Transfusion最新文献

{"title":"Directed donations for unvaccinated blood: A departure from evidence-based medicine associated with clinical harm, resource waste, and oversight gaps in a two-year single-center series.","authors":"Jeremy W Jacobs, Erika Hall, Toufik Tahiri, Princess Taylor, Chaitali Patel, Miriam Brown, Kaycie Atchison, Angela Mueller, Deva Sharma, Garrett S Booth","doi":"10.1111/trf.70195","DOIUrl":"https://doi.org/10.1111/trf.70195","url":null,"abstract":"<p><strong>Background and objectives: </strong>Requests for \"unvaccinated\" blood have been discouraged by professional and regulatory bodies because they lack scientific support and may negatively impact patient care. We describe a single-center series in which patients or surrogates refused standard blood components unless sourced from directed donors perceived to be \"unvaccinated.\"</p><p><strong>Materials and methods: </strong>We performed a retrospective review of directed donations received at Vanderbilt University Medical Center between January 1, 2024 and December 31, 2025. Data included demographics, clinical scenario, component details, and documented operational or clinical consequences.</p><p><strong>Results: </strong>Directed donor units were received for 15 patients; 13 of these patients were transfused at least one unit (n = 31 directed components: 22 red blood cell [RBC] units, 5 platelet units, 2 plasma units, 2 cryoprecipitate units). Median age was 17 years (range 0.33-73); nine patients were pediatric (<18 years). An ethics consultation was documented for one case, and a transfusion medicine consultation was documented for one case. Seven patients (47%) had at least one directed unit that was not transfused to them. Two patients clinically deteriorated in the setting of refusal of standard components, one of which also received a transfusion that deviated from institutional transfusion guidelines to avoid outdating, and two additional patients had surgical delay/cancellation with rescheduling associated with directed component availability.</p><p><strong>Conclusion: </strong>In this series, all directed units were from \"unvaccinated\" donors. These requests were associated with care delays, escalation, and inefficiencies. Health systems should implement standardized counseling, documentation, and escalation pathways consistent with existing guidance.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532980","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":"Elevating the standards of hypofibrinogenemia in trauma: Higher thresholds of admission fibrinogen predict mortality and organ dysfunction.","authors":"Justin Richards, Joseph Kufera, Mary Burgoyne, Deborah Stein, Rosemary Kozar","doi":"10.1111/trf.70200","DOIUrl":"https://doi.org/10.1111/trf.70200","url":null,"abstract":"<p><strong>Background: </strong>The precise thresholds at which admission fibrinogen predicts mortality and organ dysfunction in trauma patients are unknown.</p><p><strong>Study design and methods: </strong>Retrospective study at a single trauma center.</p><p><strong>Inclusion criteria: </strong>18-89 years, traumatic mechanism, transported from scene, and fibrinogen obtained within 30-min of arrival. Admission fibrinogen: <150, 150-199, 200-249, and ≥250 mg/dL.</p><p><strong>Primary outcome: </strong>28-day mortality. Multivariable logistic regression analysis described the risk of 28-day mortality by fibrinogen levels.</p><p><strong>Secondary outcomes: </strong>24-h mortality, acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS). The optimal threshold of admission fibrinogen associated with AKI and ARDS was determined. Results reported as odds ratio (OR) with 95% confidence interval (CI).</p><p><strong>Results: </strong>Two thousand five hundred and five patients included. Admission fibrinogen: 94 (3.8%) <150 mg/dL, 225 (9.0%) 150-199 mg/dL, 533 (21.3%) 200-249 mg/dL, and 1653 (66.0%) ≥250 mg/dL. Twenty-eight-day mortality occurred in 239/2505 (9.5%), and 114/2505 (4.6%) died within 24 h. Fibrinogen <150 mg/dL (OR: 11.86, 95% CI: 5.80-24.26; p < .001) and fibrinogen 150-199 mg/dL (OR: 2.20, 95% CI 1.22-3.96; p = .009) were associated with 28-day mortality. Admission fibrinogen <150 and 150-200 mg/dL were also associated with 24 h mortality. The optimal cutoff of fibrinogen and AKI was <238 mg/dL, which predicted AKI (OR: 2.45, 95% CI: 1.4-4.4). The optimal cutoff of fibrinogen and ARDS was <235 mg/dL, and predicted ARDS (OR: 1.9, 95% CI: 1.01-3.55).</p><p><strong>Conclusion: </strong>Admission hypofibrinogenemia <200 mg/dL is associated with 28-day and 24 h mortality in trauma patients. Admission fibrinogen is also a marker for post-traumatic AKI and ARDS.