Transfusion Medicine Reviews最新文献

{"title":"Recommended Papers of 2024 From the TMR Editorial Board.","authors":"Sunny Dzik, Zoe McQuilten, Jeannie Callum","doi":"10.1016/j.tmrv.2024.150874","DOIUrl":"https://doi.org/10.1016/j.tmrv.2024.150874","url":null,"abstract":"","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 1","pages":"150874"},"PeriodicalIF":2.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single vs Double-Unit Transfusion in Patients With Hematological Disorders Undergoing Chemotherapy or Stem Cell Transplantation: A Systematic Review And Meta-Analysis","authors":"Catalina Herrán-Fonseca ,&nbsp;Laura Jekov ,&nbsp;Carlotta Persaud ,&nbsp;Fahad Alabbas","doi":"10.1016/j.tmrv.2024.150862","DOIUrl":"10.1016/j.tmrv.2024.150862","url":null,"abstract":"<div><div>There is no consensus to support the single unit-transfusion policy (1-RBC) over the double-unit transfusion policy (2-RBC) in patients with hematological disorders undergoing chemotherapy or stem cell transplantation. We searched PubMed, Embase, and Cochrane Library. Risk ratios (RR) and mean differences (MD) were pooled. Statistical analysis was performed using Review Manager and R software. Heterogeneity was assessed using I² statistics. Hemoglobin (Hb) levels at discharge (MD −0.41 g/dL; 95% CI −0.53, −0.29 g/dL; <em>P</em> &lt; .01) and total RBC units used per admission (MD −0.82 units; 95% CI −1.60, -0.05 units; <em>P</em> = .04) were significantly lower in patients who received 1-RBC, while length of hospital stay (MD 0.05 days; 95% CI −0.29, 0.39 days; <em>P</em> = .89), severe bleeding (RR 1.52; 95% CI 0.85, 2.71; <em>P</em> = .16) and mortality (RR 0.89; 95% CI 0.52, 1.53; <em>P</em> = .69) showed no significant difference between groups. In patients with hematological disorders undergoing chemotherapy or stem cell transplantation, 1-RBC is associated with lower Hb levels at discharge and a reduction in the total number of RBC units used per admission, with no significant difference in terms of length of hospital stay, severe bleeding risk, transfusion-related adverse events and mortality.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 1","pages":"Article 150862"},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of sexual risk behaviour donor screening in Canada","authors":"Mindy Goldman,&nbsp;Antoine Lewin,&nbsp;Christian Renaud,&nbsp;Sheila O'Brien","doi":"10.1016/j.tmrv.2024.150855","DOIUrl":"10.1016/j.tmrv.2024.150855","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2022 Canadian Blood Services and Héma-Québec removed the three month deferral for men who have sex with men and adopted gender neutral criteria assessing sexual risk behaviours in all donors. We assessed the impact of these changes on the safety and adequacy of the blood supply, one year post-implementation at Canadian Blood Services and 9 months post-implementation at Héma-Québec.</div></div><div><h3>Methods</h3><div>All allogeneic donors are asked if they have had a new partner or more than one sexual partner in the last 3 months. Donors answering yes to either question are asked if they had anal sex in the last 3 months; if yes, they are deferred for 3 months. We followed HIV rates before and after the criteria change and interviewed HIV positive donors. We assessed the number of donors answering yes to the new questions and the number deferred by age, gender, and donation status. Data on donors, donations, transmissible disease markers and deferrals were extracted from our epidemiology databases. Source plasma donors were not included. Comparisons were made using the chi-square test.</div></div><div><h3>Results</h3><div>There were three HIV positive donations out of 990,291 donations pre-implementation and four out of 929,384 post-implementation (0.30/100,000 vs 0.43/100,000, <em>P</em>=.72). All post-implementation HIV positive donors were male, Canadian Blood Services' donors in Ontario. One was non-compliant with multiple criteria. No risk factors were identified in the other three positive donors, although one had English comprehension difficulties. 2.9% of donors answered yes to a new partner and/or more than one partner; the percentage answering yes to a new partner was higher than more than one partner (2.6% vs 1.2%, <em>P</em>&lt;.0001). On implementation, 0.15% of donors were deferred for a new partner and/or more than one partner and anal sex. Deferral rates were highest in first time, younger donors, with similar rates in males and females, and have decreased to 0.06% one year post-implementation.