Trente ans d’immunologie plaquettaire dans la prise en charge des thrombopénies fœtales et néonatales allo-immunes, état des lieux

Fetal and neonatal allo-immune thrombocytopenia (FNAIT) is considered as a rare disease due to the incidence (1/1000–1/2000 births). The major complication of severe thrombocytopenia is bleeding and particularly intra-cranial hemorrhage and neurologic sequelae following. Serology and molecular biology developments have reconfigured the platelet immunology diagnosis. Anti-HPA-1a allo-immunisation is responsible for more than 80% FNAIT cases with a high recurrence rate of severe bleeding complications. Therapeutic management has changed over the coming years from an invasive concept associating fetal blood sampling and in utero platelet transfusion to a non invasive treatment by intravenous immunoglobulins injection (IVIg). The purpose of this article is to provide an update on FNAIT management in the light of current developments over the past 30 years.     

Early postoperative bleeding after isolated coronary bypasses: Changes over a period of 20 years – An observational study

ObjectivesThe objectives were to analyze the evolution of the postoperative bleeding after coronary artery bypass grafting and to determine which factors impacted on this evolution.MethodsThis is a single-center retrospective study including 4590 patients undergoing coronary bypass surgery between 1995 and 2017. The study period was divided into 3 same-sized periods. We analyzed the evolution of the bleeding according to: the chest volume bleeding over the first 24 hours, the severity and the rate of transfusion during the hospital stay. Intrahospital outcomes were compared between “minor” and “major” bleedings. The risk factors of major bleeding were analyzed by multiple logistic regression.ResultsThe chest volume decreased particularly during the first years of the study period. Major bleedings decreased over the periods (7.3%, 4.9% and 3.8% respectively, P < 0.0001), as did the rate of transfusion (26.4%, 23.5% and 19.6% respectively, P < 0.0001). Major bleedings were correlated with hospital mortality (8.2% versus 1.1%, P < 0.0001). The risk factors of major bleeding were the period 1 (1995 to 2003), a renal failure, a resternotomy, the EuroSCORE, the hematocrit prior to cardiopulmonary bypass and the duration of cardiopulmonary bypass.ConclusionsPostoperative bleeding decreased mainly in the 1990s. Progressive changes in bleeding prevention and blood recovery, surgical techniques, haemoglobin threshold for transfusion decision and practitioners’ experience have contributed to these results and must be continued to optimize the postoperative outcomes.     

Hemorrhagic fever with renal syndrome in Albania. Focus on predictors of acute kidney injury in HFRS

BackgroundHemorrhagic fever with renal syndrome (HFRS) is a rodent borne zoonosis, caused by the members of the family Bunyaviridae, genus Hantavirus. The main clinical features of the infection by this virus family are fever, thrombocytopenia and acute kidney injury.ObjectiveThe aim of our study was to identify, for the first time, characteristic features of HFRS in the Albanian population.Study designThe study comprised 33 consecutive patients admitted with suspected HFRS from April 2011–April 2016 at one center. Clinical diagnosis was confirmed by ELISA and real-time PCR. Statistical analysis was performed to identify prognostic markers and indicators of disease severity.ResultsThe virus strain causing HFRS was Dobrava type in all 33 cases. The disease outbreaks occurred during the period June–July. Mean hospital stay was 15.7 ± 6.9 days. 29 (88%) of the patients were male. The mean age was 39.7 ± 14.1. 16 (48.5%) patients were from Northeast Albania. 8 (24.2%) patients required dialysis. The strongest correlation was the inverse relationship of nadir platelet count with urea and creatinine, p < 0.0001, p < 0.0079 respectively. Creatinine and hyponatremia were inversely correlated p = 0.0007, whereas hyponatremia and nadir platelet count had the highest sensitivity and specificity for development of severe AKI, 92.6%, 100%; 88.9%, 83.3% respectively. Mortality rate was 9.09%.ConclusionHFRS is a severe viral disease in Albania caused by Dobrava strain. It is associated with high mortality, 9.09% in our cohort. In our study, thrombocytopenia, urinary volume, hyponatremia were indicators of more severe disease.     

