{"title":"Molecular genetic narrative review of the novel blood group systems KANNO, SID, CTL2, PEL, and MAM","authors":"G. Denomme","doi":"10.21037/aob-21-25","DOIUrl":"https://doi.org/10.21037/aob-21-25","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41346848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio Siragusa, C. Forlini, Benedetta Fumagalli, S. Redaelli, Dario Winterton, G. Foti, M. Giani
The use of extracorporeal membrane oxygenation (ECMO) support poses several risks, particularly thrombosis and bleeding. As a result, transfusion of blood components is frequent during extracorporeal support. In this review we aim to describe the rationale and indications of blood products transfusions, and their impact on the immune function and outcome. The red blood cells (RBC) transfusion threshold is very debated, because of awareness of transfusion-associated adverse events due to liberal strategies. To date, no specific recommendations exist but a comprehensive physiologic approach appears feasible to evaluate the need for RBC transfusion. For patients without bleeding, the guidelines of the Extracorporeal Life Support Organization (ELSO) suggest fresh frozen plasma (FFP) administration if the prothrombin time (PT) ratio is higher than 1.5–2.0 and/or there is significant bleeding. Conversely, for bleeding patient indications often refer to trauma guidelines, where it is recommended to use a 1:1 ratio of RBC and FFP in massive transfusion situations. The indications for antithrombin supplementation are unknown and large inhomogeneity exists between different ECMO centers and between pediatric and adult patients. Supplementation of fibrinogen is considered only for bleeding patients and/or with fibrinogen level below 100 or 150 mg/dL. ELSO guidelines suggest 25–50 IU/kg of prothrombin complex concentrate as an alternative to FFP for patients with active bleeding and a prolonged PT. Recombinant activated factor VII might be a potential therapeutic option for intractable bleeding despite conventional treatment but may cause life-threatening thrombotic complications. Platelet transfusions might be limited to cases of severe thrombocytopenia accompanied by bleeding. ELSO guidelines recommend a target of at least 80×10/L platelets. Liberal platelets transfusion thresholds may be reasonable in case of intracranial hemorrhage. Albeit rare, multiple adverse events of blood products transfusion are described. There is no evidence of transfusion-related acute lung injury during ECMO support, likely because of the difficulty to distinguish the cause of clinical worsening in patients with severe respiratory failure. Infections represent a major contributor on morbidity and mortality in ECMO patients. However, as of today, no literature has explored the impact of transfusions on immune function of ECMO patients. Currently, there are no specific guidelines for transfusions in ECMO patients and the management is highly variable among centers. Further research is warranted on this topic.
{"title":"Transfusion of blood products during extracorporeal membrane oxygenation: a narrative review of rationale, indications, impact on immune function and outcome","authors":"Antonio Siragusa, C. Forlini, Benedetta Fumagalli, S. Redaelli, Dario Winterton, G. Foti, M. Giani","doi":"10.21037/aob-21-32","DOIUrl":"https://doi.org/10.21037/aob-21-32","url":null,"abstract":"The use of extracorporeal membrane oxygenation (ECMO) support poses several risks, particularly thrombosis and bleeding. As a result, transfusion of blood components is frequent during extracorporeal support. In this review we aim to describe the rationale and indications of blood products transfusions, and their impact on the immune function and outcome. The red blood cells (RBC) transfusion threshold is very debated, because of awareness of transfusion-associated adverse events due to liberal strategies. To date, no specific recommendations exist but a comprehensive physiologic approach appears feasible to evaluate the need for RBC transfusion. For patients without bleeding, the guidelines of the Extracorporeal Life Support Organization (ELSO) suggest fresh frozen plasma (FFP) administration if the prothrombin time (PT) ratio is higher than 1.5–2.0 and/or there is significant bleeding. Conversely, for bleeding patient indications often refer to trauma guidelines, where it is recommended to use a 1:1 ratio of RBC and FFP in massive transfusion situations. The indications for antithrombin supplementation are unknown and large