Transfusion

BackgroundThe novel coronavirus, SARS-CoV2 that causes COVID-19 has resulted in the death of more than 2.31 million people within the last year and yet no cure exists. Whereas passive immunization with COVID-19 convalescent plasma (CCP) provides a safe and viable option, selection of optimal units for therapy and lack of clear therapeutic benefit from transfusion remain as barriers to the use of CCP. Study design and methodsTo identify plasma that is expected to benefit recipients, we measured anti-SARS-CoV2 antibody levels using clinically available serological assays and correlated with the neutralizing activity of CCP from donors. Neutralizing titer of plasma samples was measured by assaying infectivity of SARS-CoV-2 spike protein pseudotyped retrovirus particles in the presence of dilutions of plasma samples. We also used this assay to identify evidence of passive transfusion of neutralizing activity in CCP recipients. ResultsViral neutralization and anti-spike protein antibodies in 109 samples from 87 plasma donors were highly varied but modestly correlated with each other. Recipients who died of COVID-19 were found to have been transfused with units with lower anti-spike antibody levels and neutralizing activity. Passive transfer of neutralization activity was documented in 62% of antibody naive plasma recipients. ConclusionsSince viral neutralization is the goal of CCP transfusion, our observations not only support the use of anti-spike SARS-CoV2 serology tests to identify beneficial CCP units, but also support the therapeutic value of convalescent plasma with high titers of anti-spike antibodies.

Structured AbstractO_ST_ABSBackgroundC_ST_ABSCivilian walking blood banks (WBBs) transfuse fresh whole blood from mobilized donors, screened using rapid diagnostic testing (RDT) for transfusion transmissible infections (TTIs), to preserve life when banked blood is unavailable. However, concerns regarding TTI risk using a RDT process instead of a more traditional, laboratory-based test persist. We aimed to understand the marginal risk of TTI using an RDT-based strategy compared to a laboratory-based test through development of a simulation model and accompanying online tool. Study Design and MethodsWe modeled expected TTIs per 100,000 donations from initial collection to transfusion and seroconversion. Parameters included TTI prevalence, donor risk-stratification, efficacy of stratification tools, TTI testing rates, platform test performance, and probability of seroconversion. ResultsA baseline TTI prevalence of 1% (95% CI: 0.25%, 1.75%) resulted in 56 TTIs (95% CI: 23, 91) when the RDT sensitivity was 90% (95% CI: 88%, 92%), 30 TTIs (95% CI: 12, 52) when the RDT sensitivity was 95% (95% CI: 93%, 97%), and 12 TTIs (95% CI: 4, 23) when the RDT sensitivity was 99% (95% CI: 97, 100%) per 100,000 donations. Compared to lab-based testing, 15,351 donations would need to be made under a high-sensitivity RDT testing strategy in order to incur one additional TTI. DiscussionIn a simulated WBB model, modern RDT platforms demonstrated favorable test characteristics, with low absolute rates of TTI, particularly when low-risk donors are selected. These findings support WBB implementation as an emergency transfusion strategy in settings lacking banked blood.

The clinical and scientific communities rely on serology testing to analyze the degree of antibody-mediated immunity afforded to recovered patients from SARS-CoV-2 infection. Neutralizing antibodies present in COVID-19 convalescent plasma (CCP) remains a practical therapy to treat COVID-19 patients requiring hospitalization. However, it remains unclear how long antibody levels persist in CCP donors after recovery. An accurate estimation of antibody kinetics in CCP donors provide an important observation to further define the extent of long-term immunity in recovered patient and simultaneously inform CCP collection processes in efforts to improve CCP dosing and therapeutic outcome. In this study, we analyzed 63 donors and measured antibody levels using two high throughput screening assays (HTSA) designed to detect antibodies targeting the spike protein (S1) and nucleocapsid protein (NP) of SARS-CoV-2 and monitored antibody levels between 2-8 consecutive donations. We show that anti-S1 antibody levels, as measured using the Ortho Total Ig HTSA, increased over time in repeat CCP donors while anti-NP antibody levels, as measured using the Abbott IgG HTSA, were unchanged or decreased over time. When we normalized these data, we found that both the absolute levels of anti-S1 antibodies and the ratio between S1 and NP antibodies tends to increase over time. These data have important implications for the convalescent donation process, patient protection from future infection and characterization of the SARS-CoV-2 immune response.

