Blood transfusion is a vital medical procedure with the potential to save lives; however, it can have serious consequences if not carried out under rigorous principles. Sub-Saharan Africa (SSA) faces considerable challenges in ensuring the security of the transfusion process, particularly in the context of transfusion-transmissible infections (TTIs). These difficulties are principally associated with the elevated prevalence of TTI in the region, including viral (e.g., hepatitis B, HIV and hepatitis C), bacterial (e.g., syphilis), and parasitic (e.g., malaria) diseases, among others. Also, the family replacement donation system, economic and technological limitations and an insufficient donor pool constitute substantial obstacles. Various solutions are currently being recommended, implemented, or applied on a variable scale, depending on the specific country and subregion, to address the challenges above. For instance, it would be judicious to implement measures to prevent infections, such as rigorous donor selection, quality testing for the primary TTI, and pathogen inactivation. This would necessitate deploying innovative and adapted communication strategies to establish a sufficient pool of regular, unpaid voluntary donors and high-quality screening. Therefore, robust and coherent national or regional blood transfusion policies should support the previously outlined measures. These policies should include rigorous quality control and haemovigilance systems and reflect local epidemiological and economic realities.

Introduction: In Sub-Saharan Africa, the true extent of the COVID-19 pandemic is not known due to the low number of tests performed and the large proportion of asymptomatic cases in the populations. This was a seroprevalence study of SARS-CoV-2 antibodies in blood donors to assess the extent of virus circulation in Burkina Faso. Methodology: It was a cross-sectional study that included unpaid blood donors between March and April 2022. A rapid diagnostic test was used to screen SARS-CoV-2 antibodies in donors' plasma. Adjustment was made based on the performance of the test evaluated in a national quality control. Results: A total of 3,084 blood donors were recruited, of whom 58.7% were male and 59.8% were from urban areas. The mean age was 22.9 ± 5.8 years, with donors aged 20 to 29 years accounting for 64.2%. The adjusted seroprevalence was 87.2%; 95% CI (86.4– 87.9). There was no difference in SARS-CoV-2 seropositivity between men and women, and between urban and rural areas. Donors aged 30-39 years had 0.5-fold lower odds of having SARS-CoV-2 antibodies than those under 20. Similarly, compared to Bobo-Dioulasso, blood donors from the Dédougou, Fada N'Gourma, and Koudougou centres had 0.5, 0.2, and 0.5 times lower odds of having SARS-CoV-2 antibodies, respectively. Conclusions: The study indicates a high population exposure to SARS-CoV-2, in contrast with the official reports from the national surveillance system. It underscores the need to strengthen surveillance and public health interventions both in urban and rural areas.

Passenger lymphocyte syndrome (PLS) is a rare cause of sudden-onset hemolytic anemia 1-3 weeks after hematopoietic stem cell or solid organ transplantation. Early recognition is key as it informs transfusion protocols. Diagnostic is based on the detection of theses antibodies using direct antiglobulin test (DAT), elution and titration. When treatment is needed, antigen-negative transfusion is sufficient in most cases. Severe cases management includes glucocorticoids, rituximab, plasmapheresis and intravenous immunoglobulins. We report two cases of PLS in living donor liver transplant with minor ABO incompatibility. Both patients developed symptomatic anemia and required red blood cell transfusions, as well as escalation of immunosuppressive therapy.