Transient pseudothrombocytopenia (PTCP) in the neonate due to the mother

Thrombocytopenia with platelet count < 50 × 10⁹/L is common laboratory finding in a severely ill newborn in neonatal intensive care units (ICU). Neonates with severe thrombocytopenia are at risk of bleeding. Most dangerous is intracerebral hemorrhage (ICH) frequently leading to death or lifelong neurological sequels. Pseudothrombocytopenia (PTCP) is a rare in vitro phenomenon of falsely low platelet count determined on hematology analyzers due to platelet clumping in ethylenediaminetetraacetic acid (EDTA) anticoagulated blood. PTCP was also reported in pregnant women with isolated thrombocytopenia. EDTA-PTCP in the neonate due to the transplacental transmission of maternal antibodies has been reported only in a few cases. Although PTCP is rare phenomenon, it should always be excluded in newborns with isolated thrombocytopenia to avoid erroneous interpretation of platelet and leukocyte count, unnecessary laboratory investigation of false positive antiplatelet antibodies and needless platelet transfusions. We report on two cases of transient PTCP in a neonate due to transplacental transfer of maternal EDTA-dependent autoantibodies of IgG class from the same mother.     

Évaluation des pratiques transfusionnelles plaquettaires

Purpose of the studyPlatelet transfusion follows the national guidelines published in 2003 by the AFSSAPS, determining, for instance, indications, transfusion threshold and platelets dose. We wanted to assess how these guidelines are routinely used in our hospital, with a special focus on transfusion threshold and delivered dose.Material and methodsWe conducted a prospective study during 11 months on every platelet transfusion. Our establishment is a medium size structure, devoted to emergency and oncology, without bone marrow transplantation. During this period, 235 products were delivered to 105 patients. Half (52%) were delivered to oncological units, a third to emergency units and the remaining to medical and surgical units.ResultsThe average dose was 4.3 ± 0.8 × 10¹¹ platelets (2.0 to 7.6 × 10¹¹ platelets), corresponding to 0.45 × 10¹¹ platelets per 7 kg. During prophylactic transfusions, the average platelet count was 9.4 ± 5.5 G/L ; during curative transfusions (43%), it was 39.0 ± 47.8 G/L and finally when platelets were infused during surgery (21%), the average platelet count was 57.8 ± 61.4 G/L.ConclusionGlobally, with regard to transfusion threshold, guidelines were followed in 71%, and 93% in oncological units. Transfusion efficacy, attested by post-transfusion platelet efficiency was above 20% in 59% of the cases. These data highlight a good respect of the transfusion thresholds in the usual platelets-consuming units, but raise the question of the dose, often under those proposed by the guidelines.     

Pierwotna małopłytkowość immunologiczna u dzieci w świetle współczesnych definicji

BackgroundPrimary immune thrombocytopenia (ITP) is one of the most common hematologic disorders in pediatric population. In 2009 the new unified terminology regarding: definition, clinical classification of the disease and response to treatment was proposed. The main study objective was the comparative analysis of clinical aspects of primary ITP in children regarding the contemporary definitions and historical criteria.MethodsData were collected through medical chart review of subjects identified from hospitalization records (Pediatrics, Hematology and Oncology Department) from the period of 2002–2011.ResultsData of 209 subjects were analyzed. According to recent definitions 206/209 patients (98.6%) could be defined. Using the historical criteria 86.12% were classified as acute and 13.88% as chronic ITP. Newly diagnosed primary immune thrombocytopenia was confirmed in 166/206 cases, persistent ITP in 20/206, and chronic ITP in 20/206 of subjects. Depending on applied criteria we noticed significant differences in acute ITP patient number. Regardless of adjusted definitions, the response rates were higher among treated patients (p < 0.0001). Historical criteria allowed to recognize lower response rate in patients treated with intravenous immunoglobulins (p = 0.009) or steroids (p = 0.033).ConclusionsContemporary definitions allow for more adequate categorization on most of the patients with primary immune thrombocytopenia considering the specific clinical aspects and different natural history of primary ITP in children.     

