Transfusion Medicine最新文献

{"title":"Prioritising parameters to minimise blood transfusions for postpartum haemorrhage: A machine learning study using national population data.","authors":"Ki Hoon Ahn, Yu-Min Choi, Kwang-Sig Lee","doi":"10.1111/tme.70097","DOIUrl":"https://doi.org/10.1111/tme.70097","url":null,"abstract":"<p><strong>Background: </strong>Postpartum haemorrhage (PPH) accounts for approximately 27% of maternal deaths worldwide and often requires blood transfusion, along with its associated risks. In resource-rich settings like South Korea, transfusion disparities persist, highlighting the need for predictive tools to optimise patient blood management (PBM).</p><p><strong>Objective: </strong>To apply machine learning (ML) to rank predictors of transfusion in PPH using national claims data.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 123 763 women with PPH (2017-2019) from the National Health Insurance Service (NHIS) database (97% population coverage) in South Korea. The dependent variable was transfusion (yes/no). We used 48 independent variables (demographics, obstetric status, medications and comorbidities) derived from ICD-10/ATC codes. The random forest model (100 trees, Gini standard impurity criterion) was trained with 80% of the data and validated with 20% of the data after random split (area under the receiver operating characteristic curve [AUC] is a model performance metric). Permutation importance rankings were used for predictors; Shapley Additive Explanation (SHAP) values assessed directional associations and interactions.</p><p><strong>Results: </strong>The transfusion rate was 6.7% (8308/123 763). The model achieved an AUC of 77.0% (95% confidence interval: 76.9-77.2). The top 10 predictors by variable importance were coagulopathy (0.311), placenta accreta (0.146), placenta previa (0.129), caesarean section (0.048), uterine atony (0.045), preterm delivery (0.041), age (0.037), vaginal laceration (0.029), iron use (0.025) and socioeconomic status (0.020). SHAP analysis confirmed a positive effect (e.g., maximum SHAP for placenta accreta = 0.2582), and the synergistic interaction between placenta accreta and coagulopathy amplified the risk.</p><p><strong>Conclusion: </strong>Coagulopathy and placental abnormalities are the most important drivers of transfusion in PPH. Explanatory ML enhances risk stratification beyond traditional models, informing PBM protocols to curb abuse and inequity. Potential integration into NHIS systems could protect maternal outcomes globally.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of BSH 2020 irradiation guidelines for children with DiGeorge syndrome.","authors":"Oliver Firth, Philip Arnold, Andrew R Gennery, Robert Johnson, Sara Mele, Tracey Shackleton, John Grant-Casey, Theodora Foukaneli, Helen V New","doi":"10.1111/tme.70095","DOIUrl":"https://doi.org/10.1111/tme.70095","url":null,"abstract":"<p><strong>Background: </strong>Transfusion-associated graft-versus-host disease (Ta-GvHD) is a rare, usually fatal complication of transfusing cellular components, prevented by irradiation. Congenital heart disease (CHD), particularly DiGeorge syndrome (del22q), may be associated with severe T-cell immunodeficiency and Ta-GvHD risk. British Society for Haematology guidelines (BSH, 2020) recommended targeted use of irradiated components for CHD based on immunological assessment; guideline adherence was unknown.</p><p><strong>Objectives: </strong>To understand UK use of irradiated components for paediatric CHD surgery and barriers to BSH guideline implementation.</p><p><strong>Methods: </strong>An electronic survey distributed to the 11 UK paediatric cardiothoracic surgical centres (January-March 2024 inclusive).</p><p><strong>Results: </strong>Of the 11 centres, 9 (82%) responded. Naïve T-cell enumeration, the BSH recommended test, was available to 8/9 (89%), but used in 4/9 (44%). 4/9 (44%) and 5/9 (56%) centres were willing to provide non-irradiated components to neonates and children >28 days of age. Of these, 1/4 (25%), 1/5 (20%), and 4/5 (80%) (for neonates, young children, and children from 2 years) required criteria additional to BSH guidelines. 8/9 (89%) centres reported ongoing barriers to guideline implementation, particularly challenges around pathway development and timely naïve T-cell enumeration.</p><p><strong>Conclusion: </strong>Overuse of irradiated components in surgery for patients with congenital heart disease is high: only 1/3 of paediatric cardiac centres adhered to BSH guidance. Reasons included difficulties in immunological diagnostic pathway development. Collaboration between paediatric cardiothoracic, transfusion and immunology teams is required to address this.