Vox SanguinisEarly View INTERNATIONAL FORUM International Forum on the Use of Irradiated Blood in Patients With Haematological Malignancy: Responses Xiao-Yin Zhang, Xiao-Yin ZhangSearch for more papers by this authorMichael Murphy, Michael MurphySearch for more papers by this authorGraham P. Collins, Graham P. CollinsSearch for more papers by this authorVernon J. Louw, Vernon J. LouwSearch for more papers by this authorGamuchirai Y. Tadzimirwa, Gamuchirai Y. TadzimirwaSearch for more papers by this authorSatyam Arora, Satyam Arora orcid.org/0000-0002-9048-5624 Search for more papers by this authorNita Radhakrishnan, Nita RadhakrishnanSearch for more papers by this authorCarlos Gonzalez, Carlos GonzalezSearch for more papers by this authorRyan A. Metcalf, Ryan A. Metcalf orcid.org/0000-0001-6074-7147 Search for more papers by this authorErica Swenson, Erica SwensonSearch for more papers by this authorMaria A. Nuñez, Maria A. NuñezSearch for more papers by this authorEdgardo Saa, Edgardo SaaSearch for more papers by this authorArwa Z. Al-Riyami, Arwa Z. Al-Riyami orcid.org/0000-0001-8649-0650 Search for more papers by this authorAli Tabatabaey, Ali TabatabaeySearch for more papers by this authorYulia Lin, Yulia Lin orcid.org/0000-0002-5562-9020 Search for more papers by this authorAditya Tedjaseputra, Aditya TedjaseputraSearch for more papers by this authorErica M. Wood, Erica M. Wood orcid.org/0000-0001-7527-2340 Search for more papers by this authorAlexandra Pedraza, Alexandra PedrazaSearch for more papers by this authorCristina Sanz, Cristina Sanz orcid.org/0000-0002-0370-3436 Search for more papers by this authorCorentin Streel, Corentin StreelSearch for more papers by this authorVéronique Deneys, Véronique DeneysSearch for more papers by this authorAmalia G. Bravo, Amalia G. BravoSearch for more papers by this authorKarla Maldonado, Karla MaldonadoSearch for more papers by this authorLuiz Amorim, Luiz AmorimSearch for more papers by this authorThais Ferraz, Thais FerrazSearch for more papers by this authorYoshihiko Tani, Yoshihiko TaniSearch for more papers by this authorNaoko Goto, Naoko GotoSearch for more papers by this authorFanny Delettre, Fanny DelettreSearch for more papers by this authorPierre Tiberghien, Pierre TiberghienSearch for more papers by this authorJaap Jan Zwaginga, Jaap Jan ZwagingaSearch for more papers by this authorTheodora Foukaneli, Theodora FoukaneliSearch for more papers by this authorPaul Kerr, Paul KerrSearch for more papers by this authorSamclide Mbikayi Mutindu, Samclide Mbikayi MutinduSearch for more papers by this authorAlphonse Mosolo Nganzele, Alphonse Mosolo NganzeleSearch for more papers by this authorRichard Schäfer, Richard SchäferSearch for more papers by this authorNancy Dunbar, Corresponding Author Nancy Dunbar [email protected] Search for more papers by this author Xiao-Yin Zhang, Xiao-Yin ZhangSearch for more papers by this authorMichael Murphy, Michael MurphySearch for more papers by this authorGraham P. Collins, Graham P. CollinsSearch for more papers by this authorVernon J. Louw, Vernon J. LouwSearch for more papers by this authorGamuchirai Y. Tadzimirwa, Gamuchirai Y. TadzimirwaSearch for more papers by this authorSatyam Arora, Satyam Arora orcid.org/0000-0002-9048-5624 Search for more papers by this authorNita Radhakrishnan, Nita RadhakrishnanSearch for more papers by this authorCarlos Gonzalez, Carlos GonzalezSearch for more papers by this authorRyan A. Metcalf, Ryan A. Metcalf orcid.org/0000-0001-6074-7147 Search for more papers by this authorErica Swenson, Erica SwensonSearch for more papers by this authorMaria A. Nuñez, Maria A. NuñezSearch for more papers by this authorEdgardo Saa, Edgardo SaaSearch for more papers by this authorArwa Z. Al-Riyami, Arwa Z. Al-Riyami orcid.org/0000-0001-8649-0650 Search for more papers by this authorAli Tabatabaey, Ali TabatabaeySearch for more papers by this authorYulia Lin, Yulia Lin orcid.org/0000-0002-5562-9020 Search for more papers by this authorAditya Tedjaseputra, Aditya TedjaseputraSearch for more papers by this authorErica M. Wood, Erica M. Wood orcid.org/0000-0001-7527-2340 Search for more papers by this authorAlexandra Pedraza, Alexandra PedrazaSearch for more papers by this authorCristina Sanz, Cristina Sanz orcid.org/0000-0002-0370-3436 Search for more papers by this authorCorentin Streel, Corentin StreelSearch for more papers by this authorVéronique Deneys, Véronique DeneysSearch for more papers by this authorAmalia G. Bravo, Amalia G. BravoSearch for more papers by this authorKarla Maldonado, Karla MaldonadoSearch for more papers by this authorLuiz Amorim, Luiz AmorimSearch for more papers by this authorThais Ferraz, Thais FerrazSearch for more papers by this authorYoshihiko Tani, Yoshihiko TaniSearch for more papers by this authorNaoko Goto, Naoko GotoSearch for more papers by this authorFanny Delettre, Fanny DelettreSearch for more papers by this authorPierre Tiberghien, Pierre TiberghienSearch for more papers by this authorJaap Jan Zwaginga, Jaap Jan ZwagingaSearch for more papers by this authorTheodora Foukaneli, Theodora FoukaneliSearch for more papers by this authorPaul Kerr, Paul KerrSearch for more papers by this authorSamclide Mbikayi Mutindu, Samclide Mbikayi MutinduSearch for more papers by this authorAlphonse Mosolo Nganzele, Alphonse Mosolo NganzeleSearch for more papers by this authorRichard Schäfer, Richard SchäferSearch for more papers by this authorNancy Dunbar, Corresponding Author Nancy Dunbar [email protected] Search for more papers by this author First published: 25 March 2025 https://doi.org/10.1111/vox.70014Read 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:Blood supply problems in remote areas are well known. To overcome this shortage, many countries have developed innovative walking blood bank (WBB) protocols. However, no common standards have yet been set for their use and common actions. Given that these procedures involve a certain risk, it would be interesting to analyse the activating criteria that lead to using this unusual protocol. Thus, this review aimed to identify indications for a WBB and the common risk mitigation measures. MATERIAL AND METHODS:This PRISMA-compliant review only included studies published from 1985 to 25th of January 2023 that describe adult male military casualties requiring blood transfused locally using a walking blood transfusion protocol. All relevant data (i.e., activation and contextual factors and risk mitigation measures) were tabulated to retrieve information from the selected military studies. RESULTS:Our results indicated that activation criteria were homogeneous across the 12 reviewed studies. Whole blood was collected from a WBB when there was a shortage of blood products and when platelets were needed. In the literature reviewed, the main risks associated with such a protocol, namely hemolytic adverse events and transfusion transmitted diseases, are mitigated by the use of typing and screening measures if they are reported. However, there is less consistency in the implementation of those risk mitigation measures. DISCUSSION:This unusual protocol needs to be integrated into the medical support plan until conventional transfusion support can take over, and should include on-site blood collection from a donor, whether a WBB or an emergency donor panel. The benefits of such a protocol outweigh the risks in a life-threatening situation, especially since these risks can be anticipated and minimised by planning to pre-screen all potential donors before their deployment. Finally, educating and training the staff who must implement this unusual procedure can also improve the safety and survival rate of future patients.

