Blood Transfusion

A novel A allele with c.575T>C variant in glycosyltransferase A leads to ABO discrepancy

Hui Zhang — 2025-08-07

Background - The ABO subtypes may lead to discrepancy between the forward and reverse typing in ABO blood group identification, which are caused by variant in the ABO gene. In this study, we reported a novel A allele which resulted in A_elphenotype and the variant occured in the disordered loop.

Materials and methods - The ABO phenotyping and genotyping were performed by standard serological methods and direct DNA sequencing of ABO gene. The effect of the amnio acid substitution on the structure and function of glycosyltransferase A(GTA) was evaluated by PolyPhen-2.

Results - The serological results of the proband assigned as A_el subtype, a novel A allele with c.575T>C (p.Ile192Thr) variant on the ABO*A1.02 was identified. The PolyPhen-2 analysis showed that the amnio acid substitution (p.Ile192Thr) may reducing the stability of the protein and weaken the GTA activity.

Conclusions - We found a novel A allele with c.575T>C variant on the ABO*A1.02 background in a Chinese blood donor, which was responsible for A_elphenotype and the variant occured in the disordered loop.

Transfusion strategies in thalassemia and sickle cell disease SITE-SIMTI-SIdEM Good Practice

Gian Luca Forni — 2025-06-20

This document is the tool through which the knowledge developed by biomedical research is transferred to daily clinical practice. It does not offer standards of care to which one can refer in acritical and decontextualized manner: these standards must be able to be expressed, for each individual case, on the basis of available clinical information, preferences of the patients and other contextual situations, accurately examined in light of the expertise of healthcare professionals. It is therefore up to the expertise and judgement of the professionals, who carefully listen to particular requests and consider the values expressed by patients, to establish which procedures or treatments are more appropriate to manage individual clinical cases.

The Good Practice (GP) is organized in two large sections:

a main section which, for each topic of interest, reports a short specific introduction and continues with recommendations for clinical practice in order to allow the reader to access the interpretation of the evidence and the recommendations made by the Authors.

No. 4 Enclosures where the following is reported:

Enclosure 1 - transfusion yield;

Enclosure 2 - perioperative management and prevention of postoperative complications;

Enclosure 3 - donation of blood, hematopoietic stem cells (HSCs), organs and tissues;

Enclosure 4 - table of matching levels.

Exploring Italians’ knowledge of, and perceptions and feelings about stem cell donation: a GITMO-IBMDR nationwide survey

Stefano Botti — 2025-06-11

Background - The current stem cell donor shortage is likely partially due to many individuals’ lack of knowledge, beliefs and feelings about the donation process. The aim of this study was to explore these factors to provide the Italian Bone Marrow Donor Registry with information to guide and optimize their awareness campaigns.

Materials and methods - A nationwide anonymous online survey was developed on behalf of the Gruppo Italiano Trapianto di Midollo Osseo and shared on various online platforms. The data were analysed for frequencies and central tendency values, and geographic areas (Northern, Central and Southern Italy), sex and median age were compared.

Results - The average age of the 1,518 recruited participants was
37.6 (±13.3) years, and 1,142 (75.2%) were females. Half of the sample (No.=759) was from Southern Italy, 213 (14%) from Central Italy and 546 (36.0%) from Northern Italy. Of the sample, 87.9% knew about The Italian Bone Marrow Donor Registry, and 72.4% were aware that donor centres recruit donors. Respondents from the north, females and older individuals knew significantly more about the stem cell donation process; on a 4-point Likert scale,
55.7% of the sample reported the strongest sense of solidarity, 36.8% felt the most gratification and 39.4% the most satisfaction. Respondents from Southern Italy systematically had significantly higher levels of negative feelings.

Discussion - Our findings identified a specific group of potential donors who systematically correlated with lower awareness about stem cell donation; educational campaigns should target this group.

