Transfusion最新文献

{"title":"Kaposi's sarcoma herpesvirus seroprevalence among blood donors in Uganda.","authors":"Tait Huso, Jodie L White, Dorothy Kyeyune, Angela D'Adamo, Nazzarena Labo, Wendell Miley, Ezra Musisi, Khan Moses, Ronnie Kasirye, Irene Lubega, Hellen Wambongo Musana, Priscilla Eroju, Mahnaz Motevalli, Raymond Goodrich, M Kate Grabowski, Thomas C Quinn, Paul M Ness, Heather A Hume, Henry Ddungu, Aggrey Dhabangi, Evan M Bloch, Mary Glenn Fowler, Philippa Musoke, Denise Whitby, Aaron A R Tobian","doi":"10.1111/trf.18236","DOIUrl":"https://doi.org/10.1111/trf.18236","url":null,"abstract":"<p><strong>Background: </strong>Kaposi's sarcoma herpesvirus (KSHV) causes a life-long infection that can progress to several types of KSHV-associated diseases. There is evidence for transfusion transmission of KSHV. In endemic regions, such as sub-Saharan African, KSHV seroprevalence is >40%. However, previous studies of blood donors utilized immunoassays that detect KSHV-associated disease-specific antigens, which may underestimate the true burden of KSHV in a healthy population.</p><p><strong>Study design and methods: </strong>We utilized samples from an on-going transfusion transmitted infection clinical trial to estimate the seroprevalence of KSHV among 4921 blood donations from healthy donors in Uganda collected between October 2019 and December 2022. A multiplexed bead-based assay was used to measure plasma IgG against five antigens encoded by the K8.1, K10.5, ORF73, ORF38, and ORF25 genes of KSHV. Significant associations between donor characteristics and seroprevalence were assessed by chi-square tests.</p><p><strong>Results: </strong>Overall, KSHV seroprevalence was 69.1%. Seroprevalence was higher in units collected from older donors compared with younger donors and male donors (71.9% [95% confidence interval (CI) = 70.4%-73.3%]) compared with female donors (61.3% [95% CI = 58.6%-64.0%]; p < .001). KSHV seroprevalnce was higher among units collected from donors positive for T. pallidum (82.5% [95% CI = 73.8%-89.3%]) compared with units collected from donors who were negative (68.8% [95% CI = 67.5%-70.1%]; p < .001). KSHV seroprevalence was higher in units that tested positive for HIV, HBV, or HCV, though these results were not statistically significant.</p><p><strong>Conclusion: </strong>Given the high seroprevalence and limited availability of lab assays that detect active KSHV infections, methods such as leukoreduction or pathogen reduction should be considered to potentially reduce the risk of transfusion transmission of KSHV.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinics and genetics of hyperhemolysis syndrome in patients with sickle cell disease.","authors":"Barbara Malta, Mina Cintho Ozahata, Isabel Cristina Gomes Moura, Luiz Amorim, Alessandra Ferraz, André Rolim Belisário, Carolina Miranda, Shannon Kelly, Brian Custer, Ester C Sabino, Carla L Dinardo","doi":"10.1111/trf.18232","DOIUrl":"https://doi.org/10.1111/trf.18232","url":null,"abstract":"<p><strong>Background: </strong>Hyperhemolysis syndrome (HHS) is a severe transfusion-related complication with a complex immune pathophysiology, primarily affecting individuals with sickle cell disease (SCD). Limited research has investigated the clinical and molecular risk factors for HHS, which could help identify at-risk patients. This study aimed to assess clinical factors associated with HHS and identify genetic variations that increase susceptibility using a candidate-gene approach.</p><p><strong>Methods: </strong>Data were obtained from the REDS-III SCD cohort, comprising 2793 patients who underwent whole-genome sequencing as part of the Trans-Omics for Precision Medicine (TOPMed) program. Clinical and laboratory data were retrospectively collected. Patients with HHS were compared to matched controls (1:4) based on clinical variables and the frequency of single nucleotide variations (SNVs) associated with HHS, autoimmunity, and red blood cell (RBC) alloimmunization.</p><p><strong>Results: </strong>HHS was identified in 13 patients (prevalence: 1.13%), the majority of whom had the HbSS genotype (69.2%). The most affected age group was 11-20 years (46.2%), and 61.5% of patients had RBC alloantibodies. Pain crisis was the most common indication for transfusion leading to HHS (41.7%). Three significant genetic variants were identified: rs10748663 (C > T) on chromosome 10 (BLNK gene), rs936469 (G > A) on chromosome 11 (PHRF1 gene), and rs6503691 (C > T) on chromosome 17 (STAT5B gene).