Background Emergency transfusion may require the availability of O-negative red blood cell concentrates without pre-transfusion testing. At the Cliniques Universitaires Saint-Luc, the emergency department was used to having access to two decentralized O-negative red blood cell concentrates. This study aims to analyze the consumption of O-negative red blood cell concentrates in emergency situations both before and after the implementation of a novel strategy aiming at optimizing stocks. This strategy provides a combined allocation of one unit of O-positive red blood cell concentrate and one unit of O-negative red blood cell concentrate decentralized in the emergency department and reserve the transfusion of the negative unit only to under 45-year-old women and under 20-year-old men. Materials and Methods A retrospective study was conducted of the transfusion and medical records of all patients who received immediate transfusions in the emergency department without pre-transfusion testing between 2008 and 2022. Results A total of 193 patients received O red blood cell concentrates without pre-transfusion testing in emergency situations between 2008 and 2022. During the first 24 h of hospitalization, 354 O-negative units were transfused. Mean ratios of number of O-negative bags between 2008 and 2020 was 1.98 unit/patient. After implementation of the new strategy, the ratio in 2021 was 1.46 unit/patient and drastically decreased in 2022 to 0.79 unit/patient. Conclusion In situations of emergency, allocating O-negative units only for women younger than 45 years and men younger than 20 years could have saved 85% of O-negative red blood cell concentrates transfused (303/354) yet balancing the immunological risk. Limiting the number of delocalized units of O-negative red blood cell concentrates in the emergency department seems to lower O-negative consumption. With this strategy, the units spared could have been transfused to patients with greater needs (e.g., sickle cell patients or chronically transfused patients).

Background: Despite major demographic changes, several decisions and initiatives, among which Patient Blood Management, have led to a significant reduction in the transfusion of packed red blood cells (RBCs) in Belgium, as it has been observed in many countries. Unfortunately, not all blood groups were propor-tionately impacted and shortage in O D-negative RBCs is regularly or chronically observed. The goal of this study was to examine how to optimize the use and the supply of O D-negative blood in our academic hospital. Methodology: All blood transfusions performed at Cliniques universitaires Saint-Luc between January 1, 2019 and December 31, 2021 were reviewed. The blood group of the patients was compared with the blood group of the RBCs actually supplied and transfused. Results: 49.823 RBCs transfusions were analyzed. The patients' needs didn't reflect those of a Caucasian population, with an increase of O (47.9%) and B (10.3%) for the ABO blood group, and a quite high propor-tion of R0r (8.6%) for the Rh blood group. Only two thirds of O D-negative RBCs were transfused to O rr or R0r patients.Conclusion: The application of PBM and the ethnic imbalance between blood donor and patient popula-tions are two important risk factors for chronic shortages of O D-negative blood. To adapt blood compo-nent resources, it is essential to have a complete picture of the real needs of patients according to their blood group profile. Blood donor centers must adapt to the evolving needs of hospitals in order to plan future supplies in a "pull-flow" approach. (c) 2023 Societe francaise de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.

