Transfusion最新文献

{"title":"Massive transfusion practices and low-titer group O whole blood utilization before and after implementation in a low-volume level I trauma center: A six-year review.","authors":"Chinelo P Onyenekwu, Debra M Lehman, Brittany Trower, Paula Woywod, Joseph P Connor","doi":"10.1111/trf.70409","DOIUrl":"https://doi.org/10.1111/trf.70409","url":null,"abstract":"<p><strong>Background: </strong>Low-titer O whole blood (LTOWB) has been increasingly incorporated into trauma resuscitation and massive transfusion protocols (MTPs). Recent randomized trials have not demonstrated superiority of prehospital LTOWB over component-based resuscitation, while the utilization and sustainability of LTOWB programs, particularly in low-volume trauma systems, remain incompletely characterized.</p><p><strong>Study design and methods: </strong>This was a 6-year review (April 2019-April 2025) of trauma MTPs at a level 1 trauma center with a low MTP frequency. Transfusion service logs, trauma flowsheets, prehospital and electronic medical records were reviewed for product usage, LTOWB utilization and discard patterns, and clinical outcomes.</p><p><strong>Results: </strong>One hundred and twenty-five MTPs were identified (122 component-only and 11 LTOWB-supported), with predominantly male (70%) and 81% blunt trauma. Component MTPs had a median RBC utilization of 6 units; 45% required ≤1 MTP line. Prehospital LTOWB use was limited: 33% of units were transfused, and only 2 of 13 patients requiring an MTP received prehospital LTOWB. LTOWB-supported MTPs typically issued 10 units, and most patients received 1-2 units. Of 524 LTOWB units procured during the first 6 months, 201 were transfused and 323 discarded (62%), with a peak discard rate of 81% early in rollout. Overall, 30-day mortality was 54%, and 25% occurred within 4 h.</p><p><strong>Conclusions: </strong>LTOWB use was limited, and early wastage was substantial. LTOWB implementation in low-volume centers should align inventory and protocols with clinical demand; stewardship measures may reduce waste and improve sustainability.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064606","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 functionally distinct HPA-1a-specific alloantibody associated with fetal/neonatal alloimmune thrombocytopenia that activates platelets via FcγRIIa.","authors":"Huiying Zhi, Cathy Paddock, Daniel Villalobos-Garcia, Janita Oosterhoff, Heng Zhang, Gestur Vidarsson, Renren Wen, Jieqing Zhu, Debra Newman, Peter J Newman","doi":"10.1111/trf.70411","DOIUrl":"10.1111/trf.70411","url":null,"abstract":"<p><strong>Background: </strong>Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal alloantibodies directed against fetal platelet antigens, most commonly human platelet antigen-1a (HPA-1a). These antibodies mediate platelet destruction and can lead to fetal and neonatal thrombocytopenia severe enough to cause life-threatening organ bleeds. Antibody titer and isotype do not reliably predict disease severity, suggesting additional heterogeneity among anti-HPA-1a antibodies.</p><p><strong>Study design and methods: </strong>We evaluated the effects of five previously characterized HPA-1a-specific monoclonal antibodies (mAbs) on platelet activation, platelet aggregation, and induction of intracellular signaling. The involvement of FcγRIIa was examined using FcγRIIa-blocking antibody IV.3, protein tyrosine kinase inhibitors, and selected monoclonal antibody Fab fragments.</p><p><strong>Results: </strong>At saturating concentrations, all five mAbs inhibited thrombin-induced aggregation. At sub-saturating concentrations, however, mAb M-204 uniquely induced spontaneous aggregation and α-granule secretion in HPA-1a-positive human, but not mouse, platelets, which lack FcγRIIa. M-204-induced aggregation was abolished by mAb IV.3 and inhibitors of Src- and Syk-family kinases and was absent using M-204 Fab fragments. M-204 induced tyrosine phosphorylation of Syk and PLCγ2 in an FcγRIIa-dependent manner. Finally, despite persistent platelet activation induced by M-204, saturating concentrations of this antibody blocked the binding of the fibrinogen mimetic antibody, PAC-1, to HPA-1a homozygous, but not HPA-1a/1b heterozygous, platelets, consistent with the known ability of HPA-1a-specific antibodies to sterically interfere with ligand binding to HPA-1a-positive αIIbβ3.</p><p><strong>Conclusion: </strong>These findings identify a previously unrecognized, functionally distinct subset of HPA-1a antibodies capable of activating platelets via FcγRIIa, suggesting a potential mechanism contributing to variability in disease severity in FNAIT.