The Accuracy of Natriuretic Peptides (BNP and NT-pro-BNP) in the Differentiation between Transfusion Related Acute Lung Injury (TRALI) and Transfusion Related Circulatory Overload (TACO) in the Critically Ill. Page 13.
There are growing reports regarding the utility of biomarkers of myocardial stretch, BNP and NT-pro-BNP, in differential diagnosis of acute pulmonary edema after blood product transfusion. Li et al. performed a prospective study of consecutive critically ill patients with acute pulmonary edema after transfusion. Their result suggested that BNP and NT-pro-BNP were of limited value in differential diagnosis of TACO vs TRALI. These findings warn against relying on the biomarker levels in decision regarding donor recall and TRALI work up. In particular, high levels of BNP and NT-pro-BNP cannot be used clinically to obviate the need for diagnostic workup of TRALI.
Enhanced Detection of Blood Bank Sample Collection Errors with a Centralized Patient Database. Page 40.
MacIvor et al. describe the use of an electronic database containing historical ABO types of recipients collected at any of the hospitals serviced by their Centralized Transfusion Service (Pittsburgh, PA) in the verification of the ABO type on a current pretransfusion sample. They showed that by having access to historical ABO types, numerous additional miscollection errors were identified and thus ABO-incompatible transfusions were prevented.
Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: A systematic review. Page 44.
Clinical evidence suggests that autologous plasma rich in platelets (PRP) could have beneficial therapeutic effects on hard and soft tissue healing due to the contents of growth factors stored in the platelets and other intra- and extra-platelet components that also contribute to regeneration. Martinez-Zapata et al. performed a systematic review with meta-analyses including all randomised controlled trials (RCTs) that assess this treatment for any clinical indication. The results show benefits in chronic periodontitis at severe stages and suggest some benefits in diabetic ulcers; well-designed, large RCTs with sample size calculations exclusively based on clinically relevant differences are needed to confirm these conclusions.
Markers of Platelet Activation and Apoptosis during Storage of Apheresis and Buffy Coat Derived Platelet Concentrates for 7 Days. Page 108.
Albanyan et al. compare activation and apoptosis markers of apheresis and buffy coat derived platelet concentrates. Although platelets in both products showed generally similar activation levels, buffy coat platelets showed higher degree of apoptosis during storage than did apheresis platelets. Buffy coat platelets, but not apheresis platelets, underwent full mitochondrial membrane potential depolarization during storage. These results suggest that the quality of platelet products may be different, and emphasise the need for clinical trials to compare the effectiveness of apheresis and whole blood derived platelet concentrates. Moreover, because of the central role of mitochondria in apoptosis, further studies are warranted to delineate the role of mitochondria in the development of the platelet storage lesion.
Identification of HIV-1 Non-B Subtypes and Antiretroviral Drug Resistant Strains in United States Blood Donors. Page 125.
HIV-1 has a high level of genetic diversity and is classified into groups, subtypes, and recombinant forms. The global distribution of these diverse strains is changing as strains increasingly appear outside their endemic regions. In this issue, Brennan et al. evaluated HIV strains in US blood donors with recently acquired (antibody negative, RNA positive) and established (antibody positive, western blot confirmed) HIV infections. The results document an increasing prevalence of HIV-1 non-B subtypes; non-B strains have slowly increased from 0% in 1986 to 4.7% of HIV infections in donations collected between 1999-2005. In addition, drug resistant HIV-1 was identified in 6.5% of infected donors. Transmission of drug resistant virus is documented in 11% of recently infected donors. These results should raise awareness of the increasing diversification of the HIV epidemic and the importance of HIV screening tests that can detect all HIV infections regardless of strain.
Ultrasound enabled topical anesthesia for pain reduction of phlebotomy for whole blood donation. Page 146.
Although topical anesthetics have been widely used to reduce the pain of venipuncture and the placement of intravenous access devices, especially in children, they have not been investigated in blood donors. In this issue, Stowell et al. report that the use of an FDA licensed ultrasound device to accelerate the onset of topical anesthesia reduced the level of pain among experienced blood donors compared to those who received the sham/placebo treatment. Although, these experienced donors also reported that the pain of the needlestick was not a significant deterrent to donation, the attitudes of non-donors in this context, which have not been studied extensively, might be different.