</p><p><strong>Conclusion: </strong>HHS primarily affects adolescents and young adults with RBC alloantibodies, often following episodic transfusions. Genetic variations in STAT5B and the IRF7-PHRF1 region suggest that the B-cell receptor signaling pathway, which is essential for B-cell differentiation, may play a critical role in HHS pathophysiology.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion probability as an alternative measure of lab-guided medical decision-making.","authors":"Malcolm Risk, Jeannie Callum, Kevin Trentino, Kevin Murray, Lili Zhao, Xu Shi, Amol Verma, Fahad Razak, Sheharyar Raza","doi":"10.1111/trf.18235","DOIUrl":"https://doi.org/10.1111/trf.18235","url":null,"abstract":"<p><strong>Background: </strong>The clinical decision to transfuse is strongly influenced by laboratory results. Analysis of transfusion decision-making through pre-transfusion laboratory results (e.g. pre-transfusion hemoglobin) is a common yet misleading approach to studying transfusion practice.</p><p><strong>Study design and methods: </strong>We introduce \"Transfusion Probability\", an alternative method overcoming many limitations of pre-transfusion lab result analyses. Under this approach, we estimate the probability of transfusion after results at a specific value (e.g. hemoglobin 7.4 g/dL) or in a range of values (e.g. 7.0-7.9 g/dL) using the proportion of tests followed by transfusion. We provide a comprehensive methodology for causal inference on the effect of patient characteristics and other variables of interest.</p><p><strong>Results: </strong>Analyses using pre-transfusion and transfusion probability were compared through a retrospective cohort study of hospitalized patients (N = 525,032). We found red blood cell transfusion probabilities of 76.2% in the 6.0-6.9 g/dL, 18.9% in the 7.0-7.9 g/dL, and 4.5% in the 8.0-8.9 g/dL hemoglobin ranges. After confounder adjustment, gastrointestinal bleeding patients were more likely to be transfused, with risk differences ranging from 6.6% in the 8.0-8.9 g/dL range to 13.8% in the 6.0-6.9 g/dL range. Pre-transfusion hemoglobin results showed minimal differences between gastrointestinal bleeding patients and other patients in unadjusted (0.00 g/dL) and adjusted analyses (-0.03 g/dL).</p><p><strong>Discussion: </strong>In contrast to pre-transfusion result analysis, transfusion probability offers a nuanced account of transfusion practice and natural comparisons between patient groups. Wider use of our approach can provide actionable insights for clinical decision-making.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of non-qualifying umbilical cord blood units to support research and quality assurance by the Canadian Blood Services Cord Blood Bank.","authors":"David S Allan, Matthew D Seftel, An Duong, Harinad Maganti, Kathy Ganz, Nicholas Dibdin, Meagan Green, Jennifer Laycock, Subh Sarkar, Charlene Ropp, Tanya Petraszko, Jelena L Holovati","doi":"10.1111/trf.18231","DOIUrl":"https://doi.org/10.1111/trf.18231","url":null,"abstract":"<p><strong>Background: </strong>Umbilical cord blood units collected by Canadian Blood Services for public banking at selected collection hospitals may not meet stringent criteria for release to the bank's inventory and can be used to support research. The Cord Blood for Research Program (CB4RP) was established when the CBS bank was established, but the breadth of research activity supported by the CB4RP has not been previously described.</p><p><strong>Methods: </strong>Records of projects and units requested to support research were reviewed and summarized from September 2014 to October 2024.</p><p><strong>Results: </strong>A total of 34 projects have been supported by the CB4RP, with a total of 2901 units requested (85.4 units per project, range 6-540). To date, 1505 fresh units and 28 frozen units have been shipped to researchers. Areas of research supported by the CB4RP include hematopoietic cell transplant research, regenerative therapy, immunology research, cancer research, transfusion research, and other categories.</p><p><strong>Conclusion: </strong>Distributing non-qualifying cord blood units for research leverages the public investments implicated in establishing the CBS CBB and supports the development of expertise across a broad range of research areas.