Transfusion Medicine Reviews最新文献

{"title":"Evaluating the Impact of Ferritin Testing: Iron Status of the Donor Pool, Changes to Hemoglobin Deferrals, and Effects on Product Availability.","authors":"Bryan R Spencer","doi":"10.1016/j.tmrv.2026.151049","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151049","url":null,"abstract":"<p><p>Blood collectors in many jurisdictions globally have implemented ferritin testing of their donor populations as an additional donor safety measure. Where performed, ferritin testing is generally conducted on a selective basis, restricted to certain populations perceived to face higher risk for or from iron deficiency or applied to periodic rather than all donations from donors. The wide array of ferritin testing configurations that currently exist, together with underlying differences in donation eligibility policies, suggests the impact of ferritin testing on blood center and donor outcomes-both desired and unfavorable ones-is likely to vary considerably across the blood donation landscape. This review examines available evidence regarding the impact of ferritin testing programs on the iron status of the blood donor pool, on the deferral rate for low hemoglobin, and on blood component availability. It presents results from 4 key papers that illustrate different configurations implemented for ferritin testing, characterizing the impact on blood center efficiency and blood donor outcomes. Original data covering several years of ferritin testing is also presented from a large United States-based blood collector, providing insights into long-term developments and donor response to notification of low-ferritin. Additional research is needed to address long-term outcomes and, especially, donor behavioral changes to address the challenge of maintaining iron levels as a regular blood donor.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151049"},"PeriodicalIF":3.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139602","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":"Long-Term Infection Risk After Extracorporeal Photopheresis for Graft-versus-Host Disease: A Hypothesis-Generating Real-World Analysis.","authors":"Caitlin Raymond","doi":"10.1016/j.tmrv.2026.151048","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151048","url":null,"abstract":"","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151048"},"PeriodicalIF":3.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139640","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":"Testosterone-Associated Erythrocytosis and Blood Donation: Therapeutic Phlebotomy, Donor Safety, and Recipient Exposure.","authors":"Emilya Huseynova, Waseem Anani","doi":"10.1016/j.tmrv.2026.151040","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151040","url":null,"abstract":"<p><p>Testosterone replacement therapy (TRT) is increasingly utilized and associated with erythrocytosis, leading some individuals to undergo therapeutic phlebotomy or present for blood donation. This emerging intersection between clinical management and blood donation raises important questions regarding donor eligibility, donor safety, recipient exposure, and regulatory oversight. This review examines evidence on testosterone-associated erythrocytosis in the context of blood donation. We review the pathophysiologic mechanisms underlying testosterone-induced erythrocytosis, summarize the current regulatory framework governing therapeutic phlebotomy and donor eligibility, and critically evaluate studies examining donor characteristics, testosterone in blood components, and potential mitigation strategies. The existing donor eligibility regulations do not contain TRT-specific provisions, but blood centers can manage these individuals by first assessing the intent to donate (altruistic or reduction of red cell mass) followed by applying standard donor eligibility criteria, therapeutic phlebotomy policies, and medical director review where appropriate. Available evidence suggests that individuals receiving TRT are increasingly encountered in blood centers and may participate in repeated donations. Laboratory studies demonstrate measurable testosterone concentrations in blood products collected from TRT donors, although the clinical significance of these findings for transfusion recipients remains uncertain. Recent studies also demonstrate that testosterone concentrations in plasma components may be substantially reduced using pathogen reduction technology. However, these observations remain limited to component-level analyses and have not been linked to recipient outcomes. Current evidence is largely descriptive and laboratory-based, highlighting substantial gaps in understanding rather than providing definitive guidance for practice. Additional research is needed to clarify donor risk profiles, determine clinical relevance of hormone exposure in transfusion recipients, and define evidence-based approaches to management of TRT-associated donors within the blood supply.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151040"},"PeriodicalIF":3.