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

Red blood cell (RBC) alloimmunization continues to challenge the foundational promise of transfusion therapy: to provide safe and universally effective support. Although most transfused individuals remain tolerant, a vulnerable minority develop alloantibodies that complicate care and increase the risk of delayed hemolytic transfusion reactions (DHTRs). While high-income nations increasingly mitigate this risk through molecular genotyping, low- and middle-income countries (LMICs) face a distinct landscape defined by antigenic mismatch and resource scarcity. This critical review evaluates alloimmunization not merely as a technical failure, but as a phenomenon driven by the collision of immunobiological susceptibility and structural health determinants. A structured literature review informed by PRISMA reporting recommendations was conducted to synthesize immunobiological and health-systems evidence across diverse epidemiological settings.We synthesize evidence on immune responsiveness alongside the economic realities of LMICs, where competing health priorities often necessitate trade-offs in laboratory capacity. By critically examining compatibility strategies through the lenses of feasibility and cost-effectiveness, we propose a risk-adapted, tiered framework for antigen matching. This approach challenges one-size-fits-all paradigms, suggesting that transfusion safety can be optimized by aligning biological risk with available resources rather than relying solely on inaccessible technologies.

Background: Pathogen reduction treatment (PRT) of platelet concentrates (PC) is one of the most recent advances in improving blood safety and lowering the risk of transfusion-transmitted diseases. The characteristics of PR-treated PC differ slightly from those of untreated PC and may affect transfusion outcomes. We established how effective PRT methods, (INTERCEPT™ Blood System) PC are when transfused to cardiac surgery patients.

Materials and methods: This study examined the influence of PRT using amotosalen and UVA light in a population of cardiac surgery patients. We analysed bleeding and platelet drop following cardiopulmonary bypass (CPB) surgery. We selected 73 patients after considering the medical exclusion criteria: 46 patients transfused with untreated platelet concentrate versus 27 patients transfused with PRT-treated platelet concentrate.

Results: Data analysis concerns the readout after the first platelet concentrate transfusion. The decrease in patient platelet count between pre-operative and H0 [Intensive Care Unit (ICU) admission], and pre-operative and H6 post-surgery did not differ significantly with or without PRT. The volume of postoperative bleeding after CPB surgery did not differ significantly regardless of whether the patient was transfused with PRT-PC or untreated PC. No difference was documented between the groups in terms of postoperative pulmonary infection rate. Regardless of the use of platelet PRT, among the factors associated with bleeding, only Fg level was independently and significantly associated. A 1mg/L increase in fibrinogen (pre-operative) is associated with a 159mL decrease in bleeding 24hours post-surgery.

Discussion: In postoperative cardiac surgery, the use of platelets treated with amotosalen/UVA for pathogen reduction does not appear to affect transfusion effectiveness and postoperative bleeding.

Although transfusion medicine is a relatively recent addition to everyday clinical practice, the current understanding of blood as a therapeutic compound does not solely result from a single century of research, but rather from the culmination of millennia of observations, experimentations and interpretations. Early conceptions about blood have largely been transmitted through myths and mythology where blood is deeply connected to themes such as strength, power, life, heritage, wellbeing, holiness, suffering and death. Interestingly, this perception appears to be universal, transcending geographical and cultural boundaries. Most medical textbooks overlook this aspect which is crucial because these symbols and archetypes acted as a cultural substratum from which the modern understanding of transfusion gradually emerged, thereby carrying with it emotional and symbolic forces that still today shape the patient's experience and perception of blood transfusion. This review article traces the origins of transfusion medicine back to its most ancient foundations. It examines how early civilizations perceived blood, the symbols associated with it, how these ideas have influenced modern science thereby transforming ancestral beliefs associated with blood into a scientifically grounded medical practice. Tracing and recognizing this intellectual lineage underscore that medicine is not isolated from culture. Itconverts blood transfusion from a purely technical act into a humanistic gesture and provide physicians with deeper understanding why certain taboos, fears, or ethical debates persists around blood transfusion and help them to better empathize with patients who may have cultural or religious concerns about transfusion.

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.

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 h 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 2750 people. Over the first 72 h the LRC prepared and delivered 373 packed red blood cells (PRBCs) to 25 hospitals in 48 missions (median delivery time 1.5 h) and collected more than 900 donor units (61% first-time donors). During the subsequent two-month conflict, the LRC distributed 2481 PRBCs and 1150 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.