</div></div><div><h3>Conclusions</h3><div>Implementation of sexual risk behavior donor screening resulted in unchanged HIV rates and a manageable impact on blood availability. Gender-neutral criteria have also simplified screening for trans donors. After over 30 years, we are no longer asking donors about their sexual orientation, increasing the inclusiveness in our donor base.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150855"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Novel Strategies to Alleviate Symptoms of β-Globinopathies: Examining the Potential Role of Embryonic ε-globin Induction","authors":"Jun Liu ,&nbsp;Kevin Park ,&nbsp;Ziyang Shen ,&nbsp;Yuhua Ye ,&nbsp;Ernie Lee ,&nbsp;Ruby Adelaide Herman ,&nbsp;Xingxin Zhu ,&nbsp;Wen Lu ,&nbsp;James Nuhfer ,&nbsp;Mahmoud A. Bassal ,&nbsp;Daniel G. Tenen ,&nbsp;Patricia Brunker ,&nbsp;Xiangmin Xu ,&nbsp;Li Chai","doi":"10.1016/j.tmrv.2024.150861","DOIUrl":"10.1016/j.tmrv.2024.150861","url":null,"abstract":"<div><div>β-thalassemia and sickle cell disease are among the most prevalent genetic blood disorders globally. These conditions arise from mutations in the β-globin gene, leading to defective hemoglobin production and resulting in anemia. Current treatments include γ-globin inducers (eg, Hydroxyurea), blood transfusions, iron chelation therapy, and bone marrow transplantation. Recently approved disease-modifying agents and promising gene therapies offer hope, yet their broad application is constrained by scalability challenges. Traditionally, research and development for β-globinopathies have focused on γ-globin induction. However, the ε-globin variant, which is active during early embryonic development and subsequently silenced prenatally, was once considered noninducible by postnatal pharmacological means. Recent studies indicate that, akin to γ-globin, enhancing ε-globin expression could compensate for impaired β-globin synthesis, potentially ameliorating the clinical manifestations of β-globinopathies. This review critically examines the viability of ε-globin induction as a therapeutic strategy for β-thalassemia and sickle cell diseases. It also delves into the burgeoning research on the mechanisms governing ε-globin silencing and its pharmacological reactivation. We conclude with a discussion of prospective research directions and drug development initiatives aimed at exploiting ε-globin's therapeutic promise.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150861"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Unit Transfusion Policy in Autologous Hematopoietic Stem Cell Transplantation: Less is Not Worse","authors":"Javier Marco-Ayala ,&nbsp;Pedro Asensi Cantó ,&nbsp;Marina Suarez ,&nbsp;Brais Lamas ,&nbsp;Marta Santiago ,&nbsp;Inés Gómez ,&nbsp;Mario Arnao ,&nbsp;Jaime Sanz ,&nbsp;Alberto Montava ,&nbsp;Miguel Ángel Sanz ,&nbsp;Javier de la Rubia ,&nbsp;Pilar Solves","doi":"10.1016/j.tmrv.2024.150859","DOIUrl":"10.1016/j.tmrv.2024.150859","url":null,"abstract":"<div><div>Single-unit red blood cell (1-RBC) transfusion policy has shown to effectively reduce transfusion burden while maintaining comparable clinical outcomes in hematological patients compared to the classical double-unit policy. However, its effects specifically after autologous stem cell transplantation (ASCT) have not been previously studied. We aimed to evaluate the impact of the 1-RBC policy on transfusion burden in a homogeneous cohort of patients undergoing ASCT. We retrospectively compared the transfusion requirements and the clinical outcomes of 187 patients transplanted from May 2019 to December 2022 under a 1-RBC policy, with a historical cohort of 153 patients transplanted from January 2016 to April 2019 under a double-unit policy. The 1-RBC policy was associated with a 32% reduction in RBC utilization and lower number of RBC transfusions at day 30 after transplantation (median 2 versus 3 units; <em>P</em> &lt; .0001), with an odds ratio of 0.49 in multivariate analysis (<em>P</em> = .03). However, the number of transfusion episodes remained similar (median of 2 in both arms; <em>P</em> = .34). No significant differences in length of stay, hemoglobin levels at discharge or 30‐day mortality were observed. In conclusion, transitioning to the 1-RBC represents a straightforward action in current practice that significantly reduces blood transfusions in patients undergoing ASCT, without negatively impacting clinical outcomes.