| 1. |
- Auvinen, Marja-Kaisa, et al.
(författare)
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Patterns of blood use in Sweden from 2008 to 2017: A nationwide cohort study
- 2020
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Ingår i: Transfusion. - : WILEY. - 0041-1132 .- 1537-2995. ; 60:11, s. 2529-2536
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Tidskriftsartikel (refereegranskat)abstract
- Background Transfusion patterns in Sweden have not been characterized on a nationwide level. Study Design and Methods We conducted a nationwide descriptive cohort study in Sweden from 2008 to 2017. Data on blood donors, donations, component manufacture, transfusions, and transfused patients were extracted from Swedish portion of the Scandinavian Donations and Transfusions (SCANDAT3-S) database. Results A total of 708 436 patients received 5 587 684 red cell, plasma, or platelet transfusions during the study period. The age-standardized transfusion rate decreased markedly during the study period for red cell units (from 53 to 39 units/1000 persons) and plasma units (from 11 to 4.9 units/1000 persons), but remained relatively constant for platelet concentrates. The transfusion rate was 30%-40% higher in males than in females in the first year of life, and higher in males over 45 years than in females. Between age 20 and 45, the majority of red cells were transfused to female patients with obstetric indications, whereas trauma was the predominant indication for male contemporaries. In females over 80 years, the largest proportion of red cells were administered due to trauma. Overall, hematological patients received 36% of all platelet units. There were large regional differences in transfusion rates for red cell units, ranging from less than 30 to greater than 60/1000 persons. Conclusion Transfusion rates in Sweden remain high but have decreased strikingly during the study period - with the exception of platelet transfusions. Based on the available data, it is difficult to draw firm conclusions about whether transfusion rates can be further reduced.
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| 2. |
- Dahlén, Torsten, et al.
(författare)
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Adverse outcomes in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors : Follow-up of patients diagnosed 2002-2017 in a complete coverage and nationwide agnostic register study
- 2022
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Ingår i: American Journal of Hematology. - : Wiley. - 0361-8609 .- 1096-8652. ; 97:4, s. 421-430
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Tidskriftsartikel (refereegranskat)abstract
- Tyrosine kinase inhibitors (TKIs) have profoundly improved the clinical outcome for patients with chronic myeloid leukemia (CML), but their overall survival is still subnormal and the treatment is associated with adverse events. In a large cohort-study, we assessed the morbidity in 1328 Swedish CML chronic phase patients diagnosed 2002-2017 and treated with TKIs, as compared to that in carefully matched control individuals. Several Swedish patient registers with near-complete nationwide coverage were utilized for data acquisition. Median follow-up was 6 (IQR, 3-10) years with a total follow-up of 8510 person-years for the full cohort. Among 670 analyzed disease categories, the patient cohort showed a significantly increased risk in 142 while, strikingly, no category was more common in controls. Increased incidence rate ratios/IRR (95% CI) for more severe events among patients included acute myocardial infarction (AMI) 2.0 (1.5-2.6), heart failure 2.6 (2.2-3.2), pneumonia 2.8 (2.3-3.5), and unspecified sepsis 3.5 (2.6-4.7). When comparing patients on 2nd generation TKIs vs. imatinib in a within-cohort analysis, nilotinib generated elevated IRRs for AMI (2.9; 1.5-5.6) and chronic ischemic heart disease (2.2; 1.2-3.9), dasatinib for pleural effusion (11.6; 7.6-17.7) and infectious complications, for example, acute upper respiratory infections (3.0; 1.4-6.0). Our extensive real-world data reveal significant risk increases of severe morbidity in TKI-treated CML patients, as compared to matched controls, particularly for 2nd generation TKIs. Whether this increased morbidity may also translate into increased mortality, thus preventing CML patients to achieve a normalized overall survival, needs to be further explored.
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| 3. |
- Dahlén, Torsten, et al.