inhomogeneity exists between different ECMO centers and between pediatric and adult patients. Supplementation of fibrinogen is considered only for bleeding patients and/or with fibrinogen level below 100 or 150 mg/dL. ELSO guidelines suggest 25–50 IU/kg of prothrombin complex concentrate as an alternative to FFP for patients with active bleeding and a prolonged PT. Recombinant activated factor VII might be a potential therapeutic option for intractable bleeding despite conventional treatment but may cause life-threatening thrombotic complications. Platelet transfusions might be limited to cases of severe thrombocytopenia accompanied by bleeding. ELSO guidelines recommend a target of at least 80×10/L platelets. Liberal platelets transfusion thresholds may be reasonable in case of intracranial hemorrhage. Albeit rare, multiple adverse events of blood products transfusion are described. There is no evidence of transfusion-related acute lung injury during ECMO support, likely because of the difficulty to distinguish the cause of clinical worsening in patients with severe respiratory failure. Infections represent a major contributor on morbidity and mortality in ECMO patients. However, as of today, no literature has explored the impact of transfusions on immune function of ECMO patients. Currently, there are no specific guidelines for transfusions in ECMO patients and the management is highly variable among centers. Further research is warranted on this topic.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43277449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ewa Olek, M. Pasierski, Artur Słomka, G. Raffa, Steven Lebowitz, M. Pilato, K. Szułdrzyński, P. Suwalski, R. Lorusso, M. Kowalewski
{"title":"Blood product transfusions on extracorporeal membrane oxygenation: a narrative review","authors":"Ewa Olek, M. Pasierski, Artur Słomka, G. Raffa, Steven Lebowitz, M. Pilato, K. Szułdrzyński, P. Suwalski, R. Lorusso, M. Kowalewski","doi":"10.21037/aob-21-30","DOIUrl":"https://doi.org/10.21037/aob-21-30","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42341364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Menard, A. Mujoomdar, L. Tapley, Nicole Relke, Joey Zheng, A. Shih, J. Callum
A transition from liberal use of transfusions prior to invasive procedures to a thoughtful, restrictive approach to transfusion is underway. This shift is being driven by the publication of very large observational studies showing a very low incidence of bleeding complication from most common procedures (even in the presence of severe thrombocytopenia and abnormal tests of coagulation) in conjunction with an evidence-based 2019 guideline from the Society for Interventional Radiology recommending restrictive use of pre-procedure transfusion. Many common invasive procedures have a major bleeding risk well less than 1% with image-guided techniques. This is excellent for patient care, however prospective randomized trials of transfusion vs. no transfusion before invasive procedures are unattainable, given the studies would require an impracticable sample size due to low event rates and would expose the transfusion group to the harms of transfusion. Indeed, a recent pilot randomized trial not only found challenges with recruitment but high rates of transfusion complications suggesting that transfusion risks currently exceed bleeding risks. Utilization studies find approximately 25% of plasma and 10% of platelets are transfused to patients as prophylaxis for bleeding prevention prior to procedures. This suggests that adherence to restrictive practices could substantially reduce adverse reactions from transfusion, minimize blood product shortages, and minimize delays in procedures for transfusion. In addition to unnecessary transfusions, the unselected use of preprocedure laboratory testing is unwarranted for all procedures. This testing is expensive, has a low positive predictive value for bleeding complications, and delays procedures unnecessarily. Numerous studies have also shown that the infusion of plasma for mildly elevated international normalized ratio (INR) test results (INR of 1.5–1.9) does not alter the INR and therefore is very unlikely to reduce the bleeding risk. Lastly, the INR does not predict the risk of bleeding and the coagulation status of patients with liver cirrhosis. Many large centers have successfully transitioned to a restrictive use of blood before procedures and published the safety of this approach. This review will provide the evidence to convince others to follow suit.
