Transfusion最新文献

{"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}

{"title":"Finger thoracostomy: Significant risks and unproven benefits in prehospital settings.","authors":"Yael Mozer-Glassberg, Irina Radomislensky, Avi Benov, Ofer Almog","doi":"10.1111/trf.18198","DOIUrl":"https://doi.org/10.1111/trf.18198","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of preventable death, with a significant portion of trauma deaths occurring in the prehospital setting. Interventions such as chest drainage may play a critical role in managing life-threatening conditions but face challenges due to poorly defined indications and reliance on anecdotal evidence rather than rigorous studies. Among chest drainage techniques, finger thoracostomy (FT) is a well-described, but controversial, method for decompressing the pleural cavity in emergencies like tension pneumothorax or hemothorax. Despite its simplicity and minimal equipment requirements, FT carries risks, including bleeding, infection, organ injury, temporary effects, and procedural failure.</p><p><strong>Study design and methods: </strong>This study examines eight FT procedures performed by Israel Defense Forces providers during the 2023-2024 \"Swords of Iron\" War in Gaza.</p><p><strong>Results: </strong>All patients sustained severe penetrating injuries, with mixed outcomes. One case highlighted severe complications, including infection and empyema weeks later. Additionally, challenges in maintaining up-to-date knowledge and adherence to protocols among reservists led to unauthorized FT procedures, emphasizing the dangers of improvisation without evidence.</p><p><strong>Discussion: </strong>Our findings, coupled with limited evidence for FT's effectiveness in prehospital settings, raise questions about its appropriateness in trauma care. These concerns highlight the critical importance of adhering to validated and evidence-based protocols in all aspects of medical practice. Deviating from such protocols not only introduces unnecessary risks but also undermines the standardization essential for optimal patient care. Further research is needed to clarify the role, if any, of FT in prehospital trauma management.</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":"143711401","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":"Novel anticoagulant-preservative solution maintained the hemostatic function of cold stored whole blood for 56 days.","authors":"K M Reddoch-Cardenas, J A Cancelas, S Nestheide, N Rugg, K Peña, C S McIntosh, J Ferdin, J Talackine, J Parker, L A Jensen, R Gonzales, J R Hess, M Zia","doi":"10.1111/trf.18207","DOIUrl":"https://doi.org/10.1111/trf.18207","url":null,"abstract":"<p><strong>Background: </strong>Whole blood (WB) is an efficient product for field medical resuscitation because of its unitary composition, tolerance for storage on ice and in field refrigerators, and simplicity of use. We measured quality parameters of a novel 8-week WB storage system.</p><p><strong>Study design and methods: </strong>Here, 500 mL of WB from healthy donors was collected in 70 mL of CPDA-1, leukoreduced with a platelet-sparing filter, pooled into ABO-compatible two-unit pools, and split into matched pairs of equal volume designated as Test or Control units. Test units received an additional 50 mL of a novel WB preservative solution (APEX units, Hemerus Medical, St Paul, MN). A total of 15 paired WB units were evaluated at Day 0 (D0) and periodically up to Day 56 (D56) of storage at 1-6°C across two centers. Quality testing included cellularity, ATP concentrations, hemolysis, blood gases, metabolites, coagulation factor levels, thromboelastography (TEG), and bacterial culture.</p><p><strong>Results: </strong>At D56, APEX units displayed higher RBC ATP concentration (3.14 vs. 2.18 μmol/gHb, p = 0.001), pH (6.53 vs. 6.50, p = 0.01), and higher bicarbonate reserve (8 vs. 5.4, p < 0.0001). D56 APEX units had greater platelet contribution to TEG clot strength (p < 0.01) and better preservation of red cell ATP (p < 0.001). Activities of fibrinogen, factor VIII, factor V, and protein S activity in APEX units remained within the reference levels on D56. No bacterial contamination was detected at the end of storage.</p><p><strong>Discussion: </strong>These findings suggest that APEX preserves RBCs effectively and maintains platelet and plasma coagulation functions for up to 56 days.</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":"143711383","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":"Exchange transfusion and pre-filter apheresis dilution for hyperviscosity syndrome refractory to conventional therapeutic plasma exchange in a patient with IgA multiple myeloma.","authors":"Anthony Valin-Thorburn, Sara-Maude Desforges, Daniel Corsilli, Jean-Gilles Guimond, Jean-Philippe Adam, Antonio Maietta, Bertrand Routy, Anne-Sophie Lemay","doi":"10.1111/trf.18188","DOIUrl":"https://doi.org/10.1111/trf.18188","url":null,"abstract":"<p><strong>Background: </strong>Significant serum paraprotein elevation leading to hyperviscosity syndrome (HVS) is a rare but serious medical complication that has been well documented in patients with hematological malignancies, including multiple myeloma and Waldenström's macroglobulinemia. This condition can result in severe neurological, renal, and cardiac complications. Standard management of symptomatic HVS includes therapeutic apheresis and the prompt initiation of chemotherapy. Although usually successful, apheresis failure due to extreme hyperviscosity has been documented.</p><p><strong>Case report: </strong>A 73-year-old Caucasian male with neurological symptoms of HVS secondary to IgA monoclonal gammopathy was transferred to our institution for urgent therapeutic plasma exchange (TPE) and HVS management. Due to severe hyperviscosity, it was impossible to obtain blood analysis, and several attempts at standard TPE failed due to clogging in the apheresis tubing. In this life-threatening situation, manual blood exchanges were successfully performed, followed by pre-filter apheresis dilution. This unconventional approach proved to be effective, allowing subsequent laboratory analysis and the continuation of conventional TPE procedures. The patient remained hemodynamically stable throughout the procedure and was subsequently started on definitive chemotherapy treatment.</p><p><strong>Conclusion: </strong>This case highlights the importance of prompt recognition of HVS in patients presenting with hematological malignancies. The use of manual exchange transfusion, in conjunction with pre-filter dilution, enabled the successful management of a patient with severe HVS in whom conventional TPE was not possible, illustrating an effective alternative approach in urgent hematological care. It also emphasizes the importance of initiating systemic treatment rapidly for the underlying hematological condition to ensure sustained improvement and prevent recurrence of HVS.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701547","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}