(författare)
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An agnostic study of associations between abo and rhd blood group and phenome-wide disease risk
- 2021
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Ingår i: eLife. - 2050-084X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are multiple known associations between the ABO and RhD blood groups and disease. No systematic population-based studies elucidating associations between a large number of disease categories and blood group have been conducted. Methods: Using SCANDAT3-S, a comprehensive nationwide blood donation-transfusion database, we modelled outcomes for 1,217 disease categories including 70 million person-years of follow-up, accruing from 5.1 million individuals. Results: We discovered 49 and 1 associations between a disease and ABO and RhD blood group, respectively, after adjustment for multiple testing. We identified new associations such as kidney stones and blood group B as compared to O. We also expanded previous knowledge on other associations such as pregnancy-induced hypertension and blood group A and AB as compared to O and RhD positive as compared to negative. Conclusion: Our findings generate strong further support for previously known associations, but also indicate new interesting relations.
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| 4. |
- Toss, Fredrik, 1984-, et al.
(författare)
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Short Term Health Outcomes Following Whole Blood Donation : A Nationwide, Retrospective Cohort Study
- 2021
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Ingår i: Transfusion. - : John Wiley & Sons. - 0041-1132 .- 1537-2995. ; 61:8, s. 2347-2355
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Tidskriftsartikel (refereegranskat)abstract
- Background: Blood donation is associated with a number of adverse events. Most of these are both uncommon and non-severe, leading to mild discomfort for the donor at worst. However, adverse events occurring outside of the donation facility have largely not been studied. In this study, we aim to further the understanding by performing the first large-scale analysis of short-term risks following whole blood donation.Methods: We set up a nationwide cohort of donors who donated whole blood between 1987 and 2018. Analyses were conducted using conditional logistic regression in a self-comparison design, where each donor was compared only to themselves, considering the 30-day risk of 16 outcomes following whole blood donation. Outcomes included cardiac/vascular diseases such as myocardial infarction, unspecified conditions such as fainting, accidents or external causes of injury, and death.Results: A total of 963,311 donors were included, 19,670 of whom experienced at least one of the outcomes within 30 days of a blood donation. For fainting and hypotonia we observed transient 2 to 5-fold risk increases on the day of donation and the subsequent 2–3 days. Importantly, the risk increase for the most pronounced effect corresponded to less than 1 additional events of fainting per 200,000 blood donations. Risks of all other outcomes were either unaffected or lower than expected right after blood donation.Discussion: To conclude, we found no evidence of new or unexpected short-term health effects after blood donation and confirmed that risks of hypotension-related events requiring hospital care are present but small.
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| 5. |
- Xu, Jingcheng, et al.
(författare)
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Ab initio calculations of elastic properties of Fe-Cr-W alloys
- 2014
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Ingår i: Computational materials science. - : Elsevier BV. - 0927-0256 .- 1879-0801. ; 84, s. 301-305
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Tidskriftsartikel (refereegranskat)abstract
- Reduced activation ferritic/martensitic (RAFM) steels are considered as the primary candidate for the blanket module in International Thermonuclear Experimental Reactor (ITER), and the basic composition of RAFM steels is Fe-Cr-W alloy. Using the exact muffin-tin orbitals method (EMTO) combined with coherent potential approximation (CPA), we investigated composition dependence of elastic properties for Fe-Cr-W random alloys in the composition range of 7.8-10.0 wt.% of Cr and 1.0-2.0 wt.% of W. Bulk modulus, shear modulus, Young's modulus, B/G ratio, and Poisson ratio are discussed as functions of ternary composition. The elastic moduli of Fe-Cr-W alloys increase with chromium content in the studied range of alloy compositions, the effect of tungsten is slight.
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| 6. |
- Zhao, Jingcheng, et al.