Platelet transfusion practice and related transfusion reactions in a large teaching hospital

BackgroundPlatelet transfusion practice varies widely since many aspects of platelet concentrate (PC) use have not been definitively determined. The objectives of this retrospective study were to present platelet transfusion practice and evaluate PC and patient characteristics, as well as their association with transfusion reaction (TR) rate.Material and methodsPlatelet transfusions over a 5-year period were analysed regarding PC characteristics (the ABO and RhD compatibility, product type, and storage duration), patient characteristics (most responsible diagnosis, age, and gender), and TR type.ResultsA total of 46,351 PCs were transfused: 76.4% whole blood-derived (WBD) and 23.6% single donor apheresis (SDA). Three thousand seven hundred seventy-six patients received platelet transfusions: 24.7% paediatric and 75.3% adult patients, 79.6% outpatients and 20.4% inpatients. As much as 63.1% of all transfused PCs were fresh (stored for ≤ 3 days), 98.0% ABO-identical, and 87.3% of all PCs given to RhD? patients were RhD?. PCs were mainly transfused to haemato-oncology (76.8%) and cardiovascular surgery patients (6.5%). Overall, 84 (0.18%) TRs were reported, with allergic TRs (ATRs) being the most common. Although PC ABO compatibility and storage duration, as well as patient age and gender, showed differences in TR rate, only the use of PCs in platelet additive solution (PAS) showed a statistically significant reduction of TRs (P < 0.001).ConclusionTransfusion practice at the University Hospital Centre Zagreb resulted in almost all patients receiving ABO and RhD identical PCs, and most of them were fresh PCs. The most important factor affecting the incidence of TRs was platelet storage solution. The use of PAS effectively reduced the rate of TRs, particularly allergic TRs.     

Greffe de cellules souches hématopoïétiques au Maroc : à propos de 87 cas

PurposeThe autologous peripheral blood stem cells (CSP) are used as a support to the restoration of the hematopoiesis in oncohematology. The objective of this work, carried out in the laboratory of cryobiology at the Center Regional of Blood Transfusion, Casablanca, is to assess the short- and long-term results of this type of autograft.Patients and methodsThis retrospective study focused on 87 patients treated for hematological malignancies in services of oncohaematology over a period from June 2004 to March 2009. One hundred and twenty-seven cytapheresis were conducted to collect the CSP. The rate of CD34+ cells ranged from two to 50 × 10⁶ per kilogram. The removal, treatment with 10% DMSO, the characterization, cryopreservation, thawing and washing of grafts on Cobe 2991 were made before the autograft.ResultsForty-nine patients were transplanted for multiple myeloma, 24 for Hodgkin's disease, 13 for a non-Hodgkin lymphoma and one for rabdomyosarcome. The mean age of patients was 35 years. The mean length of hospitalization was 27 days. The average time of release for aplasia is 7 to 49 days, with a mean of 16 days. A blood transfusion was necessary during the aplasia: two to 41 red blood cells per patient and six to 298 platelet units per patient. The short-term complications after autologous transplantation are primarily infectious. Seven times the progressive hematologic malignancies and seven deaths are regrettable.ConclusionThe autologous CSP is simple, effective and well tolerated, which should be developed in our context.     

The prevalence of Selective Immunoglobulin M Deficiency (SIgMD) in Iranian volunteer blood donors