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064631","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 missense variants in the RHAG gene that result in Rh^mod phenotype.","authors":"Youmna Al Halabi, Peter C Ligthart, Giulia Iacono, Barbera Veldhuisen, Nurcan Yagci, Ahmad Javadi, Kerly Fu, Marjan J Cruijsen, Ignace H J T de Hingh, Daan van de Kerkhof, Matthieu C J Bosman, Gestur Vidarsson, Ellen van der Schoot, Emile van den Akker","doi":"10.1111/trf.70366","DOIUrl":"https://doi.org/10.1111/trf.70366","url":null,"abstract":"<p><strong>Background: </strong>Identification of variants causing Rh deficiency phenotypes is important to allow safe transfusions and prevent hemolytic disease of the fetus and newborn. During preoperative screening for pseudomyxoma peritonei, a patient presented with suspicion of Rh-deficiency syndrome. The effect of these variants on the expression of Rh and Rh associated proteins was studied.</p><p><strong>Study design & methods: </strong>Serotyping, MLPA genotyping, and next-generation sequencing were performed on the RBCs of the proband and their family members. The effect of the variants on membrane expression of RhAG, Rh proteins, as well as Rh complex membrane proteins was evaluated using flow cytometry and western blot. Transient transfection experiments were conducted to assay the consequences of the RhAG variants on RhAG, RhD, and RhCE membrane expression.</p><p><strong>Results: </strong>Two novel missense variants in RHAG, RHAG:c.172C>T and RHAG:c.242G>A were identified resulting in an Rh^mod phenotype. The novel RHAG variants decreased RhAG expression with a concomitant reduction in expression of Rh proteins and CD47 while a slight increase in band3 expression was observed in the proband. A reduction of CD44 expression was also observed. Transfection of c.172C>T did not lead to a lower RhAG expression, while in contrast, expression of c.242G>A was significantly decreased compared to RhAGwt. Both led to a reduction of RhD and RhCE expression. Co-transfection of RHAGwt with c.172C>T or c.242G>A led to a significant reduction in RhD and RhCE expression.</p><p><strong>Conclusion: </strong>Two novel RHAG variants leading to Rh^mod phenotype were identified. A decrease in CD44 expression not previously associated with this phenotype was observed.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040801","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 commercialization of \"unvaccinated\" blood: A cross-sectional analysis of organizations marketing services based on donor COVID-19 vaccination status.","authors":"Jeremy W Jacobs, Garrett S Booth, Sheharyar Raza","doi":"10.1111/trf.70414","DOIUrl":"https://doi.org/10.1111/trf.70414","url":null,"abstract":"<p><strong>Background: </strong>Requests for blood from donors not vaccinated against COVID-19 persist despite evidence that donor vaccination does not affect transfusion recipients. We characterized organizations marketing services based on donor vaccination status.</p><p><strong>Study design and methods: </strong>We conducted a cross-sectional analysis of publicly available websites from organizations marketing access to unvaccinated blood. Between July 25 and July 26, 2026, we performed 30 prespecified Google searches in six languages and screened the first 50 results per query. We included organizations offering enrollment, paid access, documents, donor registration, matching, or assistance based on COVID-19 vaccination status. We coded geographic reach, payment, services, donor classification, diagnostic claims, blood handling, and operational limitations.</p><p><strong>Results: </strong>Eight organizations met inclusion criteria; four described international reach. All marketed an existing or planned donor registry or matching service, seven charged fees or offered paid access, six issued patient-facing documents, and seven advertised clinician directories, referrals, advocacy, or legal support. Donor status was classified through self-report, records, declarations, exemptions, social media screenshots, membership identification, or trust. One organization promoted unvalidated diagnostic tests. All depended on external clinicians, hospitals, or blood establishments; none described collecting, testing, processing, or storing blood components. Several acknowledged that matching was unavailable or not guaranteed or that hospital acceptance varied.</p><p><strong>Discussion: </strong>Organizations are monetizing vaccine misinformation by selling memberships, documents, donor registries, professional directories, and advocacy services. These products give vaccination status the appearance of a medically meaningful blood attribute and may channel unsupported directed donation requests to hospitals and blood establishments.