(författare)
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Blood use in hematologic malignancies : a nationwide overview in Sweden between 2000 and 2010
- 2018
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Ingår i: Transfusion. - : John Wiley & Sons. - 0041-1132 .- 1537-2995. ; 58:2, s. 390-401
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDPatients with hematologic malignancies receive large numbers of blood transfusions, and transfusion practices for this patient group are increasingly being scrutinized by randomized controlled trials. However, no studies so far have presented current transfusion statistics on a population level for this patient group. STUDY DESIGN AND METHODSA retrospective descriptive study was conducted that was based on the Scandinavian Donations and Transfusions Database (SCANDAT2), which includes data on all blood donations and transfusions in Sweden and Denmark since the 1960s. Incident cases of hematologic malignancies were identified in the Swedish Cancer Register between 2000 and 2010. Cases were divided into nine patient groups based on diagnosis. RESULTSA total of 28,693 patients were included in the cohort. Overall, the transfusion pattern varied depending on diagnosis and age. Patients with aggressive and acute diagnoses generally received more transfusions with immediate decline in transfusion incidence after diagnosis, whereas chronic diagnoses generally maintained more stable, but lower, transfusion incidence. In general, patients with leukemia received more transfusions than patients with lymphoma, and patients with acute leukemia as well as patients that had undergone allogeneic stem cell transplantations received the most transfusions. Within 2 years after diagnosis, patients with acute myeloid leukemia diagnosed at ages 0 to 65 years received on average between 30 to 40 red blood cell transfusions and platelet transfusions, respectively, corresponding to direct material costs close to 200,000 SEK (23,809 USD). CONCLUSIONResults from this population-based overview of blood use in hematologic malignancies showed high variability depending on diagnosis and age.
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| 7. |
- Zhao, Jingcheng
(författare)
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Bloody big data : ensuring the health of blood donors and transfused patients with health registers
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Blood transfusion is widely considered a pillar of modern medicine and is one of the most common medical interventions. A transfusion intimately links two persons and their health through the altruism of blood donors. In turn, this has necessitated the development of rigorous safety measures for both donors and recipients. Hemovigilance is the systematic surveillance of adverse events in the entire blood supply chain, stretching from blood donation to transfusion and follow-up care. Although transfusion safety has dramatically improved in recent decades, especially in regard to transfusion-transmitted infections, there are still evidence gaps for many aspects of blood donation and transfusion safety. This thesis explores several aspects of current controversies in both blood donation and transfusion safety and proposes a ‘big-data’ approach to hemovigilance with the use of data from electronic healthcare records and health registers, and provides a data-driven method for calculating longitudinal transfusion costs. In Study I, we constructed a new nationwide research database that encompasses all electronically recorded blood donations, transfusions, blood donors, transfused patients, and persons with a blood typing result in Sweden. The database is the Swedish portion of the third iteration of the Scandinavian Donations and Transfusions (SCANDAT3-S) database and contains data spanning from 1968 to 2018 for more than 8 million persons, over 21 million transfusion records, and over 300 million laboratory results. This database is one of the largest and most comprehensive research databases for blood donation and transfusion research and served as the main data source for the other studies in this thesis. In Study II, we followed up on studies that have observed CD4+ T-cell counts below 200 cells/μl, a level typically indicating AIDS, among frequent platelet donors. This is believed to be caused by frequent leukocyte depletion through the use of widely-used instruments equipped with so-called Leukoreduction System (LRS) chambers. However, it is unknown if this leads to clinically relevant immunosuppression. We conducted a nationwide cohort study of 74,408 platelet and plasmapheresis donors between 1996 and 2017 and observed an increased, donation frequency-dependent hazard ratio (HR) for both immunosuppression-related and common bacterial infections. For a subcohort, we replicated an association between donation frequency and low CD4+ T-cell counts. Together, these findings suggest that frequent platelet donation utilizing the LRS chamber is associated with both T-cell lymphopenia and an increased risk of infections. In Study III, we aimed to investigate possible transfusion-transmission of cerebral amyloid angiopathy (CAA). CAA is an amyloid-β pathology that co-occurs with Alzheimer’s disease in 80% of cases and is a common cause of multiple spontaneous intracerebral hemorrhages (ICH). Previous studies have demonstrated human-to-human transmission of CAA through peripheral injection of contaminated cadaveric pituitary hormone, but it is unknown if it is transmissible by blood transfusions. Because CAA is rarely diagnosed routinely and would not be frequently registered in health registers, we instead