Implementation of a dual platelet inventory in a tertiary hospital during the COVID-19 pandemic enabling cold-stored apheresis platelets for treatment of actively bleeding patients

Background: To increase preparedness and mitigate the risk of platelet shortage without increasing the number of collections, we introduced a dual platelet inventory with cold-stored platelets (CSP) with 14-days shelf life for actively bleeding patients during the COVID-19 pandemic. Study design and methods: We collected apheresis platelet concentrates with blood type O or A. All patients receiving CSP units were included in a quality registry. Efficacy was evaluated by total blood usage and laboratory analysis of platelet count, hemoglobin, and TEG 6s global hemostasis assay. Feasibility was evaluated by monitoring inventory and a survey among laboratory staff. Results: From 17 March, 2020, to 31 December, 2021, we produced 276 CSP units and transfused 186 units to 92 patients. Main indication for transfusion was surgical bleeding (88%). No transfusion reactions were reported. 24-h post-transfusion patient survival was 96%. Total outdate in the study period was 33%. The majority (75%) of survey respondents answered that they had received sufficient information and training before CSP was implemented. Lack of information about bleeding status while issuing platelets, high workload, and separate storage location was described as main reasons for outdates. Discussion: CSP with 14-days shelf life is a feasible alternative for the treatment of patients with bleeding. Implementation of a dual platelet inventory requires thorough planning, including information and training of clinical and laboratory staff, continuous follow-up of practice and patients, and an easy-to-follow algorithm for use of CSP units. A dual platelet inventory may mitigate the risk of platelet shortage during a pandemic situation.publishedVersio

In vitro quality of cold and delayed cold-stored platelet concentrates from interim platelet units during storage for 21 days

Background and Objectives: Based on previous success using apheresis platelets, we wanted to investigate the in vitro quality and platelet function in continuously cold-stored and delayed cold-stored platelet concentrates (PCs) from interim platelet units (IPUs) produced by the Reveos system. Materials and Methods: We used a pool-and-split design to prepare 18 identical pairs of PCs. One unit was stored unagitated and refrigerated after production on day 1 (cold-stored). The other unit was stored agitated at room temperature until day 5 and then refrigerated (delayed cold-stored). Samples were taken after pool-and-split on day 1 and on days 5, 7, 14 and 21. Swirling was observed and haematology parameters, metabolism, blood gas, platelet activation and platelet aggregation were analysed for each sample point. Results: All PCs complied with European recommendations (EDQM 20th edition). Both groups had mean platelet content >200 × 109/unit on day 21. The pH remained above 6.4 for all sample points. Glucose concentration was detectable in every cold-stored unit on day 21 and in every delayed cold-stored unit on day 14. The cold-stored group showed a higher activation level before stimulation as measured by flow cytometry. The activation levels were similar in the two groups after stimulation. Both groups had the ability to form aggregates after cold storage and until day 21. Conclusion: Our findings suggest that PCs from IPUs are suitable for cold storage from day 1 until day 21 and delayed cold storage from day 5 until day 14.publishedVersio

Effect of leukoreduction and temperature on risk of bacterial growth in CPDA-1 whole blood: A study of Escherichia coli

Background Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. Methods CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2–6°C, 20–24°C, or 33–37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2–6°C. Results Whole blood was inoculated with a median of 19.5 (range 12.0–32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0–33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20–24°C and 33–37°C in 9 of 10 bags. During storage at 2–6°C, a slow self-sterilization occurred over time with and without leukoreduction. Conclusions Storage at 20–24°C and 33–37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2–6°C will further reduce the growth of E. coli.publishedVersio