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150859"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monoclonal anti-D induces low efficiency trogocytosis: Implications for the prevention of Hemolytic disease of the fetus and newborn (HDFN)","authors":"Yoelys Cruz Leal,&nbsp;Lazaro Gil Gonzalez,&nbsp;Peter A.A. Norris,&nbsp;Alan Lazarus","doi":"10.1016/j.tmrv.2024.150854","DOIUrl":"10.1016/j.tmrv.2024.150854","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Hemolytic disease of the fetus and newborn (HDFN) is an alloimmune condition provoked by maternal IgG that crosses the placenta and causes fetal red blood cell (RBC) destruction. Donor-derived Rhesus Immune Globulin (RhIG) is the only licensed option available to prevent HDFN through a phenomenon called antibody-mediated immune suppression (AMIS). The mechanism as to how RhIG induces AMIS is poorly understood and this has hampered the successful development of monoclonal antibodies to replace RhIG. Our recent murine data suggests that trogocytosis-induced antigen loss could play a central role in AMIS induction. The present work aims to compare the ability of anti-D monoclonal antibody, clinically assessed, to promote in vitro trogocytosis under AMIS conditions compared with RhIg.</div></div><div><h3>Design and Methods</h3><div>RhD⁺human RBCs (RBCs) were fluorescently labeled with PKH67 and sensitized with different concentrations of RhIG (WinRho, SDF) or the IgG1 BRAD5 monoclonal anti-D antibody. Sensitized vs non-sensitized RBCs were incubated with or without THP-1-CD16A macrophages for 30 min and 3 hours. Fluorescent RBCs were recovered, macrophages washed, and remaining RBCs lysed. The ability of BRAD5 vs RhIG to induce RBC membrane fluorescence loss and RBC membrane transfer to the macrophages (ie., trogocytosis) as well as phagocytosis were evaluated. Median fluorescence intensity (MFI) of PKH67 on the RBC recovered, the percentage of PKH67⁺ macrophages, as well as their PKH67 MFI, were determined by flow cytometry. Confocal cell microscopy to visualize the interaction between macrophages and anti-D sensitized RBCs was performed.</div></div><div><h3>Results</h3><div>We observed that RBCs sensitized with ≥110 ng/mL of RhIG showed significant phagocytosis while lower concentrations primarily demonstrated significant trogocytosis-driven antigen loss. As the theoretical plasma concentration of anti-D in patients administered RhIG is below 100 ng/mL, our findings indicate that trogocytosis is the probable in vivo mechanism under AMIS conditions. In the case of BRAD5, this antibody, like RhIg, was capable of inducing both phagocytosis and trogocytosis. However, much higher concentrations of BRAD5 were necessary to achieve a comparable degree of trogocytosis as compared to RhIg.</div></div><div><h3>Conclusions</h3><div>This work demonstrates that RhIG has the capacity to induce trogocytosis at clinically relevant concentrations, with minimal to no phagocytosis. Conversely, the BRAD5 monoclonal antibody although capable of trogocytosis, was over ten times less efficient than RhIG, mirroring its poorer efficacy in prior clinical studies for preventing RhD alloimmunization.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150854"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Research of a Large-Scale Analysis Platform for MNS Blood Group Identification Based on Long-Read Sequencing","authors":"Hua Xu,&nbsp;Xiaomin Su,&nbsp;Qinqin Zuo,&nbsp;Liangzi Zhang,&nbsp;Xiaoyue Chu","doi":"10.1016/j.tmrv.2024.150836","DOIUrl":"10.1016/j.tmrv.2024.150836","url":null,"abstract":"<div><div><span>The objective of this study was to devise a novel approach for determining MNS blood group utilizing long-read sequencing (LRS) and to identify intricate genome variations associated with this blood group system. In this study, a total of 60 blood samples were collected from randomly selected Chinese Han blood donors. The amplification of the full-length sequences of </span><em>GYPA</em> exon 2-7 (11 kb) and <em>GYPB</em> exon 2-6 (7 kb) was conducted on the blood samples obtained from these 60 donors. Subsequently, the sequencing of these amplified sequences was performed using the PacBio platform. The obtained sequencing data were then compared with the reference sequence of the human genome (GRCh38) utilizing the pbmm2 software, resulting in the acquisition of the haploid sequences of <em>GYPA</em> and <em>GYPB</em>. The serological typing prediction was conducted using the International Society of Blood Transfusion (ISBT) database, while the analysis of SNVs sites was performed using deepvariant v1.2.0 software and reference sequence alignment. A total of 60 samples yielded unambiguous high-quality haplotypes, which can serve as a standardized reference sequence for molecular biology typing of MNSs in the Chinese population. In a total of 60 serological samples, the LRS method successfully identified the M, N, S, and s blood group antigens by analyzing specific genetic variations (c.59, c.71, c.72 for <em>GYPA</em>, and c.143 for <em>GYPB</em>), which aligned with the results obtained through conventional serological techniques. 