Blood Transfusion

Passenger lymphocyte syndrome after living-donor kidney transplantation with minor ABO incompatibility: a case report

Wed, 11 Feb 2026 00:00:00 +0000

Passenger lymphocyte syndrome (PLS) is an uncommon, immune-mediated hemolytic disorder that may develop after solid organ or hematopoietic stem cell transplantation when minor ABO incompatibility exists between donor and recipient. It is caused by donor-derived viable B lymphocytes producing antibodies against recipient erythrocyte antigens.

We describe a 28-year-old female (recipient blood group A RhD-positive) who underwent living-donor kidney transplantation from her father (donor group O RhD-positive). Two weeks post-transplant, she presented with fatigue, right shoulder and scapular pain. Laboratory evaluation demonstrated severe normocytic anemia (hemoglobin 49 g/L), elevated lactate dehydrogenase and bilirubin levels, undetectable haptoglobin, and a strongly positive direct antiglobulin test (IgG and C3d). Elution studies identified anti-A antibodies bound to red blood cells, suggestive of PLS. Imaging excluded bleeding but revealed thrombosis of the right internal jugular and brachiocephalic veins. Management included plasma-exchange (PEX), high-dose corticosteroids, and transfusion of irradiated donor-type (group O RhD-positive) red cells. The patient showed progressive hematologic recovery with normalization of hemolytic indices and preserved graft function at hospital discharge.

PLS should be considered in the differential diagnosis of acute hemolytic anemia occurring within the first three weeks after transplantation involving minor ABO mismatch. Early recognition through direct antiglobulin testing (DAT) is essential to guide transfusion strategy and immunomodulatory therapy. Combined PEX and corticosteroid treatment effectively reduced antibody-mediated hemolysis. Routine post-transplant DAT screening may facilitate prompt diagnosis and improve clinical outcomes in renal transplant recipients.

Rhnull phenotype caused by a novel RHAG allele, RHAG*c.640+1G>C, in a Chinese individual

Min Wang, Shuangshuang Jia, Shanshan Zhou, Shihui Li, Qian Liu — Tue, 17 Mar 2026 00:00:00 +0000

Rh_null blood type is characterized by the complete absence of Rh antigens on red blood cells, a condition that can lead to notable morphological abnormalities. In this study, a patient with an Rh_null phenotype was identified through serologic testing. Sequencing of RHAG revealed a novel c.640+1G>C mutation, which was subsequently confirmed to be inherited from the father and transmitted to the children.

Identification and analysis of a novel ABO allele with c.959insC variant in a Chinese blood donor

Jiancheng Liu, Wei Zhang, Feng Shao — Thu, 08 Jan 2026 00:00:00 +0000

Background - The mutation of ABO gene leads to the weakening of ABO antigen expression. The third-generation single-molecule sequencing technology is used to help accurately identify the variant blood group and analyze the molecular mechanism of antigen weakening.

Materials and methods - The ABO blood group was identified by immunohematology, and the weak antigen was detected by absorption and elution technique. Finally, the full-length sequence of ABO gene was analyzed by the third-generation single-molecule sequencing technology, including promoter, exon, intron and regulatory region.

Results - The proband was serologically identified as Ael subtype. Gene sequencing analysis showed that the genotype of the proband was ABO * O.01.01 / ABO * A.NEW heterozygous, carrying a novel mutation c.959 insC.

Discussion - This study reports the discovery of a novel Ael blood group allele, which results in reduced expression of the A antigen on the red blood cell surface.

Oxygen delivery, hemodilution and transfusion in critical illness: an underrecognized safety signal in albumin randomized trials

Raffaele Mandarano, Stefano Romagnoli, Mayutharan Balachandran, Yahya Shehabi — Thu, 04 Jun 2026 00:00:00 +0000

This research letter highlights a potential underrecognized safety signal of increased red blood cell transfusion associated with albumin therapy in critically ill patients, emphasizing the role of hemodilution and the importance of reporting transfusion exposure and long-term outcomes in future randomized trials involving albumin administration.

The effective use of platelet-rich plasma (PRP) in treating a severe traumatic knee injury in a child with hemophilia A

Samantha Pasca, Federica Fati, Clara Revetria, Stella Poda, Sonia Secchi — Tue, 17 Mar 2026 00:00:00 +0000

Platelet-rich plasma (PRP) is a therapy primarily used in orthopedics or dermatology to stimulate healing and promote tissue regeneration. There are rare cases in which it was used to treat traumatic injuries or wounds, but none in persons with hemophilia (PwH).

Our young patient was admitted to emergency hospital following a blade injury to the knee. The wound was initially sutured but not treated with a coagulation factor concentrate. Subsequently, it became infected after surgery. The infection was complicated by significant skin and subcutaneous tissue loss. PRP was used to promote tissue regeneration. Three additional applications after first treatment were needed to repair the injury. Tissue regeneration began immediately and was completed after two weeks. No further therapies were required, and the child was discharged.