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

State of the climate in 2018

In 2018, the dominant greenhouse gases released into Earth’s atmosphere—carbon dioxide, methane, and nitrous oxide—continued their increase. The annual global average carbon dioxide concentration at Earth’s surface was 407.4 ± 0.1 ppm, the highest in the modern instrumental record and in ice core records dating back 800 000 years. Combined, greenhouse gases and several halogenated gases contribute just over 3 W m−2 to radiative forcing and represent a nearly 43% increase since 1990. Carbon dioxide is responsible for about 65% of this radiative forcing. With a weak La Niña in early 2018 transitioning to a weak El Niño by the year’s end, the global surface (land and ocean) temperature was the fourth highest on record, with only 2015 through 2017 being warmer. Several European countries reported record high annual temperatures. There were also more high, and fewer low, temperature extremes than in nearly all of the 68-year extremes record. Madagascar recorded a record daily temperature of 40.5°C in Morondava in March, while South Korea set its record high of 41.0°C in August in Hongcheon. Nawabshah, Pakistan, recorded its highest temperature of 50.2°C, which may be a new daily world record for April. Globally, the annual lower troposphere temperature was third to seventh highest, depending on the dataset analyzed. The lower stratospheric temperature was approximately fifth lowest. The 2018 Arctic land surface temperature was 1.2°C above the 1981–2010 average, tying for third highest in the 118-year record, following 2016 and 2017. June’s Arctic snow cover extent was almost half of what it was 35 years ago. Across Greenland, however, regional summer temperatures were generally below or near average. Additionally, a satellite survey of 47 glaciers in Greenland indicated a net increase in area for the first time since records began in 1999. Increasing permafrost temperatures were reported at most observation sites in the Arctic, with the overall increase of 0.1°–0.2°C between 2017 and 2018 being comparable to the highest rate of warming ever observed in the region. On 17 March, Arctic sea ice extent marked the second smallest annual maximum in the 38-year record, larger than only 2017. The minimum extent in 2018 was reached on 19 September and again on 23 September, tying 2008 and 2010 for the sixth lowest extent on record. The 23 September date tied 1997 as the latest sea ice minimum date on record. First-year ice now dominates the ice cover, comprising 77% of the March 2018 ice pack compared to 55% during the 1980s. Because thinner, younger ice is more vulnerable to melting out in summer, this shift in sea ice age has contributed to the decreasing trend in minimum ice extent. Regionally, Bering Sea ice extent was at record lows for almost the entire 2017/18 ice season. For the Antarctic continent as a whole, 2018 was warmer than average. On the highest points of the Antarctic Plateau, the automatic weather station Relay (74°S) broke or tied six monthly temperature records throughout the year, with August breaking its record by nearly 8°C. However, cool conditions in the western Bellingshausen Sea and Amundsen Sea sector contributed to a low melt season overall for 2017/18. High SSTs contributed to low summer sea ice extent in the Ross and Weddell Seas in 2018, underpinning the second lowest Antarctic summer minimum sea ice extent on record. Despite conducive conditions for its formation, the ozone hole at its maximum extent in September was near the 2000–18 mean, likely due to an ongoing slow decline in stratospheric chlorine monoxide concentration. Across the oceans, globally averaged SST decreased slightly since the record El Niño year of 2016 but was still far above the climatological mean. On average, SST is increasing at a rate of 0.10° ± 0.01°C decade−1 since 1950. The warming appeared largest in the tropical Indian Ocean and smallest in the North Pacific. The deeper ocean continues to warm year after year. For the seventh consecutive year, global annual mean sea level became the highest in the 26-year record, rising to 81 mm above the 1993 average. As anticipated in a warming climate, the hydrological cycle over the ocean is accelerating: dry regions are becoming drier and wet regions rainier. Closer to the equator, 95 named tropical storms were observed during 2018, well above the 1981–2010 average of 82. Eleven tropical cyclones reached Saffir–Simpson scale Category 5 intensity. North Atlantic Major Hurricane Michael’s landfall intensity of 140 kt was the fourth strongest for any continental U.S. hurricane landfall in the 168-year record. Michael caused more than 30 fatalities and $25 billion (U.S. dollars) in damages. In the western North Pacific, Super Typhoon Mangkhut led to 160 fatalities and$6 billion (U.S. dollars) in damages across the Philippines, Hong Kong, Macau, mainland China, Guam, and the Northern Mariana Islands. Tropical Storm Son-Tinh was responsible for 170 fatalities in Vietnam and Laos. Nearly all the islands of Micronesia experienced at least moderate impacts from various tropical cyclones. Across land, many areas around the globe received copious precipitation, notable at different time scales. Rodrigues and Réunion Island near southern Africa each reported their third wettest year on record. In Hawaii, 1262 mm precipitation at Waipā Gardens (Kauai) on 14–15 April set a new U.S. record for 24-h precipitation. In Brazil, the city of Belo Horizonte received nearly 75 mm of rain in just 20 minutes, nearly half its monthly average. Globally, fire activity during 2018 was the lowest since the start of the record in 1997, with a combined burned area of about 500 million hectares. This reinforced the long-term downward trend in fire emissions driven by changes in land use in frequently burning savannas. However, wildfires burned 3.5 million hectares across the United States, well above the 2000–10 average of 2.7 million hectares. Combined, U.S. wildfire damages for the 2017 and 2018 wildfire seasons exceeded $40 billion (U.S. dollars)