BackgroundSelective Immunoglobulin M Deficiency (SIgMD) is known as a rare primary immunodeficiency characterized by an isolated deficiency of serum IgM. Other immunoglobulin levels and T-cell immunity are usually normal; although IgE may be elevated. SIgMD can be asymptomatic or with various bacterial and viral infections. It can also be associated with autoimmune diseases or malignancies. In the present study, we report for the first time, the prevalence of SIgMD in Iranian healthy adult population.Materials and MethodsA total of 3436 healthy donors were examined in the study; from August, 2006 to April, 2008. Serum IgM concentration was measured using the nephelometric method. We considered serum IgM less than 30 mg/dl as IgM deficiency.ResultsAmong 3436 participants, 65% were male and 34% were female; aging from 17 to 72 years (38.18 ± 10.78). Thirteen individuals were detected as IgM deficient subjects with the male to female ratio of 11/2, the prevalence of 0.37% and the frequency of 1/265. The mean serum IgM level was 24 ± 4.56 (16–29 mg/dl) in these cases. Among 13 IgM-deficient subjects, 7 cases were available for evaluating the clinical manifestations. In addition to atopic dermatitis which was the most common symptom in these patients, others were allergic rhinitis, food allergy, urinary tract infection and skin fungal infection. Two patients had no history of infectious disease or atopic conditions.ConclusionIn the present study we could determine the prevalence of SIgMD in our adult population (0.37%). The most common comorbid condition was atopy. Neither severe or life-threatening infections, nor autoimmune diseases (based on their history; the antibody screening was not performed as part of this study) or malignancies were found in these patients. Further evaluation is recommended to elucidate the prevalence of SIgMD among patients with recurrent infections.     

Effective and safe off-label use of caplacizumab treatment in a middle-aged obese male

This study shows clinical efficacy and safety profile of an off-label use of caplacizumab for the treatment of immune-mediated thrombotic thrombocytopenic purpura in a middle-aged obese male patient manifesting aphasia, weakness and unconsciousness. Routine blood tests revealed haemolytic anaemia, severe thrombocytopenia (platelet count = 20 × 10⁹/L) and moderate creatinine increase. Diagnosis was based on the clinical judgement and laboratory determinations (undetectable ADAMTS13 activity and presence of anti-ADAMTS13 antibodies). The patient underwent plasma-exchange and an adjunctive treatment with prednisone (1 mg/Kg/day), but the occurrence of a refractory and exacerbated form of disease suggested also using rituximab (375 mg/m² weekly for 4 weeks) and caplacizumab as salvage treatments. The caplacizumab was given at 10 mg/day subcutaneously without the first intravenous bolus. Because von Willebrand factor inhibition, platelet count recovery and remission of symptoms were achieved, use of caplacizumab with this scheme appeared to be as effective as the approved one. Although this is an off-label use, this case highlights the potential of this new treatment, in terms of drug's efficacy and safety.     

Perioperative thrombocytopenia predicts poor outcome in patients undergoing transcatheter aortic valve implantation

Purpose

To determine the time point at which thrombocytopenia after TAVI procedure is an indicator of the worst prognosis, with special consideration of perioperative platelet and coagulation activation as its potential causes.

A prospective observational study to compare transfusion outcomes in ABO identical versus ABO non-identical single donor platelet concentrates: An experience from a tertiary healthcare center in India

ABO incompatible single donor platelet concentrates (SDPC) have a concern about unsatisfactory increments as well as possibility of hemolytic transfusion reaction. But from Indian population no study has commented on the clinical and laboratory outcome of ABO mismatched platelet transfusion. The aim of study was to compare transfusion outcomes in ABO identical versus ABO non-identical single donor platelet concentrates. In this prospective observational study, 400 SDPC transfusions among different patients were included. In group A (n = 200), ABO identical SDPC transfusions and in group B (n = 200) ABO non-identical SDPC transfusions were added. Corrective count increment (CCI), absolute count increment (ACI), percent platelet recovery (PPR) were calculated and incidents of hemolytic transfusion reactions were noted. In group A mean ± SD of ACI, CCI and PPR were as 30.78 ± 12.51, 15.10 ± 6.677, 39,948.9 ± 20,099.392. In group B, mean ± SD of ACI, CCI and PPR were – 25.4 ± 15.65, 12.509 ± 5.906, 33,559.2 ± 22,150.304. And when CCI, ACI, PPR were compared with group A and group B, statistically significant differences were noted (P < 0.05). There was statistically significant difference in CCI, ACI and PPR in oncology patients and other prophylactic recipients except patients with dengue and other infectious disease. But there was no hemolytic transfusion reaction noted in any group. Our study clearly establish the potential benefits of ABO-identical PLT transfusion. It also points out that in emergency conditions or when there is a paucity in inventory, ABO non-identical SDPC transfusion may be lifesaving and clinically significant.     

