Background Transmission of pathogens through blood transfusion is still of great concern to clinicians, patients and blood providers. Pathogen reduction technologies (PRT) have been successfully applied for the treatment of labile blood components, such as plasma, platelets and whole blood (WB), which are now used in routine in many countries. We report the clinical evaluation of suspension of red blood cells (RBC‐S) derived from the WB treated with riboflavin and UV light (RF+UV). Study Design and Methods Seventy paediatric patients (0·3–17·1 years old) suffering from different malignant disorders were recruited and assigned to two groups: the control group (C) received transfusions of γ‐irradiated RBC‐S. The experimental group (T) received RBC‐S derived from WB, treated with RF+UV. Clinical efficacy was evaluated during follow‐up periods by Hb and Ht increments, and needs for transfusion support. Safety was assessed through active surveillance, recording post‐transfusion reactions, anti‐erythrocyte's antibody formation, haptoglobin and serum potassium levels. Results The clinical efficacy of RBC‐S in both groups was similar: mean post‐transfusion Hb concentration (101·6 ± 7·57 g/l vs. 100 ± 8·3 g/l; P = 0·43), and Ht level (28·5 ± 2·42% vs. 28·2 ± 2·7%; P = 0·66). Transfusion of pathogen‐reduced RBC‐S did not increase the frequency of transfusion reactions and did not induce an excessive immune response in the follow‐up period. Conclusion Transfusion of RBC‐S, obtained from pathogen‐reduced WB, is a promising method to increase the safety of blood component therapy for paediatric patients with malignant disorders without affecting clinical efficacy. A randomized clinical trial including more patients should follow this pilot study to confirm its results.
Background We used laboratory indicators to evaluate the quality of pathogenreduced red blood cell suspension (RBCS) compared with gamma-irradiated RBCS. Materials and methodsTo determine biochemical and metabolic parameters of RBCS, we obtained 50 whole blood units from healthy volunteers and randomized them into 2 groups: 25 were pathogen-reduced, and then, RBCS prepared from them. RBCS from the other 25 was gamma-irradiated. Sampling was carried out on day zero before and after treatment and at 7, 14, 21 and 28 days. To determine lymphocyte inactivation, we collected another 35 whole blood units. Each was sampled to form 3 study groups: untreated, gamma-irradiated and pathogen-reduced. Daily sampling was carried out during 3 days of storage. ResultsThe quality of RBCS from both groups was largely the same, except for haemolysis and red blood cell fragility, which were more pronounced in the pathogen-reduced group. This finding limited the shelf life of pathogen-reduced RBCS to 14 days. Lymphocyte viability was significantly reduced after both treatments. Proliferation of lymphocytes after pathogen reduction was reduced to the detection limit, while low-level proliferation was observed in gamma-irradiated samples.Conclusion Pathogen-reduced red blood cells have acceptable quality and can be used for transfusion within 14 days. Results of inactivation of lymphocytes demonstrate that pathogen reduction technology, applied on WB, can serve as an alternative to irradiation.
Extracorporeal photopheresis (ECP) has proven effectiveness for treatment of several diseases, including acute and chronic graft-versus-host disease (GVHD) after allogenic transplantation of hematopoietic blood stem cells. The standard ECP requires leukapheresis to obtain a mononuclear cell fraction. The possibility of using leukapheresis is limited by the requirements for vascular access and the somatic status of the patient. There is a relatively new method of performing ECF, called «mini-photopheresis» (mini-ECF), in which a fraction of mononuclear cells is isolated from a dose of whole blood obtained by the exfusion method. The article presents preliminary results of using mini-ECP in patients with acute and chronic GVHD. Materials and methods of research: the study included 11 patients with acute (7 patients) and chronic (4 patients) GVHD who received mini-ECP therapy from June 2018 to January 2021. Leukocyte fractions rich in mononuclear cells were prepared from the dose of whole blood of patients. The resulting fraction was diluted with 0,9% NaCl solution to less than 3% hematocrit. The cellular product was then injected with an 8-Methoxyperalene and programmed with UV spectrum A. Autologous erythrocytes and the finished cellular product were injected into the patient after irradiation. Results: 6 out of 7 patients (85,7%) with acute GVHD has responded to mini-ECP therapy. In patients with chronic GVHD, the response rate to mini-ECP therapy was 25%. In both groups there are no significant differences found in the number of leukocytes count per body mass in the finished cellular product. The correlation between the presence and severity of response to mini-ECP therapy with the number of leukocytes in the finished cellular product was not determined. None of the patients had adverse reactions and complications associated with mini-ECP therapy. Conclusion: mini-ECP is an attractive alternative for treatment of patients with steroid-resistant or steroid-dependent GVHD who cannot undergo leukapheresis. Our results are preliminary, but promising. We will continue to use this method as a second-line therapy for patients with contraindications to leukapheresis.
The problem of blood-borne infections remains relevant in transfusion medicine. Pathogen reduction technologies (PRT) provide a preventive approach to a wide range of transfusion-transmitted infectious diseases. To date, PRT widely used for a number of blood components, however, the use of these technologies for the treatment of erythrocyte-containing components has not been studied. Objective: to conduct a comparative analysis of the clinical efficacy of transfusions of pathogen-reduced and gamma-irradiated erythrocyte suspension in pediatric patients with various oncological and hematological diseases. Seventy transfusions of red blood cell suspensions (RBC-S) (35 transfusions of pathogen-reduced RBC-S and 35 transfusions of gammairradiated RBC-S) in pediatric patients with oncological and hematological diseases were analized. Clinical efficacy parameters such as the hemoglobin and the hematocrit increment after transfusion, the interval between transfusions, the frequency and severity of transfusion reactions were estimated. We also evaluated the correlation between the hemoglobin and the hematocrit increment with age, patient’s body weight, the hemoglobin concentration and patient's hematocrit before transfusion, the volume of transfusion, the hemoglobin dose and the adjusted hemoglobin dose received for transfusion. We found that the clinical efficacy and safety of RBC-Ss of the compared groups did not differ: the hematocrit and the hemoglobin increment, the frequency and severity of transfusion reactions, and the interval between transfusions were comparable between groups. There was no evidence of immune elimination and allo-sensibilization caused by pathogen-reduced RBC-S. In the group of patients receiving pathogen-reduced RBC-S, a correlation was found between the increase in the hemoglobin and hematocrit values with some of the EV indices. According to our data, the spectrum of efficiency and safety indicators of pathogen-reduced RBC-S is no worse than that of gamma-irradiated RBC-S, provided that RBC-S is used for 14 days of storage.
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