PRP therapy is an interesting, safe, and effective approach for treating traumatic injuries in PwH. It could reduce recovery times and the need for clotting factor concentrates.

Blood donation Word-of-Mouth behavior among Chinese and Indian donors: an exploration with Australian donors

Thu, 05 Mar 2026 00:00:00 +0000

Background - Cultural diversity in a blood donor panel is vital for healthcare, especially in countries where multiple cultural groups are growing in representation and have unique phenotypes. Word-of-mouth (WOM) is considered a potentially powerful way to recruit diverse donors; however, donors seldom talk about blood donation. This study explores factors influencing positive WOM about blood donation among people within Chinese and Indian communities in Australia.

Materials and methods - Six online focus groups were conducted with 35 donors (20 Chinese and 15 Indian) aged 18-57 who had donated in the past 12 months. Using thematic analysis, the factors that contributed and inhibited sharing WOM about blood donation were identified. Participants shared their WOM experiences, motivations, perceived barriers, and supports needed to enhance their WOM activities.

Results - Donors from both cultural groups recognized the benefits of discussing blood donation, however their engagement varied. Most were reactive, responding to inquiries rather than initiating conversations. Their WOM behaviors were influenced by personal experiences, conversational context, and social connections. The main concern was being perceived as bragging, while motivators included altruism and professional links to healthcare. Significant cultural differences emerged: Indian participants were cautious about WOM to avoid personal health disclosures from recipients, while Chinese donors highlighted cultural perceptions of loss of vitality from donating, especially among older individuals, as a barrier to discussing donation. A proposed model of willingness to share WOM was developed based on individuals’ goals for sharing WOM and perceived agency to do so.

Discussion - Strategies are needed to help donors view their role as including active support for blood donation. Tools and resources that give donors a "license" to initiate WOM discussions about blood donation, while addressing cultural misconceptions, may strengthen their confidence and agency to discuss blood donation.

Serology and molecular genetic analysis of weakened expression of ABO blood group antigens in Chinese pediatric population

Qian Ren, Jinfeng Li, Chunmiao Li, Xingli Liu, Xiaolin Ma — Fri, 17 Apr 2026 00:00:00 +0000

Background - The ABO blood group system is vital for red blood cell antigens. Weakened expression of ABO antigens often leads to misidentification of blood types, challenging transfusion safety.

Materials and methods - Blood samples from 44 cases underwent serological analysis using microcolumn agglutination and tube tests. To investigate genetic variations, we sequenced the promoter region and exons 1-7 of the ABO gene. We also examined the relationship between ABO haplotypes and the presence of rare alleles. We used PolyPhen-2 to predict the structure and function of glycosyltransferase B (GTB) and classify missense variants. We also conducted pedigree analysis on 4 selected cases to further understand the inheritance patterns.

Results - We detected 18 different ABO subgroup alleles in 44 cases of weakened ABO antigen expression. We found 7 subtype A (predominantly A2), 7 subtype B (which included Bw and B3), one cisAB, and 3 group B(A). The complete phenotypes we observed included A2, Bw, B3, A2B, ABw, AB3, cisAB, and B(A). Notably, we discovered a rare B allele characterized by the c.538C>T variant, which alters residue 180 to p.Arg180Cys. This variant received a PolyPhen-2 score of 1.00, suggesting a high likelihood of damaging effects. Furthermore, pedigree analysis supported an autosomal inheritance pattern for this allele.

Discussion - The weakened expression of ABO antigens in young children may result from their immature immune systems or subtyping. ABO genotyping is essential to accurately identify blood groups and ensure transfusion safety.

Transfusion practice in elderly patients across surgical disciplines in Germany - a secondary data analysis of over 21 million patients

Mon, 23 Feb 2026 00:00:00 +0000

Background - Clinicians are increasingly confronted with elderly patients across nearly all surgical disciplines. Advanced age is an independent risk factor for complications, prolonged hospitalization, and particularly for red blood cell (RBC) transfusion. The elderly suffer more frequently from anemia, which is associated with higher perioperative transfusion requirements, increased complication rates, and mortality Surgical disciplines differ not only in primary diagnoses but also in the demographics of their typical patient population.

Material and methods - Hospitalized surgical patients in Germany between January 1^st, 2013, and December 31^st 2022, were analyzed. Inclusion criteria: Age ≥65 years, surgical disciplines: General surgery, Gynecology, Cardiac surgery, Thoracic surgery, Oral and Maxillofacial surgery, Neurosurgery, Trauma and Orthopedic surgery, Urology or Vascular surgery. Exclusion criteria included unknown or overlapping surgical procedures. Risk factors, comorbidities, transfusion rates, bleeding, complications, and blood product use were assessed using ICD and OPS (the German national procedure coding system) codes. The primary endpoint was RBC transfusion rate; the secondary endpoint was preoperative transfusion rate.