High seroprevalence against hepatitis E virus in patients with chronic hepatitis C virus infection

BackgroundHepatitis E virus (HEV) genotype 3 is endemic in Europe. Superinfection with HEV in patients with underlying chronic liver disease can cause hepatic decompensation leading to increased morbidity and mortality.ObjectivesThe prevalence of anti-HEV antibodies was investigated in 204 patients with chronic hepatitis C virus (HCV) infection and different stages of fibrosis.Study designSera were analyzed for anti-HEV IgG, IgM and HEV RNA.ResultsThe median age of the patients was 55 years (IQR 40–62 years); 126 (62%) were men. Ninety-eight (48%) patients had a METAVIR fibrosis stage F2 or higher. The prevalence of anti-HEV IgG was 30% (62/204), which was significantly higher than among Swedish blood donors (17%, p < 0.01). The prevalence of anti-HEV antibodies was associated with higher age (OR 1.08 (1.05–1.11); p < 0.01). It was also higher for patients with a prior history of blood transfusion (48%) as compared to intravenous drug use (IDU; 26%) as the risk factor for acquisition of the HCV infection (OR 2.72 (1.2–6.19); p < 0.02). The prevalence of anti-HEV IgG was also significantly higher in patients with significant fibrosis, i.e. ≥F2 (38%; OR 2.04 (1.11–3.76); p = 0.02) and/or neoplasm (72%; OR 7.27 (2.46–21.44); p < 0.01).ConclusionsWhen adjusted for age, the prevalence of anti-HEV antibodies was significantly higher in patients with previous or current malignant liver disease compared to blood donors. The lack of significant correlation between HCV and HEV infections indicate low level of transmission of HEV by IDU. HEV infections warrant more attention, especially in patients with preexisting liver disease.     

Prise en charge des grossesses à risque dans un contexte d’incompatibilité fœto-maternelle plaquettaire et/ou d’allo-immunisation : avis du groupe d’experts du GFHT (Groupe français d’études sur l’hémostase et la thrombose)

IntroductionFetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially devastating disease, seen in 1/800–1000 neonates. FNAIT is the most common cause of early-onset isolated severe neonatal thrombocytopenia in maternity wards. A working group on fetomaternal platelet alloimmunization was created in 2017, under the auspices on the French Group of Thrombosis and Hemostasis (GFHT).ObjectivesThe objective was to survey clinical practices for management of high-risk pregnancies in a context of suspected or confirmed FNAIT.MethodsRecommendations published by the ICTMG were translated in French, and discussed (Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence-based practice, an international approach. British J of Haematology, 2019, 185, 549–562).ResultsThe study involved centers from France, Switzerland and Belgium: Angers, Besançon, Bordeaux, Brest, Créteil/Clamart, Genève, Grenoble, Liège, Lille, Lyon, Marseille, Nantes, Nîmes, Paris (hôpitaux Necker, Robert Debré et Trousseau), Poitiers, Rennes, Saint-Etienne, Strasbourg, Toulouse, Tours.ConclusionsExpert opinion was validated on September 23, 2020 (consensus ≥ 90%).     

What is the optimal pretransfusion testing interval for multi-transfused patients? The University Hospital of Brest experience

The red cell allo-antibodies research is mandatory before transfusion. In France, pretransfusion testing intervals that are prescribed by regulatory and accrediting agencies are commonly 72 hours. In the University hospital of Brest, the interval for multi-transfused patients has been 24 hours. In this study we aim to analyse these practice and argue the delay.MethodsThis is a retrospective study of post-transfusional allo-immunizations from 2015 to 2020. For each patient, the time interval between the last negative research and the allo-immunization was investigated.Results189 patients developed allo-antibodies. In 16 patients (8,5%), the interval for allo-immunization was 24 hours, 48 hours and 72 hours in 4, 8 and 4 patients respectively. 12 patients were transfused after the discovery of the allo-antibodies. That means if we have chosen a delay of validity of 72 hours, then 9 patients would have been transfused with a negative result.ConclusionChecking for allo-antibodies before RBC transfusion with an interval of 24 hours (and not 72 hours) is pertinent in order to assure an optimal transfusion safety and to limit the risk of hemolytic transfusion reactions. A pretransfusion testing interval of 24 hours for multi-transfused patients should be considered.     