Vekst av Escherichia coli i fullblod med og utan leukocyttar ved ulike lagringsvilkår

BAKGRUNN Tapping av leukocytthaldig citrat-fosfat-dekstrose-adenin (CPDA-1) fullblod blir utført i sivile og militære blodbankar, i tappesalar og i felt. Blod tappa i felt kan ha auka risiko for bakteriell kontaminasjon fordi vanlege hygieniske tiltak ikkje kan gjennomførast fullt ut. HENSIKT OG PROBLEMSTILLINGAR Målet med studien var å undersøkja om leukocyttreduksjon og lagringstemperatur påverkar vekst av Escherichia coli (E.coli, ATCC® 25922™) i CPDA-1-fullblod. MATERIALE OG METODE 450 ml CPDA-1-fullblod frå ti blodgivarar med blodtype 0 blei inokulert med E. coli. Testposar (n=5) blei leukocyttredusert med eit platesparande filter to timar etter inokulasjon. Kontrollposar (n=5) blei ikkje filtrert. Tre timar etter tapping blei fullblod fordelt i tre posar lagra ved 2-6 °C, 20-24 °C eller 33-37 °C. Vekst av E. coli blei kvantifisert umiddelbart, to og tre timar etter inokulasjon, dag 1, 3, 7 og 14 for alle lagringstemperaturane og dag 21 og 35 for posar lagra ved 2-6 °C. Resultat er oppgitt som gjennomsnitt (min- og maks-verdi). RESULTAT Fullblod blei inokulert med 20,26 (12,0-32,0) koloniformande einingar per ml (CFU/ml) E. coli. Etter leukocyttreduksjon gjennom filteret var konsentrasjonen av E. coli 9,32 CFU/ml (0,0-33,3) i testarmen. I kontrollarmen fagocyterte leukocyttane E. coli innan 24 timar i ni av ti posar lagra ved 20-24 °C og 33-37 °C. Det føregjekk ei sakte autosterilisering i posane lagra ved 2-6 °C i begge armane. Vekst av E. coli førte til koagulering av fullblod i begge studiearmane. KONKLUSJON Resultata våre indikerer at leukocyttar ikkje klarer å fagocytera E. coli innan to timar etter tapping, men at leukocyttreduksjon etter 24 timars kvile ved 20-24 °C før kaldlagring meir effektivt hindrar oppvekst av E. coli. Synlege koagel i fullblod kan skuldast kontaminering av E. coli. NØKKELORD E. coli, kontaminering, CPDA-1-fullblod, lagring, leukocyttreduksjon, filtrering, fagocytose, vandrande blodban