{"title":"The use of blood components prior to bedside procedures","authors":"A. Menard, A. Mujoomdar, L. Tapley, Nicole Relke, Joey Zheng, A. Shih, J. Callum","doi":"10.21037/aob-21-69","DOIUrl":"https://doi.org/10.21037/aob-21-69","url":null,"abstract":"A transition from liberal use of transfusions prior to invasive procedures to a thoughtful, restrictive approach to transfusion is underway. This shift is being driven by the publication of very large observational studies showing a very low incidence of bleeding complication from most common procedures (even in the presence of severe thrombocytopenia and abnormal tests of coagulation) in conjunction with an evidence-based 2019 guideline from the Society for Interventional Radiology recommending restrictive use of pre-procedure transfusion. Many common invasive procedures have a major bleeding risk well less than 1% with image-guided techniques. This is excellent for patient care, however prospective randomized trials of transfusion vs. no transfusion before invasive procedures are unattainable, given the studies would require an impracticable sample size due to low event rates and would expose the transfusion group to the harms of transfusion. Indeed, a recent pilot randomized trial not only found challenges with recruitment but high rates of transfusion complications suggesting that transfusion risks currently exceed bleeding risks. Utilization studies find approximately 25% of plasma and 10% of platelets are transfused to patients as prophylaxis for bleeding prevention prior to procedures. This suggests that adherence to restrictive practices could substantially reduce adverse reactions from transfusion, minimize blood product shortages, and minimize delays in procedures for transfusion. In addition to unnecessary transfusions, the unselected use of preprocedure laboratory testing is unwarranted for all procedures. This testing is expensive, has a low positive predictive value for bleeding complications, and delays procedures unnecessarily. Numerous studies have also shown that the infusion of plasma for mildly elevated international normalized ratio (INR) test results (INR of 1.5–1.9) does not alter the INR and therefore is very unlikely to reduce the bleeding risk. Lastly, the INR does not predict the risk of bleeding and the coagulation status of patients with liver cirrhosis. Many large centers have successfully transitioned to a restrictive use of blood before procedures and published the safety of this approach. This review will provide the evidence to convince others to follow suit.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45244482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Special series on thrombocytopenia due to immunization against CD36","authors":"B. Curtis","doi":"10.21037/aob-2021-03","DOIUrl":"https://doi.org/10.21037/aob-2021-03","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47717414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Molecular genetics and genomics of blood group systems","authors":"Y. Fichou","doi":"10.21037/aob-21-71","DOIUrl":"https://doi.org/10.21037/aob-21-71","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47770034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intrauterine, neonatal and pediatric transfusion therapy","authors":"Y. Mo, B. Bahar, C. Jacquot","doi":"10.21037/aob-21-59","DOIUrl":"https://doi.org/10.21037/aob-21-59","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46362240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anemia is a global health issue. It is associated with a wide variety of disease states in both medical and surgical patients. Increased morbidity and mortality are notable in patients with even mild anemia. Clinicians often consider red blood cell (RBC) transfusions as first-line therapy for patients with anemia to raise the hemoglobin (Hgb) level and increase oxygen delivery. RBC transfusion in the hemorrhaging patient can be lifeor limb-saving. However, RBC transfusion may result in serious adverse events, both acute and delayed, and thus, the medical decision to transfuse in the non-bleeding, anemic patient must be carefully considered. Recent literature identifies RBC transfusion practice, in a multitude of patient populations, can be readily avoided with attention placed on proper assessment of patient symptoms, optimal diagnosis of the etiology of the anemia, and appropriate treatment thereof. This review seeks to collate the current state of the science regarding RBC transfusions in the adult non-bleeding patient. Evidence-based alternatives to transfusion will also be briefly presented.
{"title":"Anemia and red blood cell transfusion in the adult non-bleeding patient","authors":"C. D. Burns","doi":"10.21037/aob-21-51","DOIUrl":"https://doi.org/10.21037/aob-21-51","url":null,"abstract":"Anemia is a global health issue. It is associated with a wide variety of disease states in both medical and surgical patients. Increased morbidity and mortality are notable in patients with even mild anemia. Clinicians often consider red blood cell (RBC) transfusions as first-line therapy for patients with anemia to raise the hemoglobin (Hgb) level and increase oxygen delivery. RBC transfusion in the hemorrhaging patient can be lifeor limb-saving. However, RBC transfusion may result in serious adverse events, both acute and delayed, and thus, the medical decision to transfuse in the non-bleeding, anemic patient must be carefully considered. Recent literature identifies RBC transfusion practice, in a multitude of patient populations, can be readily avoided with attention placed on proper assessment of patient symptoms, optimal diagnosis of the etiology of the anemia, and appropriate treatment thereof. This review seeks to collate the current state of the science regarding RBC transfusions in the adult non-bleeding patient. Evidence-based alternatives to transfusion will also be briefly presented.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45772290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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