Veränderungen von Transfusionsbedarf und Blutspendeaufkommen 2005-2015 unter besonderer Berücksichtigung der demographischen Veränderungen in Mecklenburg-Vorpommern

Ziel dieser Arbeit war es, die Auswirkungen des demographischen Wandels auf die Blutversorgung in Mecklenburg-Vorpommern (MV) zu analysieren. Dabei sollten Grundlagen für die Entwicklung von gesundheitspolitischen Strategien geschaffen werden, um einem Defizit in der Versorgung entgegenwirken zu können. Durch eine prospektive Longitudinalstudie mit Daten zu allen Vollblutspendern und Empfängern von Erythrozytenkonzentraten (EK) in MV in den Jahren 2005, 2010 und 2015 wird die Versorgungskette vollständig abgebildet. Derartige Informationen liegen zum jetzigen Zeitpunkt für kein anderes Bundesland vor. Es konnte gezeigt werden, dass die demographischen Veränderungen durch eine Abnahme der Spenderzahlen zu einem ausgeprägten Rückgang der Vollblutspenden geführt haben (-18,0%). Dies wird verstärkt durch einen Rückgang der Spendebereitschaft um -10,6% insbesondere bei den <30-Jährigen. Gleichzeitig konnte trotz alternder Bevölkerung auch der Blutbedarf dank des medizinischen Fortschritts um 13,5% reduziert werden. Dennoch deckten bereits im Jahr 2015 die gewonnenen Blutspenden nur noch knapp den Blutbedarf der Patienten. Die durchgeführten Vorausberechnungen für 2030 lassen erwarten, dass es mit einem Defizit von circa 18.000 EK zu erheblichen Versorgungsproblemen im Bundesland kommen wird, wenn Spendebereitschaft und Transfusionsbedarf auf dem Niveau von 2015 verbleiben. Die demographische Situation Mecklenburg-Vorpommerns ist denen der westlichen Bundesländer Deutschlands circa 10 Jahre voraus. Damit nimmt Mecklenburg- Vorpommern als Modellregion eine Vorreiterrolle bezüglich der Bewältigung der damit einhergehenden Herausforderungen für die Blutversorgung ein. Um den Blutbedarf der Patienten langfristig und überregional decken zu können, wird in Zukunft eine noch engere interdisziplinäre Kooperation von Blutspendediensten, Krankenhäusern und Gesundheitspolitik sowohl auf Landes- als auch Bundesebene notwendig sein

Longitudinal Changes in the Blood Supply and Demand in North-East-Germany 2005-2015

Background: Securing future blood supply is a major issue of transfusion safety. In this prospective 10-year longitudinal study we enrolled all blood donation services and hospitals of the federal state Mecklenburg-Western Pomerania. Methods and Results: From 2005 to 2015 (time period with major demographic effects), whole blood donation numbers declined by 18%. In male donors this paralleled the demographic change, while donation rates of females declined 12.4% more than expected from demography. In parallel, red cell transfusion rates/1,000 population decreased from 2005 to 2015 from 56 to 51 (-8.4%), primarily due to less transfusions in patients >60 years. However, the transfusion demand declined much less than blood donation numbers: -13.5% versus -18%, and the population >65 years (highest transfusion demand) will further increase. The key question is whether the decline in transfusion demand observed over the previous years will further continue, hereby compensating for reduced blood donation numbers due to the demographic change. The population structure of Mecklenburg-Western Pomerania reflects all Eastern German federal states, while the Western German federal states will reach similar ratios of age groups 18-64 years / ≥65 years about 10 years later. Conclusions: Regular monitoring of age- and sex-specific donation and transfusion data is urgently required to allow transfusion services strategic planning for securing future blood supply

Pyrolysis of dry toilet substrate as a means of nutrient recycling in agricultural systems : potential risks and benefits

Biochar is increasingly being applied as a soil amendment in agriculture. Biochar is typically produced from plant biomass and contains relatively low amounts of plant nutrients (e.g., N, P, and K), thus providing limited fertilizer value. Human excreta contains plant nutrients that could be recycled to create sustainable agricultural nutrient cycles. This study investigated the potential of biochar derived from a dry toilet substrate as soil amendment. The substrate consisted of urine, faeces, and wood chips, and was pyrolyzed at 500–650 °C for 10 min. The biochar was analyzed for plant available P, water leachable P and K, carbon stability, pH, electrical conductivity, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), dioxins, and germination tests with barley and lettuce were conducted to estimate the biochar fertilizer value and potential bio-toxicity. The biochar contained 25.0 ± 1.0 g N/kg dry mass (DM), 33.1 ± 2.1 g P/kg DM and 20.7 ± 0.2 g K/kg DM. 65% DM P was extractable by formic acid solution, 31.7% DM P and 60.5% DM K were water leachable in a ten-day column water-leaching experiment. The biochar complied with European regulations for PAHs, PCBs, dioxins and heavy metal concentrations, except for Zn and Ni. Germination of salt-resistant barley was not affected by biochar doses < 50% DM, while salt-sensitive lettuce germination was inhibited at doses ≥ 2% DM, indicating that the dry toilet substrate biochar induced salt stress. Based on these results, it is recommended that urine separation should be considered for biochar of excreta, which could reduce salt stress while maintaining concentrations of “fixed” or bioavailable nitrogen

“Blood for Blood”? Personal Motives and Deterrents for Blood Donation in the German Population