Growth of Escherichia Coli in Whole Blood With and Without Leukocytes at Different Storage Conditions

BAKGRUNN Tapping av leukocytthaldig citrat-fosfat-dekstrose-adenin (CPDA-1) fullblod blir utført i sivile og militære blodbankar, i tappesalar og i felt. Blod tappa i felt kan ha auka risiko for bakteriell kontaminasjon fordi vanlege hygieniske tiltak ikkje kan gjennomførast fullt ut. HENSIKT OG PROBLEMSTILLINGAR Målet med studien var å undersøkja om leukocyttreduksjon og lagringstemperatur påverkar vekst av Escherichia coli (E.coli, ATCC® 25922™) i CPDA-1-fullblod. MATERIALE OG METODE 450 ml CPDA-1-fullblod frå ti blodgivarar med blodtype 0 blei inokulert med E. coli. Testposar (n=5) blei leukocyttredusert med eit platesparande filter to timar etter inokulasjon. Kontrollposar (n=5) blei ikkje filtrert. Tre timar etter tapping blei fullblod fordelt i tre posar lagra ved 2-6 °C, 20-24 °C eller 33-37 °C. Vekst av E. coli blei kvantifisert umiddelbart, to og tre timar etter inokulasjon, dag 1, 3, 7 og 14 for alle lagringstemperaturane og dag 21 og 35 for posar lagra ved 2-6 °C. Resultat er oppgitt som gjennomsnitt (min- og maks-verdi). RESULTAT Fullblod blei inokulert med 20,26 (12,0-32,0) koloniformande einingar per ml (CFU/ml) E. coli. Etter leukocyttreduksjon gjennom filteret var konsentrasjonen av E. coli 9,32 CFU/ml (0,0-33,3) i testarmen. I kontrollarmen fagocyterte leukocyttane E. coli innan 24 timar i ni av ti posar lagra ved 20-24 °C og 33-37 °C. Det føregjekk ei sakte autosterilisering i posane lagra ved 2-6 °C i begge armane. Vekst av E. coli førte til koagulering av fullblod i begge studiearmane. KONKLUSJON Resultata våre indikerer at leukocyttar ikkje klarer å fagocytera E. coli innan to timar etter tapping, men at leukocyttreduksjon etter 24 timars kvile ved 20-24 °C før kaldlagring meir effektivt hindrar oppvekst av E. coli. Synlege koagel i fullblod kan skuldast kontaminering av E. coli. NØKKELORD E. coli, kontaminering, CPDA-1-fullblod, lagring, leukocyttreduksjon, filtrering, fagocytose, vandrande blodbankBACKGROUND Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in civilian and military blood banks, both in donation facilities and far forward. Due to environmental conditions, blood collected under field conditions may have increased risk of bacterial contamination. AIMS AND OBJECTIVES The aim of this study was to examine the effects of leukocyte reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. METHODS AND MATERIAL 450 mL CPDA-1 whole blood from ten group O donors was inoculated with E. coli. Test units (n=5) were leukoreduced with a platelet-sparing filter two hours after inoculation. Control units (n=5) remained unfiltered. Three hours after donation, the units were split into three bags and stored at 2-6°C, 20-24°C or 33-37°C. Bacterial growth was quantified immediately, two and three hours after inoculation, on days 1, 3, 7 and 14 for all storage temperatures, and additionally on days 21 and 35 for storage at 2-6°C. Results are given as mean values (range). RESULTS Whole blood was inoculated with mean 20.26 (range 12.0-32.0) colony-forming units per mL (CFU/mL) E. coli. After leukoreduction mean 9.32 CFU/mL (range 0.0-33.3) E. coli remained in the test arm. Leukocytes in the control arm did phagocyte E. coli within 24 hours at 20-24°C and 33-37°C in nine of ten bags. A slow self-sterilization occurred during storage in both arms at 2-6°C. Growth of E. coli led to clot formation in both study arms. CONCLUSIONS Our findings indicate that leukocytes are not able to phagocyte E. coli within two hours after donation. However, the rest at 20-24°C for 24 hours before cold storage more efficiently prevents growth of E. coli. Visible clots in whole blood may indicate contamination by E. coli. KEY WORDS E. coli, contamination, CPDA-1 whole blood, storage, leukoreduction, filtration, phagocytosis, walking blood bankMasteroppgåve for radiograf/bioingeniørRAB395MAMD-HELS