The impact of a closed-loop electronic blood transfusion system on transfusion errors and staff time in a children's hospital

ObjectivesTo assess the impact of a closed-loop electronic blood transfusion system on transfusion errors and staff time.Materials and methodsBefore and after study in all wards of a children's hospital, involving patients and staff of all the wards. The changes were closed-loop electronic blood transfusion, barcode patient identification, electronic blood transfusion administration records and error pop-up warning. The main outcome measures were percentage of blood transfusion errors, time spent on transfusion tasks.ResultsTransfusion errors were identified in 3.87% of 2556 blood transfusion orders pre-intervention and 0.78% of 2577 orders afterwards (P < 0.01). Phlebotomists, nurses, and physicians may make mistakes, including wrong blood type when apply for blood, wrong patient when blood draw or transfusion, wrong dose when apply for blood and the wrong tube label when blood draw or cross-matching, which are significantly reduced after change (1.09% vs 0.31%, 1.13% vs 0%, 0.31% vs 0%, 1.33% vs.0.78%, P < 0.01). Time spent on blood apply was 5.3 ± 1.2 min, hand over blood bag at the transfusion department was 14.9 ± 1.4 min and blood transfusion was 15.8 ± 2.4 min. Time per transfusion round decreased to 2.6 ± 1.0 min, 6.3 ± 1.6 min and 9.3 ± 2.2 min respectively (P < 0.01).ConclusionsA closed-loop electronic blood transfusion, barcode patient identification and error pop-up warning reduced transfusion errors, and increased confirmation of patient and blood types identity before transfusion. Time spent on blood transfusion tasks reduced.     

Does intraoperative transfusion during total knee arthroplasty reduce the need for transfusion after surgery?: A preliminary retrospective cohort study

ObjectivesAfter total knee arthroplasty (TKA), many patients experience anemia due to blood loss. To prevent postoperative anemia and allogeneic blood transfusion after TKA, we used prophylactic allogeneic or autologous blood transfusion intraoperatively. This study evaluated the effects of prophylactic transfusion during TKA.Materials and methodsThis retrospective cohort study included 579 patients receiving scheduled unilateral TKA. We allocated the patients into three groups, the prophylactic allogeneic transfusion (Group AL), prophylactic autologous transfusion (Group AT), and no prophylactic transfusion with intra-articular tranexamic acid administration (Group C) groups. After propensity score matching, we compared the rate of postoperative allogeneic blood transfusions until three days after TKA, postoperative hemoglobin and hematocrit levels until four days after TKA, and the side effects in each groups.ResultsThe postoperative allogeneic blood transfusion rates were statistically higher in group AL and AT than in group C (18.2% and, 18.9% vs 2.3%, respectively; P < 0.000). The postoperative hemoglobin and hematocrit levels were statistically lower in group Auto than in group C (P < 0.0001), but the levels in group AL were not different from those of group C (P = 0.493 vs. P = 0.384 respectively). In addition, the side effects were statistically higher in group AL and AT than in group C.ConclusionProphylactic intra-operative transfusions did not reduce the rates of allogeneic transfusions and produced more side effects and hypotension after surgery than intra-articular tranexamic acid administration with no prophylactic transfusion in patients undergoing TKAs.     

