Objective This study aims to investigate and analyze the distribution of MN blood type among ethnic minorities in China. Methods Through a systematic retrieval of the 981 literature related to MN blood group distribution, 120 literature, meeting the criteria of this study, with complete data were selected. The literature covers 49 ethnic minorities. SPSS 26 statistical software was used to analyze the data. Results The results showed that among the 49 ethnic minorities in China, the phenotype distribution of MN blood type was MN>MM>NN, with proportions of 42.54%, 41.86%, and 15.06% respectively. The gene frequency for MN blood type exhibited a trend of m>n, with a gene frequency of m being 0.6313 and n being 0.3687. Cluster analysis divided the Chinese ethnic minorities into three groups based on the gene frequency for m, showing the characteristics of Group I>Group II>Group III. Conclusion The MN blood type characteristics in Chinese ethnic minorities show a higher frequency of the M gene compared to the N gene. The frequency of the M gene is higher in southern ethnic minorities than in northern ones. There are significant differences between southwestern ethnic minorities and the Han nationality, but no differences with long-term mixed/settled Han populations.

Objective To analyze the distribution of platelet antibodies in hospitalized patients and explore the clinical significance of platelet antibody detection. Methods A total of 95 987 hospitalized patient cases from a tertiary hospital in Xi'an from April 1, 2021 to December 31, 2023 were collected. Platelet antibodies were detected by solid-phase agglutination method. Statistical analysis was performed on variables including gender, age, blood type, department, history of blood transfusion, pregnancy history, and disease type. Results Among 95 987 hospitalized patients, the positive rate of platelet antibody detection reached 4.35%. The positive rate of platelet antibodies in female hospitalized patients (5.29%) was higher than that in male patients (3.31%), and the difference was statistically significant (x2=224.124). The positive rate of platelet antibodies in those with pregnancy history (7.92%) was higher than that in those without pregnancy history (4.19%), and the difference was significant (x2=292.773). Similarly, the positive rate of platelet antibodies in those with transfusion history (7.79%) was higher than that in those without transfusion history (3.97%), and the difference was significant (x2=300.209). There was a significant correlation between the positive rate of platelet antibodies and the number of pregnancies (x2=91.061). Conclusion The positive rate of platelet antibodies in 95 987 inpatient cases was 4.35%. The positive rate of platelet antibodies had a close relationship with a history of blood transfusions and pregnancies, and it increased with the number of pregnancies. For patients with multiple transfusion histories and pregnancy histories, screening for platelet antibodies holds significant diagnostic value.

Background and Objectives:Multimorbidity is increasingly prevalent among the middle-aged population, yet it is largely often overlooked. We aimed to explore and compare the differences in multimorbidity patterns by sex and age among middle-aged inpatients from China and the United Kingdom. Research Design and Methods:We analyzed 184 133 hospitalization records from Shaanxi, China, and 180 497 from the UK Biobank for -middle-aged populations. Using network analysis, we examined multimorbidity patterns by sex, age groups (40-44, 45-49, 50-54, and 55-59 years), and countries. We also identified hub diseases in both sex-specific and sex-age-specific networks and their corresponding roles in forming multimorbidity patterns. Results:In both China and the United Kingdom, males exhibited higher multimorbidity prevalence (China: 58.51% vs 55.33%, 1.06×; United Kingdom: 31.15% vs 29.79%, 1.05×) and greater complexity of multimorbidity patterns (China: 1179 patterns vs 990 patterns, 1.19×; United Kingdom: 438 patterns vs 377 patterns, 1.16×) than females. In sex-specific networks, males in both countries demonstrated the specificity of circulatory, genitourinary, and endocrine/nutritional/metabolic-associated multimorbidity patterns, while females demonstrated specific genitourinary and neoplasm-associated multimorbidity patterns. Hub diseases in these networks are distributed in similar disease categories. In sex-age-specific networks, dominant multimorbidity patterns and hub diseases shifted by age. In males, both countries showed stable but dominating circulatory, endocrine/nutritional/metabolic and digestive-associated multimorbidity patterns with aging. In comparison, Chinese females demonstrated an increase in nervous system-associated multimorbidity patterns and a decrease in genitourinary-associated multimorbidity patterns with ageing; British females demonstrated an increase in mental/behavioral-associated multimorbidity patterns and a stable but dominating -genitourinary-associated multimorbidity patterns. Discussion and Implications:In both China and the United Kingdom, males demonstrated more complex multimorbidity than females. With ageing, multimorbidity patterns are stable in males, while females in China and the United Kingdom each develop different and specific multimorbidity patterns. These findings may inform targeted interventions for middle-aged inpatients with multimorbidity by sex and age.