ObjectiveThis study aimed to evaluate the impact of combined use of chemiluminescent immunoassay (CLIA) and nucleic acid amplification testing (NAAT) to improve transfusion transmitted Hepatitis B Virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus-1 (HIV-1) among blood donors in Pakistan. DesignRetrospective, single center observational. SettingRegional blood center at tertiary care hospital in urban Pakistan. ParticipantsAll adults of 18 years or above who were eligible to donate blood after meeting the pre-donation screening criteria during the study period (n = 26,778). Outcome MeasuresPrimary outcome measure was to estimate the incremental yield of HBV, HCV, and HIV-1 infections using combined CLIA+NAAT compared to CLIA-alone per 100,000 donations. Secondary outcome was to calculate inter-test agreement and discordance between CLIA and NAAT methods. ResultsAmong 26,778 donors, the combined CLIA+NAAT testing detected a total of 2,423.6 viral infections per 100,000 donations, NAAT alone contributed 739.7/100,000 of these. For HBV, NAAT uniquely detected 489/100,000 additional cases missed by CLIA; the combined detection rate was 1,561/100,000. For HCV, NAAT-only yield was lower (247/100,000), with total detection of 825.3/100,000. HIV-1 was rare in the donor pool; incremental NAAT yield was 3.7/100,000, with a combined detection rate of 37.3/100,000. Agreement between tests was substantial for HBV ({kappa} = 0.63) and moderate to fair for HCV ({kappa} = 0.47) and HIV-1 ({kappa} = 0.40). The discordant cases detected by NAAT alone for HBV, HCV and HIV-1 were 183, 431 and 37 respectively. McNemars test showed statistically significant differences (p < 0.001) across all markers, with large effect sizes for HIV-1 (0.92, 95% CI: 0.80-1.00) and HCV (0.69, 95% CI: 0.65-0.73). ConclusionIntegrating CLIA with NAAT enhanced the detection of HBV, including occult and window period infections, and refined estimates of active HCV and HIV-1 infections which significantly improved blood transfusion safety. STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThe selection bias was reduced by including all consecutive eligible blood donors during study period. C_LIO_LIThe information bias was minimized through uniform, fully automated, and validated protocols for combined CLIA and NAAT testing of blood donors. C_LIO_LIThe single center retrospective study design restricts generalizability and causal inference. C_LIO_LIThe false positives/negatives and genetic variability were not confirmed. C_LI

BackgroundTo identify blood donors eligible to donate Coronavirus Disease-2019 (COVID-19) Convalescent Plasma (CCP), a large blood center began testing for antibodies to SARS-CoV-2, the etiologic agent of COVID-19. We report the seroprevalence of total immunoglobulin directed against the S1 spike protein of SARS-CoV-2 in US blood donors. MethodsUnique non-CCP donor sera from June 1-July 31, 2020 were tested with the Ortho VITROS Anti-SARS-CoV-2 total immunoglobulin assay (positive: signal-to-cutoff (S/C) [&ge;]1). Donor age, sex, race/ethnicity, ABO/RhD, education, and experience were compared to June and July 2019. Multivariate regressions were conducted to identify demographics associated with the presence of antibodies and with S/C values. ResultsUnique donors (n=252,882) showed an overall seroprevalence of 1.83% in June (1.37%) and July (2.26%), with the highest prevalence in northern New Jersey (7.3%). In a subset of donors with demographic information (n=189,565), higher odds of antibody reactivity were associated with non-Hispanic Native American/Alaskan (NH-NAA/A) and Black (NH-B), and Hispanic (H) race/ethnicity, age 18-64, middle school or lesser education, blood Group A, and never or non-recent donor status. In positive donors (n=2,831), antibody signal was associated with male sex, race/ethnicity (NH-NAA/A, NH-B and H) and geographic location. ConclusionsSeroprevalence remains low in US blood donors but varies significantly by region. Temporal trends in reactivity may be used to gauge the effectiveness of public health measures. Before generalizing these data from healthy donors to the general population however, rates must be corrected for false positive test results among low prevalence test subjects and adjusted to match the wider demography.

