The Daily Sign-Out

RBC Transfusion Associated with Increased Susceptibility to Lung Inflammation

Another recent article that I finally had a chance to read and ruminate on: Danielle Qing and colleagues from have published an intriguing article in the December 1, 2014 issue of the American Journal of Critical Care and Respiratory Medicine, "Red Blood Cells Induce Necroptosis of Lung Endothelial Cells and Increase Susceptibility to Lung Inflammation."  The article merits a read if you're interested in either transfusion medicine or lung pathology.

In both in vitro and murine models, RBC transfusion seems to prime lung inflammation through necroptosis (link to recent review article) of lung endothelial cells, followed by danger signal release of disease-associated molecular patterns, or DAMPs.  A novel finding in this study is that necroptosis may be an important mechanism that for cellular damage and organ dysfunction that is clinically observed associated with RBC transfusion. The methodology of using human lung microvascular endothelial cells and human RBCs stored under clinical conditions makes this model of injury more potentially relevant at the clinical level since it likely is a better approximation of what is occurring in vivo.

However, these findings quite jibe with the results of the TRISS trial published in NEJM last October.  One might expect that patients with sepsis who receive more RBC transfusions would have worse clinical outcomes than those who receive none or fewer transfusions.  But in this study similar clinical outcomes (mortality at 90 days and rates of ischemic events and use of life support) were observed in ICU patients with severe sepsis between those who received RBC transfusion at liberal transfusion threshold versus a restrictive threshold, even though the latter group received more transfusions.  It would be great to have a RCT that compared no to any RBC transfusions in this study population, measure necroptosis and DAMPs, and observe clinical outcomes.

Prevalence of HHV-8 in U.S. blood donors is low

One less thing to worry less about regarding transfusion-transmitted infections.

 

Transfusion: Prevalence of human herpesvirus 8 in healthy blood donors is low.

The first systematic study of human herpesvirus 8 in U.S. blood donors found that the prevalence of detectable genomes of HHV-8, which causes Kaposi's sarcoma, is very low in healthy donors. According to the study, featured in the May issue of Transfusion, a sensitive and quantitative real-time polymerase chain reaction assay was used to detect HHV-8 DNA from purified CD19+ B lymphocytes from 962 randomly selected U.S. whole-blood donors.

Read the abstract and editorial.

CDC reports increase in hepatocellular carcinoma

The CDC reported last week in the May 7, 2010 MMR a significant increase in the incidence of cases of HCC in the U.S. over the study period from 2001-2006.

To determine trends in HCC incidence in the United States, CDC analyzed data for the period 2001--2006 (the most recent data available) from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) surveillance system. This report summarizes the results of that analysis, which determined that the average annual incidence rate of HCC for 2001--2006 was 3.0 per 100,000 persons and increased significantly from 2.7 per 100,000 persons in 2001 to 3.2 in 2006, with an average annual percentage change in incidence rate (APC) of 3.5%.

The incidence rate for males (5.0 per 100,000 persons) was approximately three times higher than the rate for females (1.3) (Table 1). The HCC rate for males increased from 4.5 in 2001 to 5.4 in 2006, and the rate for females increased from 1.2 to 1.4 (Figure). During 2001--2006, the APC for males (3.6%) was significantly higher than the APC for females (2.3%).

While the highest incidence rate was highest in Asian/Pacific Islanders (7.8 per 100,000 persons), the rate in this group did not change over the study period.  However, the largest significant increases in HCC incidence rates were among whites (Annual Percentage Change = 3.8%), blacks (APC = 4.8%), and persons aged 50--59 years (9.1%).

An accompanying editorial note points out the association between chronic HBV and HCV infection and HCC as well as the similar age/race distribution of patients with HCC and chronic viral hepatitis.  A sobering fact as this relates to transfusion medicine and blood banking is that most of the estimated 3.8 to 5.3 million persons who have chronic viral hepatitis in the United States are unaware of their disease.  A recent IOM report addresses issues related to prevention and control of viral hepatitis B/C and HCC.  This is a persistent and stubbornly resistant problem and threat to the safety of the blood supply despite increased vigilance and more sophisticated testing, especially with regard to hepatitis C virus.

Study opens discussion on use of plasma from female donors

Study opens discussion on use of plasma from female donors - Related Stories - AABB SmartBrief.

Noted this from my daily AABB SmartBrief.  Transfusion-related acute lung injury (TRALI) has been a stubbornly enigmatic disease entity since being first described in detail about 25 years ago.  Since antibody-associated TRALI (the most common and severe form) has almost exclusively been associated with women donors with a history of pregnancy, many centers have followed a straight-forward policy of excluding all female donors for plasma-rich products (e.g., FFP and apheresis platelets).  The U.K. instituted this policy nationally in 2003.  While in that country saw a decline of 66% in the incidence of "probable" TRALI and associated deaths in the three years following adoption of this policy, the price is exclusion of a large pool of donors.  Further refinements of such a policy are in progress but perhaps this study might provoke a prospective study to be undertaken.

FDA reports fatalities related to transfusion and blood collection for 2009

The FDA has released the summary for 2009 of transfused-related fatalities.  Of 74 transfusion-recipient fatality reports, they determined that 44 of the fatalities were transfusion-related, 22 of the fatalities were cases in which transfusion could not be ruled out as the cause of the fatality, and 8 of the fatalities were unrelated to the transfusion.

Interestingly, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) accounted for the highest numbers of reported fatalities, followed by non-ABO hemolytic transfusion reactions. 

Another finding of note is that there were no reports of fatal microbial infections associated with RBCs, compared to 5 reports in FY2008, which were all due to Babesia infections.

A pdf of the report can be downloaded at the link above.