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FAIRly deferred: Low impact of the individualised risk assessment policy on blood donor deferrals in England.","authors":"Katherine Daly, Claire Reynolds, Katy Davison, Susan R Brailsford","doi":"10.1111/tme.70091","DOIUrl":"https://doi.org/10.1111/tme.70091","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of the individualised risk-based donor selection guidelines on deferral of blood donors at donation sessions in England.</p><p><strong>Background: </strong>From June 2021, the 3-month deferral for sex between men was replaced by an individualised risk assessment known as FAIR (For the Assessment of Individualised Risk). Assessing the impact of deferral at donation informs donor and policy management.</p><p><strong>Methods: </strong>Data were obtained from the NHS Blood and Transplant donor management system for deferrals associated with FAIR deferral codes or injecting drug use after FAIR implementation, 14 June 2021 to 13 June 2023. Rates for each deferral category were estimated by age group, sex, ethnic group, and donor type. Pre-donation forms were reviewed for evidence of multiple deferrable behaviours, and return rates were calculated for temporarily deferred donors.</p><p><strong>Results: </strong>Over 2 years, 286 donors were deferred on-session due to FAIR (9.0 donors per 100 000 donations made). Highest adjusted incidence rate ratios of deferral were seen in first-time, male, 17- to 24-year-old, and Mixed and Other ethnicity donors. Multiple FAIR deferrals were observed in 10 donors. Of 220 temporarily deferred donors, 56.8% returned to donate within 6 months.</p><p><strong>Conclusion: </strong>The impact of FAIR on donation session appears low, supported by good return rates. First-time, male, and younger donors were most affected. Multiple FAIR deferrals in a donor were rare, suggesting donors at higher risk were not attending to donate. Clarity on deferral application may aid donors and staff to defer appropriately. Further investigation is needed to determine levels of ineligible donation.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional validation of a modified platelet desialylation test for immune and hereditary thrombocytopenias.","authors":"Karen Nogueira Chinoca Ziza, Thamy Caroline Silva, Mateus Domentino, Marina Cavalcanti Albuquerque Veiga Conrado, João Vitor Bernardo Oliveira, Felipe Augusto Rós, Caroline Gabe, Elyse Moritz, Akemi Chiba, Paula Villaça, Vanderson Rocha, Alfredo Mendrone-Junior, José Bordin, Dante Langhi, Carla Luana Dinardo","doi":"10.1111/tme.70096","DOIUrl":"https://doi.org/10.1111/tme.70096","url":null,"abstract":"<p><strong>Background: </strong>Thrombocytopenia arises from heterogeneous inherited and acquired disorders, and identifying the underlying platelet clearance mechanisms remains challenging. Platelet desialylation, characterised by loss of sialic acid and consequent exposure of terminal β-galactose residues recognised by the Ashwell-Morell receptor, represents an alternative pathway of hepatic platelet clearance. This study aimed to validate a modified platelet desialylation test (PDT) and assess its applicability in multitransfused, alloimmunized, and hereditary thrombocytopenia patients as a functional in vitro assay to detect plasma-induced platelet desialylation and explore its potential as a complementary biomarker of platelet clearance mechanisms.</p><p><strong>Methods: </strong>PDT performance was evaluated using plasma from 20 healthy donor pools, 10 antibody-positive refractory patients, and 15 individuals with hereditary thrombocytopenias by FITC-RCA-I flow cytometry. Analytical validation included assessment of reproducibility, incubation time, lectin concentration, and ratio-based result interpretation.</p><p><strong>Results: </strong>β-Lactose showed significantly lower expression mean fluorescence intensity (MFI) than both untreated reference control and neuraminidase-treated conditions (p < 0.00001), whereas patient plasma exhibited higher fluorescence than the reference control (p < 0.0001). A 1 h incubation using 0.3 μL per reaction RCA-I-FITC stock solution (5 mg active conjugate/mL) provided stable and reproducible discrimination. In inherited thrombocytopenias, 66.7% of patients were PDT-positive despite HLA/HPA antibodies being detected in only 13.3%. PDT-positive samples showed increased desialylation-associated MFI (p = 0.002) with a strong correlation between MFI and ratio (ρ = 0.877). The assay required approximately 4 h and cost US$3.62 per test.