*27 were identified. HLA-B*27:04 (OR: 39.4, P < .0001) and HLA-B*27:05 (OR: 13.8, P = .0011) were associated with AS. In contrast, HLA-B*27:06 was not found to be associated with AS (OR: 0.4, P = .241). AS patients carrying HLA-B*27:04 were more likely to have enthesitis and younger age at onset than those carrying HLA-B*27:05.CONCLUSIONS:HLA-B*27:04 and HLA-B*27:05 were both found to be strongly associated with Thai AS. HLA-B*27:06 showed a neutral allele for Thai AS. AS patients with HLA-B*27:04 had more enthesitis and younger age at onset than those with HLA-B*27:05.

To identify characteristics associated with HLA-B27, and to identify factors associated with delayed diagnosis in Thai patients with axial spondyloarthritis (axSpA). This cross-sectional study included Thai patients were diagnosed with axSpA by a rheumatologist at Siriraj Hospital. Clinical data were collected. Regression analyses were employed to identify factors associated with study outcomes. Of total 177 patients, 127 (72%) were positive HLA-B27. Uveitis [Odds ratio (OR) 4.0], age at onset of the first musculoskeletal symptom of ≤ 28 years [OR 3.5], female [OR 0.4], and psoriasis [OR 0.4] were significantly associated with HLA-B27 in multiple regression analysis. Those with positive HLA-B27 had less spinal flexibility. Elevated C-reactive protein ( p = 0.012) was associated with shorter delay in diagnosis, while uveitis ( p < 0.001) and younger age at onset of the first symptom ( p = 0.002) were associated with longer delay in diagnosis in multiple regression analysis. Younger age at onset of the first musculoskeletal symptom and uveitis were associated with HLA-B27 and delayed diagnosis in axSpA patients. Young people with musculoskeletal symptom and uveitis should be referred to a rheumatologist to rule out or make a timely diagnosis of axSpA.

As an East-Asian international study, we evaluated erythrocyte alloimmunity by gender and history of transfusion or pregnancy. In total, data from more than 1,826,000 patients were analyzed, from whom 26,170 irregular erythrocyte antibodies were detected in 22,653 cases. Antibody frequencies in these cases were as follows: anti-E, 26.8%; anti-Lea, 20.0%; anti-P1, 7.1%; anti-M, 6.4%; anti-Mia, 5.6%; anti-c + E, 5.6%; anti-Leb, 4.6%; anti-D, 2.8%; anti-Fyb, 2.6%; anti-Lea+Leb, 2.5%; anti-Dia, 2.0%; and others. For pregnant patients, anti-D (12.7%) was statistically more frequent. For transfused patients, anti-E (37.3%), anti-c + E (9.5%), anti-C + e (3.3%) and anti-Jka (3.1%) were significantly more frequent.

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Background: There has been an increased interest in platelet-derived microparticles (PMPs) in transfusion medicine. Little is known about PMP status during the preparation of platelet concentrates for transfusion.Aim: The aim of this study is to compare the PMP levels in platelet components prepared using the buffy coat (BC), platelet-rich plasma platelet concentrate (PRP-PC), and apheresis (AP) processes.Methods: Platelet components were prepared using the PRP-PC and BC processes. Apheresis platelets were prepared using the Trima Accel and Amicus instruments. The samples were incubated with annexin A5-FITC, CD41-PE, and CD62P-APC. At day 1 after processing, the PMPs and activated platelets were determined using flow cytometry.Results: Both the percentage and number of PMPs were higher in platelet components prepared using the Amicus instrument (2.6 +/- 1.8, 32802 +/- 19036 particles/mu L) than in platelet components prepared using the Trima Accel instrument (0.5 +/- 0.4, 7568 +/- 5298 particles/mu L), BC (1.2 +/- 0.6, 12,920 +/- 6426 particles/mu L),and PRP-PC (0.9 +/- 0.6, 10731 +/- 5514 particles/mu L). Both the percentage and number of activated platelets were higher in platelet components prepared using the Amicus instrument (33.2 +/- 13.9, 427553 +/- 196965 cells/mu L) than in platelet components prepared using the Trima Accel instrument (16.2 +/- 6.1, 211209 +/- 87706 cells/mu L), BC (12.9 +/- 3.2, 140624 +/- 41003 cells/mu L), and PRP-PC (21.1 +/- 6.3, 265210 +/- 86257 cells/mu L).Conclusions: The study suggests high variability of PMPs and activated platelets in platelet components prepared using different processes. This result may be important in validating the instruments involved in platelet blood collection and processing. (C) 2016 Elsevier Ltd. All rights reserved.