4 Mur samples that had been previously validated through serology and molecular biology were successfully confirmed, and complete haploid sequences were obtained. Notably, one of the Mur samples exhibited a novel breakpoint, <em>GYP</em> (<em>B1-136-B ψ 137-212-A213-229-B230-366</em>), thereby representing a newly identified subtype. Single molecule sequencing, which eliminates the necessity for PCR amplification, effectively encompasses GC and high repeat regions, enhancing accuracy in quantifying mutations with low abundance or frequency. By employing LRS analysis of the core region of <em>GYPA</em> and <em>GYPB</em>, diverse genotypes of MNS can be precisely and reliably identified in a single assay. This approach presents a comprehensive, expeditious, and precise novel method for the categorization and investigation of MNS blood group system.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150836"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole Blood Donor Iron Management Across Europe: Experiences and Challenges in Four Blood Establishments","authors":"K. van den Hurk ,&nbsp;M. Arvas ,&nbsp;D.J. Roberts ,&nbsp;J. Castrén ,&nbsp;C. Erikstrup","doi":"10.1016/j.tmrv.2024.150860","DOIUrl":"10.1016/j.tmrv.2024.150860","url":null,"abstract":"<div><div>Whole blood donors lose iron while donating and frequent blood donation is therefore known to induce a risk of iron deficiency and/or anemia. In this review we present, compare and discuss the pros and cons of 4 distinctive donor iron management strategies in England, Finland, the Netherlands, and Denmark. Donor iron management policies in the countries concerned are described for the year 2021, and data on donor and donation numbers, low hemoglobin (Hb) deferral rates and Hb levels are presented. In England Hb levels were only measured in donors failing a copper sulphate test, while in the other 3 countries Hb is measured at every donation. In Finland, donors considered at risk of iron deficiency receive iron supplements, while in the Netherlands, ferritin-guided donation intervals without iron supplementation are in place. In Denmark, iron supplementation is provided to donors with low ferritin levels. Low-Hb deferral rates and average Hb levels are quite similar across the included countries, with the exception of higher deferral rates in England. To conclude, despite significant diversity in donor iron management approaches, low Hb deferral rates and average Hb levels are similar among the included countries except for England, where higher deferral rates were observed that are likely attributed to the absence of iron supplementation or ferritin-guided deferral. Achieving an optimal, more tailored iron management strategy requires further research and a nuanced understanding of both donor demographics and physiological responses to optimize the effectiveness and safety of blood donation practices.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150860"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-Amyloid Related Neurodegenerative and Neurovascular Diseases: Potential Implications for Transfusion Medicine","authors":"Ryan T. Muir ,&nbsp;Jeannie L. Callum ,&nbsp;Amy Y.X. Yu ,&nbsp;Moira K. Kapral ,&nbsp;Richard H. Swartz ,&nbsp;Sandra E. Black ,&nbsp;Bradley J. MacIntosh ,&nbsp;Dean A. Fergusson ,&nbsp;Steven Kleinman ,&nbsp;Andrew D. Demchuk ,&nbsp;Peter K. Stys ,&nbsp;Eric E. Smith ,&nbsp;Michael D. Hill","doi":"10.1016/j.tmrv.2024.150858","DOIUrl":"10.1016/j.tmrv.2024.150858","url":null,"abstract":"<div><div>Cerebral amyloid angiopathy (CAA) is a progressive cerebrovascular and neurodegenerative disorder that is caused by the aberrant accumulation of soluble beta-amyloid isoforms in the small vessel walls of the cerebral and cerebellar cortices and the leptomeninges. Vascular beta-amyloid deposition increases vulnerability to intracerebral hemorrhage (ICH). Clinically, CAA can be the underlying cause of up to half of spontaneous lobar ICHs and can also present with convexity subarachnoid hemorrhage, transient focal neurologic episodes and progressive cognitive decline leading to