Transfusion最新文献

Background: Guidelines for red blood cell transfusion recommend incorporating patient factors and clinical context beyond hemoglobin (Hb) levels. However, limited data exist on which factors clinicians consider important. Understanding these decision-making elements can clarify how guidelines are applied and inform future research. This study aimed to identify and prioritize factors that influence transfusion decisions among inpatient clinicians.

Study design and methods: Inpatient clinicians who are high utilizers of transfusion were administered a survey and asked to rate the importance of 30 decision-making factors using a 3-point Likert scale (very, somewhat, not important). Additional questions addressed transfusion practices and anemia management using a 5-point Likert scale (very much disagree to very much agree). Descriptive statistics were used to characterize study participants and survey responses, and regression models explored associations between responses and participant characteristics.

Results: Of 95 eligible clinicians, 85 (89%) completed the survey. Only 7 of the 30 factors were rated as "very important" by more than 66% of respondents; 5 of these were Hb-related. Importance assigned to other non-Hb-related factors varied. Most clinicians (85%) do believe that anemia can result in significant adverse consequences. Most clinicians further believe that restrictive transfusion is standard of care (88%) and optimal (68%), but also that transfusion decisions need to incorporate factors other than a patient's Hb level (84%) at the same time.

Conclusion: Despite guidelines suggestions, there is a lack of consensus on what clinical factors beyond Hb clinicians believe are important in making transfusion decisions.

Background: Extremely preterm neonates often require red blood cell (RBC) transfusions derived from adult donors. These transfusions introduce adult hemoglobin into a neonatal hematopoietic system dominated by fetal hemoglobin (HbF), shifting the oxygen-dissociation curve and increasing oxygen delivery to immature tissues. This contributes to oxidative stress and has been associated with prematurity-related diseases. Cord blood (CB)-derived red cell concentrates (CB-RCCs) offer a new physiological alternative by preserving HbF. To enable clinical implementation, CB-RCCs must meet (inter)national quality standards. This study investigated the impact of pre-filtration dilution, storage in non-di(2-ethylhexyl)phthalate (DEHP) plasticized bags, and three additive solutions-saline-adenine-glucose-mannitol (SAGM), phosphate-adenine-glucose-guanosine-saline-mannitol (PAGGSM), and SOL-X-on CB-RCC quality over 21 days.

Study design and methods: CB was collected after term delivery and processed within 24 h into leukocyte- and platelet-depleted CB-RCCs. Products, either pre-filtration diluted or undiluted, were stored up to 21 days in 1,2-cyclohexane dicarboxylic acid diisononyl ester- or DEHP-plasticized polyvinyl chloride bags containing SAGM, PAGGSM, or SOL-X additive solutions. Quality parameters were assessed on Days 1, 7, 14, and 21. Quality standards were compared against (inter)national requirements for adult RCC.

Results: Pre-filtration dilution to maximize yield was found to impair product quality. CB-RCCs stored in non-DEHP bags with PAGGSM showed the lowest hemolysis at Day 21 (0.30 ± 0.09%), outperforming SAGM (0.57 ± 0.16%). Red blood cells in non-DEHP bags also preserved adenosine triphosphate levels and deformability better than in DEHP bags.

Discussion: We demonstrated that CB-RCCs stored in non-DEHP bags with PAGGSM as an additive solution meet (inter)national Blood Bank quality standards up to 21 days of in vitro storage.

Background: Traumatic brain injury (TBI) carries significant mortality and morbidity in civilian and military populations. Current treatment guidelines for TBI are primarily supportive, and no pharmacological agent exists to attenuate the progression of brain injury. Valproic Acid (VPA) has long been used to treat neurological disorders; however, recent work has demonstrated its potential as a neuroprotective agent. We have already demonstrated that VPA administration in swine models of TBI (with or without associated hemorrhage and polytrauma) significantly improves survival and neurological recovery and decreases brain lesion size compared to controls. This paper introduces a phase 2/3 clinical trial that is designed to evaluate the efficacy and safety of VPA administration in patients with TBI.