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119130","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 State of Transfusion Medicine in Low- and Middle-income Countries: A Critical Narrative Review.","authors":"Rajini Kurup, Jimmy Naipaul, Pedro Lewis, Tejroi Naipaul, Rita Persaud, Abilash V Nair","doi":"10.1016/j.tmrv.2026.151046","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151046","url":null,"abstract":"<p><p>An annual global shortfall of over 100 million blood units is borne almost entirely by low- and middle-income countries (LMICs), with measurable consequences for patient survival. Despite sustained advocacy, the evidence on transfusion medicine across these settings has not been systematically and critically reviewed. A narrative review was conducted across 9 electronic databases, applying strict LMIC-specific, date-bound eligibility criteria. Studies conducted in LMIC settings addressing any aspect of transfusion medicine and published within the preceding 15 years were eligible. Seven studies met the inclusion criteria; this scarcity reflects a genuinely thin peer-reviewed evidence base and is itself reported as a finding. The reviewed literature identifies substantial deficiencies across transfusion systems in LMIC settings, spanning regulatory frameworks, hemovigilance, voluntary donation, infection screening, and infrastructure. The evidence base is geographically narrow and predominantly descriptive: it documents what is lacking but offers limited explanatory or evaluative reach. All 7 studies were rated as moderate quality. The most significant evidential gap is the near-total absence of outcome-level data: only 1 study examines the relationship between system performance and patient survival, finding that 1 in 5 children in Kenya who were prescribed a blood transfusion died before receiving it. Transfusion medicine in LMICs is characterized by substantial and consistent deficiencies attributable to shared structural determinants, whose specific expression in each setting is nonetheless shaped by local institutional and political conditions. The evidence base documents these deficiencies but cannot explain their origins or determine what would change them. Transfusion system reform in LMICs requires legislative and regulatory engagement, not only technical assistance; voluntary donation programs require sustained governance commitment to remain stable; and outcome-level research across diverse LMIC settings is the most urgent research priority.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151046"},"PeriodicalIF":3.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119181","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":"International Assessment of Blood Donor False-positive Infectious Disease Screening Rates and Re-entry Practices: A BEST Collaborative Study.","authors":"Cyril Jacquot, Antoine Lewin, Ramir Moreno Alcantara, Hendrik Feys, Lisa Jarvis, Ann Jones, Syria Laperche, Suchitra Pandey, Claire Reynolds, Torsten J Schulze, Claire Styles, Laura Tonnetti, Nelson Tsuno, Thijs van de Laar, Ralph Vassallo, Silvano Wendel, Mindy Goldman","doi":"10.1016/j.tmrv.2026.151047","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151047","url":null,"abstract":"<p><p>False-positive infectious disease screening results in blood donors can lead to unnecessary donor deferral, emotional distress, and loss of future donations. We aimed to evaluate false-positive rates and re-entry practices across several international blood collectors. In this multinational retrospective study, 17 blood collectors provided data from January 2021 through December 2023 on infectious disease screening algorithms/methodologies, false-positive rates for HIV, HBV, HCV, and syphilis, and donor re-entry processes and rates. Participants also reported deferral policies and donor communication strategies. Donor data were stratified and analyzed using descriptive statistics by donor type (first time vs repeat), registration as male or female, calendar quarters, and jurisdiction. Across more than 28 million whole blood donations, false-positive rates per 10,000 tests were low for all screened pathogens: HIV (5.27, 95% confidence interval [CI] = 5.19-5.36), HBV (6.10; 95% CI = 6.01-6.19), HCV (5.20; 95% CI = 5.12-5.28), and Treponema pallidum (syphilis) (10.89; 95% CI = 10.77-11.01). Using chi-square test, false-positive rates differed significantly among pathogens (P < .0001), but rates were consistent across jurisdictions, testing platforms, and years. Seasonal variation was detected in the Northern hemisphere using 2-proportion z-tests with Bonferroni correction. First-time donors demonstrated higher false-positive rates for all markers. Blood collectors reported a range of re-entry reinstatement rates during the 3-year period. False-positive rates were low across jurisdictions for all pathogens screened and remained stable over time, especially among repeat donors. Re-entry programs reported different donor outreach efforts and success in re-qualifying donors (for HIV mean 15.7%, range 0%-39%; for syphilis mean 17.9%, range 0%-44.3%).</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151047"},"PeriodicalIF":3.