Profil clinico-biologique et immunohématologique des patients atteints de β-thalassémie en Tunisie : à propos de 26 cas

Aim of the studyTo study the clinical and biological profile of β-thalassemic patients in our region, reflecting the quality of their care.Patients and methodsA retrospective study (2010–2011) on 26 β-thalassemic patients followed in the pediatrics service at CHU Farhat Hached Sousse, Tunisia. Epidemiological, clinical and biological data were collected from medical records and transfusion files of patients. The transfusion protocol adopted was to maintain a hemoglobin level > 10 g/dL by regular transfusions every 3–4 weeks. Iron chelation therapy, in order to maintain serum ferritin < 1500 ng/mL, was introduced when serum ferritin exceeded 800–1000 ng/mL.ResultsThe mean age of patients at diagnosis was 15 months. The clinical impact of anemia had resulted in failure to thrive in 54% of patients and facial dysmorphism in 23%. The average transfusion requirement was estimated at 311.02 mL/kg/year with 6 cases of hyperconsumption. The immunohaematological monitoring showed the appearance of anti-RBC alloimmunization in one patient and 4 cases of autoimmunization. Poor adherence of chelation therapy was 62% and causing 5 cases of cardiac complications, 4 cases of liver injury and 14 cases of endocrine complications.ConclusionImproving the therapeutic care of β-thalassemic children requires better monitoring of transfusion recovery and improved adherence to chelation therapy.     

Effets indésirables transfusionnels de nature allergique en pédiatrie, étude sur 3 ans

Purpose of the studyIn the transfused patients, in France, in 2011, allergy ranked as the third adverse transfusion reaction. In order to evaluate the incidence and symptomatology of allergic adverse transfusion reactions in the paediatric people, a study was performed.Patients and methodsIt was focused on patients under 18 years of age cared for in hospitals of the Rhone-Alpes area. The national haemovigilance database (e-FIT) reports of allergic transfusion reactions were reviewed.ResultsFrom January 1st 2009 to December 31st 2011, among 2,165 reports, 141 (6.5%) adverse transfusion reaction reports were collected in paediatric patients. Sixty-eight (48.2%) indicated allergic reactions and corresponded to 64 recipients. As regards clinical manifestations, forty-eight (70.6%) indicated cutaneous signs only, 3 (4.4%) mentioned pulmonary signs only and 9 (13.2%) reported both. Urticaria was observed in 38 cases (55.9%). Bronchospasm was notified in 4 cases but there was no angioedema. As for the severity of reactions, one adverse transfusion reaction was severe (grade 2) and 2 were life-threatening (grade 3). The most involved blood component was the apheresis platelet concentrate (40 cases, 58.8%) followed by the red blood cell concentrate (17 cases, 25.0%) and the methylene blue-treated fresh-frozen plasma (11 cases, 16.2%).ConclusionThis study shows that among paediatric recipients, cutaneous signs are predominant in allergic adverse transfusion reactions and that the apheresis platelet concentrate is the most frequently involved blood component.     

The impact of COVID-19 on transfusion-dependent thalassemia patients of Karachi,Pakistan: A single-center experience

ObjectivesWith the advent of COVID-19 in Pakistan, the already fragmented blood transfusion services (BTS) received a severe blow, putting the lives of transfusion-dependent thalassemia children on stake. This study aimed to assess the impact of the COVID-19 on blood transfusion therapy (BTT) of thalassemia patients and suggest ways to ensure safe and reliable blood supplies amid such health crises.Material and methodsA retrospective, cross-sectional study was conducted from October 2019 (before COVID-19) to July 2020 (during COVID-19) based on the data provided by a thalassemia center, named Help International Welfare Trust, Karachi, Pakistan. SPSS version 24.0 was used for the data analysis. Data were described in the form of means and percentages.ResultsThere was a significant reduction in the consumption of PRBCs bags after the emergence of COVID-19 (P = 0.002). Moreover, the number of thalassemia patients receiving BTT was dropped by 10.56% during the pandemic. There was a strong negative correlation observed between the rising cases of COVID-19 in Pakistan and the number of patients missing their therapy sessions (r = ?0.914, P = 0.030). A considerable decline in the reserves of all Rhesus-negative blood groups amid the COVID-19 outbreak was also observed.ConclusionThe COVID-19 pandemic adversely affected the already suboptimal care catered to thalassemia patients in Karachi, Pakistan. The fear of the virus contraction coupled with the lockdown and restricted mobility has disrupted the entire transfusion chain from donor to the recipient. Collaborated efforts by the government and healthcare authorities are essential to ensure sufficient blood for thalassemia patients amid the pandemic.