Methods: In this randomized, double-blind, placebo-controlled, multicenter trial, patients with moderate to severe TBI (GCS 3-12) across nine level 1 trauma centers in the US will be randomized to receive either standard of care treatment and 250 mL of isotonic saline (control), or standard of care treatment and intravenous VPA at either 50 mg/kg (low-dose VPA group), or 100 mg/kg (high-dose VPA group). The primary endpoint of this clinical trial will be neurological status as measured by the Extended Glasgow Outcome Scale (GOS-E) 3 months post-TBI.

Discussion: Our team has conducted multiple large animal studies that strongly support the cytoprotective effects of VPA treatment. The goal of this upcoming trial is to study the efficacy and safety of two doses of VPA in patients with moderate to severe TBI.

Trial registration: ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT07166393, September 3, 2025.

Background: Liberal platelet transfusion practices increase neonatal morbidity and mortality. The mechanisms underlying this harm are unknown but may involve the immune rather than hemostatic functions of platelets, as well as the significant differences between adult (transfused) and neonatal platelets, particularly the higher P-selectin surface expression on activated adult platelets. In this study, we investigated the immune/inflammatory effects of transfusing adult platelets into newborn mice.

Study design and methods: Washed platelets from wild-type (WT) or P-selectin^-/- adult donors or Tyrode's buffer control were transfused into WT and thrombocytopenic c-MPL^-/- pups. Blood was collected 2- or 4-h post-transfusion to measure a panel of plasma inflammatory cytokines, neutrophil extracellular trap (NET) formation, and the percentage of circulating platelet-monocyte and platelet-neutrophil aggregates (PMAs and PNAs).

Results: Transfusion of adult WT platelets into post-natal Day 10 (P10) and 5 (P5) WT pups increased plasma concentrations of inflammatory cytokines 2- and 4-h post-transfusion, including interleukin-6 (IL-6) and Keratinocyte-derived chemokine (KC). Transfusion of WT platelets into P10 thrombocytopenic c-MPL^-/- pups similarly increased plasma inflammatory cytokines, PMA and PNA percentages, and NET formation. Compared to WT platelets, P-selectin^-/- platelets induced similar elevations in plasma cytokines, but NET formation was attenuated and PMA and PNA percentages were comparable to those of sham-transfused pups.

Discussion: In a murine model of neonatal thrombocytopenia, transfusion of adult platelets increased PMA and PNA percentages, plasma inflammatory cytokines, and NET formation through both P-selectin-dependent and -independent mechanisms. These effects may contribute to the negative outcomes seen with liberal neonatal platelet transfusion practices.

Background: Alloimmunization against D-antigen can cause severe Hemolytic Disease of the Fetus and Newborn (HDFN). Traditionally, anti-D-titers are measured using a saline indirect antiglobulin test (tube testing). Anti-D-titers ≥8 during pregnancy trigger an escalation in maternal care. Tube testing is labor-intensive and known for imprecision. Automated gel-based titration is more sensitive and precise than tube titration for the detection of anti-D. A gel titer correlated with potential fetal anemia has not been established, as studies comparing gel and tube titers provide widely variable results. This multicenter study tested anti-D samples in parallel to characterize the difference in sensitivity between tube and automated gel assays.

Study design and methods: Patients alloimmunized to RhD had samples tested using tube and automated gel titration methods. A total of 647 samples were tested in parallel. A subset of 141 samples also had anti-D levels quantified using continuous flow analysis (CFA). Controlled lots of R₂R₂ red blood cells and standardized reagents were utilized.

Results: Results demonstrated that gel-based methods yielded mean titers 2.5-3 dilutions higher than tube; this difference diminished at tube titers >128. Notably, several samples previously considered negative by tube were positive by gel. Anti-D levels quantified by CFA demonstrated a good correlation with tube and gel testing (R = 0.75-0.9 for tube; R = 0.85-0.89 for gel).

Discussion: A tube titer of 8 to 16 correlates with an automated gel titer of 32-128 when R₂R₂ cells are used. Results using the CFA method correlate well with tube and gel analyses.