</p><p><strong>Conclusion: </strong>The PDT is a practical, reproducible, and cost-effective assay capable of detecting physiologic, enzymatic, and immune-mediated platelet desialylation, providing a complementary biomarker for investigating thrombocytopenic disorders.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a pop-up stop a TACO? A best practice advisory alert as a clinical decision support tool to mitigate the occurrence of transfusion-associated circulatory overload.","authors":"Lianne Rotin, Farzana Tasmin, Rita Ieshu, Michael Jamorski, Christine Cserti-Gazdewich","doi":"10.1111/tme.70094","DOIUrl":"10.1111/tme.70094","url":null,"abstract":"<p><strong>Background: </strong>Transfusion-associated circulatory overload (TACO) prevention requires identification of susceptible patients and enactment of appropriate mitigation strategies. We implemented a clinical decision support (CDS) tool at our institution to reduce TACO occurrence by alerting transfusing clinicians to at-risk patients.</p><p><strong>Methods and materials: </strong>A CDS tool was designed to screen patient charts for TACO risk factors (age > 60, renal/cardiac impairment and prior TACO) at the time of inpatient blood component ordering through the electronic health record (EHR). The presence of risk factors triggered a Best Practice Advisory (BPA) pop-up featuring mitigation strategies. TACO rates and frequencies were compared pre- and post-BPA implementation using a Z-test.</p><p><strong>Results: </strong>TACO as a proportion of transfusion reactions decreased 40% from 9.6% (406/4208) to 5.8% (47/804) in the 941 days after BPA implementation (z = 3.44, p = 0.00056). TACO frequency decreased 44% from 1 of 11.2 days to 1/20.0 days post-BPA (z = 4.00, p < 0.00001), while overall reaction frequency decreased 8% from 1 of 1.08 days to 1 of 1.17 days (z = 7.31, p < 0.00001). Among 47 post-BPA TACO events, 38 were subjected to the CDS algorithm, with the BPA firing for 4 of 36 (11%) of cases with TACO risk factors.</p><p><strong>Conclusions: </strong>TACO rates decreased at our institution following BPA implementation, despite BPA under-firing. Ongoing monitoring for BPA sustained effects is needed.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Valadares initiative on patient blood management in Portugal: Accelerating implementation in line with WHO guidance.","authors":"Diana Castro Paupério","doi":"10.1111/tme.70055","DOIUrl":"10.1111/tme.70055","url":null,"abstract":"<p><strong>Background: </strong>Patient blood management (PBM) is an evidence-based, patient-centred standard of care that improves clinical outcomes. In Portugal, national modelling by the Anaemia Working Group Portugal (2017) estimated that comprehensive PBM implementation could benefit about 384 000 patients and reduce red blood cell transfusions by 51.2% within the first year. Despite a supportive legislative framework established in 2018, implementation has remained inconsistent and below expectations. The World Health Organisation's Implementation Guidance (2025) calls for decisive action, highlighting the need for renewed governance, structured education, and coordinated national efforts to translate policy into practice.</p><p><strong>Methods: </strong>A multidisciplinary expert panel of national and international PBM leaders met at the Local Health Unit of Gaia-Espinho (ULSGE). Drawing on the WHO Implementation Guidance (2025), the WHO Policy Brief on PBM (2021), and national policy instruments, the panel identified key barriers, enablers, and strategic priorities for PBM implementation in Portugal.</p><p><strong>Results: </strong>Four strategic domains were prioritised: (1) governance and leadership; (2) education and training across all professional levels; (3) implementation tools and processes, including standardised pathways and goal-directed haemostatic algorithms; and (4) monitoring, audit, and continuous improvement through clinical and economic indicators integrated into dashboards. These recommendations, collectively termed the Valadares Initiative, promote universal PBM adoption, systematic benchmarking, and alignment with national quality and safety frameworks.</p><p><strong>Conclusion: </strong>Portugal has the legislative foundation and clinical expertise to advance PBM. Progress now requires stronger governance, adequate resourcing, and structured education. The Valadares Initiative offers a consensus-based roadmap to accelerate PBM implementation and provides transferable insights for other health systems.