BackgroundIn the absence of structured donor registries, social media platforms have become a dominant mechanism for blood donor recruitment in many low-resource settings. However, the implications of this shift for transfusion timeliness and system reliability remain unclear. ObjectiveTo evaluate the impact of social media-sourced donors on transfusion delay, donor reliability, and hemovigilance-related outcomes compared with conventional donor pathways. MethodsThis prospective analytical study included 400 transfusion episodes across tertiary hospitals in Bangladesh. Donor sources were categorized as social media (SM) or conventional (CON). The primary outcome was delay-to-transfusion. Secondary outcomes included donor-related irregularities, documentation completeness, near-miss events, and acute transfusion reactions. Multivariable logistic regression identified predictors of delay [&ge;]4 hours. ResultsSocial media-sourced donors were associated with significantly longer transfusion delays (5.98 vs 2.97 hours; p<0.001). Delay [&ge;]4 hours occurred in 83.6% of SM cases versus 17.6% of CON cases (OR 23.78). Donor-related irregularities were observed in 85% of SM episodes and absent in CON donors. Safety outcomes did not differ significantly between groups. Social media donor sourcing remained the strongest independent predictor of delay (adjusted OR 18.09). ConclusionUnregulated social media-based donor recruitment introduces substantial delays and undermines system reliability without improving access. Integration of digital tools into regulated donor systems is essential to strengthen transfusion timeliness and hemovigilance in resource-limited settings.

PurposeWe tested the hypothesis that addition of biomarkers of multimorbidity and biological ageing would improve the predictive accuracy of point-of-care viscoelastometry or laboratory tests of coagulation for clinically important bleeding following cardiac surgery. MethodsThe analyses included 2437 participants in the Coagulation and Platelet laboratory Testing in Cardiac surgery (COPTIC study) with complete clinical, TEG(R)5000 Thromboelastography, ROTEM(R), Multiplate(R) aggregometry, full blood count, laboratory reference tests of coagulopathy, and biomarkers of biological ageing and multimorbidity. Models with different biomarkers to predict the composite primary outcome, Clinically Important Bleeding, was developed using logistic regression and internally validated using 10-fold cross-validation. Discrimination, calibration, and clinical utility of the models were assessed comprehensively. ResultsFor the primary outcome, the AUROC for the best predictive model using TEG/ROTEM with other biomarkers was 0.694 (0.612-0.775). The best predictive model included laboratory reference tests of coagulation, full blood count results, and biomarkers of multimorbidity and ageing, AUROC=0.701 (0.620-0.781), although clinical utility was not superior to using laboratory reference tests alone. Discrimination was higher for components of the primary outcome; large volume ([&ge;]4 units) red cell transfusion 0.754 (0.602-0.903), and large volume procoagulant transfusion 0.723 (0.590-0.857), but not for excess loss in drains/re-sternotomy 0.701 (0.613-0.788). Calibration was generally good among the models. ConclusionDiagnostic tests for bleeding following cardiac surgery demonstrate moderate discrimination, although this was influenced by the definition of bleeding. Small improvements in discrimination with inclusion of additional disease biomarkers, with similar calibration and clinical utility. Take-home message1. Current diagnostic tests demonstrate moderate predictive accuracy for excessive bleeding following cardiac surgery. In this study, addition of biomarkers of multimorbidity and biological ageing improved discrimination but not clinical utility. 2. Existing clinical definitions of bleeding represent heterogeneous phenotypes, presenting a barrier to research investigating the disease processes. Important abbreviations used in this paper: O_LICIB - Clinically Important Bleeding C_LIO_LICCB - Clinical Concern about Bleeding C_LIO_LIAUROC - Area Under the Receiver Operating Characteristic Curve C_LI