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532193","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 utilization during gene therapy for sickle cell disease: A single institution experience.","authors":"Ross M Fasano, Elizabeth M Cappello, Reuben P Jacob, Patricia E Zerra, Ann E Haight, Suhag Parikh, Elizabeth Stenger, Marianne E M Yee","doi":"10.1111/trf.70189","DOIUrl":"https://doi.org/10.1111/trf.70189","url":null,"abstract":"<p><strong>Background: </strong>Gene therapy (GT) is a transformative therapy for sickle cell disease (SCD) that requires transfusion support to suppress hemoglobin S (HbS) for hematopoietic progenitor cell (HPC) mobilization and autologous hematopoietic cell transplantation (HCT). Given the prevalence of red blood cell (RBC) alloimmunization in patients with SCD and recommendations to provide prophylactic minor antigen matching, knowledge of transfusion utilization and duration during the GT process is necessary for transfusion management.</p><p><strong>Study design and methods: </strong>We performed a retrospective review of transfusion utilization of all patients with SCD who received GT at our center through 2024. Transfusions were recorded for three time periods: (1) ≤120 days before first HPC collection, (2) time from first collection to HPC infusion, (3) HPC infusion to transfusion independence.</p><p><strong>Results: </strong>Nine patients received GT, 4 (44%) with RBC alloimmunization. One patient became alloimmunized (ant-Jk^a) during pre-HPC transfusion management. Four patients had 1 mobilization cycle, 5 patients had 2 cycles, with a median of 3 collection days (1-5). Median RBC transfusion utilization was 38 units (range 27-55): 15 units (9-27) for Period 1, 20 units (10-30) for Period 2, 6 units (4-9) for Period 3. Median platelet utilization was 13 units (7-31) in Period 3.</p><p><strong>Discussion: </strong>The transfusion support of patients with SCD during GT has unique considerations due to RBC transfusion requirements for HPC mobilization cycles. This single institution report will help support transfusion planning and decision making about the feasibility of transfusion support for patients with extensive RBC alloimmunization.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522189","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":"Development of anti-D in a severe delayed hemolytic transfusion reaction due to DAU3, a partial D variant allele.","authors":"Phuong-Lan Nguyen, Nicholas Tong, Hannah Bell","doi":"10.1111/trf.70191","DOIUrl":"https://doi.org/10.1111/trf.70191","url":null,"abstract":"<p><strong>Background: </strong>The Rh blood group system, of which RHD is the most notable, is one of the most clinically important red blood cell antigen groups next to ABO.</p><p><strong>Study design and method: </strong>In this case report, we describe a severe delayed hemolytic transfusion reaction caused by allo-anti-D in a patient with Sickle Beta Zero Thalassemia initially typed O RHD positive via standard serologic type and screen.</p><p><strong>Results: </strong>Further serologic testing revealed the development of an allo-anti-D, suggestive of a partial D phenotype. The patient was confirmed to carry the DAU3 allele using confirmatory molecular genotyping.</p><p><strong>Discussion: </strong>This case highlights the importance of timely identification and reporting of delayed transfusion reactions, especially in the context of prior sensitization events. Additionally, careful investigation of serologic patterns to identify partial D variants is important to optimize the clinical management of affected patients in the case of trauma, obstetrics, or operative care. We suggest the necessity of molecular testing in high-exposure patient populations to prevent adverse outcomes from unexpected allo-anti-D development.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504953","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":"Multiple consecutive daily therapeutic plasma exchange using exclusively albumin replacement fluid in low bleeding risk patients is associated with only rare and mild bleeds.","authors":"Jay S Raval, Joseph R Griggs, Andres E Mindiola Romero, Chelsea Reyes, Sarah Mertens, Cynthia Ornelas, Lizabeth Marinaro, Marian A Rollins-Raval","doi":"10.1111/trf.70159","DOIUrl":"https://doi.org/10.1111/trf.70159","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic plasma exchange (TPE) using exclusively albumin replacement fluid depletes coagulation factors, particularly fibrinogen, and concerns about performing multiple consecutive daily procedures due to iatrogenic bleeding exist. Fibrinogen testing to guide bleeding risk stratification is vague. We characterize our experience of changing our standard clinical practice by performing up to five consecutive daily TPE using exclusively albumin replacement fluid in conjunction with halting empiric coagulation testing (including fibrinogen testing) and fibrinogen supplementation.