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":"290-294"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor retention and return patterns in Saudi Arabia: Implications for blood safety and supply stability.","authors":"Wajnat A Tounsi, Bushra S Almalki","doi":"10.1111/tme.70049","DOIUrl":"10.1111/tme.70049","url":null,"abstract":"<p><strong>Background: </strong>Sustaining a safe and sufficient blood supply requires not only recruiting first-time donors but also retaining them over time. In Saudi Arabia, donor retention remains poorly understood, with limited data on return behavior, demographic influences, and temporal trends. This study aims to evaluate patterns of donor return at a tertiary hospital in Saudi Arabia and explore implications for blood supply stability.</p><p><strong>Materials and methods: </strong>This is a retrospective observational analysis of 48 241 blood donations by 38 562 unique blood donors at King Fahd Armed Forces Hospital from November 2019 to November 2024. Donors were classified as first-time or repeat donors based on donation frequency. Inter-donation intervals, monthly donation trends, and seasonal influences (Ramadan and Hajj) were assessed using descriptive statistics and chi-square tests.</p><p><strong>Results: </strong>Only 13.2% of donors returned for a subsequent donation, yet these repeat donors contributed 30.6% of all blood units. The average inter-donation interval was 455 days, with 29.2% returning after more than 500 days. Significant seasonal variation was observed in which repeat donation rates declined during Ramadan (27.1%) and Hajj (29.5%) compared to other months (31.0%) (p < 0.0001). Demographically, older age was positively associated with repeat donation, while female participation remained low.</p><p><strong>Conclusion: </strong>Donor retention in Saudi Arabia is low and characterized by wide variability in return timing. These findings underscore the need for structured, behaviorally informed retention strategies. We propose a relationship-centered strategic framework to improve donor engagement, leveraging personalized communication, cultural inclusivity, and temporal targeting to enhance blood supply resilience.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":"222-230"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of fetal cfDNA in maternal blood.","authors":"Klaus Rieneck, Frederik Banch Clausen, Morten Hanefeld Dziegiel","doi":"10.1111/tme.70036","DOIUrl":"10.1111/tme.70036","url":null,"abstract":"<p><strong>Background: </strong>An NGS-based assay was developed to determine the presence or absence of paternally inherited genetic variants in cfDNA derived from the fetus in the plasma of pregnant women. This assay can be used in connection with NGS-based prenatal prediction of fetal blood groups in immunised pregnant women. The purpose of the assay is to minimise the risk of a false-negative outcome in the situation with a prediction of the absence of a blood group allele from the fetus.</p><p><strong>Methods: </strong>The underlying principle was to examine genetic markers, with each single marker giving a small contribution to the probability of differentiating between individuals (woman and fetus) and combining several markers into one multiplex PCR assay with enough discerning power to determine whether cfDNA from a fetus was present in maternal plasma. If only maternal cfDNA was detected, a prediction of the absence of a fetal blood group might be due to a false-negative result based on insufficient amounts of fetal cfDNA.</p><p><strong>Results: </strong>The assay did not require knowledge of maternal or paternal genotypes. The genetic markers were deletion or insertion variants and were selected using an SQL algorithm searching all autosomes from gnomAD v 3 on the Google Cloud Platform and included alleles with a frequency close to 0.5 in four different ethnic populations, including several other criteria. The final assay consisted of a multiplex PCR amplification of 22 different biallelic delin markers, each located on a separate chromosome. The assay is informative in >99% of cases with at least one primer set. After experimental testing, an algorithm for scoring test results was defined, and the cut-off was set at <0.15%.</p><p><strong>Conclusion: </strong>Per sample, the control assay required one extra dedicated multiplex PCR, which was eventually spiked into the sequencing reaction. The assay estimated the presence of non-self-genetic variation and may have applications beyond control for the presence of fetal cfDNA.