Our study seeks to provide a theoretical foundation for the clinical use of cold-stored platelets (CSPs) by interpreting ultrastructural images and quantitatively analyzing structural changes. CSPs, room temperature -stored platelets (RTPs), and delayed CSPs (delayed-CSPs) were continuously observed using scanning electron microscopy and transmission electron microscopy at eight time points. Super-resolution fluorescence microscopy was employed to observe changes in platelet microtubules and mitochondrial structure and function, whereas platelet counts, metabolism, and relevant functional indicators were measured concurrently. Quantitative statistical analysis of platelet size, morphology, canalicular systems, and five organelles was performed under electron microscopy. In CSPs stored for 1 day, the platelet shape changed from circular or elliptical to spherical, with size decreasing from 2.8 pound 2.2 mm to 2.0 pound 2.0 mm. CSPs exhibited wrinkling and reorganization of platelet microtubule proteins, with organelles aggregating toward the central region. CSPs stored for 14 days and delayed-CSPs for stored for 10 days exhibited numerous structurally intact and active cells. The percentage of structure-intact active cells was 92% in both groups, respectively. RTPs stored for 5 and 7 days showed minimal changes in size, a normal microtubule skeleton, and were primarily in a resting state. However, RTPs stored for 10 and 14 days displayed swelling, irregular disintegration of the microtubule skeleton, and the presence of membranous structures and vacuolated cells. The percentage of structure-intact active cells was only 45% and 7%, respectively. Our findings confirmed that the maximum storage time of platelets was 5-7 days for RTPs, within 10 days for delayed-CSPs, and 14 days for CSPs. (c) 2024 International Society for Experimental Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BackgroundThe World Health Organization emphasizes the importance of completely voluntary blood donation to maintain safe and sustainable blood supplies. However, the benefits of blood donation for donors, such as reducing the risk of disease, remain a topic of debate due to the existence of the healthy donor effect (HDE). This effect arises because of inherent health differences between blood donors and the general population, and it is also considered a methodological issue. ObjectiveThis study aims to generate a more detailed health profile of blood donors from a donor cohort study to mitigate and quantify the HDE and properly interpret the association between blood donation and disease outcomes among blood donors. MethodsA retrospective cohort study was conducted between January 2012 and December 2018 among donors before their first donation. One-to-one propensity score matching was conducted through a random selection of individuals without any history of blood donation, as reported from their electronic health records. We conducted a Poisson regression between blood donors and non–blood donors before the first donation to estimate the adjusted incidence rate ratio (AIRR) of selected blood donation–related diseases, as defined by 13 categories of International Classification of Diseases, Tenth Revision (ICD-10) codes. ResultsOf the 0.6 million blood donors, 15,115 had an inpatient record before their first donation, whereas 17,356 non–blood donors had an inpatient record. For the comparison between blood donors and the matched non–blood donors, the HDE (the disease incidence rate ratio between non–blood donors and blood donors) was an AIRR of 1.152 (95% CI 1.127-1.178; P<.001). Among disease categories not recommended for blood donation in China, the strongest HDE was observed in the ICD-10 D50-D89 codes, which pertain to diseases of the blood and blood-forming organs as well as certain disorders involving the immune mechanism (AIRR 3.225, 95% CI 2.402-4.330; P<.001). After age stratification, we found that people who had their first blood donation between 46-55 years old had the strongest HDE (AIRR 1.816, 95% CI 1.707-1.932; P<.001). Both male and female donors had significant HDE (AIRR 1.082, 95% CI 1.05-1.116; P=.003; and AIRR 1.236, 95% CI 1.196-1.277; P<.001, respectively) compared with matched non–blood donors. Conclusions: Our research findings suggest that the HDE is present among blood donors, particularly among female donors and those who first donated blood between the ages of 46 and 55 years. Trial RegistrationChinese Clinical Trial Registry ChiCTR2200055983; https://www.chictr.org.cn/showproj.html?proj=51760

