Transfusion最新文献

Background: Pica is an eating disorder characterized by the persistent craving and consumption of non-food substances such as ice, chalk, starch, or raw pasta. Pica symptoms are more common in people with iron deficiency and resolve upon treatment. Without iron supplementation, volunteer blood donors can become iron deficient after repeated donations, making them an ideal population to study pica.

Study design and methods: A genome-wide association study (GWAS) was conducted with 12,157 volunteer blood donors within the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) RBC-omics study. Three pica outcomes of interest were evaluated, including ice-only consumption, non-ice consumption, or either type of pica (combined). Candidate single nucleotide polymorphisms (SNPs) were tested for replication using all of us (AoU).

Results: Within REDS-III, 2.4% of donors reported pica symptoms, and nine genome-wide significant SNPs were identified as associated with pica. Within a stratified European population of 7493 REDS-III donors, seven genome-wide significant SNPs were identified. Both overall and in the European stratum, ferritin levels were lower in pica cases than controls (36.0 ± 43.2 ng/mL vs. 53.3 ± 69.2 ng/mL overall and 33.8 ± 41.0 ng/mL vs. 43.8 ± 55.3 ng/mL). Of these, one SNP, rs73277282, near the gene encoding the neuropeptide VF (NPVF) replicated in the AoU dataset (REDS-III p = 1.53 x 10^-8; AoU p = .02).

Discussion: Neuropeptide VF has been previously shown to regulate food intake and energy balance, suggesting that polymorphisms associated with its expression may synergize with iron deficiency to produce pica behaviors.

Background: In cases of massive transfusion, intravenous access can be limited. Additionally, delivering different products through separate lines and infusion methods adds unnecessary steps. RBC, plasma, and whole blood (WB) are delivered via rapid infusers; cryoprecipitate (CRYO) is infused through separate access and is not approved with these devices.

Study design and methods: We examined the impact of different transfusion methods on hemostatic performance and factor activity using two available CRYO products. Ten bags of CRYO, ten bags pathogen-reduced CRYO (Intercept® Fibrinogen Complex, IFC), and 20 units of WB were obtained. Each CRYO bag was infused with one unit of WB by three techniques: (1) gravity infusion with filter, (2) rapid infuser at 70 mL/min, and (3) pressure bag and filter. Hemostatic potential was measured by thrombelastography (TEG), thrombin generation (CAT), and factor levels (ACLTOP). Post-each infusion, disposable tubing and infusion parts were inspected for evidence of clumping or clogging.

Results: Both standard CRYO and IFC demonstrated maintained or improved TEG, CAT, and factor levels when subjected to a rapid infuser device and pressure bag. When compared with gravity infusion, a rapid infuser device and pressure bag demonstrated maintained or improved values by TEG, CAT, and factor activity. No evidence of clumping or clogging of tubing was encountered in the 20 runs performed. No evidence of system dysfunction with use of CRYO through these devices was found either.

Discussion: Restriction of CRYO infusion through rapid infuser devices or with pressure bags should be reconsidered. Future clinical trials are warranted.

Background: Traumatic injury remains a leading cause of death, often due to uncontrolled hemorrhage and trauma-induced coagulopathy (TIC). TIC is critically triggered by the endotheliopathy of trauma, involving endothelial cell injury and glycocalyx degradation. Despite conventional advances, the stable casualty rate underscores the urgent need for new precision resuscitation strategies that acknowledge factors like biological sex.

Design: The central hypothesis is that estrogen confers a survival advantage in hormonally active females through a dual action: endothelial cell stabilization (halting glycocalyx shedding) and its inherent procoagulant effect. The analysis assesses the therapeutic potential of both exogenous estrogen and female-derived blood products to mitigate endotheliopathy and coagulopathy.

Results: Literature suggests that the female sex, particularly the pre-menopausal age group, possesses an intrinsic advantage linked to circulating estradiol. Estrogen supplementation is noted to mitigate bleeding risks, as clinical reviews in surgical and critical care settings consistently demonstrated a reduction in transfusion requirements and improved hemostasis after administering conjugated estrogen. Current literature findings underscore the therapeutic utility of estrogen in targeting endotheliopathy and coagulopathy.

Conclusion: The evidence suggests that estrogen plays a critical, context-dependent role. One of the most compelling benefits is estrogen's capacity to maintain endothelial integrity, thereby correcting trauma-induced endotheliopathy. This mechanism, coupled with its inherent procoagulant effect, underlies the observed female survival advantage. Targeting this sex-based mechanism is a promising avenue to enhance trauma management. Future large-scale, randomized controlled trials are needed to validate the efficacy of direct estrogen supplementation and the strategic utilization of female-donated blood products in trauma resuscitation.

