Transfusion Medicine Reviews最新文献

{"title":"Journal Club","authors":"","doi":"10.1016/j.tmrv.2025.150892","DOIUrl":"10.1016/j.tmrv.2025.150892","url":null,"abstract":"","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 2","pages":"Article 150892"},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552697","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":"Ultra-Restrictive Transfusion Thresholds in Critically Ill Adults: Are We Ready for the Next Step?","authors":"Caroline M. Schaap,&nbsp;Robert B. Klanderman,&nbsp;Anna-Linda Peters,&nbsp;Alexander P.J. Vlaar,&nbsp;Marcella C.A. Müller","doi":"10.1016/j.tmrv.2025.150893","DOIUrl":"10.1016/j.tmrv.2025.150893","url":null,"abstract":"<div><div>Anemia is almost universal in critically ill patients, with 25% receiving blood transfusions as clinicians aim to prevent insufficient oxygen delivery. The current 'restrictive' hemoglobin (Hb) threshold of 7 g/dL for the nonbleeding critically ill population is supported by several landmark transfusion trials. While some trials have investigated lower transfusion thresholds, these were not conducted in this specific population. Transfusion is associated with various risks including transfusion-associated circulatory overload, transfusion-related acute lung injury, and hemolytic reactions. Moreover, transfusion products are scarce and expensive as they are produced from voluntary blood donations. Therefore, it is essential to limit blood transfusion to when absolutely necessary. Research indicates that several patient categories tolerate lower Hb levels than 7 g/dL. For instance, studies on acute hemodilution in healthy volunteers have shown that lower Hb levels do not lead to organ ischemia. Similarly, studies involving patients who refuse transfusions, often report lower Hb levels down to 5g/dL or less. These lower Hb levels appear to have limited impact on mortality or morbidity related outcomes. In patients with severe burns or hematological disorders, Hb levels below 7 g/dL are not associated with significant adverse outcomes. These findings suggest that the transfusion threshold for critically ill patients could potentially be lowered, as Hb levels under 7 g/dL do not inherently lead to increased mortality or morbidity. An individualized approach to deciding whether to transfuse or not might be best. This shift in transfusion practice could help reduce costs and minimize the risks associated with blood transfusions.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 2","pages":"Article 150893"},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579498","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":"Recommended Papers of 2024 From the TMR Editorial Board","authors":"Sunny Dzik ,&nbsp;Zoe McQuilten ,&nbsp;Jeannie Callum","doi":"10.1016/j.tmrv.2024.150874","DOIUrl":"10.1016/j.tmrv.2024.150874","url":null,"abstract":"","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 1","pages":"Article 150874"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","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":"Transfusion Medicine at the End of the First Quarter of the 21st Century","authors":"Sunny Dzik ,&nbsp;Jeannie Callum ,&nbsp;Zoe McQuilten","doi":"10.1016/j.tmrv.2024.150873","DOIUrl":"10.1016/j.tmrv.2024.150873","url":null,"abstract":"","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 1","pages":"Article 150873"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143171959","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":"Platelet Additive Solutions and Pathogen Reduction Impact on Transfusion Safety, Patient Management and Platelet Supply","authors":"Georges Andreu ,&nbsp;Karim Boudjedir ,&nbsp;Nicolas Meyer ,&nbsp;Monique Carlier ,&nbsp;Christian Drouet ,&nbsp;Jean-Yves Py ,&nbsp;Charles Tacquard ,&nbsp;Paul Michel Mertes ,&nbsp;Imad Sandid","doi":"10.1016/j.tmrv.2025.150875","DOIUrl":"10.1016/j.tmrv.2025.150875","url":null,"abstract":"<div><div>Since 1998, leuko-reduction is used in France for all platelet concentrates (PCs), apheresis-derived (APCs) and pooled whole blood-derived buffy-coats (BCPCs). Platelet additive solutions (PAS), introduced in 2005, accounted for over 80% of the platelet supply from 2011 to 2017. The Intercept pathogen reduction technology (PR), started in a pilot study in 2007, was generalized in 2018. Between 2007 and 2021, the use of BCPCs increased steadily from 23% to 70% of the supply. Objectives: to analyze the impact of these modifications on adverse transfusion reactions (ATRs), patient management and blood transfusion organization. Results: The overall incidence of ATRs /10⁵ PCs is significantly lower with PAS- and PR-PCs as compared to PCs in plasma (PL), with the decreasing hierarchy PL &gt; PAS &gt; PR. PAS- and PR-PCs lead to significantly lower incidences of allergy and alloimmunization to RBC antigens (RC-AI) ATRs. The incidence of bacteria transmission (TTBI) is significantly reduced by 95% with PR-PCs. APC-related ATR incidence is significantly higher than BCPC for allergy (+233%), TTBI (+100%), APTR (+75%), Major-ABO-II (+65%), HLA/HPA-AI (+38%), FNHTR (+22%), and life-threatening ATRs (+106%). A single diagnosis is significantly less associated with APCs: RC-AI (-47%). The generalization of PR-PCs, which exhibit a lower platelet content than PAS- and PL-PCs, is associated with a significant 9% decrease in the ATR incidence per PC, a 13% increase in the number of PCs transfused per patient, and a nonsignificant 3% increase in the ATR incidence per patient. The outdated PCs percentage declined significantly from 3.7% to 1.7%.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 1","pages":"Article 150875"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143238987","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 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}