Patients with chronic liver disease (CLD) and cirrhosis present a rebalanced hemostatic system in the three phases of haemostasis. This balance is however unstable and can easily tip towards bleeding or thrombosis. Management of both spontaneous bleeding and bleeding during invasive procedures remains a challenge in this patient population. Transfusion of blood products can result in circulatory overload and thereby worsen portal hypertension. As an alternative to fresh frozen plasma (FFP), prothrombin complex concentrates (PCC) may have merit in patients with liver disease because of their low volume. The impact of PCC in in-vitro spiking experiments of cirrhotic plasma is promising, but also warrants cautious use in light of thromboembolic risk. The majority of existing studies carried-out in CLD patients are retrospective or do not have an adequate control arm. A prospective study (the PROTON trial) was set up in 2013 to investigate the utility of PCC in patients undergoing liver transplantation. However, the study has never recruited the planned number of patients. Robust data on PCC safety in CLD is also required. The limited existing evidence does not seem to indicate an excessive thromboembolic risk. Currently, the utilisation of PCC in CLD cannot be routinely recommended but can provide an option for carefully selected cases in which other measures were not sufficient to control bleeding and after delicately weighing risks and benefits.

Background: Shortages of O-negative red blood cells are becoming increasingly common, forcing hospitals' blood transfusion services to find solutions to conserve this blood group for patients who need it most. The present study aimed to retrospectively evaluate the practice of transfusing selected RhDnegative patients with RhD-positive red blood cells and to assess the impact of this measure on patients and blood transfusion service management. Methodology: Transfusion data of 1199 RhD-negative patients hospitalised at Cliniques Universitaires Saint-Luc between 2019 and 2022 were analysed. For patients who received RhD-positive red blood cells, age, gender, reason for hospital admission, indication for transfusion, and immunohematology analyses were recorded. These data enabled an assessment of transfusion practices over the years, characterisation of patients who received RhD-mismatched transfusions, determination of the alloimmunisation rate, and calculation of the total number of RhD-negative red blood cells saved. Results: During the study period, 141 RhD-negative patients received 604 RhD-positive red blood cells. A change in transfusion practices was observed over the years, with a greater proportion of RhD-negative patients being transfused with RhD-positive red blood cells in 2022 (28%) compared to 2019 (2%). The overall alloimmunisation rate was at least 20%, and 416 red blood cells were saved without any consequences. Patients undergoing cardiovascular surgery received the highest number of RhD-positive red blood cells. Conclusion: The transfusion of selected RhD-negative patients with RhD-positive red blood cells is a lowrisk practice that helps conserve RhD-negative red blood cells. However, there is a minimum 20% risk of alloimmunisation, which could have clinical and transfusion-related consequences in the future. (c) 2023 Societe francaise de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.

In sub-Saharan Africa, antibody detection tests remain inaccessible because of the high cost and limited shelf life of red blood cell (RBC) reagents. This study aimed at investigating the feasibility and performance of locally prepared RBC reagents for antibody detection in Burkina Faso. We conducted an experimental study comparing commercial RBC panels and a local panel prepared from phenotyped blood donors in Ouagadougou, Burkina Faso. Antibody detection testing was performed by the indirect antiglobulin test using a gel card filtration column in a low-ionic-strength solution. Judgment criteria were the concordance rate and the kappa agreement coefficient of results generated by the two panels. A total of 302 blood donors were phenotyped for the major antigens of the RH, KEL, MNS, FY, JK, LE, and P1PK blood group systems. From this pool of donors, we designed an RBC detection panel that was used to screen for unexpected antibodies in 1096 plasma samples from 832 patients with a history of transfusion and 264 recently delivered or pregnant women with no history of blood transfusion. A positive antibody detection test was observed in 8.1 percent of the samples using the local panel versus 6.4 percent with the commercial panels. A total of 23 samples were negative with the commercial panels and positive with the local panel, while the findings were reversed for four samples. The concordance rate was 97.5 percent, and the kappa agreement coefficient was 0.815. Our results suggest that the development of local RBC panels can be an alternative to commercial panels in countries with limited resources. It could also be a cost-effective intervention, mainly for children under 5 years of age, women of childbearing age, and pregnant women, all of whom are most at risk for malaria and sickle cell disease complications. Blood services could develop and implement appropriate strategies to make phenotyped donor pools available for the design of suitable RBC panels.