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040837","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":"Approach to red cell transfusions and stem cell transplant in an alloimmunized sickle cell patient with hyperhemolysis history.","authors":"Sarah Tehseen, Georgina Martin, Akash Gupta, Victor Lewis","doi":"10.1111/trf.70358","DOIUrl":"https://doi.org/10.1111/trf.70358","url":null,"abstract":"<p><strong>Background: </strong>Patients with sickle cell disease (SCD) are highly predisposed to alloimmunization and severe hemolytic reactions. Hyperhemolysis, a transfusion reaction that causes destruction of transfused and autologous red cells, may occur without new red cell antibody production or with antibodies not considered clinically significant in SCD. Avoidance of transfusions is the key preventative strategy; however, transfusions are unavoidable for SCD patients undergoing hematopoietic stem cell transplant [HSCT]). This case outlines our approach for safe transfusions in an SCD patient undergoing HSCT.</p><p><strong>Case report: </strong>A 15-year-old alloimmunized SCD patient experienced hyperhemolysis after red cell exchange, requiring immune suppressive therapy and a delay in planned HSCT. To ensure safe red blood cell (RBC) transfusions in the peri-transplant period, the patient's humoral immune response was suppressed via Rituximab before pre-transplant red cell exchange. Additionally, the patient and sibling donor had RHD haplotype mismatch with recipient anti-D, which could predispose to delayed red cell engraftment and prolonged posttransplant transfusion requirements. Hence, we used a plasma cell-depleting agent (Daratumumab) pre-transplant. Early and close collaboration with the transfusion laboratory, national immunohematology reference laboratory, and the rare blood program facilitated the timely availability of compatible units via extensive serologic testing, use of monocyte monolayer assay, and donor RBC genotyping. The patient underwent pre-transplant red cell exchange with no hemolytic reactions and had minimal post-transplant transfusion requirements.</p><p><strong>Conclusion: </strong>Safe transfusions in SCD patients with hyperhemolysis undergoing HSCT require timely collaboration between laboratory and clinical services, careful selection of matched RBC units for transfusion, extensive serologic testing, and suppression of humoral immune response.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040737","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":"Global evaluation of cellular therapy processing facility medical director and laboratory director training: The BEST collaborative study.","authors":"Suzanne R Thibodeaux, Anh Dinh, Jo-Anna Reems, Richard Schäfer, Joseph Schwartz, Linda S Barnes, Phyllis Warkentin, David H McKenna","doi":"10.1111/trf.70369","DOIUrl":"https://doi.org/10.1111/trf.70369","url":null,"abstract":"<p><strong>Background: </strong>Cell processing facility accreditation requires Medical Directors and Laboratory Directors, but formal training pathways are not systematically delineated. This study provides information on cell processing facility Medical Directors and Laboratory Directors' role-specific education (RSE) worldwide.</p><p><strong>Study design and methods: </strong>Data collected on cell processing facilities included country, staff, regulatory and accreditation status, institutional affiliation, cellular therapy product types, and volume. Questions regarding Medical Directors included country, clinical specialty and subspecialty, year completed, and formal RSE. Laboratory Director questions included country and training focus, year completed, and formal RSE.</p><p><strong>Results: </strong>Surveys completed (n = 123) included Medical Directors (n = 70) and Laboratory Directors (n = 71) across 30 countries over 6 continents. Medical Directors reported 101 clinical specialties, and 72 clinical subspecialties, of which 34 (33.3%) and 39 (54.2%) included RSE, respectively. Laboratory Directors (n = 71) held MD (n = 20), PhD (n = 34), MD/PhD (n = 7), or other (n = 11) academic degrees. Laboratory Directors with MDs completed 42 clinical specialties and 27 clinical subspecialties, 15 (35.8%) and 13 (48.1%) of which included RSE, respectively. Six of 52 (11.5%) Laboratory Directors with graduate or other academic degrees (n = 52) included RSE. Role-specific educational experiences varied highly across all training programs. Notably, most responses for any given role and educational activity indicated no experience at all.</p><p><strong>Discussion: </strong>Standardized role-specific educational programs for cell processing facility Medical Directors and Laboratory Directors are lacking and, when present, are highly variable. Coordinated development of educational content and reciprocally acknowledged curricula and certificates could help standardize training for future cell processing facility leaders.