Clinical impact of Amotosalen and UV-A treatment (INTERCEPT™ Blood System) for platelet concentrate preparation in cardiac surgery

Paul-Michel Mertes — 2025-08-22

Background - Ensuring transfusion safety remains a major challenge. Pathogen-reduction technologies (PRT), such as the INTERCEPT™ Blood System (IBS), use amotosalen (a psoralen) as intercalating agent in nucleic acids and ultraviolet A (UV-A) light to block pathogen replication, reducing the risk of transfusion-transmitted infections. While IBS is approved for platelet concentrate (PC) treatment, its clinical impact on platelet function remains debated. In November 2017, IBS was implemented across all French blood banks (Établissement Français du Sang, EFS) for PCs.

Materials and methods - We conducted a retrospective "before-after" study to evaluate the impact of PRT on platelet transfusion and clinical bleeding in cardiac surgery. The pre-PRT period was from January 2016 to June 2017, and the post-PRT period from January 2018 to June 2019. The study included adult patients who received PCs during or within two days after cardiac surgery in two teaching hospitals (Nancy and Reims). Patients with heart transplantation or requiring mechanical circulatory support were excluded.

Results - A total of 357 (Nancy) and 314 (Reims) patients were included, with no changes in anticoagulation, antiplatelet therapy, or surgical procedures. Platelet transfusion amount significantly decreased post-PRT (from 0.64 [0.54-0.81] to 0.57 [0.49-0.75] ×10¹¹/10 kg; p<0.01), while transfusion of other blood products remained unchanged. Postoperative outcomes, including mediastinal drainage, reoperation for bleeding, ICU stay, and overall hospital stay, were also unchanged.

Discussion - The implementation of PRT using IBS did not impair the hemostatic properties of transfused platelets during cardiac surgery. Platelet and other blood product use, as well as clinical outcomes, were similar before and after PRT introduction. IBS-treated PCs are thus comparable to standard PCs in managing bleeding in cardiac surgery.

Predicting massive blood transfusions in liver transplantation: the McCluskey Risk Index revised 20 years later

Jacopo Belfiore — 2025-07-24

Background - Liver transplantation (LT) is a life-saving procedure for end-stage liver disease (ESLD), yet massive perioperative transfusions (MT) remain a significant concern. The McCluskey Risk Index (McRI), a widely used tool for predicting MT, was developed nearly two decades ago and does not fully account for recent advancements in LT practices and patient demographics. This study aims to evaluate the validity of the McRI in a contemporary LT cohort and propose a revised McRI (revMcRI) incorporating additional predictors.

Materials and methods - A retrospective observational cohort study was conducted on 604 LT patients at a high-volume national center in Italy over five years. Patient demographic, clinical, and laboratory data were analyzed to assess MT risk, defined as transfusion of ≥6 packed red blood cell (PRBC) units within 24 hours of LT. Univariable and multivariable logistic regression analyses identified significant predictors, which were incorporated into the revMcRI. The discriminatory power of the revMcRI was evaluated using the area under the receiver operating characteristic curve (AUROC).

Results - Among the cohort, 24.7% of patients required MT. The original McRI demonstrated predictive validity but did not fully capture contemporary risk factors. The revised model, revMcRI, incorporated MELD score, donation after circulatory death (DCD), and additional laboratory parameters. The revMcRI showed superior predictive performance compared to the original McRI, with AUROC values of 0.8121 and 0.8117 for MT defined as ≥6 and ≥5 PRBC units, respectively (p=0.02 and p=0.01 for AUROC comparison).

Discussion - The revMcRI enhances the predictive accuracy of MT in LT by integrating modern risk factors. This refined model enables improved preoperative risk stratification and perioperative blood management, with potential implications for transfusion medicine, anesthesiology, and transplant surgery. Further validation in multicenter cohorts is warranted.

Surveillance of blood donors detects an exceptional Parvovirus B19 outbreak in Switzerland in 2023/2024

Mauro Serricchio — 2025-07-09

Background - Human Parvovirus B19 is a common human pathogen that causes fifth disease that can be severe for immunocompromised people and unborn children. Blood donations are routinely screened for the presence of Parvovirus B19 DNA to release plasma for the fractionation industry.