Background: Sub-Saharan African countries face the challenge of immunological transfusion safety that puts many patients at risk of post-transfusion hemolytic reactions. This is because pre-transfusion testing for irregular/unexpected antibodies that helps to prevent these risks are neither universally available nor accessible. The aim of our study was to determine the prevalence of red blood cell alloantibodies and their specificity in patients transfused in Burkina Faso.Materials and Methods: This was a cross-sectional study including patients who had received at least one blood transfusion. Indirect antiglobulin testing using LISS-enhanced medium gel column agglutination technique was used for antibodies screening and identification. Enzymatic technique with papain-treated red cell reagent was performed in attempt to solve some difficulties if necessary as well as auto-control test and RH-KEL phenotyping when possible to help antibodies identification.Results: A total of 832 patients were included, 51.6% of whom were female, and the median (IQR) age was 34 (20-49) years. Of these, 43.7% had chronic kidney disease and 20.4% were sickle cell patients. The median (IQR) number of immunisation episodes (blood transfusion and pregnancies) was 3 (2-6) with the median (IQR) number of blood units received per patient of 2 (1-5). The proportion of patients with RBCs antibodies was 6.4% (53/832), with mainly anti-Rh antibodies. A combination of 2 antibodies was found in 7 patients and a combination of 3 antibodies in one patient. Antibodies of unknown specificity (AUS) were encountered in 29%. Independent factors associated with antibody positivity were age (OR = 1.02; p = 0.026), sickle cell disease (OR = 3.23; p = 0.017) and receiving more than 10 blood units (OR = 7.33; p = 0.01).Conclusion: In this study, the proportion of patients with RBC antibodies was quite similar to that observed in Sub-Saharan African countries. However, the availability and accessibility of pre-transfusion compatibility tests as well as the quality of methods used should be improved to ensure the safety of blood transfusions.

To date, 43 blood group systems with 349 red blood cell (RBC) antigens have been recognized. The study of their distribution is useful for blood services to improve their supply strategies for providing blood of rare phenotypes, but also to design indigenous RBC panels for alloantibody screening and identification. In Burkina Faso, the distribution of extended blood group antigens is not known. This study aimed to investigate the extended profiles of blood group antigens and phenotypes of this population and to raise limitations and potential strategies for the design of local RBC panels. We conducted a cross-sectional study that included group O blood donors. Extended phenotyping for antigens in the Rh, Kell, Kidd, Duffy, Lewis, MNS, and P1PK systems was performed using the conventional serologic tube technique. The prevalence of each antigen and phenotype combination was determined. A total of 763 blood donors were included. The majority were positive for D, c, e, and k and negative for Fya and Fyb. The prevalence of K, Fya, Fyb, and Cw was less than 5 percent. The most frequent Rh phenotype was Dce, and the most common probable haplotype was R0R0 (69.5%). For the other blood group systems, the K-k+ (99.4%), M+N+S+s- (43.4%), and Fy(a-b-) (98.8%) phenotypes were the most frequent. Antigenic polymorphism of blood group systems by ethnicity and geography argues for the design and evaluation of population-sourced RBC panels to meet specific antibody profiles. However, some of the specificities identified in our study, such as the rarity of double-dose antigen profiles for certain antigens and the cost of antigen phenotyping tests, are major challenges to overcome.

Objectives: While transfusion is a common and safe therapeutic procedure in health care facilities, trans-fusion reactions can occur, whether acute or delayed, mild or life-threatening. In face of these reactions, the biological analysis laboratory plays a central role in their diagnosis. The objective of this article is to develop decisional algorithms for laboratory tests to be performed according to the clinical symptoms developed by the patient during or after transfusion.Methods: Based on the information collected by reviewing the literature and the procedures used in our hospital, we then developed biological investigation algorithms according to the symptoms presented by the patient, rather than the presumed reaction.Results and conclusion: We have developed symptom-based algorithms for acute transfusion reactions management that streamline laboratory testing and simplify the differential diagnosis.(c) 2022 Societe francaise de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.