Background: To reduce the risk of transfusion-transmitted babesiosis (TTB), the Food and Drug Administration (FDA) released guidance in 2019 requiring Babesia screening of all donations collected in 14 states on the East Coast and Upper Midwest (Connecticut, Delaware, Massachusetts, Maryland, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Virginia, and Vermont Minnesota and Wisconsin), plus Washington, DC. The American Red Cross (ARC) implemented Babesia blood donation screening in those areas in May 2020. Screening uses a transcription-mediated amplification (TMA) nucleic acid test (NAT) on pools of 16 whole-blood samples. NAT-reactive samples are tested for B. microti antibody by immunofluorescence assay (IFA).

Case reports: From October 2021 to December 2025, the ARC has identified positive donors in four TTB cases. In all instances, the implicated donation was a Babesia untested red blood cell (RBC) unit collected in a non-endemic state where screening is not performed (West Virginia, Oregon, Georgia, and Michigan). All cases were travel-related: three donors reported travel to endemic states, while the fourth was a resident of an endemic state who donated during a vacation in a non-endemic state.

Conclusion: The regional approach of Babesia blood testing has dramatically reduced the risk of TTB. However, the cases described in this report highlight the ongoing vulnerability posed by donor travel and underscore the need to continue monitoring the current geographic screening strategy.

Background: Hemorrhage is the leading cause of preventable death on and off the battlefield that leads to coagulation dysfunction and endotheliopathy. To improve understanding of the nature and timing of these pathologies, we sought to profile markers of coagulopathy and endotheliopathy between survivors and non-survivors in a swine model of uncontrolled hemorrhage.

Study design and methods: Anesthetized Yorkshire cross-bred swine (n = 39) were subjected to a 45 s uncontrolled bleed following a 6-mm laceration to the femoral artery. Following applications of various hemostatic dressings, anesthetized swine were monitored up to 24 h with periodic blood sampling. Serum/plasma was assayed for coagulopathy and endotheliopathy biomarkers and compared between survivors (24 h post-hemorrhage) and non-survivors.

Results: The injury resulted in a 62% mortality with 95% succumbing to injury within ~3 h. Hyaluronan and heparan sulfate were elevated in the fatality groups at 1 h (p < .05) and 2 h (p < .05), respectively. The fatality group at 1 h exhibited reduced plasminogen activator inhibitor-1 (PAI-1, p < .001) and elevated tissue plasminogen activator (p < .01) and D-Dimer (p < .05) relative to survivors. Survivors experienced significant elevations in C-reactive protein (p < .0001), PAI-1 (p < .0001), heparan sulfate (p < .0001), E-selectin (p < .0001), and vascular cell adhesion molecule-1 (p < .01) compared to baseline.

Discussion: These results suggest that acute fatalities undergo hyperfibrinolysis followed by glycocalyx shedding. Survivors may experience longer term complications due to delayed/on-going inflammation and/or endothelium activation. This characterization of severe hemorrhage provides insights into the nature and progression of coagulopathy and endotheliopathy that emulate clinical findings which can be used for evaluating future therapeutics to reduce preventable deaths.

Background: RhD mismatched transfusions in RhD negative women have the potential to impact future pregnancies through alloimmunization and development of hemolytic disease of the fetus and newborn (HDFN). As use of RhD positive emergency-release blood products in pediatric trauma has increased, it has become clear that a significant alloimmunization risk also exists for RhD negative girls, which has not been addressed by existing literature. This article describes a best-practice guideline to manage RhD negative pediatric females who receive RhD positive transfusions.

Design: Pathology or transfusion medicine staff are notified of RhD-mismatched blood transfusions and eligibility for therapy with RhIG is determined. Patients are evaluated by Pediatrics or Pediatric Hematology. These consultants will provide counseling and offer treatment.

Results: Management strategy depends on red blood cell volume (RBCv) transfused. Pediatric females who receive RBCv <20% of their TBV are eligible to receive RhIG, while those who receive >20% are not. Unlike in adult females, TBV calculations change with age. All should be screened for the development of anti-D antibodies between 6 and 12 months after transfusion, regardless of treatment with RhIG. When the patient reaches adulthood, she should be followed by ObGyn and undergo repeat antibody testing before becoming pregnant.

Conclusion: Protocols for the management of mismatched transfusions in RhD negative women have been established, but there are no published guidelines directing management of similar pediatric patients. The described approach provides a safe and effective framework to mitigate RhD alloimmunization risk for these pediatric patients, thereby safeguarding their future reproductive outcomes.