Materials and methods - Voluntary, unremunerated blood donations from six regions of Switzerland were tested by Interregional Blood Transfusion Swiss Red Cross since 2008. Individual blood donations with viral titers exceeding 10³ IU/mL are removed from the blood supply and the viral genotype, viral titers, and serological status were determined.

Results - From 2008 until September 2024, 2,789,113 blood donations were tested for the presence of Parvovirus B19 DNA, of which 271 were considered positive. Two small outbreaks in the years 2013 and 2017 and an unprecedented massive outbreak in winter/spring 2023/2024 were detected. The incidence in the 2023/2024 outbreak was 15.1 per 10,000 donations and thus about ten times higher than in the previous outbreaks with 1.6 and 1.2 positive cases per 10,000 donations, respectively. Of the genotyped cases from the 2023/2024 outbreak all were caused by Parvovirus B19 of genotype 1a2. Viral titers reached maximum values of 3×10¹² IU/mL. Serological data show an inverse correlation between viral titers and presence of protective IgG antibodies.

Discussion - Similar to the situation in other European countries, Switzerland was struck with an unprecedented Parvovirus B19 outbreak in 2023/2024. The outbreak follows a two-year stretch with no positive Parvovirus B19 cases. It is likely that the measures implemented in 2020 to confine the spread of SARS-CoV-2 had a strong impact on other infectious diseases like Parvovirus B19.

Early fibrinogen replacement based on shock index and lactate levels in massive postpartum hemorrhage: a retrospective cohort study

Mehmet Küçükbaş — 2025-07-10

Background - Massive postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Timely fibrinogen replacement is critical in hemostatic resuscitation, yet laboratory delays may hinder early intervention. This study evaluates the clinical outcomes of early fibrinogen concentrate administration in massive PPH using a protocol based on shock index and serum lactate levels rather than laboratory-confirmed hypofibrinogenemia.

Materials and methods - This retrospective cohort study included 103 PPH patients treated at a tertiary hospital in Istanbul, Turkey, between 2016 and 2020. Patients were divided into four groups based on fibrinogen dose: Group I (<2 g), Group II (2–4 g), Group III (>4 g), and Group IV (non-massive PPH, no fibrinogen). A predefined protocol guided early fibrinogen administration based on clinical indicators. Fibrinogen was administered without awaiting lab confirmation.

Results - Group III had the highest estimated blood loss (2,600±500 mL) and Group IV the lowest (600±150 mL; p<0.001). ICU admission was significantly lower in Group III (23.8%) than in Group I (62.1%; p=0.020). Group III patients also had fewer secondary surgical interventions and reduced transfusion requirements compared to Groups I and II. No thromboembolic events or mortality were observed in any group.

Discussion - Early fibrinogen replacement based on shock index and lactate levels appears feasible and beneficial in managing massive PPH. This approach was associated with improved hemostatic control, reduced ICU admissions, and fewer surgical interventions. Prospective studies are warranted to further assess this strategy’s safety, efficacy, and cost-effectiveness.

Transfusion strategies in hemoglobinopathies: what the latest update of Good Practices tell us in the era of new therapeutic advances

Francesca Schieppati — 2025-11-03

PREVIEW

In 2014, the Italian Society of Thalassemia and Hemoglobinopathies (SITE) and the Italian Society of Transfusion Medicine and Immununohematology (SIMTI) working groups joined efforts and knowledge to develop the first “Recommendations for transfusion strategies in hemoglobinopaties”¹, an expert opinion-based tool for the management of transfusion therapy in transfusion-dependent thalassemia (TDT) and sickle cell disease (SCD).
In this issue of Blood Transfusion, Forni et al.², propose an update of these recommendations, not only by a systematic review of the most recent literature and a qualified methodological approach, but also offering a structured discussion of specific recommendations in order to transfer awareness developed through biomedical research to clinicians dealing with patients affected by hemoglobinopathies, in the frame of Good (Clinical) Practices. The Italian Society of Hemapheresis and Cell Manipulation (SIdEM) contributed with SITE and SIMTI to this work. [ ... ]

