Transfusion Medicine Reviews最新文献

{"title":"ADAMTS13 Testing During Clinical Remission of Immune Thrombotic Thrombocytopenic Purpura: A Critical Review","authors":"Danielle H. Robinson ,&nbsp;Maple Huang ,&nbsp;Diva Baggio ,&nbsp;Giles Kelsey ,&nbsp;Abbey Willcox ,&nbsp;Kay Htun ,&nbsp;Amanda K. Davis","doi":"10.1016/j.tmrv.2025.150896","DOIUrl":"10.1016/j.tmrv.2025.150896","url":null,"abstract":"<div><div>Immune thrombotic thrombocytopenic purpura (iTTP), an autoimmune disorder characterised by thrombocytopenia and microangiopathic haemolytic anaemia, is associated with significant morbidity. The diagnosis is made when ADAMTS13 activity is &lt;10% in conjunction with supporting clinical features. Treatment includes plasma exchange with immunosuppressive and anti-von Willebrand factor therapies. While diagnosis and management of acute iTTP are well established, our understanding of optimal monitoring during clinical remission remains incomplete. Clinical relapse of iTTP occurs most commonly within the first year of remission, however, there is little consensus as to the frequency of ADAMTS13 monitoring during clinical remission and when to intervene when there is ongoing deficiency. Through selecting studies that performed ADAMTS13 activity testing during clinical remission of iTTP we critically analyse the current research of ADAMTS13 monitoring during clinical remission and suggest areas for further research with a focus on clinically important outcomes.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 2","pages":"Article 150896"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860368","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 Utility of a Critical Antibody Titer in Anti-K Alloimmunized Pregnancies: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy","authors":"Jeremy W. Jacobs ,&nbsp;Ronan P. Sugrue ,&nbsp;Jerome Jeffrey Federspiel ,&nbsp;Melissa C. Funaro ,&nbsp;Brian D. Adkins ,&nbsp;Garrett S. Booth ,&nbsp;Masja de Haas ,&nbsp;Jia Jennifer Ding ,&nbsp;Danijela Drndarevic ,&nbsp;Sejal Kabre ,&nbsp;Shengxin Liu ,&nbsp;Yolentha M. Slootweg ,&nbsp;Eleonor Tiblad ,&nbsp;Kenneth J. Moise Jr ,&nbsp;Elizabeth A. Abels","doi":"10.1016/j.tmrv.2025.150895","DOIUrl":"10.1016/j.tmrv.2025.150895","url":null,"abstract":"<div><div>Anti-Kell (anti-K) alloimmunization is a known cause of severe hemolytic disease of the fetus and newborn (HDFN), yet the utility of a critical maternal antibody titer in guiding clinical management remains debated. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of a maternal anti-K titer threshold of ≥8 for predicting the need for intrauterine intervention due to severe anti-K–mediated HDFN. In parallel, we characterized all reported cases of severe HDFN occurring in the setting of low maternal anti-K titers (&lt;8). Studies were excluded if they lacked reported titers, did not include K-positive or K-unknown fetuses, failed to report fetal outcomes, or included interventions that could lower maternal alloantibody levels. Studies that assessed all alloimmunized patients meeting inclusion criteria were incorporated into a diagnostic test accuracy (DTA) meta-analysis; all eligible studies were included in a qualitative synthesis. Fifty-four studies, comprising 582 fetuses, met inclusion criteria. Of these, 6 studies (350 fetuses) were included in the DTA analysis, which demonstrated a pooled sensitivity of 97.0% (95% CI, 88.7%–99.2%) and specificity of 33.1% (95% CI, 27.9%–38.8%) for an anti-K titer ≥8. Among fetuses affected by severe HDFN, 98.6% (204/207) were associated with maternal anti-K titers ≥8. These findings suggest that severe disease is uncommon in the setting of low anti-K titers and support the use of a critical titer threshold to inform antenatal surveillance. Reevaluation of current clinical guidelines may be warranted in light of these data.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 2","pages":"Article 150895"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850131","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":"Identifying Modifiers of CAR T-Cell Therapeutic Efficacy and Safety: A Systematic Review and Individual Patient Data Meta-Analysis","authors":"Manoj M Lalu ,&nbsp;Samuel Igweokpala ,&nbsp;Natasha Kekre ,&nbsp;Matthew S Jeffers ,&nbsp;Joshua Montroy ,&nbsp;Maryam Ghiasi ,&nbsp;Kevin Hay ,&nbsp;Scott McComb ,&nbsp;Risini Weeratna ,&nbsp;Harold Atkins ,&nbsp;Brian Hutton ,&nbsp;Ayel Yahya ,&nbsp;Ashish Masurekar ,&nbsp;Philippe Giguere ,&nbsp;Elham Sabri ,&nbsp;Mohamad Sobh ,&nbsp;Dean A Fergusson","doi":"10.1016/j.tmrv.2025.150897","DOIUrl":"10.1016/j.tmrv.2025.150897","url":null,"abstract":"<div><div>CAR T-cell therapy is effective in relapsed/refractory hematologic malignancies, but its use has been tempered by heterogeneity in response and safety outcomes. We performed individual patient data meta-analysis (IPDMA) of CAR T-cell therapy in patients with hematologic malignancies to explore whether patient-level factors modify therapeutic efficacy/safety. We searched MEDLINE, Embase, and Cochrane CENTRAL for relevant trials. IPD was collected and pooled from each included trial, and prevalence of outcomes among strata of potential modifiers was explored. Our primary outcome was complete response, and the secondary outcomes were cytokine release syndrome (CRS), and immune effector cell associated neurotoxicity syndrome (ICANS). We identified 89 trials comprising 2,331 patients for the IPDMA. Complete response proportion ranged from 25% to 75% depending on cancer type. Decreased complete response was seen in those that received bridging therapy compared to those that did not (34% vs 58%, RR:0.55, 95% CI:0.30-0.98), as well as with autologous cell sources compared to allogeneic sources (53% vs 67%, RR:0.61, 95% CI:0.43-0.87). Compared to CAR T-cell therapies targeting CD19 alone, therapies that combine CD19 targeting with additional targets such as CD20, CD22, CD30, CD33, LeY, NKG2D, or BCMA were associated with higher complete response rates (72% vs 58%, RR:1.69, 95% CI:1.15-2.50). Autologous cell sources demonstrated increased risk of ICANS relative to allogeneic sources (24% vs 3%, RR:10.48, 95% CI:1.87-58.57). Safety and efficacy of CAR T-cell therapy within specific cancer types was also affected by modifiers including bridging therapy, CAR T-cell source, CAR T-cell target, sex, age, number of cell infusions, co-stimulatory domain, and dose.</div></div>","PeriodicalId":56081,"journal":{"name":"Transfusion Medicine Reviews","volume":"39 2","pages":"Article 150897"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869721","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":"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}