dementia. The majority of CAA is sporadic, with increasing prevalence with age and often coexists with Alzheimer's Disease (AD). Genetic and iatrogenic etiologies are rare. Cases of CAA and AD have been linked to the use of cadaveric pituitary hormone and later life iatrogenic CAA has also been described following early-life neurosurgical procedures with cadaveric dura grafts. Together these data suggest a capacity of beta-amyloid transmissibility. A recent study found that in over 1 million transfusion recipients from donors who later developed (i) &gt;1 ICH or (ii) one ICH event and dementia, had an elevated risk of developing future ICH. Considering prior reports of transfusion associated variant-Creutzfeldt Jakob Disease in humans and <em>in vivo</em> evidence in sheep, coupled with emerging data supporting beta-amyloid's <em>prion-like</em> properties, raises the question of whether CAA could be transmissible by blood transfusion. This would also have implications for screening, especially in an era of emerging plasma biomarkers of cerebral amyloidosis. Given the public health concerns raised by this biologically plausible question, there is a need for future studies with well-characterized definitions – and temporal ascertainment – of CAA <em>exposure</em> and <em>outcomes</em> to examine whether CAA is transfusion-transmissible, and, if so, with what frequency and timing of onset.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150858"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal irradiation of platelets: Does irradiation affect the quality, effectiveness, and safety of platelets for transfusion?","authors":"Lorna Cain ,&nbsp;Louise J. Geneen ,&nbsp;Michael Wiltshire ,&nbsp;Catherine Kimber ,&nbsp;Sue Proffitt ,&nbsp;Josie Sandercock ,&nbsp;Carolyn Dorée ,&nbsp;Susan J. Brunskill ,&nbsp;Lise J. Estcourt","doi":"10.1016/j.tmrv.2024.150840","DOIUrl":"10.1016/j.tmrv.2024.150840","url":null,"abstract":"<div><div>We aimed to identify any detrimental effects on platelet quality and clinical effectiveness, of irradiated platelets compared to non-irradiated platelets for transfusion. The review was conducted in accordance with PRISMA guidelines. The protocol was prospectively registered on PROSPERO [CRD42023441930]. Our search identified 3002 references, of which we included 44 studies. Forty-one were <em>in vitro</em> only studies, two studies were in healthy volunteers, and one study reported clinical outcomes in thrombocytopenic patients. X-ray was used exclusively in three studies, and alongside gamma irradiation in one study. Two studies did not report the source of irradiation. The remaining 38 studies used gamma irradiation only. We assessed risk of bias (ROB) for studies reporting clinical and <em>in vivo</em> outcomes using ROB 2.0 (3 studies). We adapted a ROB tool designed for animal studies to assess ROB for the studies reporting <em>in vitro</em> outcomes (43 studies). We assessed the certainty of the evidence for the eight outcomes deemed most important to assess platelet quality and clinical effectiveness (where day 0 is the day of the blood draw).<ul><li><span>•</span><span><div>High certainty of a small decrease in pH (day 7) with irradiation: mean difference (MD) 0.04 lower (95% CI, −0.07 to −0.00).</div></span></li><li><span>•</span><span><div>Moderate certainty of an increase in P-selectin (day 5) with irradiation: MD 1.58 % higher (95% CI, 0.72-2.45).</div></span></li><li><span>•</span><span><div>Moderate certainty of no difference in supernatant glucose (days 5 and 7) and P-selectin (day 7).</div></span></li><li><span>•</span><span><div>Very low certainty of any difference in pH (day 5), post-transfusion bleeding risk (WHO 2+), and post-transfusion platelet survival time.</div></span></li></ul></div><div>Overall, gamma irradiation has little to no effect on most markers of platelet quality and effectiveness. Where there is evidence of detriment from irradiation, differences are small <em>in vitro</em>, and are unlikely to affect clinical outcomes following transfusion. However, the evidence base is limited. Only half the studies could be included in any analysis. There is very limited evidence for x-ray as a source of irradiation and, given the potential benefits of using x-ray over gamma irradiation (ease of use and safety requirements), we would welcome further research comparing x-ray to gamma, and x-ray to a non-irradiated control.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"38 4","pages":"Article 150840"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}