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040810","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 FUT1 mutation c.268G>A (p.Gly90Ser) associated with the para-Bombay B blood phenotype.","authors":"Yang Li, Li Tian, Hao Yu, Yourong Fu, Changxin Shen","doi":"10.1111/trf.70380","DOIUrl":"https://doi.org/10.1111/trf.70380","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026137","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":"First-time blood donors experience less venipuncture pain than anticipated.","authors":"Johan O Wedin, Daphne Wu, Anders E Henriksson","doi":"10.1111/trf.70395","DOIUrl":"https://doi.org/10.1111/trf.70395","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the perceived pain associated with blood donation. This study aimed to investigate expected and perceived pain among first-time blood donors.</p><p><strong>Study design and methods: </strong>In this prospective observational study, 140 consecutive first-time blood donors (70 men and 70 women) were included. The donors were asked to grade the expected pain prior to their first whole blood donation and to grade the perceived pain after the procedure. The pain was graded using an 11-point Numerical Rating Scale (NRS) from 0 (no pain) to 10 (worst imaginable pain). The association between experienced pain and drop-out as a blood donor at 2 years was also investigated.</p><p><strong>Results: </strong>The mean age of first-time blood donors was 30.6 years, with no difference between men and women (31.2 vs. 30.0 years, p = .533). First-time blood donors significantly overestimated the venipuncture pain, with on average 1.16 units lower perceived (β = -1.16, t = -5.335, p < .001). Men reported both higher expected and perceived pain rates than women, but with no statistically significant interaction between pain discrepancy and sex (β = -0.41, t = -1.351, p = .179). In a multivariable logistic regression model, perceived pain was not associated with deregistration as a blood donor at 2 years.</p><p><strong>Conclusions: </strong>First-time blood donors experience significantly less pain than expected while donating blood. This knowledge should be used to reduce anxiety in first-time blood donors and profiled in donor recruitment campaigns to possibly increase the number of available blood donors.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017986","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":"Unexpected neonatal ABO discrepancy revealing ABO*cisAB.05 during routine cord blood testing.","authors":"Ali Ghais, Melissa Boileau, Anne-Marie Vincent, Remy Lamontagne, Marie-France Gagnon, Lambert Busque, Gabriel André Leiva-Torres, Nadia Baillargeon, Ahmad Ghais","doi":"10.1111/trf.70401","DOIUrl":"https://doi.org/10.1111/trf.70401","url":null,"abstract":"<p><strong>Background: </strong>An apparent AB blood group in a neonate born to a group O mother can raise diagnostic, transfusion, and parentage-sensitive concerns. CisAB alleles are rare ABO variants in which a single inherited allele encodes glycosyltransferase activity producing both A and B antigens. ABO*cisAB.05 is particularly uncommon, and its detection during routine neonatal cord blood testing has not, to our knowledge, been previously reported.</p><p><strong>Case report: </strong>A term female neonate born to a group O, RhD-positive mother and a group AB, RhD-positive father typed as AB, RhD positive on routine cord blood testing. The direct antiglobulin test was negative by gel but weakly positive by tube anti IgG, with anti-B in an acid eluate, providing serologic evidence of subclinical ABO incompatibility without clinically significant hemolysis. Repeat testing and reference laboratory evaluation reproduced an AB-like, RhD-positive phenotype, with 4+ reactivity to anti-A, anti-B, and anti-A,B reagents, anti-A1 lectin negativity, and anti-H lectin positivity graded as 2+. Because the result appeared discordant with the maternal group, identity and specimen concordance were evaluated first. Short tandem repeat analysis confirmed maternity and cord blood-buccal swab concordance. ABO exon sequencing identified an ABO*cisAB.05/ABO*O.01.01 genotype, explaining the discrepancy.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first ABO*cisAB.05 case identified through routine neonatal cord blood testing. A stepwise approach beginning with repeat serology and patient/specimen identity confirmation, followed by targeted molecular testing, can resolve the discrepancy while minimizing premature parentage-related conclusions and guiding safe transfusion planning.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017949","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":"Enabling a cord blood donor testing plan by comparing the test characteristics of two anti-cytomegalovirus tests.","authors":"Mei Yiep, Steven J Drews, Laura Battaglia, Matthew Seftel, Mitzi Estrada, Stacey Kawamura, Daniela Leto, Melanie Skakle, Ilona Resz","doi":"10.1111/trf.70406","DOIUrl":"https://doi.org/10.1111/trf.70406","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012795","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}