Background and ObjectivesDiagnostic blood loss is a significant factor in the development of anaemia in neonates with very low birth weight. This study aimed to assess the clinical efficacy of intervention approaches involving varying diagnostic blood loss and red blood cell transfusion volumes in neonates with very low birth weights experiencing anaemia during hospitalization.Materials and MethodsA total of 785 newborns with anaemia weighing less than 1500 g were enrolled from 32 hospitals in China. The study involved monitoring diagnostic blood loss and red blood cell transfusion and evaluating relevant interventions such as red blood cell transfusion and clinical outcomes. Three intervention approaches were established based on the difference between blood loss and transfusion (Intervention Approaches 0, 1 and 2). The primary outcomes measured were unsatisfactory weight gain during hospitalization and neonatal mortality. The secondary outcomes included related complications.ResultsIn the non-hospital-acquired anaemia group, Intervention Approach 2 had the highest incidence of below-normal weight gain (odds ratio [OR]: 3.019, 95% confidence interval [CI]: 1.081-8.431, p = 0.035). Multivariate analysis revealed that Intervention Approach 1 had a protective effect on weight gain. In the hospital-acquired anaemia group, Intervention Approach 2 had the highest incidence of below-normal weight gain (OR: 3.335, 95% CI: 1.785-6.234, p = 0.000) and mortality (OR: 5.341, 95% CI: 2.449-11.645, p = 0.000), while Intervention Approach 1 had the lowest incidence of intraventricular haemorrhage. Intervention Approach 1 demonstrated favourable outcomes in both anaemia groups.ConclusionIntervention Approach 1 improved weight gain and reduced mortality and complications in both the non-hospital-acquired and hospital-acquired anaemia groups.

Background Platelets play an important role in acute bleeding.Whether 4℃cold stored platelets (CSPs) can be an effective substitute for platelets at room temperature (RTPs) is rarely reported, we carried out the clinical application observation trial of CSPs in China for the first time. Method A prospective, double-blind, randomized clinical trial was conducted on surgical patients with related bleedingto assess the hemostatic potential of CSPs compared with RTPs. The primary outcomes measured were drainage volume, platelet counts, and Thrombelastography-maximum amplitude. Secondary outcomes included hospital stays, length of stay in the intensive care unit, medical expenses. Results A total of 62 patients were completed the final clinical observation. There were 31 cases ineach of the CSPs group and RTPs group. With in 1–12 hours, 13–24 hours, 25–48 hours, and 49–72 hours after platelet transfusion, drainage volume: 8.5ml/h vs 20.83ml/h ,0.52ml/h vs 5.0ml/h, 3.5ml/h vs 5.0ml/h, 0.63ml/h vs 4.1ml/h. platelet counts:58×109/L vs 79×109/L, 54×109/Lvs77×109/L,63×109/L vs 75×109/L, 66×109/Lvs79×109/L. TEG-MA: 50.1mm vs 52.0mm ,50.1mm vs 54.8mm, 53.0mm vs 56.6, 56.0mm vs 53.2mm.There was no overall difference between the two groups by Generalized estimation equation at different times (Pdrainage=0.933,PPLT counts=0.473,PTEG−MA=0.246). The secondary outcomes (hospital stay, ICU stay time, medical cost, discharge outcome) were no difference between the CSPs group and RTPs group (P > 0.05). There were no significant differences in adverse platelet transfusion events between the groups (P > 0.05). Conclusion CSPs and RTP have equivalent efficacy and safety in the treatment of surgery-related bleeding. This trial provides reliable evidence to support the clinical application of CSPs. Trial registration Chinese Clinical Trial Registry: ChiCTR2000036353;Principal investigator's name: Jiangcun Yang. Date of registration: 22/08/2020.