BackgroundSnakebite envenoming (SBE) remains a major neglected tropical disease in Sudan. Venom-induced consumption coagulopathy (VICC) is the most frequent and fatal systemic complication, particularly following envenoming by hemotoxic Echis species. Robust clinical data on VICC in Sudan are limited. MethodsWe conducted a prospective hospital-based cohort study at Sinja Teaching Hospital, Sennar state, Sudan, from March to September 2022. All patients admitted with SBE were enrolled. VICC was diagnosed using the 20-minute whole blood clotting test (WBCT20) and laboratory coagulation assays. Clinical features, laboratory abnormalities, management, and outcomes were recorded until discharge or death. ResultsAmong 119 patients with SBE (mean age 34.5 {+/-} 9 years; 79.8% male), VICC developed in 96 (80.7%). Echis spp. were implicated in 86.6% of cases based on patient recognition. Spontaneous systemic bleeding occurred in 88.5% of VICC patients, and life-threatening hemorrhage in 30.2%, most commonly intracerebral hemorrhage. Acute kidney injury occurred in 36.5% of VICC cases. WBCT20 was positive in all VICC patients and showed high diagnostic sensitivity. Despite administration of fresh frozen plasma, mortality among VICC patients was 30.2%. All paediatric patients died. ConclusionsVICC was highly prevalent and associated with severe hemorrhage, acute kidney injury, and high mortality in this snakebite-endemic region of Sudan. Supportive therapy alone was insufficient to prevent fatal outcomes, reflecting delayed presentation and the absence of effective Echis-specific antivenom. Improved access to species-appropriate antivenom, early referral, and adherence to evidence-based management are critical to reducing snakebite-related mortality in Sudan. Author SummarySnakebite envenoming is a neglected tropical disease that disproportionately affects rural and agricultural communities in low-resource settings. In Sudan, snakebite remains a major but underreported cause of illness and death. One of its most serious complications is venom-induced consumption coagulopathy (VICC), a disturbance of blood clotting that can lead to severe bleeding and organ failure. We studied all patients admitted with snakebite envenoming to a teaching hospital in southeastern Sudan over six months. More than 80% of patients developed VICC, most often following bites attributed to Echis species, which are common in this region. Many patients experienced spontaneous bleeding, and nearly one-third developed life-threatening hemorrhage, most frequently bleeding in the brain. Acute kidney injury was common. Despite supportive treatment, almost one-third of patients with VICC died, and all children in the study died. Our findings highlight the severe and largely preventable burden of snakebite envenoming in this setting. Delayed presentation to hospital, reliance on traditional healers, and the lack of effective antivenom against locally prevalent snake species contributed to poor outcomes. This study highlights the urgent need to improve access to appropriate antivenom, strengthen health-care systems, and implement evidence-based management of snakebite envenoming to reduce avoidable deaths and disability in Sudan.

iii.Background and ObjectivesThe "Pan-European Transfusion Research InfrAstructure" (PETRA) project was established to advance the use of donor, blood product, and patient datasets in Europe, aiming to benefit both patient and donor health. Here, the initial PETRA objective was to describe the landscape of existing donor and blood establishment (BE) databases. Materials and MethodsAn online survey was circulated to the European Blood Alliances BE members. The survey collected information on the feasibility of accessing donor data, and challenges and possibilities for linking these datasets with information on the associated blood products and transfusion recipients, and donors own health records. ResultsSeventeen BEs across 16 countries completed the survey. The majority could, in principle, link their donor data to product data (13 BEs (76%)) and recipient data (10 BEs (59%)), for research purposes. However, capabilities were limited and in only 29% of the BEs was the donor to recipients linkage an automated process. BEs reported significant challenges to achieve full vein-to-vein linkage, including legal constraints and lack of consent (11 BEs) and resources (10-14 BEs). IT and data issues as well as lack of knowledge and training were cited as obstacles by a minority of BEs. ConclusionWhilst the survey results suggest considerable interest in developing linkages between blood donors, their products, and recipients, many challenges remain due to a variety of obstacles. First steps in working towards a PETRA may be assistance to navigate legal frameworks as well as investing in resources and quality and harmonisation of data collections. iv. HighlightsO_LI17 blood establishments (BEs) in 16 countries responded to a survey on obstacles and opportunities for achieving vein-to-vein datasets. C_LIO_LIIn 59% of the BEs donor-to-recipient links can be established for research improving transfusion outcomes, but only in 29% this is an automated process. C_LIO_LIIn order to work towards a "Pan-European Transfusion Research InfrAstructure" (PETRA), legal frameworks, adequate donor consent and (financial and human) resources are the most common obstacles that require addressing. C_LI

At the beginning of the SARS-CoV-2 pandemic, transfusion of COVID-19 convalescent plasma (CCP) was considered as one of the possibilities to help severe patients to overcome COVID-19 disease. The use of CCP has been controversial as its effectiveness depends on many variables from the plasma donor and the COVID-19 patient, for example, time of convalescence or symptoms onset. This was a feasibility study assessing the safety of multiple doses of CCP in mechanically ventilated intubated patients with respiratory failure due to COVID-19. Thirty (30) patients with severe respiratory failure, in ICU, with invasive mechanical ventilation received up to 5 doses of 300 to 600 ml of CP on alternate days (0,2,4,6 and 8) until extubation, futility, or death. Nineteen patients received five doses, seven received four, and four had 2 or 3 doses. On day 28 of follow-up, 57% of patients recovered and were at home and the long-term mortality observed was 27%. The ten severe adverse events reported in the study were unrelated to CCP transfusion. This study suggests that transfusion of multiple doses of convalescent plasma (CP) is safe. This strategy may represent an option to use in new studies, given the potential benefit of CCP transfusions in the early stage of infection in unvaccinated populations and in settings where monoclonal antibodies or antivirals are contraindicated or not available. Summary boxO_LITransfusion of multiple doses (up to 5 doses) of 300-600 ml of convalescent plasma from COVID-19 recovered patients is safe as it does not induce more severe effects than a single dose. C_LIO_LIIndependent of the number of transfused doses, most patients had detectable levels of total and neutralizing antibodies in plasma. C_LIO_LIFuture studies are needed to determine if multiple transfusion doses are more efficient in preventing severity than a single dose. C_LI