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of red blood cells storage duration on the development of acute kidney injury: A secondary analysis of the TRANSFUSE multicenter randomized controlled trial.","authors":"Cécile Aubron, Elizabeth M Moore, Bridget Ady, Eldho Paul, Maija Kaukonen, Lynne Murray, Jonathan Barrett, Matthew Bailey, Timothy Bowles, Sean Kelly, Claire Cattigan, David Cooper, David Ernest, David Evans, Jason Fletcher, Craig French, David Gattas, Dhaval Ghelani, Seton Henderson, Alex Kazemi, Bruce King, Peter Kruger, Janet Liang, Christopher MacIsaac, Colin McArthur, Alistair Nichol, Sandra Peake, Michael C Reade, Brent Richards, John Santamaria, Paul Young, Michael Bailey, Rinaldo Bellomo, D James Cooper, Zoe K McQuilten","doi":"10.1111/trf.18230","DOIUrl":"https://doi.org/10.1111/trf.18230","url":null,"abstract":"<p><strong>Background: </strong>Red blood cell (RBC) transfusion is associated with an increased risk of acute kidney injury (AKI). The extent to which RBC storage affects this association is unclear. We aimed to evaluate the association between storage duration and the occurrence or worsening of any degree of AKI in critically ill patients.</p><p><strong>Study design and methods: </strong>In this pre-planned sub-study of the Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) trial, which compared mortality of critically ill patients receiving either the freshest available allogenic RBC unit or standard availability RBC, patients hospitalized in one of the 31 participating sites and who did not have Stage 3 AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) classification were eligible. The primary outcome was the cumulative proportion of patients who developed any degree of new AKI.</p><p><strong>Results: </strong>A total of 899 patients were included. The mean (SD) RBC storage duration was 22.4 (7.4) versus 11.9 (5.4) days in the standard issue RBC and short-storage RBC groups, respectively (p < 0.01). The percentage of patients who developed any stage of new AKI was similar between groups (24.8% in the standard issue RBC group versus 26.1% in the short-storage RBC group; p = 0.66) (Relative Risk 0.95, [95% confidence intervals 0.76-1.19]). There was no difference in secondary outcomes.</p><p><strong>Discussion: </strong>In this pre-planned sub-study of the TRANSFUSE trial, compared with using standard issue RBC, the transfusion of the freshest available RBC was not associated with a decrease in AKI.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O blood usage trends in the pediatric population 2015-2019: A multi-institutional analysis.","authors":"K Annen, S Andani, G Bosma, D Abbott, S Arinsburg, F Nguyen, N Ibeh, K Nicol, P Hernandez, R Jackups, M Delaney, B Bahar, Y Mo, B Alexander, D K Noland, T E Wong, J Andrews","doi":"10.1111/trf.18225","DOIUrl":"https://doi.org/10.1111/trf.18225","url":null,"abstract":"<p><strong>Background: </strong>In 2019, AABB released the bulletin \"Recommendations on the Use of Group O Red Blood Cells\" in which the recommendations about pediatric and neonatal blood transfusions were limited. Eight U.S. pediatric hospitals sought to determine trends in pediatric group O blood use and clarify which pediatric populations receive group O blood transfusions despite a non-group O blood type.</p><p><strong>Study design and methods: </strong>Eight U.S.-based institutions serving a pediatric population provided data from their respective Electronic Health Records. Data submitted included unit blood type, patient blood type, patient age, sex, and discharge diagnosis. If the discharge diagnosis was not available, the admitting diagnosis was substituted. GPT-4 was used to sort diagnoses into categories for analysis. Data were visualized using a series of alluvial plots, spaghetti plots, and tables. Tables were stratified on variables of interest (blood type, age, sex, diagnosis) to explore O blood type distribution among different patient populations.</p><p><strong>Results: </strong>A total of 142,227 discrete transfusion events were identified, of which 52,731 recipients were non-O blood type. Overall, 35,575 transfusion events of O blood went to A, B, or AB blood type recipients (67%). Additionally, 26% of Rh(D) negative transfusion events went to recipients who were Rh(D) positive. Top diagnostic categories for receiving O blood type were cardiovascular disorders (22%) and sickle cell anemia (15%).</p><p><strong>Discussion: </strong>This study highlights opportunities to address O blood supply challenges by identifying where non-O blood may be utilized safely in the vulnerable pediatric population.