Results - A total of No.=21,143,317 patients were analyzed of which No.=2,640,608 (12%) received RBC transfusion. The highest transfusion rate was seen in Trauma and Orthopedic surgery (17.2% - No.=1,116,082). Trauma and Orthopedic surgery also had the highest risk (Odds Ratio [OR]) for RBC Transfusion (1.36 [1.35-1.36]). The highest preoperative transfusion rate was noted in general surgery, where 48.2% (No.=384,553) of the transfused patients received at least one RBC transfusion prior to surgery.

Discussion - Our study revealed that the highest transfusion rate in elderly patients is in Trauma and Orthopedic surgery, while the highest rate of preoperative transfusion was seen in General surgery. It would seem worthwhile to reduce these rates wherever possible, and these are the disciplines which offer the most room for improvement and would thus benefit most from consistent establishment of PBM programs.

Lipidomic and metabolomic analysis of human erythrocytes during storage for transfusion applications

Thu, 12 Mar 2026 00:00:00 +0000

Background - The preservation of concentrated red blood cells (RBCs) is crucial for their vitality and functionality. During storage, various metabolic changes occur, such as the loss of ATP, diphosphoglycerate, and potassium, as well as oxidative damage to proteins, lipids, and carbohydrates. Lipids, the most abundant class of metabolites in cells, are essential for maintaining the integrity and function of the red blood cell membrane. This study aims to evaluate molecular changes and identify potential biomarkers to optimise RBC transfusion by analysing metabolic and lipid profiles of preserved RBC at different time points.
Materials and methods - Thirty samples from 10 freshly collected RBC units from 10 donors, were collected at three time points: collection, after 20 days, and after 40 days, and stored properly. The RBCs were then centrifugated, and the pellet was stored at −80°C for the metabolomic and lipidomic analyses using liquid chromatography coupled with mass spectrometry.
Results - Lipidomic analysis revealed a progressive reduction in major membrane phospholipid classes, including phosphatidylcholines, phosphatidylethanolamines, sphingomyelins, and phosphatidic acids. At increased resolution, molecular-species-level analysis identified selective depletion of arachidonate-containing phosphatidic acid species alongside a concomitant increase in free arachidonic acid, indicating active phospholipid remodeling during storage. Metabolomic profiling confirmed previously described alterations in glycolysis, energy metabolism, and redox-related pathways and revealed coordinated changes in metabolites linked to phospholipid synthesis and turnover.
Discussion - These findings confirm established features of RBC storage lesions while providing refined insight into membrane lipid remodeling at the molecular species and fatty acid building block levels. The integrated lipidomic and metabolomic approach highlights specific lipid signatures associated with RBC membrane aging, which may complement existing frameworks for studying storage-associated cellular changes and support future investigations linking molecular remodelling to functional RBC quality metrics.

Comparison between cold-stored platelets treated with riboflavin and UV light versus untreated cold-stored platelets

Thu, 16 Apr 2026 00:00:00 +0000

Background - Riboflavin and UV light-based pathogen reduction technology (PRT) and cold-stored platelets (CSP) have a significant impact on platelet (PLT) function. The aim of this study is to determine whether the use of both methods is beneficial.

Materials and methods - Twenty buffy coat (BC) PLT concentrates were grouped into 10 type-matched pairs, which were pooled and split into 10 non-PRT-treated PLTs and 10 PRT-treated PLTs, diluted in platelet additive solution (PAS-E) and leukoreduced. Both groups were cold-stored at 2-6ºC without agitation for 14 days (non-PRT CSP and PRT CSP). Hemostatic function and metabolic parameters were monitored on day 1 pre-refrigeration and on days 3, 7 and 14 of cold storage.

Results - No swirling and no aggregates were observed at any time in either group after cold storage for 14 days. PRT CSP were less metabolically active (with better pH, lower lactate, lower pCO₂ and higher pO₂) than non-PRT CSP (p<0.001) after 14 days of cold storage. PRT CSP and non-PRT CSP resulted in faster clot formation over storage (p<0.001). Clot strength was reduced under optimal levels on day 14 in the PRT CSP (p<0.001).

Discussion - The enhanced hemostatic PLT function achieved by CSP, i.e., faster clot formation, is also maintained by riboflavin and UV light treatment. The combination of riboflavin and UV light-based PRT and CSP has the added benefit of reducing platelet metabolism, which may have a positive effect on PLT viability. Further research is required to assess whether the in vitro benefits of combining PRT and CSP are confirmed in clinical trials.