Aims and objectives To investigate the consistency in the prevalence and associated factors of frailty determined by the physical-originated Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale and the multidimensional Tilburg Frailty Indicators (TFI) scale. Background Accurate assessment of frailty and the identification of its associated factors could guide the development and implementation of holistic and individualised treatment plan. However, recommendations regarding the selection of frailty assessment tools are inconclusive. Design This is a cross-sectional study, the reporting of which followed the STROBE guidelines. Methods A total of 1220 older adults were recruited from a university affiliated tertiary hospital in Xi'an City, Northwest China, and administrated with a social-demographic and health-related information sheet, the FRAIL, the TFI, the Short-Form Mini-Nutritional Assessment, the Pittsburgh Sleep Quality Index and the 5-level EuroQol 5 dimensions questionnaire. Descriptive statistics and binary logistic regression analysis were used to investigate the prevalence of frailty and its associated factors. Results The prevalence of physical-originated and multidimensional frailty was 55.2% and 77.6%, respectively. The consistency between the two scales was low. Taking the combined use of the two instruments as the reference, the TFI and FRAIL could identify 89.99% and 64.02% of the participants with frailty. Polypharmacy, health-related quality of life and sleep quality were found to be associated with both physical-originated and multidimensional frailty. Nutritional status and level of physical activity were additionally identified as the independent associated factors of multidimensional frailty. Conclusions The prevalence of frailty among hospitalised older adults is high. There is low consistency between the FRAIL and TFI in detecting frailty. The TFI exhibited higher sensitivity in detecting individuals with frailty and its associated factors. Relevance to clinical practice The findings of this study supported a single use of the TFI for the assessment of frailty in the hospital setting.

Objectives: Environmental, socioeconomic, and genetic factors all are associated with respiratory diseases. We aimed to investigate the association between the ABO blood group and the susceptibility to respiratory diseases. Methods: We constructed a retrospective cohort study of blood donors in Shaanxi, China between January 1, 2012, and December 31, 2018, to investigate the impacts of the ABO blood group on the risk of hospitalization due to respiratory diseases. Results: Of 1,686,263 enrolled participants (680,788 females), 26,597 were admitted to the hospital for respiratory diseases. Compared with blood group O, blood groups A, B, and AB all demonstrated a higher risk for diseases of the upper respiratory tract (International Classification of Diseases, Tenth Revision: J30–J39) (ARR (Adjusted relative risk) 1.139, 95% confidence interval [1.106–1.225]; 1.095 [1.019–1.177]; 1.178 [1.067–1.30], respectively). Conversely, blood group A was found to have a lower risk (0.86 [0.747–0.991]) for influenza (J09–J11) and blood group B had a lower risk for pneumonia (J12–J18) (0.911 [0.851–0.976]) than blood group O. The duration of hospitalization was significantly different across the blood groups in J09–J11 and J30–J39 (P <0.05). Conclusion: The blood group appears to be a prognostic factor in differentiating the occurrence of specific respiratory diseases and duration.

This study aimed to investigate blood transfusion rates and spectrum of diseases in hospitalized neonates treated with blood transfusion in China to provide supporting data for future studies on neonatal blood transfusion.Data on hospitalized neonates were obtained from more than 100 experts from the Department of Neonatology of 55 hospitals in China between January 1, 2012 and December 31, 2016, using a standardized survey. A statistical analysis was conducted to evaluate the data collected, including the blood transfusion rates, blood component transfused, spectrum of diseases, and spectrum of major diseases.Between 2012 and 2016, 541,128 neonates were hospitalized in the 55 hospitals surveyed. There were 70,433 neonates who received blood transfusion, with an average transfusion rate of 13.02%. The rates of red blood cell transfusion, platelet transfusion, and plasma transfusion were 9.44%, 0.66%, and 4.77%, respectively. The neonatal blood transfusion rate was 17.99% in Northeast China, 9.74% in Northwest China, and between 10.60% and 16.22% in other regions. The neonatal blood transfusion rate was 12.3% in general hospitals and 13.8% in women and children's hospitals. The top 10 diseases identified in hospitalized neonates treated by blood transfusion were, in rank order, as follows:prematurity,pneumonia, hyperbilirubinemia, bacterial sepsis, respiratory distress syndrome, anemia, hemolytic disease, asphyxia, hemorrhage, and necrotizing enterocolitis.The neonatal blood transfusion rate in China is 13.03%.The rank order in the disease spectrum of the hospitalized neonates and that in hospitalized neonates treated with blood transfusion are different.

