Transfusion最新文献

{"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}

{"title":"Drawing and storing whole blood using a 3D printed bottle cap and a disinfected 500 mL drinking bottle-A proof-of-concept study: Part 2.","authors":"Martin Rognhaug, Hanne Braathen, Håkon Skogrand Eliassen","doi":"10.1111/trf.18200","DOIUrl":"https://doi.org/10.1111/trf.18200","url":null,"abstract":"<p><strong>Background: </strong>Disruptions in supply chains during crises and wars necessitate innovative solutions for blood collection. This study evaluates the feasibility and safety of using a 3D-printed bottle cap (BC²L) with a standard 500 mL drinking bottle for whole blood collection as an alternative to traditional systems.</p><p><strong>Study design and method: </strong>We conducted a feasibility study with 20 healthy adult volunteers. Participants were randomized to donate blood into either the BC²L-drinking bottle setup (Test) or a conventional single blood collection bag (control). Blood samples were analyzed for hemolysis, bacterial contamination, and mechanical integrity immediately post-donation, and at 24 and 72 h. Donation time and donor safety were also assessed. Bacterial growth testing and hematological analyses followed sterile procedures to measure hematological quality.</p><p><strong>Results: </strong>Blood collection was completed within a mean time of 7 min across both groups. Hemolysis levels remained below clinically significant thresholds in both setups, and no bacterial contamination was observed. While the BC²L system demonstrated effective blood collection, minor leakage was noted in some bottles during transportation, attributed to the limitations of the 3D-printing process.</p><p><strong>Conclusion: </strong>The BC²L system represents a feasible, low-cost alternative for whole blood collection in resource-limited or crisis settings. It demonstrated comparable safety and mechanical integrity to standard systems. However, manufacturing refinements are needed to address leakage during transport. This study supports the potential of the BC²L as a valuable tool for enhancing medical preparedness in austere environments.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693376","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":"Identification of a novel variant (c.1-111A>G) located in GATA-1 motif of RHCE proximal promoter in two Chinese patients with the rare D-- phenotype.","authors":"Ran Zhang, Jizhi Wen, Changjiu Tang, Shuangshuang Jia, Qi Chen, Yanli Ji","doi":"10.1111/trf.18223","DOIUrl":"https://doi.org/10.1111/trf.18223","url":null,"abstract":"<p><strong>Background: </strong>D-- is a rare phenotype lacking the expression of the C, c, E, and e antigens and several high-frequency antigens on the red cells. Anti-Rh17 (Hr0) could be developed in individuals with the D-- phenotype to cause hemolytic transfusion reactions (HTR) and hemolytic disease of the fetus and newborn (HDFN). Nuleotide(s) change of the RHCE gene and RHCE-D-CE hybrid alleles are the common molecular basis of the D-- phenotype.</p><p><strong>Study design and methods: </strong>One D-- Chinese patient detected in routine RhD and RhCE serologic testing and another D-- Chinese patient identified with anti-Rh17 were recruited. Further RHD, RHCE, and RHAG whole gene sequences were analyzed using the PacBio sequencing. A dual-luciferase reporter assay was performed to verify the effect of the variant identified in the promoter of the RHCE gene on the transcriptional activity of the reporter gene in vitro.</p><p><strong>Results: </strong>A homozygous RHCE*Ce(1-111G)/Ce(1-111G) genotype and a heterozygous RHCE*CeN.08/Ce(1-111G) genotype carried one novel variant (c.1-111A>G) located in the GATA-1 motif of the RHCE proximal promoter was identified in two D-- patients, respectively. In the reporter assay, the luciferase transcriptional activity of the mutant RHCE promoter [c.1-111G] construct reduced from ~1.0 to 0.28 relative luciferase activity normalized to RHCE wild-type, with a ~72% reduction rate.</p><p><strong>Conclusion: </strong>The novel variant of the GATA-1 motif of the RHCE proximal promoter was identified to diminish the binding of the GATA-1 transcription factor and markedly down-regulate the transcription activity of the RHCE gene to abolish the expression of RhCE antigens, causing the rare D-- phenotype.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693377","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":"Analysis of time to death for children with life-threatening hemorrhage from traumatic, surgical, and medical etiologies.","authors":"Rachel P Vaizer, Christine M Leeper, Liling Lu, Cassandra D Josephson, Julie C Leonard, Mark H Yazer, Joshua B Brown, Philip C Spinella","doi":"10.1111/trf.18144","DOIUrl":"https://doi.org/10.1111/trf.18144","url":null,"abstract":"<p><strong>Introduction: </strong>Life-threatening hemorrhage (LTH) is a significant cause of mortality in pediatrics. Timing of mortality in children with LTH is important for future trials.</p><p><strong>Methods: </strong>In a secondary analysis of the prospective observational massive transfusion in children (MATIC) study, time-to-event analysis was performed to determine timing of death based on etiology of LTH and cause of death.</p><p><strong>Results: </strong>There were 449 children with LTH; the etiologies of LTHs included trauma (46%), operative (34%), and medical (20%). The cause of death at 24 h in the trauma group was 56% from hemorrhage and 42% from central nervous system (CNS) failure; in operative group it was 94% from hemorrhage and 6% CNS failure; in medical group it was 84% hemorrhage and 3% CNS failure. The median (interquartile range [IQR]) time to death (hours) varied by cause of death (hemorrhagic: 3.3 [1.0-10.3], CNS failure: 30.4 [9.0-63.6]). For traumatic LTH, 90% of hemorrhage-related deaths occurred within 19 h and 90% of CNS failure deaths occurred within 92 h. For operative LTH, 90% of hemorrhage-related deaths occurred within 5 days and 90% of CNS failure deaths occurred within 28 days. For medical LTH, 90% of hemorrhage-related deaths occurred within 44 h and 90% of CNS failure deaths occurred within 24 days.</p><p><strong>Conclusion: </strong>In children, timing of death differs according to etiology of LTH and by cause of death. The choice of primary outcome for trials in children with LTH should consider these differences based on the etiology of LTH being studied.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693373","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}