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.
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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
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