This study compared the corrective effects of storage of platelets at 4 degrees C and at 22 degrees C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications. In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4 degrees C (1, 3, 5, 7, 10, 14 days) and at 22 degrees C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices. Platelets stored at 4 degrees C (1, 3, 5,7, 10, 14 days) and at 22 degrees C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 x 10(9)/L to greater than 120 x 10(9)/L for 4 degrees C storage, and 20 to 27 x 10(9)/L to greater than 120 x 10(9)/L for 22 degrees C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4mm to greater than 43mm for 4 degrees C storage, and 12.2 to 14.4mm to greater than 44.8mm for 22 degrees C storage. Thromboelastography reaction time values decreased from 9.9-24.9 minutes to 3.8-5.5 minutes for 4 degrees C storage, and 9.9-22.7 minutes to 4.3-4.5 minutes for 22 degrees C storage. Platelets stored at 4 degrees C (1, 3, 5,7, 10, 14 days) and at 22 degrees C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 x 10(9)/L to greater than 99 x 10(9)/L for 4 degrees C storage, and 12 to 34 x 10(9)/L to greater than 120 x 10(9)/L for 22 degrees C storage. TEG-MA results improved from 21.4 to 32.1mm to greater than 49.1mm for 4 degrees C storage, and 21.4 to 31.6mm to greater than 50.5mm for 22 degrees C storage. Platelets stored at 4 degrees C and 22 degrees C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4 degrees C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.

目的 了解外科大量输血时血细胞检测与凝血指标检测频率与病死率的相关性.方法 对中国不同区域20家三级综合医院1682例输血患者进行多中心回顾性分析,采用统一调研表格,统计分析红细胞悬液输注量<10 U及≥10 U情况下血细胞检测及凝血检测频次与病死率.结果 ①不同输血量时(<10 U组,≥10 U组)血细胞检测及凝血检测频率差异均有统计学意义(P<0.05).②外科不同病类红细胞悬液输注量≥10 U血细胞检测及凝血检测1次以上与没有检测者差异均有统计学意义(Qsmh=8.2867,P=0.0040;Qsmh=20.3839,P<0.0001).③外科大量输血患者血细胞检测及凝血指标检测频次与病死率均呈负相关(r=-0.900,P=0.037;r=-0.975,P=0.005).结论 外科大量输血时血细胞检测及凝血指标检测的及时性对降低患者死亡率具有一定的意义.

Objective To evaluate the corrective effects of platelets stored at 4℃ with the help of a in vitro hemorrhage model Platelets agitated at 22℃ were used as comparison.we hope this study would provide valuable experimental bata for the preservation of platelets in clinical applications.Methods Sample platelets with a total volume of 5×200 mL were divided into 2× 100 mnL each 200 mL for storage at 4℃ and 22℃,respectively.An in vitro model of hemorrhage was established with the in vitro hemodilution method where blood was diluted with normal saline (NS) with a ratio of 1∶9.The in vitro corrective effects of the platelets stored at 4℃ and 22℃ were evalutaed by Thromboelastography (TEG) test and routine blood marker level tests,where these two groups of platelets were prepared in a mix of suspended erythrocytes and fresh frozen plasma with a ratio of 1 ∶ 1 ∶ 1.Results Platelets stored at 4℃ and those agitated at 22℃ for 1,3,and 5 days were determined to be corrected in the in vitro hemorrhagie model,where platelet counts (× 109/L) were corrected from 20-27 to 127-161 and 128-160,respectively (P＞0.05).The TEG-MA (mm) were corrected from 12.7-14.4 to 45-51 and 47-50 while TEG-R values were corrected from 27.7-9.9 to 4.4-4.3 and 4.5-4.7,respectively (P＞0.05).For platelets stored at 4℃ for 7-14 days,platelet counts (× 109/L) were corrected from 18-27 to 162-161 and TEG-MA(mm)were corrected from 8.8-14.5 to 46-43 with TEG-R(min) corrected from 24-13 to 5.5-5.2(P＜0..05).Conclusion Correction has been detected using the hemorrhage model.The platelet counts,TEG-R,and TEG-MA values have been corrected,thus supporting the claim that platelets stored at 4℃ for 10-14 days presents fine coagulation quality.

