‘Chameleonic' Serological Findings Leading to Life-Threatening Hemolytic Transfusion Reactions

Background: The phenomena of co-incidence of transfusion-induced allo- and autoantibodies, blockage and/or loss of red blood cell (RBC) antigens are conspicuous and may result in confusion and misdiagnosis. Case Report: A 67-year-old female was transferred to the intensive care unit due to hemolysis which developed 2 days following transfusion of three Rh(D)-negative RBC units in the presence of strongly reactive autoantibodies. Standard serological testing and genotyping were performed. Upon arrival, the patient was typed as Ccddee. Her hemolysis was decompensated, and an immediate blood transfusion was required. In addition, direct and indirect antiglobulin tests (DAT and IAT) as well as the eluate were strongly positive. Emergency transfusion of Rh(D)-negative RBCs resulted in increased hemolysis and renal failure. An exhaustive testing revealed anti-D, anti-c, CCddee phenotype and CCD.ee genotype. Three units of cryopreserved CCddee RBCs were transfused, and the patient's condition immediately improved. The discrepancy between Rh-D phenotyping and genotyping was likely caused by masking of the D-epitopes by the autoantibodies. In fact, further enquiry revealed that the patient had been phenotyped as Rh(D)-positive 6 months ago and had been transfused at that time following hip surgery. Conclusion: The phenomena of transfusion-induced autoantibodies, masked alloantibodies, antigen blockage and/or loss are rare but important features which should be considered in patients presenting with autoimmune hemolytic anemia and/or hemolytic transfusion reactions

Good Feasibility of the New German Blood Donor Questionnaire

Background: We assessed the effect of the uniform donor questionnaire (UDQ) on deferral rates in first-time and repeat donors. We focused on the introduced question about unprotected sexual contact with a new partner. Another goal was a stratified comparison of the deferral rates of the donor questionnaire (DQ) and UDQ. Methods: Data on donors and deferrals using the DQ and UDQ were collected at four blood establishments. The comparison included a 2-year period by questionnaire version. For the comparison of the questionnaires, an adjusted multinomial logistic regression was performed. Results: The analysis included 260,848 donations. First-time (FTD) and repeat donations (RD) showed higher deferral rates with the UDQ (FTD +5.4%, RD +1.4%). Deferral due to a new partner was 3.0% in first-time and 0.4% in repeat donors. The majority of these occurred in the youngest age groups. The most frequent deferral criterion was ‘disease' (5.1%). Conclusion: The regression revealed stronger predictors for deferral than the questionnaire version. Especially younger age carried a higher and independent risk for deferral. The additional deferrals of mainly young first-time donors due to a new sexual partner may identify those donors with potential heterosexual risk behavior who would otherwise not be identified

Prospektive Surveillance der neonatalen Sepsis

Auf der Intensivstation der Abteilung für Neonatologie der Klinik und Poliklinik für Kinder- und Jugendmedizin der Universität Greifswald wurde eine prospektive Studie auf Grund einer vermutlich erhöhten Rate neonatater Sepsisfälle durchgeführt. Von Juli bis Dezember 2000 wurden regelmäßig von der Umgebung der Frühgeborenen Abstriche genommen und mikrobiologisch untersucht. Gleichzeitig wurden die Krankenakten der Neonaten aufgearbeitet und relevante Daten wie Geburtsgewicht, Gestationsalter, intravenöse Zugänge, Atemhilfen, Antibiose, Art der Nahrung, Sepsisbeginn und CrP- Wert in ein Protokoll eingetragen. Zusammenhänge zwischen den aufgenommenen Parametern und Sepsishäufigkeit wurden mittels statistischer Berechnungen untersucht. Es stellte sich heraus, dass die Sepsishäufigkeit entscheidend von dem Gestationsalter abhängig ist. Neonaten, die vor der 30. Schwangerschaftswoche geboren wurden, hatten in 94,1 % der Fälle eine Sepsis. Frühgeborene, die nach der 32. SSW geboren wurden, hatten hingegen nur eine Rate von 17,4 %. Von den Kindern, die zwischen der 30. und 32. SSW geboren wurden, hatten 58,3 % eine Sepsis. Bei Neugeborenen mit einem Gestationsalter < 30. SSW ist das Immunsystem noch so stark unterentwickelt, dass bei ihnen schon physiologische Hautkeime eine Infektion auslösen können. Deshalb müssen Neugeborene unter der 30. SSW streng aseptisch gepflegt werden. Die häufigsten Erreger, die bei den Abstrichen isoliert wurden, waren KNS, Klebsiella spp. und Candida spp. Bei 82 % der Patienten wurden KNS, bei 75 % der Kinder Klebsiella spp, nachgewiesen. Candida spp. wurde bei 12 von 28 Patienten isoliert. Dies spricht für eine Verbreitung dieser Erreger auf der Intensivstation, die bei Unterlassung von Distanzierungs- und Desinfektionsmaßnahmen durch das Personal von Kind zu Kind übertragen werden können.keine Angabe

