Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine最新文献

Background: Red blood cell (RBC) transfusions can be a life-saving intervention, particularly in critically ill patients. However, over the past two decades, their potential for harm has become increasingly evident, leading to the adoption of restrictive transfusion strategies. Current guidelines recommend a transfusion threshold of 7.0 g/dL hemoglobin (Hb) in critically ill patients. However evidence for this exact limit is lacking and there is increasing evidence that Hb-levels under 7 g/dL do not inherently lead to increased mortality or morbidity. This study aims to explore the feasibility of a more restrictive RBC transfusion threshold of 5.0 g/dL compared to the current threshold of 7.0 g/dL in the majority of critically ill patients.

Methods: The study will be a prospective randomized controlled pilot trial conducted in critically ill patients (18 years or older). Participants will be randomized to be treated according to a 5.0 g/dL or a 7.0 g/dL RBC transfusion threshold. Transfusions will be administered 1 RBC unit at a time when the assigned threshold is reached. The primary endpoint is the feasibility of the intervention, expressed as protocol compliance, defined as the percentage of RBC transfusions initiated below the assigned threshold. Secondary outcomes include the SOFA score, protocol violations, incidence of major bleeding, early signs of organ hypoperfusion or organ ischemia, use of life support, acute kidney injury, 30-day mortality, ICU and hospital stay duration, readmission rates, and cost-effectiveness.

Discussion: This pilot study aims to determine whether employing a more restrictive transfusion threshold of 5.0 g/dL is feasible when compared to the current 7.0 g/dL threshold in critically ill patients. This study could pave the way for a future large-scale trial that may lead to more stringent transfusion policies, potentially improving patient outcomes, reducing transfusion-related risks in critically ill populations and limit the dependence on donor red blood cells.

Trial registration: This trial was registered at Highly restrictive vs normal red blood cell transfusion strategy in anemic critically ill patients - A feasibility trial | Research with human participants (identifier: NL-OMON57318) at 12th of February 2025. Note: the numbers in brackets in this protocol refer to the SPIRIT(1) checklist item numbers.

Background: Lebanon's fragmented blood transfusion system faces major risks during humanitarian crises. We describe the national blood-supply response to a mass-casualty event (the pager explosion, Sept 17, 2024) followed by a two-month escalation of hostilities (Sept 21-Nov 20, 2024). The objective is to evaluate the effectiveness, operational challenges, and lessons learned from the coordinated Ministry of Public Health (MOPH) - Lebanese Red Cross (LRC) blood management response during this crisis.

Materials and methods: Retrospective review of MOPH reports, LRC dashboard data, meeting minutes, and quarterly narrative reports covering the acute (72 hours after the explosion) and chronic (two-month war) phases. Key operational metrics (units collected, units distributed, delivery missions, donor characteristics) were extracted and summarized.

Results: The Pager explosion injured around 2,750 people. Over the first 72 hours the LRC prepared and delivered 373 packed red blood cells (PRBCs) to 25 hospitals in 48 missions (median delivery time 1.5 hours) and collected more than 900 donor units (61% first-time donors). During the subsequent two-month conflict, the LRC distributed 2,481 PRBCs and 1,150 fresh frozen plasma units to 56 hospitals, despite center damage, security restrictions, staff fatigue, and declining donor turnout. Centralized command, real-time inventory visibility, pre-approved transport clearances, donor management, and targeted communication sustained supply and safety.

Conclusion: Rapid centralization of coordination, real-time data sharing, standardized communication, and predefined protocols preserved transfusion capacity in an extreme, resource-limited crisis. Institutionalizing these mechanisms and integrating all hospital blood banks would strengthen national transfusion resilience and offer a scalable model for other low- and middle-income settings.

Background: Platelet refractoriness is a frequent and challenging problem in thrombocytopenic patients who require long-term platelet transfusions. However, real-world practice in diagnosing and managing refractoriness remains variable with no inclusive guidelines. This study aimed to address this variability by means of conducting a survey.

Methods: We conducted an anonymous, web-based survey of U.S. hematology and oncology practitioners in 2024-2025 to capture current approaches to platelet refractoriness. The 20-item survey explored diagnostic thresholds, use of HLA antibody testing, application of calculated panel reactive antibody (cPRA) in clinical decision-making, strategies for selecting specialty platelets, and platelet transfusion thresholds across clinical scenarios. Responses were analyzed descriptively.

Results: 28 practitioners responded, most of whom were attending hematologists at academic centers. Awareness of the technical platform for HLA antibody testing was limited, with nearly 90% of respondents unable to identify the assay used at their center. Few institutions reported a defined cPRA threshold to trigger specialized platelet support. For prophylaxis, most adhered to a 10×10³/µL threshold in inpatients, while outpatient thresholds varied more widely.

Conclusions: This national survey highlights marked heterogeneity in the recognition and management of platelet refractoriness among hematology and oncology practitioners. Development of targeted guidelines addressing immune-mediated refractoriness could help standardize practice and optimize patient care.

Background: Adults with hemoglobinopathies require lifelong transfusion support and long-term monitoring, which may substantially affect daily life and treatment burden. Data describing patient-reported transfusion practices in Greece remain limited.

Objectives: To describe transfusion practices, chelation therapy, monitoring patterns, and patient-reported daily life impact among Greek adults with hemoglobinopathies.

Methods: A cross-sectional anonymous online survey was distributed to adults (≥18 years) with self-reported hemoglobinopathies living in Greece. The questionnaire collected data on demographics, disease category, transfusion frequency, chelation therapy, monitoring practices, complications, and patient-reported impact on daily life. Analyses were descriptive.

Results: Transfusion practices and chelation therapy among participants are summarized in Table 1.A total of 114 respondents (mean age 49.4 ± 9.6 years; 53.5% female) completed the survey. Most participants reported regular transfusion therapy, commonly at intervals of ≤15 days, with variable transfusion volumes per session. Chelation therapy was widely reported, although adherence varied. Monitoring practices, including imaging for iron overload, were inconsistently reported. Participants described substantial treatment-related burden, including frequent healthcare visits and concerns regarding blood availability.

Conclusions: Greek adults with hemoglobinopathies report considerable transfusion-related treatment burden affecting daily life. These findings support the need for structured follow-up pathways and patient-centered care strategies.

Background: The legal shelf life of platelet concentrates (PCs) has been extended from 5 to 7 days in France since 2018. Our study aimed to determine whether this increase in PC storage time has produced a significant impact on transfusion-related adverse reactions (ARs).

Methods: A retrospective study was conducted in the Grand Est region of France between January 2022 and December 2023 using data from the e-FIT hemovigilance database and the record of PCs transfused held by the "Etablissement Français du Sang" (EFS).

Results: In 2022 and 2023, 270 ARs related to platelet transfusions were reported in the Grand Est region of France, 240 of which were classified as possibly, probably or certain attributable to the transfusion. The majority of these immediate ARs were allergies, febrile non-hemolytic transfusion reactions and immunological incompatibilities. We found no significant correlation of the platelet storage time (≤ 3 days versus 4-7 days) with the three main immediate adverse reactions (p=0.24), or with isolated alloimmunization (p=0.55). The storage time did not affect the incidence of ARs following transfusion of either buffy coat PC or apheresis PC (p=0.20). Finally, no association was observed between the age of PCs and the severity of ARs (p=0.24).

Conclusion: Our results show that storage of platelets for 4 to 7 days has no significant effect on the occurrence or severity of ARs. Prospective studies will be necessary to assess the impact of platelet storage time on transfusion efficacy and the potential benefit of considering the age of the platelets for certain patients.