BackgroundEnvenoming from numerous sources, such as snakes, scorpions, and spiders, is a major health issue across the world, resulting in millions of cases and tens of thousands of deaths annually. Venom induced symptoms ranges from systemic reactions like nausea and vomiting to localised pain and swelling. One major risk is the development of venom induced consumption coagulopathy (VICC), which might result in significant consequences. Plasmapheresis is being investigated as a possible therapy for severe envenoming. ObjectivesWe aim to assess the effectiveness and potential advantages of plasmapheresis in snakebite cases, focusing on clinical results. We seek to find if plasmapheresis improves neurological, renal, and hematological dysfunction and impacts secondary outcomes, including patient discharge rates, morbidity, mortality, duration of hospital stay, and the number of plasmapheresis sessions required. MethodsFollowing PRISMA guidelines, we conducted a systematic search of articles published between 1980 and July 2023 across multiple databases. MeSH terms related to snakebite and plasmapheresis were applied without publication or language type restrictions. Inclusion criteria considered case reports, cross-sectional studies, or case series featuring plasmapheresis in snakebite management. Inclusions were participants aged 18 years or older with confirmed or suspected snakebites, meeting plasmapheresis indications. Exclusions included participants under 18 years, studies reporting only in vitro data, review articles, and redundant reporting. The emphasis was on Emergency Departments or Intensive Care Units. ResultsIn a review of 147 cases (1980 to July 2023), the most common snake was the hump-nosed viper (Hypnale hypnale). Renal, neurological, and hematological dysfunctions improved after plasmapheresis. The mean plasmapheresis sessions were 2.1, and the average hospital stay was 13.13 days. ConclusionOnce the data has been analyzed, the result emphasizes the clinical importance of plasmapheresis in snakebite envenoming. It helps decision-making when standard therapies are insufficient or ineffective, potentially saving lives. Author SummarySnakebites pose a significant global health threat, causing numerous deaths and serious injuries annually. While antivenom is the primary treatment, its not always effective or available. This study explores an alternative treatment called plasmapheresis, a method that filters harmful substances from the blood. We reviewed 147 cases of snake envenoming treated with plasmapheresis between 1980 and 2023. Our findings show that plasmapheresis can improve various complications caused by snake venom, including kidney problems, nerve damage, and blood disorders. On average, patients received about two plasmapheresis treatments and stayed in the hospital for around 13 days. The study suggests that plasmapheresis could be a valuable option when standard treatments arent working well enough. It might help save lives in severe cases of snake envenoming. While more research is needed, this review provides important insights for doctors treating snakebite victims, especially in areas where snakebites are common and resources are limited.

Purposevon Willebrand factors (vWFs), hemostatic factors, are produced as large multimers and are shear stress-dependently cleaved to become the appropriate size. A reduction in vWF large multimers develops in various conditions including the use of extracorporeal life support, which can cause excessive-high shear stress in the blood flow and result in hemostatic disorders. The objective of this prospective study was to investigate the impact of venovenous extracorporeal membrane oxygenation (VV ECMO) use on the status of vWF large multimers and hemostatic disorders during single lung transplantation (SLT). MethodsWe prospectively enrolled 12 patients who underwent SLT at our center. Among them, seven patients were supported by VV ECMO intraoperatively (ECMO group) and the remaining five patients underwent SLT without ECMO support (control group). The vWF large multimer index (%) was defined as the ratio of the large multimer proportion in total vWF (vWF large multimer ratio) derived from a patients plasma to that from the standard human plasma. ResultsThe vWF large multimer index at the end of the surgery was significantly lower in the ECMO group than in the control group (112.6% vs. 75.8%, respectively; p < 0.05). The intraoperative blood loss and the amounts of intraoperative transfusion products in the ECMO group tended to be greater than those in the control group; however, the differences were not significant. ConclusionDuring SLT, the intraoperative use of VV ECMO caused a decrease in the vWF large multimer index. However, the vWF large multimer index was maintained at > 75% in average at the end of SLT, which did not affect the bleeding complications.