A cross-sectional study of blood donors' psychological characteristics over eight weeks

Background: Previous studies suggest that blood donation impacts blood donors’ psychological state, with either positive or negative effects, such as feeling more energetic or more exhausted. It has not yet been described how long these effects last. Materials and Methods: This prospective cohort study consisted of a qualitative and a quantitative part: (1) Psychological characteristics which changed after blood donation were identified by structured interviews of regular whole blood donors (n = 42). Based on this, a questionnaire addressing 7 psychological dimensions was established. (2) The psychological state of 100 blood donors was assessed after blood donation by applying the questionnaire 15–30 min before and during donation, as well as 15–30 min, 6 h, 24 h, 72 h, 1 week, and 8 weeks after donation. The resulting changes were summarized to a score. Furthermore, potential correlations of the score with pre-donation blood pressure, hemoglobin, or body mass index were calculated. Results: Seven items were identified which changed in at least 25% of blood donors (mood, concentration, satisfaction, resilience, spirit of initiative, physical well-being, energy level). In the 100 blood donors, the well-being score increased (positive effects, n = 23), showed minor changes (n = 53), or decreased (negative effects, n = 24). The positive effects lasted for about 1 week and the negative effects for 3 days. Conclusion: While the frequency of psychological effects following blood donation identified by our study was comparable to others, the changes of the psychological state in our donors were traceable for a longer period than previously acknowledged

Pharmacokinetics of Phenprocoumon in Emergency Situations&ndash;Results of the Prospective Observational RADOA-Registry (Reversal Agent Use in Patients Treated with Direct Oral Anticoagulants or Vitamin K Antagonists Registry)

Background: Phenprocoumon has been used as an oral anticoagulant in patients with thromboembolic disease for more than 40 years. So far its pharmacokinetics have not been analyzed in emergency situations. Methods: Phenprocoumon-treated patients with major bleeding or urgent surgery were included in a prospective, observational registry. Phenprocoumon drug concentrations were analyzed in samples, collected as part of routine care using ultraperformance liquid chromatography tandem mass spectrometry. Moreover, anticoagulant intensity and drug half-life (t1/2) were calculated. Results: 115 patients were included. Phenprocoumon levels declined over time with a half-life of 5.27 and 5.29 days in patients with major bleedings (n = 82) and with urgent surgery (n = 33). Baseline phenprocoumon levels were 2.2 times higher in the bleeding group compared to the surgery group (1.92 vs. 0.87 ng/mL, p &lt; 0.0001). International normalized ratio (INR) values decreased rapidly during the first 24 h. In 27.6% of patients a rebound of INR (recurrent increase &gt; 1.5) was observed which was associated with significantly increased bleeding rates (22% vs. 4.2% in patients with or without INR rebound, p = 0.012). Conclusions: In emergency situations, the long half-life of phenprocoumon may cause INR rebound and associated recurrent bleedings. Optimal management may need to include repeated vitamin K supplementation over days