It is crucial to provide updated knowledge about blood (non-)donors, as it is necessary to design targeted interventions with the aim of retaining blood donors and thus contributing to a functioning health system. This study investigates the prevalence and socio-demographic patterning of lifetime blood donation, assessing blood donation intention within the next 12 months and exploring personal motives and deterrents of blood donation qualitatively in the German population. A face-to-face cross-sectional survey with 2531 respondents was conducted, representative of the German population in terms of age, gender, and residency. Closed as well as open questions were asked. Qualitative content analysis was used for coding the qualitative material. Basic descriptive statistics were conducted to address our research questions. More than one-third of the participants reported that they have donated blood at least once in their lifetime. Motives and deterrents were assigned to 10 domains with 50 main categories and 65 sub-categories. The most frequently stated motives for blood donation were “altruism”, “social responsibility”, and “charity”, whereas the most frequently stated deterrents were “health status”, “age”, and “lack of time”. This study provides information to tailor recruitment and reactivation strategies to address donors at different career steps—from non-donor to loyal donor

Characteristics of Recipients of Red Blood Cell Concentrates in a German Federal State

Background: Annual transfusion rates in many European countries range between 25 and 35 red blood cell concentrates (RBCs)/1,000 population.It is unclear why transfusion rates in Germany are considerably higher (approx. 50–55 RBCs/1,000 population). Methods: We assessed the characteristics of transfusion recipients at all hospitals of the German federal state Mecklenburg-Western Pomerania during a 10-year longitudinal study. Results: Although 75% of patients received ≤4 RBCs/patient in 2015 (1 RBC: 11.3%; 2 RBCs: 42.6%; 3 RBCs: 6.3%; 4 RBCs: 15.0%), the mean transfusion index was 4.6 RBCs due to a minority of patients with a high transfusion demand. Two thirds of all RBCs were transfused to only 25% of RBC recipients. Consistently, male patients received a higher number of RBCs (2005: 54.2%; 2015: 56.8%) and had a higher mean transfusion index than female patients (mean 5.1 ± 7.2; median 2; inter-quartile range [IQR] 2–4 vs. mean 4.0 ± 5.8; median 2; IQR 2–4). The absolute transfusion demand decreased between 2005 and 2015 by 13.5% due to a composite of active reduction (clinical practice change) and population decline in the 65- to 75-year age group (lower birth rate cohort 1940–1950); however, with major differences between hospitals (range from –61.0 to +41.4%). Conclusion: Transfusion demand in a population could largely be driven by patients with high transfusion demand. Different treatment practices in this group of patients probably add to the major differences in transfusion demand per 1,000 individuals between countries. The available data cannot prove this hypothesis. Implementation of a diagnosis-related group-based monitoring system is urgently needed to allow informative monitoring on the population level and meaningful comparisons between transfusion practices

Laboratory confirmed vaccine-induced immune thrombotic thrombocytopenia: Retrospective analysis of reported cases after vaccination with ChAdOx-1 nCoV-19 in Germany

BACKGROUND: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe adverse event of SARS-CoV-2 vaccination. We describe the characteristics of patients reported in Germany based on the Brighton Collaboration (BC) case definition criteria for Thrombosis and Thrombocytopenia Syndrome (TTS) and focus on patients with complete anti-platelet factor 4 (PF4)-antibody laboratory work up. METHODS: The adverse drug reaction database of the Paul-Ehrlich Institute was queried for TTS cases following ChAdOx1 nCoV-19 vaccination from February 1, until May 21, 2021. Cases with reports from the Greifswald laboratory were analysed in detail. FINDINGS: PF4 antibody tests were available for 69 suspected TTS cases reported to the Paul-Ehrlich Institute, of whom 52 patients fulfilled the BC case definition; 37 (71%) women, 15 (29%) men, median age 46·0 years (interquartile range 31·0-60·3 years). Cerebral venous sinus thrombosis was confirmed in 37 (71%), (additional) multiple thromboses in 19 (37%) patients. Twelve patients died. Non-survivors showed lower platelet counts compared to survivors (median nadir 15,000/µL vs 49,000/µL; p&lt;0·0001). Combined anti-PF4/heparin IgG ELISA and PF4-dependent platelet activation testing yielded sensitivity of 96% (95% confidence interval 87-100%) and specificity of 77% (50-93%) for TTS. Four patients with thrombocytopenia but without thrombosis presented with severe headache or cerebral bleeding, explaining the lower specificity. INTERPRETATION: VITT has high mortality and can present with isolated thrombocytopenia, severe headache, and bleeding. Demonstration of platelet activating anti-PF4 IgG has high sensitivity for TTS and captures a wider spectrum of clinically relevant VITT than the current BC case definition

Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report

Background and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, how long symptomatic VITT can persist. Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies. Methods: Clinical and laboratory findings are presented, including the course of platelet counts, D-Dimer levels, clinical presentation, imaging, SARS-CoV-2-serological and immunological, platelet activating anti-PF4-IgG, as well as autopsy findings. Results: The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient’s serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage. Conclusions: Complicated VITT with extremely high anti-PF4-IgG titers over three months can induce recurrent thrombocytopenia despite treatment with IVIG and anticoagulation. Plasma exchange, immunoadsorption, and /or immunosuppressive treatment may be considered in complicated VITT to reduce extraordinarily high levels of anti-PF4-IgG. Long-term therapy in such cases must take the individual bleeding risk and CSVT risk into account