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Patient outcomes

Recent studies

Preventing problems for newborn babies with non-invasive testing

Babies whose blood contains the Rh D antigen (Rh positive) can suffer from life-threatening anaemia, known as haemolytic disease of the newborn (HDN),  if they are born to mothers who lack the Rh D negative antigen (Rh negative). This problem can be avoided by injecting the mother with anti-D antibodies (which are supplied by certain volunteer donors through plasma donations) during pregnancy.

Researchers at the Blood Service have developed a diagnostic test that uses a blood sample from an Rh negative mother to check the blood type of her fetus. If the fetus is Rh positive, anti-D antibodies can be administered. This testing has the potential to reduce the use of expensive anti-D antibodies. A cost-benefit analysis of the screening test is being conducted, and the test is being extended to blood groups other than Rh D that can also result in HDN.

Improving transfusion safety using genetic testing

Conventional blood typing uses antibodies to determine the blood group of a patient. Apart from the commonly known A, B, O and Rh blood systems, there are many other antigens that can lead to reactions in transfused patients if they are incompatible. In some cases, antibodies are not able to accurately determine a blood group, and genetic testing provides more accurate results. The Blood Service is exploring powerful genetic testing to improve the matching of donor and recipient, especially for minority ethnic groups and rare blood groups.

Reducing the incidence of transfusion complications

Transfusion-Related Acute Lung Injury (TRALI) is a rare complication of blood transfusion. Patients with TRALI have breathing difficulties and low blood oxygen following a transfusion. In collaboration with the Prince Charles Hospital Critical Care Research Group and the Australian Defence Forces, Blood Service researchers are studying the link between blood components’ storage conditions and TRALI. Using sheep as a model to mimic the human condition, as well as experiments in a laboratory, this research aims to understand the mechanisms of TRALI and ultimately reduce its incidence.

Ensuring treatments are used wisely

Intravenous immunoglobulin (IVIg) is an effective treatment for some cases of chronic inflammatory demyelinating polyneuropathy (CIDP), a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms. IVIg is a blood product purified from donated plasma, each patient dose being made from the pooled plasma of over 1,000 donors. Not all patients respond to IVIg treatment, and for those that do, clinical assessment of improvements can take 3-6 months. This research aims to improve usage of our valuable IVIg resource by developing a blood test to identify early which patients will respond to treatment.

Molecular signals during blood transfusion

Blood transfusion can be associated with complications in some patients. There is evidence that storage conditions of red blood cells prior to transfusion can be linked to patient outcomes. The Blood Service is researching how a patient’s blood cells respond to transfusion with a variety of molecular signals that may contribute to these poor outcomes.

Understanding how red blood cells work

Red blood cells undergo a variety of molecular and metabolic changes during storage that may impact on their function after transfusion. A number of studies at the Blood Service are seeking to understand these changes so that overall transfusion safety can be improved. Some of the factors we are investigating are:

  • fundamental red blood cell physiology
  • the effect of donor variables on the quality of red blood cells, and
  • changes in red blood cells during storage which can stimulate clotting and molecules that regulate the lifespan of red blood cells.

Does removing white cells make transfusion safer?

One undesirable outcome associated with blood transfusion is the persistence of donor white cells in the transfusion recipient, known as microchimerism. The development of this condition is a significant risk for patients who have received multiple transfusions. Since 2008, white blood cells have been removed from red blood cell units by filtration before transfusion (known as leucodepletion) to minimise this risk.

This research has found that despite the introduction of leucodepletion, microchimerism still occurs in massively transfused patients. The Blood Service is conducting studies to improve our understanding of how microchimerism develops.

Selected Publications

Aubron C, Bailey M, McQuilten Z, Pilcher D, Hegarty C, Martinelli A, Magrin G, Irving D, Cooper DJ, Bellomo R: Duration of red blood cells storage and outcome in critically ill patients. Journal of critical care 2014, 29(3):476 e471-478. http://www.ncbi.nlm.nih.gov/pubmed/24559574

Chemonges S, Shekar K, Tung JP, Dunster KR, Diab S, Platts D, Watts RP, Gregory SD, Foley S, Simonova G et al: Optimal management of the critically ill: anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care. BioMed Research International 2014, 2014:468309. http://www.ncbi.nlm.nih.gov/pubmed/24783206

Chemonges S, Tung JP, Fraser JF: Proteogenomics of selective susceptibility to endotoxin using circulating acute phase biomarkers and bioassay development in sheep: a review. Proteome science 2014, 12(1):12. http://www.ncbi.nlm.nih.gov/pubmed/24580811

Fung YL, Minchinton RM, Tung JP: How do you solve a problem like transfusion-related acute lung injury? ISBT Science Series 2014, 9(1):287-293. http://dx.doi.org/10.1111/voxs.12063

Fung YL, Tung JP, Minchinton RM: Neutrophil antibodies are clinically important. ISBT Science Series 2014, 9(1):253-257. http://dx.doi.org/10.1111/voxs.12062

Hodge S, Dean MM, Eisen DP: Lectins as potential adjunct therapeutics for COPD emphysema? Journal of Pulmonary & Respiratory Medicine 2013, 3:e130. http://omicsonline.org/lectins-as-potential-adjunct-therapeutics-for-copd-emphysema-2161-105X.1000e130.php?aid=16311