Background Retaining repeat blood donors is essential for maintaining a safe and sustainable blood supply. While pain during venepuncture has been linked to lower donor return, the influence of donor-perceived needle quality on future donation remains unclear, particularly in low- and middle-income countries. This study examined whether perceived needle quality was associated with willingness to donate again among blood donors in Bangladesh. Methods We conducted a cross-sectional analytical study among 100 consecutively recruited whole-blood donors from participating blood donation centres in Bangladesh. Participants completed a structured questionnaire assessing demographic characteristics, donation history, procedural pain using a 10-point Visual Analogue Scale (VAS), pre-donation fear, perceived needle quality, vasovagal symptoms, overall satisfaction, and willingness to donate again on a five-point ordinal scale. Univariable ordinal logistic regression was used for variable screening, followed by multivariable proportional-odds ordinal logistic regression with purposeful variable selection. Statistical significance was set at p < 0.05. Results The mean donor age was 35.8 +/- 11.8 years, and 88% of participants were male. High procedural pain (VAS >= 4) was reported by 73% of donors, whereas 48% expressed high willingness to donate again. After adjustment, procedural pain was the only independent predictor of future donation intention. Each one-point increase in pain score reduced the odds of greater willingness to donate again by 54% (adjusted OR 0.46, 95% CI 0.37-0.57; p < 0.001). Donor-perceived needle quality was not associated with willingness to donate again (adjusted OR 1.09, 95% CI 0.47-2.56; p = 0.840) and showed no association with procedural pain. Conclusions Procedural pain, rather than donor-perceived needle quality, was the principal determinant of willingness to donate again. Interventions that improve donor comfort and minimise venepuncture pain may strengthen donor retention. Larger prospective studies using actual donor return behaviour are warranted.

IntroductionThe efficacy of SARS-CoV2 standard single donor convalescent plasma varied according to the application time and most importantly the amount of antibody that is administered. Single donor plasma has some drawbacks; such as the insufficient levels of neutralizing antibody activities, the requirements of blood group compatibility, and the risk of infection transmission. In this study, the efficacy and safety of pathogen inactivated, isohemagglutinin-depleted (concentrated) and pooled convalescent plasma was investigated. MethodsIn this study, ACB-IP 1.0 convalescent plasma product was prepared as follows; first, convalescent plasma was collected from different donors, then pathogen-inactivation was carried-out, and isohemagglutinins were cryodepleted, respectively. Finally, concentrated convalescent plasma product was pooled and stored until use. A total of sixteen patients were treated with two different convalescent plasma products. Nine patients were treated with standard single donor convalescent plasma and seven were treated with pathogen-free, concentrated, pooled convalescent plasma (ACB-IP 1.0) between 01 March 2020 and 31 December 2020. The outcomes of these two plasma products were compared regarding SARS-CoV2 antibody titers, neutralizing antibody activities, length of hospitalization and mortality rates. ResultsFive out of six single donor plasma SARS-CoV2 antibody titers remained below 12 s/co, but the antibody titers of all ACB-IP 1.0 plasma were above 12 s/co. SARS-CoV2 total antibody titers of ACB-IP 1.0 plasma were statistically higher than the antibody titers of single donor plasma. Mean total plasma neutralizing antibody activity of ACB-IP 1.0 plasma (1.5421) was found statistically higher than single donor plasma (0.9642) in 1:256 dilution ({rho}=0.0087) The mortality rate of the patients treated with ACB-IP 1.0 plasma showed statistically lower (p: 0,033) than the patients treated with single donor plasma. The administration of either single donor plasma or ACB-IP 1.0 plasma to the patients within eight days significantly shortened the length of hospitalization compared to administration of either plasma to the patients later than eight days ({rho}= 0,0021) DiscussionPathogen-free, concentrated, pooled convalescent plasma may resolve the bias in SARS-CoV2 antibody titers and neutralizing antibody activities, without requiring blood group compatibility that allows patient accessibility in a shorter time and has safe plasma characteristic. This study indicates that ACB-IP 1.0 may be a superior product compared to standard single donor plasma.