studied possible transfusion-transmission of spontaneous ICH suggestive of CAA. In a binational cohort study of 1,089,370 red-cell recipients between 1970 and 2017, patients that received blood from a donor that subsequently developed multiple spontaneous ICH were associated with an increased hazard ratio for developing spontaneous ICH themselves. This was observed independently in both the Swedish (HR, 2.73; 95% confidence interval [CI], 1.72 to 4.35) and Danish cohort (HR, 2.32; 95% CI, 1.04 to 5.19), after adjusting for known confounders. This association was not observed for ischemic stroke, which is associated with many of the same risk factors as spontaneous ICH but not with CAA. These findings support possible transfusion-transmission of CAA, but other explanations should not be rejected without further mechanistic studies. In Study IV, we assessed if blood donor sex and parity affected the survival of adult patients transfused with red-cells. Antibodies produced during pregnancy in blood donors have been associated with transfusion-related acute lung injury in recipients and led to the use of predominantly male donor plasma, in some regions also platelets. However, data on red-cell transfusions have been contradictory. Some, but not all, observational studies have found increased mortality among recipients of female donors, parous donors, and sex-mismatched transfusions. We conducted a nationwide study of 368,778 adult patients transfused with red-cells between 2010 and 2018. We demonstrated that donor sex and parity were distributed as-if randomized and constituted a natural experiment. However, female blood donors had lower hemoglobin counts and their units were less efficacious, creating a phenomenon known as treatment-confounder feedback that causes bias in standard regression models. Using inverse probability weighting to mitigate bias due to treatment-confounder feedback, we exploited the natural experiment to emulate a randomized controlled trial. We found no difference in 2-year overall survival comparing transfusions from female to male donor red-cells only (-0.1%; 95% CI, -1.3 to 1.1%) and parous female to male donor red-cells only (0.3%; 95% CI, -0.6 to 1.2%), nor in any subgroup defined by patient sex and age. Comparatively lower hemoglobin counts among female donors is a previously unrecognized source of bias and may help explain the diverging results from previous studies. In Study V, we calculated longitudinal transfusion costs for patients with myelodysplastic syndromes (MDS) stratified by disease severity defined using the Revised International Prognostic Scoring System (IPSS-R). Transfusion costs included the acquisition cost of blood products, labor costs for nurses, cost for consumables, and costs for laboratory testing. We constructed algorithms to calculate cost based on incident data on blood transfusions and laboratory testing. These algorithms accounted for whether transfusions were administered in an inpatient or outpatient setting, that the first transfusion requires longer administration time than subsequent transfusions, needs for cross-matching, and high patient mortality. In 2018 US dollars, transfusion costs after 4 years ranged from $8805 (95% CI, $6482 to $11,625) in the very low IPSS-R category to $80,106 (95% CI, $61,460 to $95,792) in the very high IPSS-R category.
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| 8. |
- Zhao, Jingcheng, et al.
(författare)
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Frequent platelet donation is associated with lymphopenia and risk of infections : A nationwide cohort study
- 2021
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Ingår i: Transfusion. - : John Wiley & Sons. - 0041-1132 .- 1537-2995. ; 61:2, s. 464-473
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recently, plateletpheresis donations using a widely used leukoreduction system (LRS) chamber have been associated with T-cell lymphopenia. However, clinical health consequences of plateletpheresis-associated lymphopenia are still unknown.Study Design and Methods: A nationwide cohort study using the SCANDAT3-S database was conducted with all platelet- and plasmapheresis donors in Sweden between 1996 and 2017. A Cox proportional hazards model, using donations as time-dependent exposures, was used to assess the risk of infections associated with plateletpheresis donations using an LRS chamber.Results: A total of 74 408 apheresis donors were included. Among donors with the same donation frequency, plateletpheresis donors using an LRS chamber were at an increased risk of immunosuppression-related infections and common bacterial infections in a dose-dependent manner. While very frequent donors and infections were rare in absolute terms resulting in wide confidence intervals (CIs), the increased risk was significant starting at one-third or less of the allowed donation frequency in a 10-year exposure window, with hazard ratios reaching 10 or more. No plateletpheresis donors that used an LRS chamber experienced a Pneumocystis jirovecii, aspergillus, disseminated mycobacterial, or cryptococcal infection. In a subcohort (n = 42), donations with LRS were associated with low CD4+ T-cell counts (Pearson's R = -0.41; 95% CI, - 0.63 to -0.12).Conclusion: Frequent plateletpheresis donation using an LRS chamber was associated with CD4+ T-cell lymphopenia and an increased risk of infections. These findings suggest a need to monitor T-lymphocyte counts in frequent platelet donors and to conduct future investigations of long-term donor health and for regulators to consider steps to mitigate lymphodepletion in donors.
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