Risk Factors for Alloimmunisation after red blood Cell Transfusions (R-FACT): a case cohort study

INTRODUCTION: Individuals exposed to red blood cell alloantigens through transfusion, pregnancy or transplantation may produce antibodies against the alloantigens. Alloantibodies can pose serious clinical problems such as delayed haemolytic reactions and logistic problems, for example, to obtain timely and properly matched transfusion blood for patients in which new alloantibodies are detected. OBJECTIVE: The authors hypothesise that the particular clinical conditions (eg, used medication, concomitant infection, cellular immunity) during which transfusions are given may contribute to the risk of immunisation. The aim of this research was to examine the association between clinical, environmental and genetic characteristics of the recipient of erythrocyte transfusions and the risk against erythrocyte alloimmunisation during that transfusion episode. METHODS AND ANALYSIS STUDY DESIGN: Incident case-cohort study. SETTING: Secondary care, nationwide study (within the Netherlands) including seven hospitals, from January 2005 to December 2011. STUDY POPULATION: Consecutive red cell transfused patients at the study centres. INCLUSION: The study cohort comprises of consecutive red blood cell transfused patients at the study centre. EXCLUSION: Patients with transfusions before the study period and/or pre-existing alloantibodies.Cases defined as first time alloantibody formers; Controls defined as transfused individuals matched (on number of transfusions) to cases and have not formed an alloantibody. STATISTICAL ANALYSIS: Logistic regression models will be used to assess the association between the risk to develop antibodies and potential risk factors, adjusted for other risk factors. ETHICS AND DISSEMINATION: Approval at each local ethics regulatory committee will be obtained. Data will be coded for privacy reasons. Patients will be sent a letter and an information brochure explaining the purpose of the study. A consent form in presence of the study coordinator will be signed before the blood taking commences. Investigators will submit progress summary of the study to study sponsor regularly. Investigators will notify the accredited ethics board of the end of the study within a period of 8 weeks.Stemcel biology/Regenerative medicine (incl. bloodtransfusion

Associations of health status with subsequent blood donor behavior — an alternative perspective on the Healthy Donor Effect from Donor InSight

Introduction: In donor health research, the ‘Healthy Donor Effect’ (HDE) often biases study results and hampers their interpretation. This refers to the fact that donors are a selected ‘healthier’ subset of a population due to both donor selection procedures and self-selection. Donors with long versus short donor careers, or with high versus low donation intensities are often compared to avoid this HDE, but underlying health differences might also cause these differences in behaviour. Our aim was to estimate to what extent a donor´s perceived health status associates with donation cessation and intensity. Methods: All active whole blood donors participating in Donor InSight (2007–2009; 11,107 male; 12,616 female) were included in this prospective cohort study. We performed Cox survival and Poisson regression analyses to assess whether self-reported health status, medication use, disease diagnosed by a physician and recently having consulted a general practitioner (GP) or specialist were associated with (time to) donation cessation and donation intensity. Results: At the end of 2013, 44% of the donors in this study had stopped donating. Donors in self-rated good health had a 15% lower risk to stop donating compared to donors in perceived poorer health. Medication use, disease diagnoses and consulting a GP were associated with a 20–40% increased risk to stop donating and a lower donation intensity, when adjusting for age, number of donations and new donor status. Both men and women reporting good health made on average 10% more donations. Conclusion: Donors with a “good” health status were less likely to stop donating blood and tended to donate blood more often than donors with perceived poorer health status. This implies that the HDE is an important source of selection bias in studies on donor health and this includes studies where comparisons within donors are made. This HDE should be adjusted for appropriately when assessing health effects of donation and donors’ health status may provide estimates of future donation behavior

Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: A meta-analysis

Introduction Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes. Methods PubMed and Embase were searched from December 2019 through September 2020. Studies reporting extractable data (ie, crude numbers, and unadjusted or adjusted risk/ORs) by ethnic group on any of the five studied outcomes: confirmed COVID-19 infection in the general population, hospitalisation among infected patients, and disease severity, intensive care unit (ICU) admission and mortality among hospitalised patients with SARS-CoV-2 infection, were included using standardised electronic data extraction forms. We pooled data from published studies using random-effects meta-analysis. Results 58 studies were included from seven countries in four continents, mostly retrospective cohort studies, covering a total of almost 10 million individuals from the first wave until the summer of 2020. The risk of diagnosed SARS-CoV-2 infection was higher in most ethnic minority groups than their White counterparts in North American and Europe with the differences remaining in the US ethnic minorities after adjustment for confounders and explanatory factors. Among people with confirmed infection, African-Americans and Hispanic-Americans were also more likely than White-Americans to be hospitalised with SARS-CoV-2 infection. No increased risk of COVID-19 outcomes (ie, severe disease, ICU admission and death) was found among ethnic minority patients once hospitalised, except for a higher risk of death among ethnic minorities in Brazil. Conclusion The risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic. PROSPERO registration number CRD42020180085

Utility of zinc protoporphyrin in management of whole blood donors

Item does not contain fulltex

Outcomes among the donors during follow-up.

<p>Outcomes among the donors during follow-up.</p

Health status of whole blood donors at their participation in Donor InSight (DIS, 2007–2009).

<p>Health status of whole blood donors at their participation in Donor InSight (DIS, 2007–2009).</p

Associations of self-reported health status with donation intensity—Relative risk (95% confidence intervals).

<p>Associations of self-reported health status with donation intensity—Relative risk (95% confidence intervals).</p

Associations of self-reported health status with time to donation cessation (hazard ratios and 95% confidence intervals), adjusted for age, smoking, baseline donation intensity and new donor status; for men (gray) and women (white).

<p>Time from participation in DIS to donation cessation or censoring (31-12-2013) was calculated in days.</p