Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial.

Background: The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request.

Study Design And Methods: At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management.

A paradigm shift in trauma resuscitation: evaluation of evolving massive transfusion practices.

Importance: The evolution of damage control strategies has led to significant changes in the use of resuscitation after traumatic injury.

Objective: To evaluate changes in the administration of fluids and blood products, hypothesizing that a reduction in crystalloid volume and a reduced red blood cell (RBC) to fresh frozen plasma (FFP) ratio over the last 7 years would correlate with better resuscitation outcomes.

Design: Observational prospective cohort study.

Diminished need for folate measurements among indigent populations in the post folic acid supplementation era.

Context: The mandated fortification of processed grains with folic acid in the United States and Canada in 1998 was intended to reduce the incidence of neural tube defects in pregnant women. The incidence of folate deficiency in most populations has declined dramatically since then.

Objective: To determine the rate of folate deficiency in a cohort of indigent patients, a population among those at highest risk for folate deficiency.

Clinically relevant differences in prothrombin time and INR values related to blood sample collection in plastic vs glass tubes.

We compared prothrombin times (PTs) and international normalized ratios (INRs) for blood samples drawn into plastic vs glass collection tubes. We collected 60 venous blood samples into 4.5-mL glass and 2 plastic tubes (2.

Intermittent low-level viremia in very early primary HIV-1 infection.

Serial samples from source plasma donors with confirmed new HIV infection were investigated for low-level viremia (LLV) (ie, < 100 genome copies [cp]/mL) at time points preceding the period of steadily rising viremia above 100 cp/mL (ramp-up viremia). Fifteen of 44 plasma donor panels previously studied for the dynamics of HIV viremia during primary infection contained 70 samples with undetectable HIV-1 RNA by quantitative polymerase chain reaction (PCR). On retesting with a sensitive qualitative reverse transcriptase PCR assay (95% detection at 4 cp/mL), we identified LLV in 13 of 15 panels and 23 of 69 retested samples.

Emerging infections in transfusion medicine.

The risk of transfusion-transmitted infectious diseases (TTIDs) has declined dramatically in high-income nations over the past 2 decades, primarily because of extraordinary success in preventing HIV and other established transfusion-transmitted viruses from entering the blood supply. Despite this achievement, TTIDs remain a public health concern, and attention is refocusing on new and emerging pathogens, such as West Nile virus, infectious proteins (the presumed cause of variant Creutzfeldt-Jakob disease), and other transmissible organisms such as bacteria and parasites. In this article the authors concentrate on this heterogeneous group of infectious agents, describe individual pathogens and the risks they pose to transfusion recipients, and comment on existing and evolving procedures that are designed to protect the blood supply from this threat.

HCV viral load in anti-HCV-reactive donors and infectivity for their recipients.

Background: An attempt has been made to determine the minimum level of HCV nucleic acid in donors associated with infection of recipients. This is important for considerations about assay sensitivity, use of minipool versus single-donation testing, and continued use of serologic testing.

Study Design And Methods: A total of 5387 specimens from the Transfusion-Transmitted Viruses Study in the 1970s were screened for antibody to HCV (anti-HCV).

Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.

Objectives: The characterization of primary HIV infection by the analysis of serial plasma samples from newly infected persons using multiple standard viral assays.

Design: A retrospective study involving two sets of archived samples from HIV-infected plasma donors. (A) 435 samples from 51 donors detected by anti-HIV enzyme immunoassays donated during 1984-1994; (B) 145 specimens from 44 donors detected by p24 antigen screening donated during 1996-1998.

Comparative sensitivity of HBV NATs and HBsAg assays for detection of acute HBV infection.

Background: A study was designed to estimate relative analytic sensitivity and window-period (WP) closure and to project incremental yield of newer HBsAg tests, pooled-sample NAT, and single-sample NAT, compared to currently licensed HBsAg tests.

Study Design And Methods: HBV DNA and HBsAg test results for 23 HBV seroconversion (SC) panels were first analyzed to construct a model of primary HBV viremia. One-hundred representative samples were then selected from 10 panels and coded with 28 analytical controls.