Delayed hemolytic transfusion reaction associated with anti-Au(a) antibody in a young male with beta-thalassemia

Aleksander Luniewski — 2025-08-06

We report the first case of a clinically significant delayed hemolytic transfusion reaction associated with anti-Au^a antibody in an 18-year-old male with beta-thalassemia and pre-existing anti-D, -C, and -Jk^b antibodies. Following transfusion with antigen-negative red blood cells, a new anti-Au^a antibody was identified, confirmed by a positive Monocyte Monolayer Assay. These findings underscore the importance of vigilance in identifying rare antibodies that may impact transfusion strategies and advanced therapeutic options.

Mitapivat therapy in a patient with nonsense homozygous mutation of the Pyruvate Kinase L/R gene: a case report

Sara Ceglie — 2025-07-17

Pyruvate kinase deficiency causes chronic hereditary non-spherocytic hemolytic anemia and is associated with long-term complications including iron overload, liver cirrhosis, endocrinopathies, osteoporosis, and pulmonary hypertension. Mitapivat is a first-in-class oral allosteric activator of erythrocyte-specific isoforms of the PK enzyme shown to increase hemoglobin, reduced hemolysis and improve patient reported outcome. The drug was approved after ACTIVATE and ACTIVATE-T trials for patients with PK deficiency; these trials were restricted to patients carrying at least one missense mutation of the gene, who tent to respond better than those with two non-missense mutations. Herein we report the case of a transfusion-dependent patient affected by PK deficiency due to homozygous mutation of c.1528C>T, p.Arg510Ter treated with Mitapivat. Despite the nonsense mutation, this patient showed a significant decrease in hemolysis, reduction in transfusion needs and improvement of clinical conditions.

Gender difference among blood donors: should laboratory ranges be changed?

Samantha Pasca — 2025-04-15

Gender differences is a topic currently much discussed in medicine. Therapies and drugs, as well as laboratory investigations and clinical studies, should be studied and performed equally in male and female populations . Not having laboratory tests with different ranges for the two sexes can lead to the error of defining (or not defining) a certain clinical situation as pathological. In our study, we have evaluated the gender differences found in the analysis of different laboratory tests in a group of potential blood donors. The results obtained highlighted differences in most of the parameters considered. This could lead to a possible re-evaluation of laboratory ranges, based on gender, to be clearly indicated in clinical reports.

Artificial Intelligence in transfusion medicine: a paradigm shift on the horizon

Fabrice Cognasse — 2025-08-04

From predicting blood demand to enhancing donor recruitment, AI has the potential to improve efficiency and safety. Machine learning helps to manage blood inventory, reduce waste and ensure a timely distribution. Preliminary applications suggest that personalized AI strategies may encourage repeat donations, helping to maintain a stable blood supply.
Emerging screening methods powered by AI have been tested and show promise in detecting potential risks faster and more accurately. AI also has the potential to enhance blood matching, reducing complications and improving patient outcomes. Despite its benefits, AI poses challenges like data privacy, algorithmic bias, and regulatory hurdles. Future research will focus on refining the role of AI, ensuring ethical implementation, and improving transfusion care. With responsible innovation, AI could revolutionize blood transfusion and save lives worldwide.

Real world analysis of long-term efficacy of isovolemic red cell exchange in sickle cell disease: a single center experience

Nikhil Vojjala — 2025-05-22

Automated Red Cell Exchange (RCE) using apheresis machines has been known since the 1980s. We implemented the IHD RCE strategy using SPECTRA OPTIA in mid-2021 during the Corona Viral Disease-19 (COVID-19) pandemic with the intention to decrease the number of PRBC units used, rather than increasing the time interval between sessions. This single-centre retrospective study demonstrated the sustainability of IHD over 2.5 years. While some patients required an increase in the number of PRBC units used at initiation, we demonstrated a durable 18.5% reduction in number of PRBC units used without any significant change in FCR at 2.5 years.