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I do it: An institutional protocol for the management of RhD negative women who receive RhD positive blood.","authors":"Rahaf Alkhateb, Kirea Mazzolini, Vipulkumar Pravinbhai Prajapati, Chantal Harrison, Kayla E Ireland, Donald Jenkins, John Daniels, Leslie Greebon","doi":"10.1111/trf.18181","DOIUrl":"https://doi.org/10.1111/trf.18181","url":null,"abstract":"<p><strong>Background: </strong>RhD alloimmunization can result from blood transfusion or fetomaternal hemorrhage (FMH). Preventing alloimmunization in childbearing-age women with FMH via utilization of RhD immunoglobulin (RhIG) is well known; however, there are no established protocols for RhD-mismatched transfusions in emergent or traumatic settings. Here, we describe our hospital protocol for managing RhD negative women who receive RhD positive transfusions.</p><p><strong>Design: </strong>Pathology or Transfusion Medicine staff are notified of RhD-mismatched blood transfusions. Women with childbearing potential are evaluated by Obstetrics and Gynecology (ObGyn) to determine patients' childbearing desires and physical capabilities, as well as their ability to tolerate RhIG administration. Pathologists determine eligibility for therapy with RhIG: criteria include RhD negative females, ≤50 years old, without current or historical Anti-D, who have been transfused <20% of their total blood volume (TBV) with RhD positive blood.</p><p><strong>Results: </strong>Management strategy depends on red blood cell volume (RBCv) transfused. Patients who receive an RBCv ≤20% of their TBV are eligible to receive RhIG, while an RBCv >20% makes individuals ineligible for prophylaxis with RhIG. Red cell exchange (RCX) is not offered at our institution, regardless of RBCv transfused. Women who receive RhIG should be screened for the development of antibodies using direct and indirect antiglobulin tests for 6-12 months posttransfusion. Future pregnancies of alloimmunized women should be carefully monitored.</p><p><strong>Conclusion: </strong>Our therapeutic plan involves identifying eligible patients based on set criteria. This is the first published protocol to prevent RhD alloimmunization in females of childbearing age due to RhD-mismatched transfusions.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating reimbursement for prehospital blood transfusions: A nationwide survey.","authors":"Timothy Hurson, Randall Schaefer, Christine Carico, Russell Griffin, Eric Bank, Jon Krohmer, Donald Jenkins, John Holcomb, Zain Hashmi","doi":"10.1111/trf.18217","DOIUrl":"https://doi.org/10.1111/trf.18217","url":null,"abstract":"<p><strong>Background: </strong>Prehospital blood transfusion improves survival among patients in hemorrhagic shock but remains underutilized, in part due to financial barriers. However, little is known about how prehospital blood transfusion programs are reimbursed. The objective of this study is to determine the percentage of prehospital blood transfusion programs that receive reimbursement, the percentage of patients receiving blood who were public health insurance-eligible (pediatric and geriatric patients), and the most common reason for blood transfusions in these populations.</p><p><strong>Study design and methods: </strong>An electronic survey was administered to Emergency Medical Services agencies with an active blood transfusion program in 2024.</p><p><strong>Results and discussion: </strong>Of the 53/150 agencies who responded to the survey, only 6 (11%) agencies reported receiving reimbursement for prehospital blood transfusions. However, 53 (100%) agencies reported transfusing geriatric patients, and 43 (81%) agencies reported transfusing pediatric patients, both groups that are eligible for public health insurance. Medical emergencies were the most common indications for transfusion in geriatric patients, whereas blunt and/or penetrating injuries were the primary indications for transfusion in pediatric patients. For most agencies, geriatric and pediatric patients were frequent recipients of blood transfusions, each comprising up to 50% of the total transfusions administered.</p><p><strong>Conclusion: </strong>Many patients who receive prehospital blood transfusion are public health insurance-eligible. Health policy changes to enable government reimbursement for prehospital blood transfusions would provide critical financial support for this life-saving intervention.