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129293","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":"Plasma Donor Health Protection: Mapping Current Practices Through an International Survey.","authors":"Su Someh, Marloes Spekman, Susan Mikkelsen, Elodie Pouchol, Peter O'Leary, Pierre Tiberghien, Jørgen Georgsen, Kate Sommerville, Hans van Remoortel, Christian Erikstrup, Katja van den Hurk","doi":"10.1016/j.tmrv.2026.151039","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151039","url":null,"abstract":"<p><p>With rising demands for plasma-derived medicinal products (PDMPs), the pressure on plasma donors is increasing. Donation practices vary worldwide and depend on differing guidelines. However, an inventory of current international practices is still lacking. Here, we assess plasma donor health protection practices across blood establishments in Europe and North America. We distributed an online survey about plasmapheresis procedures and donor health protection measures to representatives of plasma collecting organizations. Between March and June 2023, we received 20 responses from 19 countries to an online survey distributed via the European Blood Alliance and social media. Plasma is collected via plasmapheresis by 17 organizations, which were included for analysis. The typical donor is required to be aged 18 to 65 at registration, have a minimum weight of 50 kg, have suitable veins for plasmapheresis, and be in good general health. The maximum plasmapheresis frequency ranges from 12 to 104 donations annually (mode = 26). Predonation hemoglobin or hematocrit levels are assessed by 15 of 17 organizations. All organizations measure total protein, and 7 organizations include immunoglobulin G levels (both primarily in new donors and annually). Many plasma donor health protection practices are similar across organizations. Most nonprofit organizations seem to employ conservative donation frequencies (maximum annual frequency <34). Organizations allowing more frequent donations generally combine this with more frequent biomarker measurements. To conclude, our study provides insights into international plasma donation practices. These findings support efforts to establish more uniform policies while meeting the growing plasma demand and maintaining donor health.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151039"},"PeriodicalIF":3.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139682","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 Potential Impact of Undisclosed Use of HIV Treatment and Prevention Antiretrovirals on Blood Safety.","authors":"Renata Buccheri, Eduard Grebe, Brian Custer","doi":"10.1016/j.tmrv.2026.151045","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151045","url":null,"abstract":"<p><p>The use of antiretroviral (ARV) medications for HIV treatment and prevention is a potential blood safety concern. HIV screening algorithms rely on the predictable appearance of viral RNA, p24 antigen, and anti-HIV antibodies during acute and early infection. However, exposure to ARVs can alter these biomarker dynamics and potentially compromise HIV detection. Evidence indicates that early initiation of antiretroviral therapy (ART) can suppress viremia, leading to incomplete seroconversion, reduced serologic reactivity, and seroreversion. HIV acquisition may also occur in individuals receiving pre- or postexposure prophylaxis (PrEP/PEP), resulting in delayed or altered progression of virologic and serologic markers. Long-acting injectable PrEP formulations, particularly cabotegravir, have been associated with prolonged delays in HIV diagnosis, Undisclosed ART among donors who have HIV infection has been reported in studies from South Africa, Brazil, and the USA. Undisclosed PrEP use has been reported in Canada, the Netherlands, the UK, and the USA. This has the potential to lead to undetected HIV infections in blood donors. Broader availability of ARVs and implementation of HIV treatment and prevention programs increase the relevance of this issue for blood safety. A limitation for defining ARV-associated HIV transfusion transmission risk is the availability of high-quality evidence on the likelihood of donations with altered biomarkers of infection. A framework for risk assessment in the context of sparse data is described. Additional evidence and evaluation of known or potential undisclosed ART, PrEP or PEP use in donors is required before more precise risk estimates are possible.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151045"},"PeriodicalIF":3.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083081","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":"Recruiting and Retaining Young Blood Donors: Recent Evidence and Next Steps.","authors":"Claire van Teunenbroek, Rita Kottasz, Joris Melchior Schröder","doi":"10.1016/j.tmrv.2026.151037","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151037","url":null,"abstract":"<p><p>Individuals under 30 represent a small share of the already limited blood donor pool, making their recruitment and retention critical to maintaining a sustainable blood supply. This article presents a narrative review of 13 recent studies (published since 2023) on engaging younger blood donors and discusses the effectiveness of emerging interventions. We find that existing interventions primarily target three mechanisms: (1) awareness, (2) social engagement, and (3) emotional arousal. Findings suggest that educational approaches can increase knowledge and reduce misconceptions, social and community-based interventions can initially strengthen motivation and participation, and interventions targeting anxiety can improve donation experiences, particularly among younger and first-time donors. However, evidence of sustained behavioral change remains limited, as most studies rely on short-term outcomes and self-reported intentions rather than observed donation behavior. The findings suggest that increasing young donor participation requires coordinated action across educational institutions, blood collection agencies, and social communities, as each is positioned to influence different stages of the donor journey. At the same time, the review reveals a structural \"vacancy\" in donor development: while responsibility for influencing young donors is distributed across multiple actors, no actor is clearly positioned to coordinate and sustain these efforts. We argue that strengthening the future donor base requires not only effective interventions but also system-level approaches that address this coordination gap.