Background:Bone marrow (BM), which is a good source of stem cells and biological factors, has the potential to enhance bone fusion. Simple centrifugation technique is one of the procedures used to concentrate BM aspirate for increasing number of cells. However, there are limited clinical study for using BM concentrate augmentation in spinal fusion.Objective:This study was designed to examine the spinal fusion enhancement effects of bone marrow (BM) concentrate augmentation on poster lateral lumbar fusion (PLF) with autologous local bone graft in terms of both quality and quantity, as compared with a control procedure without BM concentrate augmentation.Material and Method:Twelve patients with L4-L5 spondylolisthesis scheduled for PLF after decompressive laminectomy and pedicle screw instrumentation were included in this study. This prospective randomized controlled trial was conducted at Siriraj Hospital during the 2009 to 2012 study period. Patients were randomly assigned to two groups. One group underwent PLF with local bone graft with BM concentrate augmentation (BM group) and the other group underwent PLF with local bone graft only (non-BM group). Clinical outcomes were evaluated by the Oswestry Disability Index (ODI) preoperatively and at 3 and 6 months after PLF. Bone fusion quality was evaluated by bony bridging on 3D-CT imaging. Fusion mass volumes were measured on quantitative 3D-CT scans at 1 week and 6 months, postoperatively.Results:Clinical outcome scores did not differ between groups. Six-month postoperative 3D-CT imaging showed complete PLF bridging in 58.3% and 100% of patients in the BM and non-BM groups, respectively. PLF mass volumes were decreased at 6 months by 51.1% in the BM group and by 48.5% in the non-BM group. One patient in the BM group had local inflammation at the BM aspiration site.Conclusion:Bone marrow concentrate augmentation in this small randomized controlled trial failed to demonstrate positive effects on autologous local bone graft in posterolateral lumbar fusion relative to both quality and quantity. The high percentage of incomplete bridging should also be noted and further investigated.

Objectives: This study aims to evaluate the current hemoglobin screening methods for prospective blood donors in Thailand. Materials and Methods: Fingerstick capillary blood samples and venous blood samples were obtained from blood donors and measured hemoglobin concentration by two hemoglobin photometers (Hemocue 301 and DiaSpectT System) and Sysmex XS800i. Results: The comparison analysis showed a good correlation between both hemoglobin screening methods and the venous-Sysmex method (the gold standard), for fingerstick-Hemocue 301 r = 0.87 and r2 = 0.75 and for fingerstick-DiaSpectT r = 0.84 and r2 = 0.70. The mean hemoglobin concentration of the venous-Sysmex method was 14.24 ± 1.21 g/dL (11.5-17.7 g/dL). The mean hemoglobin concentration of fingerstick-Hemocue 301 method was 14.75 ± 1.28 g/dL (difference 0.51 ± 0.65 g/dl, p < 0.01). The mean hemoglobin concentration of fingerstick-DiaSpectT method was 14.27 ± 1.35 g/dl (difference 0.03 ± 0.74 g/dL, p = 0.52). Conclusion: Hemoglobin concentration from the hemoglobin screening methods by hemoglobin photometers had a good correlation with the result from the gold standard method, but there was variation of accuracy according to the types of hemoglobin photometers.