Hvordan kan innskuddsløsninger bli bedre enn ytelsespensjon? En studie av pensjonsforløpet til ansatte i offentlige og private sykehjem i Oslo

Pensjon er et aktuelt tema i stadig endring som påvirker alle. Vi spør: Hvordan kan innskuddsløsninger bli bedre enn ytelsespensjon? Med Monte Carlo-simulering har vi simulert pensjonsforløp til individene i utvalget vårt, 891 ansatte ved sykehjem i Oslo. Vi har sett hvordan investeringsprofil, innskuddssats, pensjonsalder og risikoaversjon påvirker nytten av pensjonsutbetalinger. Hovedresultatene viser at innskuddsløsningene blir bedre enn ytelsespensjon dersom innskuddssatsen settes høyt nok eller dersom pensjonsalderen økes tilstrekkelig. Vi finner at hvis man har en innskuddssats på 7 % og investeringsprofil 100 % så vil de fleste i utvalget vårt ha større nytte av hybridpensjon enn ytelsespensjon dersom de går av med pensjon ved 67 år. For innskuddspensjon må innskuddssatsen være 10 % eller pensjonsalder 70 år før de fleste får større nytte av innskuddspensjon enn ytelsespensjon

In vitro quality and hemostatic function of cold-stored CPDA-1 whole blood after repeated transient exposure to 28°C storage temperature

Background Blood products are frequently exposed to room temperature or higher for longer periods than permitted by policy. We aimed to investigate if this resulted in a measurable effect on common quality parameters and viscoelastic hemostatic function of cold stored CPDA-1 whole blood. Study Design and Methods 450 ml of whole blood from 16 O Rh(D) positive donors was collected in 63 ml of CPDA-1 and stored cold. Eights bags were exposed to five weekly 4-h long transient temperature changes to 28°C. Eight bags were stored continuously at 4°C as a control. Samples were collected at baseline on day 1, after the first cycle on day 1 and weekly before each subsequent cycle (day 7, 14, 21, 28 and 35). Hemolysis, hematological parameters, pH, glucose, lactate, potassium, thromboelastography, INR, APTT, fibrinogen, and factor VIII were measured. Results CPDA-1 whole blood repeatedly exposed to 28°C did not show reduced quality compared to the control group on day 35. Two units in the test group had hemolysis of 1.1% and 1.2%, and two in the control group hemolysis of 0.8%. Remaining thromboelastography clot strength (MA) on day 35 was 51.7 mm (44.8, 58.6) in the test group and 46.1 (41.6, 50.6) in the control group (p = .023). Platelet count was better preserved in the test group (166.7 [137.8, 195.6] vs. 117.8 [90.3, 145.2], p = .018). One sample in the test group was positive for Cutibacterium acnes on day 35 + 6. Conclusion Hemolysis findings warrant further investigation. Other indicators of quality were not negatively affected.publishedVersio

Effect of leukoreduction and temperature on risk of bacterial growth in CPDA-1 whole blood: A study of Escherichia coli

Background Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. Methods CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2–6°C, 20–24°C, or 33–37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2–6°C. Results Whole blood was inoculated with a median of 19.5 (range 12.0–32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0–33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20–24°C and 33–37°C in 9 of 10 bags. During storage at 2–6°C, a slow self-sterilization occurred over time with and without leukoreduction. Conclusions Storage at 20–24°C and 33–37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2–6°C will further reduce the growth of E. coli