</p><p><strong>Methods: </strong>In this 5-year prospectively monitored experience, patients received 3-5 consecutive daily TPE using exclusively albumin replacement fluid. Patients with active bleeding, personal or family bleeding history, therapeutic anticoagulant or antiplatelet drugs, thrombocytopenia, or major interventional procedure within 24 h of TPE did not receive this updated treatment plan. Coagulation testing (including fibrinogen testing) was not ordered prior to any TPE. Events of interest were bleeding within 72 h after any TPE procedure.</p><p><strong>Results: </strong>Overall, 228 unique patients had a total of 264 treatment series with a total of 1351 TPE performed. Sixty-eight patients had 84 series, 101 patients had 116 series, and 59 patients had 64 series with 3, 4, and 5 consecutive daily TPE, respectively. Fourteen early and minor bleeds, predominantly central venous catheter-associated, occurred within 24 h after TPE and were mild (bleeding rate 1.4% per consecutive daily TPE and 6.1% per patient).</p><p><strong>Conclusions: </strong>Our findings indicate that patients with low bleeding risk receiving up to five consecutive daily TPE using exclusively albumin replacement fluid without empiric coagulation testing (including fibrinogen testing) or fibrinogen supplementation experience only rare and mild bleeds.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504973","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":"Using blood donor surveillance and clinical case data to shape our understanding of Babesia epidemiology in Manitoba, Canada.","authors":"Steven J Drews, Carmen L Charlton, Sandra Ramirez-Arcos, Craig Jenkins, Valerie Conrod, Laura Todd, Evan M Bloch, Paul Van Caeseele, Derek Stein, Lori Osmond, Mindy Goldman, Sheila F O'Brien, Chantale Pambrun","doi":"10.1111/trf.70179","DOIUrl":"https://doi.org/10.1111/trf.70179","url":null,"abstract":"<p><strong>Background: </strong>Babesia is a parasite transmitted by the Ixodes tick and has the potential to be transfusion transmitted. Climate change and changing Ixodes tick distributions in Canada raised questions about the impact of Babesia on the blood supply. Following a risk-based decision making (RBDM) process, Canadian Blood Services initiated a multi-year Babesia nucleic acid test (NAT) surveillance program in 2024. The first year of the project focused on a region (Manitoba, Canada) previously determined by the RBDM analysis to be of highest risk for Babesia NAT-positive donations. The aim of this study is to provide an update on this multi-year surveillance project that will shape our understanding of Babesia epidemiology in multiple Canadian provinces.</p><p><strong>Study design and methods: </strong>From July 11, 2024 to November 9, 2024, samples were collected in Roche Whole Blood Collection tubes at all whole blood donation sites in Manitoba. Specimens underwent one-time individual testing on the cobas Babesia NAT on the Roche cobas 6800 platform (Roche Diagnostics GmbH, Mannheim, Germany). Clinical cases of babesiosis were reviewed for the period 2013-2025.</p><p><strong>Results: </strong>Of the 13,608 (98%) whole blood donations tested by Babesia NAT, none were positive. Clinical case rates of babesiosis in Manitoba ranged from 0 to 0.13 per 100,000 population annually.</p><p><strong>Discussion: </strong>Changing climate and Ixodes tick distributions have led to concerns that the epidemiology of Babesia infection in Canadian blood donors is increasing. Babesia NAT on specimens from an elevated-risk area for Babesia infection in Canada did not identify Babesia-positive blood donors.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504967","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":"A novel intronic variant ABO*AW allele resulting in weak A expression.","authors":"Yujung Jung, Samantha Harris, Shelley Fletcher, Lay See Er, Sunitha Vege, June Fertes, Mohammad Alam, Moritz Stolla, Theresa Nester","doi":"10.1111/trf.70178","DOIUrl":"https://doi.org/10.1111/trf.70178","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504942","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 intron 1 variant c.28+5808C>T on an ABO*A1.01 background is associated with an A₃ phenotype.","authors":"Yongkui Kong, Huifang Jin, Di Zhu, Xiaoyan Zhang, Zhuanyun Du","doi":"10.1111/trf.70188","DOIUrl":"https://doi.org/10.1111/trf.70188","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487263","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":"A novel JK-null allele due to splicing variant.","authors":"Christophe Tournamille, Yann Fichou, Caroline Benech, Vintuya Muralitharan, Camille Levy, Evelyne Heng, Nathalie Bouly, Aline Floch","doi":"10.1111/trf.70181","DOIUrl":"https://doi.org/10.1111/trf.70181","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487201","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":"Zero transfusions, multiple interventions: Is Acute Normovolaemic Hemodilution solving a problem that no longer exists?","authors":"Apalak Garg, P Suganya, K Rajasekhar, Tanvi Sood","doi":"10.1111/trf.70184","DOIUrl":"https://doi.org/10.1111/trf.70184","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481600","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}