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":"265-278"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145347495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe hypotensive transfusion reaction in a patient with liver dysfunction: A case report.","authors":"Priya Prasad, Jeeva George, Jijo Joseph Joseph, Vandana G Hari, Anju Francis","doi":"10.1111/tme.70048","DOIUrl":"10.1111/tme.70048","url":null,"abstract":"<p><strong>Background: </strong>Massive transfusion protocols (MTPs) are essential for managing substantial intraoperative bleeding. However, transfusion-related complications such as hypotensive transfusion reactions (HyTRs), although uncommon, can be overlooked during emergencies, particularly in patients with hepatic impairment.</p><p><strong>Case presentation: </strong>A 56-year-old woman with compensated cirrhosis, hepatic metastases, hypertension (on carvedilol), and well-controlled type 2 diabetes presented with progressive lower limb weakness from a compressive extradural spinal lesion. Surgery required activation of an MTP. She received four units each of O-positive packed red blood cells (PRBCs), random donor platelets (RDPs), and Fresh Frozen Plasma (FFP). Haemorrhage was controlled and the patient stabilised; MTP was discontinued. Approximately 5 min after starting the fourth unit of FFP, she developed sudden, profound isolated hypotension without other signs of allergic reaction, hemolysis or volume overload. The transfusion was stopped and vasopressors restarted; blood pressure normalised within 10 min. Alternative causes were systematically excluded. Given the temporal relationship with FFP and underlying hepatic dysfunction, a bradykinin-mediated HyTR was considered. Histopathology later confirmed poorly differentiated pancreaticobiliary adenocarcinoma.</p><p><strong>Conclusion: </strong>This case highlights the importance of recognising bradykinin-mediated HyTRs during FFP transfusion, especially in patients with liver dysfunction where impaired bradykinin degradation may contribute to accumulation. Prompt recognition, exclusion of alternative causes, and supportive management are crucial for favourable outcomes.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":"302-306"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the best approach to blood transfusion in sickle cell disease? A scientometric analysis and literature review.","authors":"Christiane Ruffato Carminati, Lucas Fernandes Ananias, Saulo Fernando Moreira da Silva, Anna Cecília Dias Maciel Carneiro, Helio Moraes de Souza, Sarah Cristina Sato Vaz Tanaka, Fernanda Bernadelli De Vito","doi":"10.1111/tme.70064","DOIUrl":"10.1111/tme.70064","url":null,"abstract":"<p><strong>Background: </strong>Blood transfusion remains a cornerstone in the management of sickle cell disease (SCD); however, it is frequently complicated by red cell alloimmunisation. A significant debate persists within the scientific community regarding the optimal strategy to mitigate this risk: the traditional, pragmatic approach of serologic phenotyping versus molecular genotyping, which is technically superior yet more resource-intensive.</p><p><strong>Objectives: </strong>This mini-review aims to map the framework of this scientific debate and synthesize current evidence through a dual methodology.</p><p><strong>Methods and materials: </strong>A scientometric analysis was conducted on 224 articles indexed in Scopus and Web of Science using the Bibliometrix package for R, followed by a structured narrative review of 26 selected studies.</p><p><strong>Results: </strong>The scientometric findings confirm growing interest in this topic, identifying two distinct yet interconnected research clusters that reflect the ongoing dialectic between phenotyping and genotyping, with the latter emerging as a 'hot topic' over the past decade. The narrative synthesis highlights a predominance of evidence supporting genotyping as the most accurate approach to preventing alloimmunisation, particularly given the high prevalence of RH system variants in individuals with SCD. In contrast, cost-effectiveness analyses and implementation studies underscore substantial financial and logistical barriers that favour a more pragmatic, stepwise approach.</p><p><strong>Conclusion: </strong>We conclude that the future of transfusion safety in SCD does not lie in a binary choice but rather in a synergistic and stratified integration of both strategies. Implementing protocols that target genotyping for high-risk patients, while simultaneously optimising the use of extended phenotyping, represents the most promising pathway to balance safety, cost and accessibility-ultimately ensuring the best possible transfusion therapy for this vulnerable population.</p>","PeriodicalId":23306,"journal":{"name":"Transfusion Medicine","volume":" ","pages":"211-221"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}