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes on the use of hyperhemolysis prophylaxis in pediatric sickle cell disease patients with history of hyperhemolysis syndrome.","authors":"HyoJeong Han, Lisa Hensch, In Lei, Titilope Fasipe, Jun Teruya, Shiu-Ki Rocky Hui","doi":"10.1111/trf.18227","DOIUrl":"https://doi.org/10.1111/trf.18227","url":null,"abstract":"<p><strong>Background: </strong>Hyperhemolysis syndrome (HS) is a rare but severe transfusion-associated complication seen in patients with sickle cell disease (SCD). The management of HS includes avoidance of post-hyperhemolysis red blood cell (RBC) transfusion to avoid reoccurrence of HS (recurrent HS). However, complete avoidance of post-hyperhemolysis RBC transfusion (PHRT) is sometimes not clinically possible, and the standard of care for recurrent HS prophylaxis for patients requiring PHRT has not been established.</p><p><strong>Case report: </strong>We present a retrospective case series of four pediatric patients with SCD and a history of HS requiring PHRT, and describe their HS prophylaxis and outcomes. All patients received HS prophylaxis before transfusion, and three patients received an additional prophylactic regimen post-transfusion. Three patients were transfused with extended phenotype-matched RBCs, while one patient received only Rh (D, C/c, E/e) and K antigens matched RBCs. Only one patient did not develop recurrent HS after PHRT. Three patients had documented hemolysis, and two patients met our criteria for recurrent HS, all requiring escalation of care.</p><p><strong>Discussion: </strong>Even though the patients were treated in the same institution, there was variability in the choice of HS prophylaxis therapy and selection of RBCs, which can be attributed to the lack of guidance on PHRT management. We observed a lack of conclusive evidence in the effectiveness of prophylactic combination immunosuppressive therapy. Our observations suggest caution must be taken when transfusing patients with SCD and a history of HS, as there are no definitive therapies to effectively mitigate the risk of recurrent HS.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of oxygen extraction rate changes following red blood cell transfusion in the intensive care unit: A prospective observational noninterventional study.","authors":"Ahmet Salih Tüzen, Murat Aksun, Atilla Şencan, Senem Girgin, Birzat Emre Gölboyu, Gizem Kırbaş, Ozan Şanlı","doi":"10.1111/trf.18164","DOIUrl":"https://doi.org/10.1111/trf.18164","url":null,"abstract":"<p><strong>Background: </strong>The decision-making process for red blood cell transfusion (RBCT) in critically ill patients in the intensive care unit (ICU) remains primarily guided by hemoglobin-based thresholds. However, as a component of personalized medicine, innovative and individualized criteria should be developed to optimize RBCT decisions. This study aims to assess the impact of RBCTs on oxygenation parameters and patient outcomes, with a specific focus on the oxygen extraction ratio (O₂ER).</p><p><strong>Study design and methods: </strong>This prospective observational study included 77 critically ill patients receiving RBCTs according to ICU transfusion protocols. The primary hypothesis is that patients with an O₂ER > 0.30 will benefit most from RBCTs. To investigate this, patients receiving RBCTs were divided into two groups: those with O₂ER > 0.30 (RBCTs appropriate) and those with O₂ER ≤ 0.30 (RBCTs appropriateness questionable). The two groups were compared in terms of primarily O₂ER, other oxygenation parameters, and clinical outcomes. The primary outcome was the change in O₂ER following RBCTs, while secondary outcomes encompassed other oxygenation parameter changes.</p><p><strong>Results: </strong>The O₂ER > 0.30 group showed significant improvement in O₂ER (0.38 ± 0.04 vs. 0.32 ± 0.05; p < .001), whereas no such improvement was observed in the O₂ER ≤ 0.30 group (0.26 ± 0.03 vs. 0.28 ± 0.05; p: .017). Additionally, the O₂ER > 0.30 group exhibited improvements in central venous oxygen saturation (ScvO₂) following RBCTs, which were not seen in the O₂ER ≤ 0.30 group.</p><p><strong>Discussion: </strong>Our study reveals promising insights into the impact of RBCTs on O₂ER; however, these physiological changes did not result in significant clinical improvements. Hence, this study provides a rational basis for the feasibility of implementing a personalized strategy focused on physiological triggers for RBCTs.</p><p><strong>Trial registration number: </strong>NCT05798130 (https://clinicaltrials.gov/study/NCT05798130).</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}