Assessing operational readiness for plasma fractionation within Indonesia’s National Transfusion Medicine System: a cross-sectional mixed-methods study

Fri, 20 Mar 2026 00:00:00 +0000

Background - Plasma-derived medicinal products (PDMPs) such as albumin, immunoglobulins, and clotting factors are essential in treating life-threatening conditions. Indonesia lacks local plasma fractionation capacity and relies heavily on imports, leading to high costs and financial strain on the National Health Insurance. Developing national plasma production capacity is vital for pharmaceutical independence and health system resilience.

This study assessed the readiness of regional blood centers and hospital blood center in Indonesia as potential suppliers of plasma raw material for domestic PDMP production and identified logistical and governance challenges in the existing system.

Materials and methods - A cross-sectional mixed-methods study was conducted in five institutions ‒four regional blood centers and one hospital blood center‒ across Java. Readiness was evaluated across three domains: preparation, inventory, and transportation. Instruments were adapted from WHO, LIAT, and LSAT guidelines, with expert-validated content. Content validity was ensured through expert panel review involving WHO and national regulatory representatives, and reliability was measured using the Kuder-Richardson Formula 20 (KR-20). Quantitative data were analyzed descriptively using Kruskal-Wallis and Dunn’s tests, while qualitative data were thematically analyzed.

Results - The overall KR-20 was 0.821, indicating strong reliability (Preparation=0.801; Inventory=1.00; Transportation=0.856). No significant inter-institutional differences were observed (p=0.406), suggesting uniformly high readiness. Bias testing confirmed consistent scoring patterns.

Discussion - This study provides a structured baseline assessment of Indonesia’s readiness to support domestic PDMP production, revealing strong preparedness across key operational domains. While readiness does not yet translate to full production capacity, these findings establish an evidence-based foundation for future implementation, investment planning, and governance reforms toward a sustainable and transparent plasma supply chain.

Prehospital whole blood after SWiFT and TOWAR: not superior, not settled

Daniele Prati, Luca Barcella, Chiara Novelli, Irene Cuppari — Fri, 12 Jun 2026 00:00:00 +0000

N/A

Cold platelets, redefined: pathogen reduction without surrendering hemostatic intent

Fabrice Cognasse, Hind Hamzeh Cognasse, Jose Maria Garcia-Gala, Konstanze Aurich — Fri, 10 Jul 2026 00:00:00 +0000

Plasma pathways for Low and Middle Income countries – needed more than ever

Albert Farrugia, Leni von Bonsdorff — Fri, 10 Jul 2026 00:00:00 +0000

This Commentary addresses the article “Assessing Operational Readiness for Plasma Fractionation within Indonesia’s National Transfusion Medicine System: A Cross-Sectional Mixed-Methods Study” by Roestan et al published in this issue of Blood Transfusion. The authors review the progression of Low and Middle Income Countries (LMIC) towards a level of strategic independence of the supply of Plasma Derived Medicinal Products (PDMPS) from global market forces, particularly the paid plasma donor population of the United States (USA). They draw on the Indonesian experience to suggest possible pathways for achieving the goal of accessing PDMPs from a publicly managed blood and plasma collection system.

A case of early pregnancy pulmonary embolism following mifepristone administration: a call for increased pharmacovigilance and research

Thu, 11 Jun 2026 00:00:00 +0000

Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality, although it is rarely reported in the very early stages of pregnancy or in the setting of following medical abortion.

We present the case of a woman in her late 20s from West Africa who developed bilateral pulmonary embolism a few hours after taking mifepristone as part of a medical abortion protocol at approximately 4–5 weeks of gestation. The patient’s medical history was unremarkable, with no personal or family history of VTE and no chronic medical conditions. She had two previous uneventful pregnancies, was normoweight and a non-smoker. She did not experience hyperemesis gravidarum, had not undertaken long-distance travel, and had not been immobilized during the preceding six months. Furthermore, she had not undergone assisted reproductive technologies and was not receiving chronic medications, including oral contraceptives.

Pulmonary embolism was confirmed by contrast-enhanced chest computed tomography, which revealed bilateral segmental emboli in the lower lobes with associated parenchymal consolidations suggestive of infarct-type lesions.

She was treated with low molecular weight heparin followed by edoxaban, resulting in rapid and complete clinical recovery.

Although pregnancy itself represents a well-established hypercoagulable state and remains the most likely predisposing factor for VTE in this case, the occurrence of pulmonary embolism in close temporal proximity to mifepristone administration is noteworthy. This observation should be interpreted with caution and does not establish a causal relationship. Rather, it underscores the need for heightened clinical awareness of VTE even in very early pregnancy and highlights the importance of further research and pharmacovigilance to better characterize thromboembolic risk in this clinical context.