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":"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":"S320-S327"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","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":"Freeze-dried plasma: Hemostasis and biophysical analyses for damage control resuscitation.","authors":"Aron A Shoara, Kanwal Singh, Henry T Peng, Katy Moes, Jeong-Ah Yoo, Sahar Sohrabipour, Sanewal Singh, Rex Huang, Peter Andrisani, Chengliang Wu, Katerina Pavenski, Paul Y Kim, Bernardo Trigatti, Colin A Kretz, Ori D Rotstein, Shawn G Rhind, Andrew N Beckett","doi":"10.1111/trf.18124","DOIUrl":"10.1111/trf.18124","url":null,"abstract":"<p><strong>Background: </strong>Effective hemorrhage protocols prioritize immediate hemostatic resuscitation to manage hemorrhagic shock. Prehospital resuscitation using blood products, such as whole blood or alternatively dried plasma in its absence, has the potential to improve outcomes in hemorrhagic shock patients. However, integrating blood products into prehospital care poses substantial logistical challenges due to issues with storage, transport, and administration in field environments.</p><p><strong>Study design and methods: </strong>We utilized hemostatic assays and advanced biophysical techniques, such as calorimetry, infrared spectoscopy, dynamic light scattering, and biolayer interferometry, to compare the functional and structural properties of freeze-dried plasma (FDP; OctaplasLG Powder, Octapharma AB) with those of fresh plasma controls.</p><p><strong>Results: </strong>Hemostatic characterization of FDP revealed that clot formation properties and coagulation parameters were largely comparable to fresh plasma controls, with some variations observed in Von Willebrand factor-ADAMTS13 axis and fibrinolysis. No change to moisture content of FDP (~1% water content) was observed after 6-month storage at ambient conditions. Biophysical analyses of FDP during transfusion demonstrated spontaneous exothermic mixing of FDP in plasma, a dilution effect from saline, as well as comparable stability to plasma controls. Quantification of ligand-binding affinities of platelet receptors activated GPIIbIIIa and GPIbα showed comparable binding properties to plasma controls.</p><p><strong>Conclusion: </strong>Our results show that FDP exhibits hemostatic functionality and protein stability on par with fresh plasma, as assessed by novel, highly sensitive techniques. FDP therefore represents a viable alternative to conventional plasma in damage control resuscitation, offering significant logistical and storage advantages for prehospital and remote applications, especially in scenarios where whole blood is unavailable.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S250-S264"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"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":"S48-S56"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035994/pdf/","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":"OA","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":"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":"S219-S226"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","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":"Estimating the prevalence of preoperative iron deficiency and its impact on red blood cell transfusion in adolescents undergoing scoliosis surgery: A pilot study.","authors":"Annie Qiu, Daysha Fliginger, Yona Feit, Fthimnir Hassan, Lawrence G Lenke, Guohua Li, Eldad A Hod, Lisa Eisler","doi":"10.1111/trf.18246","DOIUrl":"10.1111/trf.18246","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency (ID) is the leading cause of anemia, contributes to reduced physical and cognitive performance, and increases the likelihood of red blood cell (RBC) transfusion in surgical patients. Adolescents undergoing scoliosis surgery are not routinely screened for ID, though they are at heightened risk of anemia and other adverse effects.</p><p><strong>Study design and method: </strong>Patients aged 11-18 years undergoing scoliosis surgery from September 2021 through August 2023 at our institution were approached for participation in a pilot study examining iron and hematologic parameters from the preoperative period through surgical recovery and their association with RBC transfusion.</p><p><strong>Results: </strong>Clinical and laboratory data were obtained from a convenience sample of 46 adolescents (33 females, 13 males), of whom 17.4% (8/46) were anemic and 33.3% (14/42) were iron deficient. ID was more common in female patients (p = .017). RBC transfusions were given in 10.9% (5/46) of patients, more often in those with ID than without (28.6% vs. 3.6%, respectively, p = .018). At a clinic visit several weeks after surgery, 50% (12/24) of patients tested were anemic, while 74% (17/23) had low iron stores.</p><p><strong>Conclusions: </strong>Findings from this pilot study suggest that ID is present in over 30% of adolescents undergoing scoliosis surgery and is associated with a greater likelihood of receiving an RBC transfusion, while most patients had low iron stores during surgical recovery. Larger studies are needed to confirm the extent to which preoperative ID impacts the likelihood of RBC transfusion and to evaluate the benefit of iron supplementation.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"851-857"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuing Medical Education.","authors":"","doi":"10.1111/trf.18239","DOIUrl":"https://doi.org/10.1111/trf.18239","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":"65 5","pages":"956"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102792","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":"\"War medicine\" The Battle for whole blood: 1943-1945 and beyond.","authors":"Emily Mayhew","doi":"10.1111/trf.18151","DOIUrl":"https://doi.org/10.1111/trf.18151","url":null,"abstract":"<p><p>This article aims to convey two particular statements of historical value for its readers. Firstly, it seeks to remind everyone with an interest in the history of the United States (US) Blood Program that the use of whole blood in the combat casualty care in this great military campaign was by no means certain. Secondly, it hopes to draw the attention of the readers of Transfusion to the very considerable efforts of their professional predecessors to record the process whereby whole blood did, eventually, become the standard of care. Compiled by the Army Historical Unit, the Official History of the US Army Medical Department in World War contains a number of volumes detailing what it summarizes as \"War Medicine.