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151037"},"PeriodicalIF":3.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149163","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":"Machine Learning for Donor Safety and Engagement: An Analytical Assessment.","authors":"Sheharyar Raza, Na Li, Ruchika Goel","doi":"10.1016/j.tmrv.2026.151024","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151024","url":null,"abstract":"<p><p>Blood donor recruitment, retention, and safety face mounting challenges from an aging donor base and declining donation rates, and there is need for innovation in donor engagement. Machine learning (ML) offers tools to model donor behavior, physiology, and risk, but the maturity, methodological rigor, and translational readiness of this literature have not been systematically characterized. This study aimed to systematically identify and critically appraise studies applying ML methods to blood donation. We conducted structured searches of PubMed for articles published since January 1, 2018 (search date May 7, 2026). Studies were included if they explicitly applied ML; addressed donor safety, engagement, recruitment, retention, health, or adverse reactions; and demonstrated empirical or real-world relevance. Included studies underwent critical appraisal of design, predictors, outcome definition, model development, validation strategy, and practical implications. Of 54 articles identified in systematic search, 5 were selected, addressing donor return prediction, lipemic plasma triglyceride screening in a small, highly selected cohort, anticipatory vasovagal reaction prediction from facial thermal imaging using neural networks, cross-country hemoglobin deferral prediction with model exchange, and externally validated iron recovery prediction using ensemble models. Gradient-boosted and tree-based ensemble models predominated, with SHAP-based interpretation, cross-validation, and external or multi-national validation being used in studies. Common limitations included small or highly preselected samples limiting generalizability; a lack of external validation; underuse of decision-analytic or hard operational endpoints; and minimal discussion of deployment, workflow integration, or ongoing evaluation. ML applications in blood donor services remain at an early, exploratory stage with promising but heterogeneous performance.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151024"},"PeriodicalIF":3.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946362","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":"Potential Pathomechanisms of Reverse Transfusion-Related Acute Lung Injury (TRALI): An Under-Recognized Transfusion Complication.","authors":"Jonas Lowack, Charissa E van den Brom, Philippa G Phelp, Alexander P J Vlaar, Rick Kapur","doi":"10.1016/j.tmrv.2026.151023","DOIUrl":"https://doi.org/10.1016/j.tmrv.2026.151023","url":null,"abstract":"<p><p>Transfusion-related acute lung injury (TRALI) is a potentially fatal blood transfusion complication that is characterized by noncardiogenic pulmonary edema within 6 hours post-transfusion. Specific therapies are not available, thus understanding the pathophysiological mechanisms is essential. Currently, our understanding of the TRALI pathophysiology is based on a 2-hit requirement. The first hit constitutes a priming of the immune system associated with systemic inflammation. The second hit comes through transfused antibodies reactive against recipient leukocytes and/or endothelium, or biological response modifiers. Interestingly, recent case reports suggest a so far underrecognized occurrence of TRALI by a reverse mechanism in the presence of leukoreduced products. In this so called \"reverse TRALI,\" preexisting recipient antibodies react with transfused components such as cells or soluble antigens, triggering pulmonary endothelial cell damage culminating in pulmonary edema through predominantly unknown and unexplored mechanisms. In this review, we have summarized the published literature with suspected reverse TRALI cases, consisting of 11 clinical reports of 25 patients in total (1976-2022). Remarkably, we observed a trend in reverse TRALI cases attributed to granulocyte transfusions in 13 out of 25 cases (52%). The pathomechanisms of reverse TRALI are largely uninvestigated. To start shedding light on this, we furthermore propose several potential mechanisms for reverse TRALI based on literature. We have stratified on transfused soluble antigens, in relation to recipient cells such as polymorphonuclear leucocytes, macrophages/monocytes, and to pathogenic processes including antibody-Fc mediated complement activation, production of reactive oxygen species (ROS), formation of neutrophil extracellular traps (NETs) and secretion of pro-inflammatory cytokines. Our hypothesized pathomechanisms of reverse TRALI are a starting point to investigate this transfusion complication, with potential diagnostic, preventive and therapeutic implications.</p>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":" ","pages":"151023"},"PeriodicalIF":3.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892950","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}