Objective To compare the metabolic changes in platelets stored at 4℃ and those with agitation at 22℃ in order to provide an experimental basis for the preservation technology of platelets.Methods Blood samples were collected for platelets stored at 4℃ for 1,3,5,7,10,14,and 21 days as well as for those stored with agitation at 22℃ for 1,3,and 5 days.The levels of gas indicators,biochemical indicators,and hypotonic shock response (HSR) were measured for platelets stored under different conditions.Results There were no significant changes in the pH,Na+,Ca,and Cl-levels of platelets stored at 4℃ for 7 days (P＞0.05).There were significant changes in the pH,Na+,Ca+,Cl-,pCO2,pO2,lactate (Lac),HCO3-,ctCO2,and Gap(K+) levels of platelets stored with agitation at 22℃ for 5 days (P＜0.005).On the 5th day,platelets stored at 22℃ showed significantly lower pH values than platelets stored at 4℃,while the lactate dehydrogenase (LDH) and Lac levels were significantly higher than for platelets stored at 4℃ (P＜0.005).The LDH,pH,K+,pCO2,pO2,Lac,HCO3-,ctCO2,and Gap(K+) levels between the two groups showed significant differences (P＜0.05).Platelets stored at 4℃ for 5 days showed no significant changes in the recovery from HSR (P＞0.05),while those stored at 22℃ showed a reduced rate of HSR recovery of 53.77％ between the 5th and 1st day.Conclusion The comparison of platelet metabolism between platelets stored at 4℃ and those agitated at 22℃ reveals that platelets stored under cold conditions show low metabolism,low lactate production,low reduction in pH,and low glucose consumption.Platelets stored at 4℃ for 10-14 days still show some HSR recovery.In terms of metabolic data,platelets stored at 4℃ are recommended to be stored for 10-14 days.

Objective To study platelet count and morphological changes of platelets stored under different conditions (at 4℃,and agitated at 22℃),in order to provide experimental data for the preservation technology of platelets.Methods Blood samples were collected for manual preparation of platelets,which were stored at 4℃ for 1,3,5,7,10,14,and 21 days (experimental group) and at 22℃ for 1,3,5,7,and 10 days.The platelet count,Wright staining,and scanning electron microscopy of the platelets from these two groups were compared.Results Changes in the platelet count for platelets stored at 4℃ for 21 days and those agitated at 22℃ for 5 days were not significant (P＞0.05).Differences in the mean platelet volume (MPV) and platelet distribution width (PDW) values of platelets stored with agitation at 22℃ within 5 days showed an increasingly statistically significant trend (P＜0.05).Additionally,there were no significant changes in the MPV and PDW values for platelets stored at 4℃for 14 days (P＞0.05).Wright staining revealed that the size and morphology of platelets preserved at 4℃ for 21 days were not significantly changed.The platelet cytoplasm appeared uniformly dense and darker in color;shape was irregular with most cells appearing to be nearly round,size varied,and minimal platelet aggregation occurred.For platelets stored with agitation at 22℃,the platelet cytoplasm appeared sparse and lighter in color and platelet number was lower.Scanning electron microscopy of platelets stored at 4℃ for 10-14 days revealed significant platelet activation,aggregation,uneven surface,and significant long pseudopodia formation.For platelets stored with agitation at 22℃for 7 and 10 days,the platelet number and aggregation were lower.Some of these platelets also appeared to have an empty halo,nearly round shape,no obvious formation of pseudopodia,and no obvious platelet activation.Conclusion In comparison,the platelet count,cell morphology,platelet membrane,and cytoplasmic structure of cells stored at 4℃for 10-14 days were better than those stored with agitation at 22℃for 5 days.

Abstract The aim of this study was to provide an overview of massive transfusion in Chinese hospitals, identify the important indications for massive transfusion and corrective therapies based on clinical evidence and supporting experimental studies, and propose guidelines for the management of massive transfusion. This multiregion, multicenter retrospective study involved a Massive Blood Transfusion Coordination Group composed of 50 clinical experts specializing in blood transfusion, cardiac surgery, anesthesiology, obstetrics, general surgery, and medical statistics from 20 tertiary general hospitals across 5 regions in China. Data were collected for all patients who received ≥10 U red blood cell transfusion within 24 hours in the participating hospitals from January 1 2009 to December 31 2010, including patient demographics, pre-, peri-, and post-operative clinical characteristics, laboratory test results before, during, and after transfusion, and patient mortality at post-transfusion and discharge. We also designed an in vitro hemodilution model to investigate the changes of blood coagulation indices during massive transfusion and the correction of coagulopathy through supplement blood components under different hemodilutions. The experimental data in combination with the clinical evidence were used to determine the optimal proportion and timing for blood component supplementation during massive transfusion. Based on the findings from the present study, together with an extensive review of domestic and international transfusion-related literature and consensus feedback from the 50 experts, we drafted the guidelines on massive blood transfusion that will help Chinese hospitals to develop standardized protocols for massive blood transfusion.