BACKGROUND: The transport and storage conditions of thawed plasma are not strictly regulated by the FDA and applying red blood cell transport standard of 1-10 degrees Celcius to recently thawed plasma often results in high discard rates. This study evaluated the extended 120-hour (5-day) coagulation factor stability and sterility of thawed plasma frozen within 24 hours (PF24) following a 6-hour transport cooler simulation. STUDY DESIGN AND METHODS: Fourteen PF24 units (8 group O, 6 group B) were thawed at 30-37 degrees Celcius and assigned as control (n=7, direct 1-6 degrees Celcius refrigeration) or experiment (n=7) units. Experiment units were held at room temperature for 30 minutes, stored in validated transport coolers for 6 hours, and then transferred to 1-6 degrees Celcius refrigeration. Measurements of temperature, prothrombin time (PT), Factor V (FV) activity, and Factor VIII (FVIII) activity were conducted at 0-, 6-, 24-, and 120-hour post-thaw. Sterility testing was performed at 0-hour and 120-hour using automated aerobic and anaerobic blood cultures. RESULTS: No statistically significant differences were observed between control and experiment units at 120-hour for mean PT (15.09 vs. 15.16 seconds, p = .44), FV activity (81.14 vs. 74.57%, p = .23), or FVIII activity (61.86 vs. 53.00%, p = .22). Delta analysis (120h-0h) confirmed equivalent factor decay rates between groups. All bacterial cultures showed no growth at 120-hour. CONCLUSION: A 6-hour cooler time of thawed PF24 does not accelerate coagulation factor degradation or compromise sterility over an extended 5-day shelf life. These findings validate flexible inventory return policies, allowing blood banks to reduce product waste.

Hema-Quebec, the blood supplier in the Province of Quebec, Canada, collects and tests convalescent plasma used in a clinical trial to determine the clinical efficacy of this product for the treatment of hospitalized COVID-19 patients. So far, we have collected 1159 plasma units from 282 COVID-19 convalescent donors. The presence of antibodies to the receptor binding domain (RBD) of SARS-CoV-2 spike protein in convalescent donors was established at the first donation. Seropositive donors were asked to donate additional plasma units every six days. Until now, 15 donors have donated at least four times and, in some cases, up to nine times. This allowed us to perform a longitudinal analysis of the persistence of SARS-CoV-2 RBD-specific antibodies in these repeat donors, with the first donation occurring 33-77 days after symptoms onset and donations up to 71-114 days after symptoms onset thereafter. In all donors, the level of antibodies remained relatively stable up to about 76 days after symptoms onset but then started to decrease more rapidly to reach, in some convalescent donors, a seronegative status within 100-110 days after symptoms onset. The decline in anti-RBD antibodies was not related to the number of donations but strongly correlated with the numbers of days after symptoms onset (r = 0.821). This suggests that de novo secretion of SARS-CoV-2 RBD antibodies by short-lived plasma cells stopped about 2-3 months after disease onset, an observation that has important implications for convalescent plasma collection and seroprevalence studies undertaken several months after the peak of infection.

ObjectiveTo analyze the experience of the last six years with ECMO in Uncontrolled Donation after Circulatory Death (uDCD), assessing the clinical and logistical factors that determine donation effectiveness and the viability of retrieved organs, with the nurse perfusionist as the central figure in organ perfusion. MethodsRetrospective observational study of uDCD procedures performed at Hospital Clinic de Barcelona between June 2019 and October 2025. ResultsOf 184 out-of-hospital ECMO-CPR activations, 108 (58.7%) underwent perfusion; 72 donor cases (66.7%) were generated, and 109 kidneys (75.7%) and 3 livers (4.15%) were retrieved. The annual number of uDCD donors was heterogeneous. Compared with non-effective donors, effective donors were significantly younger (48.1 {+/-} 12.4 vs 53.0 {+/-} 10.7 years, p=0.03) and had fewer comorbidities such as hypertension (13.8% vs 33.0%, p=0.018) and diabetes (4.1% vs 16.6%, p=0.027). Although effective donors had a shorter cannulation time (25.6 {+/-} 13.9 vs 29.1 {+/-} 11.9 min, p=0.09), the difference was not statistically significant; however, cardiocompressor time did show a significant difference (58.9 {+/-} 17.7 vs 65.8 {+/-} 18.2 min, p=0.03). ConclusionsuDCD was a useful source of transplantable organs, mainly kidneys (two out of every three perfused patients became donors), in the current context of scarcity of brain-dead donors. Shorter warm ischemia times (cardiocompressor and cannulation times) were significantly associated with more effective organ donation. The multidisciplinary transplant team may benefit from perfusion professionals with expertise in extracorporeal oxygenation therapy.