Introduction: Hemorrhagic shock is the most common preventable cause of death in trauma patients. Early transfusion significantly improves survivability in patients suffering from hemorrhagic shock. We hypothesized that machine learning models could reduce time to initial transfusion by more rapidly identifying patients likely to require blood products.

Study design and methods: We conducted a retrospective model-development and internal-validation study using the Trauma Quality Improvement Program (TQIP) dataset from 2019 to 2022. Adult patients aged 18 years or older were included; the only exclusion criterion was missing transfusion outcome data. Models evaluated included logistic regression, ridge regression, Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest, and extreme gradient boosting (XGBoost) assessed using an 80/20 train-test split. Five-fold cross-validation was used for hyperparameter tuning. Area under the receiver operating characteristic curve (AUROC) was used for model optimization.

Results: A total of 1,232,956 patients were included, of whom 109,819 (8.9%) received transfusions. XGBoost achieved the highest AUROC (0.8452). With a decision threshold of 0.0816 selected by maximizing balanced accuracy on the test set, accuracy was 0.7298, sensitivity was 0.7927, and specificity was 0.7236. SHapley Additive exPlanations (SHAP) values showed that Injury Severity Score, systolic blood pressure, activation level, pulse rate, and age were the most influential predictors.

Discussion: XGBoost demonstrated strong predictive performance using only arrival-time variables, and SHAP explanations offered clinically intuitive reasoning. These characteristics highlight the model's potential as a rapid decision-support tool, although external validation remains an important next step.

Background: Cryopreserved platelets can support availability in settings where fresh platelets are inaccessible. Freeze-dried plasma (FDP) may serve as an alternative reconstitution medium to fresh frozen plasma (FFP) when plasma thawing is impractical. The effects of FDP on cryopreserved platelet quality remain underexplored. Thus, we aimed to evaluate its suitability.

Study design and methods: Cryopreserved platelets were prepared from double-dose buffy-coat concentrates, split, prewashed, and frozen using dimethyl sulfoxide (DMSO) (5-6%). After thawing, paired units were resuspended in FFP (AB = 8) or FDP (OctaplasLG Powder, AB = 8). Platelet count and mean platelet volume were analyzed alongside blood gas parameters. Additionally, extracellular lactate dehydrogenase (LDH), sP-selectin, and VEGF were measured in the supernatant. Platelet markers (aggregation, adhesion, and activation) and microparticles were analyzed by flow cytometry. Clotting ability was evaluated using ROTEM.

Results: After thawing, FDP units contained significantly more platelets than FFP units 206 ± 27 versus 176 ± 18 ×10⁹/units (p = .0006). LDH activity was lower (p = .040), whereas VEGF levels were higher (p = .0003) in the FDP group. Oxygen and carbon dioxide pressure differed significantly, yet pH was normal. Phenotypic expression and microparticle content demonstrated no significant differences. FDP units showed a shorter clotting time in ROTEM EXTEM (50 ± 5 vs. 58 ± 9 s, p = .035), although clot strength was similar.

Discussion: FDP-reconstituted platelets were functionally comparable to those reconstituted with FFP, while demonstrating improved recovery and enhanced clot initiation, potentially due to differences in plasma composition. Given its logistical advantages, particularly in resource-limited settings, FDP represents a promising reconstitution medium for cryopreserved platelets.

Background: Previous studies suggest that in children with hemorrhagic shock following injury, prehospital blood transfusion improves survival. Quantifying and understanding the current demand for blood transfusion will help us improve the use and availability of prehospital blood for pediatric patients. This study sought to describe the current demand for and utilization of prehospital blood resuscitation following motor vehicle crash (MVC) in pediatric trauma populations from 2020 to 2023.

Study design and methods: Hypotensive patients ≤14 years after MVC included in the National Emergency Medical Services Information System (NEMSIS) from 2020 to 2023 were identified. Hemodynamic instability was based on age-defined systolic blood pressure and heart rate parameters. Total number and percentage of children who received prehospital blood transfusion, including components or whole blood, were calculated.

Results: The database included 391,764 children involved in an MVC. Of these, 1913/391,764 (0.5%) were potentially eligible for prehospital blood transfusion based on prehospital hemodynamic status, yet of the 1913 patients, only 39/1913 (2%) received prehospital blood. Eligible patients were generally older than 10 years (64%) and MVCs occurred in urban areas (77%).

Discussion: Only 2% of hemodynamically unstable pediatric MVC patients received prehospital blood. Prehospital blood resuscitation is underutilized in pediatric MVC populations, suggesting an urgent need for focused evaluation to identify barriers and promote increased utilization.