\" This official history devotes an entire volume to the subject of the Blood Program and its development of front line transfusion, as well as including supplementary material in other volumes where transfusion proved to be a crucial component in successful medical provision (such as the volume on Surgery). The editors and contributors had a clear understanding of the fundamental importance of the achievement of the blood program and were determined to reflect this in what would become their definitive work.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":"65 Suppl 1 ","pages":"S1-S3"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential military applications for a new freeze-dried plasma.","authors":"Anthony E Pusateri, Adam J Kishman, Mohamad Azlan Bin Ariffin, Sarah Watts, Emrys Kirkman, Richard B Weiskopf, Brendan S O'Brien, Sandy J Snyder, Sylvain Cardin, Ewell M Hollis, Oliver Hegener","doi":"10.1111/trf.18213","DOIUrl":"10.1111/trf.18213","url":null,"abstract":"<p><p>Hemorrhage is a leading cause of potentially preventable death in both military and civilian trauma. Current resuscitation approaches minimize crystalloids and emphasize plasma and other blood components to achieve a balanced transfusion as early as possible after injury. Owing to the nature of military operations, military medical systems must contend with great distances, degraded infrastructure, and harsh environments, as well as combat and humanitarian assistance and disaster relief (HADR) scenarios. These factors limit both patient movement and the ability to deliver blood products to the point of need. Current projections are that future military scenarios will have longer times to reach a medical treatment facility than experienced in recent conflicts, increasing the need for logistically efficient blood products. Freeze-dried plasma (FDP) is rapidly available, easy to use, and shelf-stable at room temperature, making it easier to deliver at the point of need in challenging military environments. For the past 30 years, FDP has been available in only a few countries. Where it has been available, it has become the preferred plasma for austere or military expeditionary settings. Recently, a new FDP, OctaplasLG Powder, was approved in 17 countries worldwide and for emergency use by the Canadian and United States militaries. It is expected that FDP will soon become available to many more militaries. This review discusses the importance of plasma, reassesses the potential military uses of FDP across the range of military operations, and provides a brief discussion of OctaplasLG Powder.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S240-S249"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781253","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":"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":"1001-1006"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","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":"PF4-dependent P-selectin expression assay in comparison to the heparin-induced platelet activation assay for the diagnosis of heparin-induced thrombocytopenia.","authors":"Romy T Meier, Anne-Tess Jolink, Michelle Kempe, Brian R Curtis, Suzanne Hofstede-van Egmond, Masja de Haas, Leendert Porcelijn, Rick Kapur","doi":"10.1111/trf.18242","DOIUrl":"10.1111/trf.18242","url":null,"abstract":"<p><strong>Background: </strong>Heparin-induced thrombocytopenia (HIT) is a severe complication characterized by thrombocytopenia and thrombosis. The presence of antibodies against heparin/platelet factor 4 (PF4) complexes is a key indicator for HIT. Diagnostic laboratory testing generally includes detection of anti-heparin/PF4 and/or functional testing such as the heparin-induced platelet activation assay (HIPAA). However, current functional tests are time-consuming and require specific technical skills. The PF4-dependent P-selectin expression assay (PEA) is a flow cytometry-based test that evaluates activation of donor platelets in the presence of HIT patient serum.</p><p><strong>Methods: </strong>We conducted the PEA with 23 patient sera that were positive in both the anti-PF4/heparin enzyme-linked immunosorbent assay (ELISA) and HIPAA and 26 sera that tested negative in the anti-PF4/heparin ELISA. We next compared the PEA to the HIPAA using a retrospective clinical cohort of 195 sera of suspected HIT patients and tested the reproducibility of the PEA.</p><p><strong>Results: </strong>The PEA was found to have a sensitivity of 73.9% and a specificity of 73.1% compared to the HIPAA. In our retrospective clinical cohort, we found that 74.4% (145 out of 195 samples) had identical results in both the HIPAA and PEA, with a specificity of 64.94% and sensitivity of 80.51% for the PEA compared to the HIPAA. Reproducibility testing of the PEA across three independent runs demonstrated consistent results in 83.3% (30 out of 36 samples).</p><p><strong>Discussion: </strong>These findings suggest that the PEA is a promising functional test for HIT laboratory diagnostics based on the relatively high sensitivity; however, further studies are needed to validate its clinical applicability.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"848-850"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796345","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}