Objective To comparison and analysis the changes in functional of platelets stored.at 4℃ and those agitated at 22℃ were compared to provide an experimental basis for the cryopreservation technology of platelets.Methods Blood samples were collected for platelets stored at 4℃ for 1,3,5,7,10,14,and 21 days,as well as for those stored with agitation at 22℃ for 1,3,and 5 days.Thromboelastography (TEG),light transmittance aggregometry,and flow cytometry were used to test platelets that had been stored under the different conditions.Results The thromboelastograph of platelets stored at 4℃ showed that their MA values were still within the normal range after 21 days of storage.The five TEG indicators of platelets stored with agitation at 22℃ for 5 days showed low coagulation (P＜0.05).The maximum platelet aggregation rate of platelets stored at 4℃ for 1 day was higher than 50％ and was higher than that of platelets stored with agitation at 22℃ (P＜ 0.05).After 5 days of storage,the COLL-and ACA-induced maximum aggregation rate of platelets stored at 4℃ was maintained at above 80％,while the maximum aggregation rate by the four inducers for platelets agitated at 22℃ was less than 5％.For platelets stored at 4℃ for 10-14 days,although the four aggregation rates were reduced,they were significantly higher those of platelets stored with agitation at 22℃ for 5 days (P＜0.05).Analysis of activated procaspase-activating compound 1 (activated Ⅱb/Ⅲa) and CD62P (P-selectin) on the platelet surface revealed that a large number of platelets stored at 4℃ after 10-14 days remained in the mid and late activation states.Conclusion Platelets stored at 4℃ showed better aggregation,coagulation,and higher activity than platelets stored with agitation at 22℃.Platelets can be stored in vitro for 10-14 days.

Objective To compare the corrective effects on platelets in storage at 4℃ and agitation at 22℃ on the in vitro thrombocytopenic mode in order to provide an experimental basis for the preservation of platelets for clinical application.Methods Thromboelastography and platelet count were used to evaluate the in vitro corrective effects on thrombocytopenic platelets stored at 4℃ and those agitated at 22℃ for various durations.Results Platelets stored at 4℃ and those agitated at 22℃ for 1,3,and 5 days were corrected using thrombocytopenic platelets prepared using the same blood samples.The platelet counts were corrected from 10-30× 109/L to greater than 100× 109/L.Platelets that had been stored at 4℃ for 7-14 days achieved similar correction values.Platelets that had been stored at 4℃ for 10-14 days and those agitated at 22℃ for 5 days were corrected using thrombocytopenic platelets.Their corrected thromboelastography (TEG)-MA values were within the normal range,and thus the corrective effects were achieved.Conclusion Platelets stored at 4℃ for 10-14 days and those agitated at 22℃ for 5 days were corrected using the in vitro thrombocytopenia mode.Based on the platelet counts,the TEG-MA values showed that corrective effects were achieved,thus supporting the claim that platelets stored at 4℃ for 10-14 days could achieve good coagulation effects.

BACKGROUNDPlatelet (PLT) storage at cold temperatures (4°C) can reduce bacterial contamination and lower the risk of transfusion‐related complications. We compared the effects of 22 and 4°C storage conditions for PLTs to further explore the efficiency of hemostasis in acute bleeding and extended PLT shelf life.STUDY DESIGN AND METHODSManually prepared PLTs (PLT concentrates in plasma, not PLT additive solution) were stored at 4 and 22°C. The PLT counts, scanning electronic microscope observations, blood gas indices, biochemical indices, PLT aggregative function, and surface CD62P expression were monitored and compared between the groups.RESULTSThere was no obvious change in PLT counts between Day 21 at 4°C and Day 5 at 22°C. PLTs stored at 4°C for 10 to 14 days were dramatically activated, had rough surfaces, and showed a significant degree of long pseudopodia formation. The pH of the PLTs on Day 5 was lower at 22°C than at 4°C, while the lactate dehydrogenase and lactic acid levels in the former group were significantly higher (p < 0.005). The maximum aggregation rates induced by collagen and arachidonic acid in the PLTs stored at 4°C for 5 days remained higher than 80%, while the rates induced by four inducers in the PLTs stored at 22°C were less than 5%. PLTs stored at 4°C for 10 to 14 days showed higher surface expression of PAC‐1 and CD62P.CONCLUSIONPLT counts, cellular morphologies, PLT membranes, cytoplasmic structures, aggregation rates, and hemostatic PLT function stored at 4°C for 10 to 14 days were better than those stored at 22°C for 5 days.