Background and ObjectivesLiquid plasma (LQP) stands out as an alternative to thawed plasma (TP) for emergent transfusions due to longer shelf life. We aim to measure fibrinogen, Protein C, Protein S, FV, FVII, and FVIII activity in LQP, quantify how these factors levels change during storage, and characterize how they compare in LQP to TP. Materials and MethodsCoagulation factor activities were measured on Days 15, 26, and 27 for LQP (n=26) and Day 5 for TP (n=31). Bayesian statistics was used to compare coagulation factor activity and quantify changes in activity during storage. ResultsFibrinogen and Protein C activity in Day 26 LQP (LQP26) was comparable to Day 5 TP (TP5) with posterior mean activity of 257 mg/dL vs 246 mg/dL and 100.4% vs 108.7%, respectively. FV, FVII, and FVIII had lower activity in LQP26 vs TP5 with posterior mean activities of 42.6% vs 72.0%, 55.0% vs 59.7%, and 48.8% vs 59.2%, respectively. Protein S in LQP26 was low with posterior mean activity of 28.0%, which was less than half that of TP5 at 66.4%. From Day 15 to Day 26, FVII in LQP decreased at a rate of -3.49% per day whereas fibrinogen, Protein C, Protein S, FV, and FVIII activity in LQP remained relatively stable. ConclusionCompared to TP5, LQP26 has comparable activities of fibrinogen, Protein C, FVII, lower activities of FV and Protein S, and slightly lower activity of Factor VIII. LQP is a viable alternative for use in emergency transfusions and massive transfusion protocols. Highlights- Liquid plasma has comparable activities to thawed plasma for fibrinogen, Protein C, and Factor VII, which is advantageous for emergency use due to its extended shelf life. - Liquid plasma has adequate fibrinogen and Protein C levels on the last day of expiration. - Liquid plasma has [~]50% FV, FVII and FVIII activity levels on the last day of expiration, making it a sufficient replacement option to TP for active bleeding.

BackgroundTranslational research driven by large-scale biological testing requires significant volumes of blood for research testing. However, blood is also required for clinical management of research subjects, which must take priority. Paradoxically, much of the blood drawn for clinical management goes unused. Here, we present our approach for retrieving unused blood samples collected for clinical management and recycling them for research purposes. MethodsClinical Blood samples were collected for 60 days during a 61-day xenotransplantation experiment in a brain-dead decedent. Twice weekly, research staff went to the chemistry and hematology laboratories and collected stored blood, serum, and plasma samples that were >12 hours old. Sample collection and storage before retrieval was per standard clinical protocols. Samples were de-identified and relabeled and brought to a central biorepository for processing and storage. The quantity of plasma, serum, red blood cells (RBCs), and peripheral blood mononuclear cells (PBMCs) collected from clinical labs and bespoke research blood draws were compared. ResultsUnused blood from clinical samples yielded a minimum of 6.0 ml per day of plasma, representing 62% of all plasma obtained. Serum was only recoverable on 13 days (22%), with a mean 2.3 ml collected on those days, representing 8% of all serum obtained. PBMCs were only recoverable on six days (10%). ConclusionsOverdrawn clinical laboratory samples represent an untapped resource of blood samples for research and can help augment samples collected explicitly for research purposes. With careful planning, this represents an opportunity to minimize iatrogenic blood loss in clinical-translational research.

BackgroundMassive intraoperative bleeding (IBL) in liver transplantation (LT) poses serious risks and strains healthcare resources necessitating better predictive models for risk stratification. As traditional models often fail to capture the complex, non-linear patterns underlying bleeding risk, this study aimed to develop data-driven machine learning models for predicting massive IBL during LT using preoperative factors. MethodsTwo hundred ninety consecutive LT cases from a prospective database were analyzed. Logistic regression models were built using 73 preoperative demographic and laboratory variables to predict massive IBL ([&ge;] 80 mL/kg). The dataset was randomly split (70% training, 30% testing). The model was trained and validated through three-fold cross-validation, with backward stepwise feature selection iterated 100 times across unique random splits. The final model, based on a high stability index, was evaluated using the area under the curve (AUC). ResultsMassive IBL was observed in 141 patients (48.6%). In standard logistic regression, significant differences were found in 42 of 73 factors between groups stratified by massive IBL, however, substantial multicollinearity limited interpretability. In the feature selection across 100 iterations, the data-driven model achieved an average AUC of 0.840 in the validation and 0.738 in the test datasets. The final model, based on 11 selected features with a high stability index, achieved an AUC of 0.844. An easy-to-use online risk calculator for massive IBL was developed and is available at: https://tai1wakiya.shinyapps.io/ldlt_bleeding_ml/. ConclusionsOur findings highlight the potential of machine learning in capturing complex risk factor interactions for predicting massive IBL in LT.