Hyland CA: The challenge and paradox in serology RhD typing for blood donors and patients. Blood transfusion = Trasfusione del sangue 2013, 11(1):4-5. http://www.ncbi.nlm.nih.gov/pubmed/22871819

Kaukonen KM, Bailey M, Ady B, Aubron C, French C, Gantner D, Irving D, Murray L, Nichol A, Pettila V et al: A randomised controlled trial of standard transfusion versus fresher red blood cell use in intensive care (TRANSFUSE): protocol and statistical analysis plan. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine 2014, 16(4):255-261. http://www.ncbi.nlm.nih.gov/pubmed/25437218

Kildey K, Flower RL, Tran TV, Tunningley R, Harris J, Dean MM: Characterization of ENU-induced Mutations in Red Blood Cell Structural Proteins. Comput and Struct Biotech J 2013. http://www.ncbi.nlm.nih.gov/pubmed/24688720

Kildey K, Rooks K, Weier S, Flower RL, Dean MM: Effect of age, gender and mannose-binding lectin (MBL) status on the inflammatory profile in peripheral blood plasma of Australian blood donors. Hum Immunol 2014, 75(9):973-979. http://www.ncbi.nlm.nih.gov/pubmed/25167768

Lopez GH, Condon JA, Wilson B, Martin JR, Liew YW, Flower RL, Hyland CA: A novel FY*A allele with the 265T and 298A SNPs formerly associated exclusively with the FY*B allele and weak Fyb antigen expression: implication for genotyping interpretative algorithms. Vox Sang 2014:52-57 http://www.ncbi.nlm.nih.gov/pubmed/25092430

McBean RS, Hyland CA, Flower RL: Approaches to determination of a full profile of blood group genotypes: single nucleotide variant mapping and massively parallel sequencing. Comput Struct Biotechnol J 2014, 11(19):147-151. http://www.ncbi.nlm.nih.gov/pubmed/25408849

McBean R, Hyland C, Davis A, Condon J, Parsons K, Flower R: Blood Group genotype analysis of Australian reagent red blood cell donors across three genotyping platforms: consistent detection of 7.0% phenotype genotype non-concordance. ISBT Science Series 2014, 9(2):295-338.

McDonald C, Colebourne K, Faddy HM, Flower R, Fraser JF: Plasma selenium status in a group of Australian blood donors and fresh blood components. Journal of trace elements in medicine and biology: organ of the Society for Minerals and Trace Elements (GMS) 2013, 27(4):352-354. http://www.ncbi.nlm.nih.gov/pubmed/23890534

Milford EM, Reade MC, Shekar K, Tung JP, Fraser JF: An age-of-blood transfusion trial in the trauma setting is crucial and animal models may help inform trial design. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine 2014, 16(2):149-150. http://www.ncbi.nlm.nih.gov/pubmed/24888291

Milford EM, Tung JP, Reade MC: Letter: The need for a definitive clinical trial of cryopreserved red blood cells. The journal of trauma and acute care surgery 2014, 77(6):1004. http://www.ncbi.nlm.nih.gov/pubmed/25423546

Simonova G, Tung JP, Fraser JF, Do HL, Staib A, Chew MS, Dunster KR, Glenister KM, Jackson DE, Fung YL: A comprehensive ovine model of blood transfusion. Vox Sang 2014, 106(2):153-160. http://www.ncbi.nlm.nih.gov/pubmed/23992472

Scott SA, Nagl L, Tilley L, Liew YW, Condon J, Flower R, Hyland CA: The RHD(1227G>A) DEL-associated allele is the most prevalent DEL allele in Australian D- blood donors with C+ and/or E+ phenotypes. Transfusion 2014, 54(11):2931-2940. http://www.ncbi.nlm.nih.gov/pubmed/24894016

Stanworth SJ, Estcourt LJ, Powter G, Kahan BC, Dyer C, Choo L, Bakrania L, Llewelyn C, Littlewood T, Soutar R et al: A no-prophylaxis platelet-transfusion strategy for hematologic cancers. The New England Journal of Medicine 2013, 368(19):1771-1780. http://www.ncbi.nlm.nih.gov/pubmed/23656642

Tran HB, Ahern J, Hodge G, Holt P, Dean MM, Reynolds PN, Hodge S: Oxidative stress decreases functional airway mannose binding lectin in COPD. PloS one 2014, 9(6):e98571. http://www.ncbi.nlm.nih.gov/pubmed/24901869

Tsui NBY, Hyland CA, Gardener GJ, Danon D, Fisk NM, Millard G, Flower RL, Lo YMD: Noninvasive fetal RHD genotyping by microfluidics digital PCR using maternal plasma from two alloimmunized women with the variant RHD(IVS3+1G>A) allele. Prenatal Diagn 2013, 33(12):1214-1216. http://www.ncbi.nlm.nih.gov/pubmed/23999893

Tung JP, Bierman W, Knauth C, Flower RL, Dean MM: Divergent in vitro inflammatory responses to antibodies relevant to transfusion-related acute lung injury. Transfusion Medicine 2013, 23(s2):YS04.