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Review, conceptual model, and gap analysis of transfusion burden in hematological diseases.

INTRODUCTION: Hematological diseases affect millions of people worldwide, and many of these patients require blood transfusions. Although the potential adverse clinical outcomes associated with transfusions are well documented, the patient perspective of transfusion burden in hematological diseases is not. This perspective is critical, as health-related quality of life scores alone cannot fully capture patients' experiences. AREAS COVERED: A comprehensive review was conducted to understand the patient perspective of transfusion burden in hematological diseases. This study included a targeted …

Efficiency and safety gains from bedside electronic transfusion checks in four hospitals in England.

Bedside electronic transfusion check (BETC) systems support safer practice by aiding staff in patient identification during group and screen (G&S) sample labelling and blood component administration, steps where most transfusion errors occur. While the safety rationale is clear, the significant costs necessitate robust cost-benefit evaluation. During phased BETC implementation in four London hospitals, we mapped in detail transfusion workflow, quantifying staff time saved under three modes of technology adoption which enable three corresponding states of organisational use: Mode-A (baseline: m

How I Treat Pediatric Hematology-Oncology Patients from Families Identifying as Jehovah's Witnesses.

Caring for pediatric hematology-oncology patients from families identifying as Jehovah's Witnesses presents opportunities to align clinical and ethical care considerations, particularly regarding blood transfusion refusal. Although transfusion avoidance is often presumed, patient and family preferences are heterogeneous and influenced by individual conscience, cultural context, and interpretation religious guidance. This article explores practical approaches to transfusion‑averse care through three illustrative cases. The first involves an adolescent with relapsed Hodgkin lymphoma considering …

Effect of Superficial Anastomoses on Circulatory Dynamics in Twin-Twin Transfusion Syndrome.

The role of superficial anastomoses in the survival of fetuses with twin-twin transfusion syndrome after fetoscopic laser photocoagulation is unknown. This study aimed to evaluate how superficial anastomoses affect the circulatory dynamics of both fetuses with twin-twin transfusion syndrome using ductus venous Doppler waveforms. We included all twin-twin transfusion syndrome (TTTS) patients who underwent fetoscopic laser photocoagulation in our institution from 2006 to 2019; fetal demise cases after fetoscopic laser photocoagulation were excluded. We recorded ductus venous Doppler waveforms on

Preoperative risk factors for massive transfusion, prolonged ventilation requirements, and mortality in patients undergoing liver transplantation.

BACKGROUND: Despite improvements in techniques and management of liver transplant patients, numerous perioperative complications that contribute to perioperative mortality remain. Models to predict intraoperative massive blood transfusion, prolonged mechanical ventilation, or in-hospital mortality in liver transplant recipients have not been identified. In this study we aim to identify preoperative factors associated with the above mentioned complications. METHODS: A retrospective observational analysis was conducted on data collected from 124 orthotopic liver transplants performed at a singl…

Anti-HI can cause a severe delayed hemolytic transfusion reaction with hyperhemolysis in sickle cell disease patients.

BACKGROUND: Delayed hemolytic transfusion reaction (DHTR) is a life-threatening condition in sickle cell disease (SCD) patients that is frequently complicated by hyperhemolysis. Antibodies resulting from antigen disparity between donors of European ancestry and patients of African ancestry are common, but situations involving antibodies not classically of clinical significance are also encountered. Anti-HI is generally considered to be an innocuous naturally occurring antibody. STUDY DESIGN AND METHODS: We describe two cases of hyperhemolysis with anti-HI and provide details of the reported c

Gamma irradiation and red cell haemolysis: a study at the Universiti Kebangsaan Malaysia Medical Centre.

Gamma-irradiation of blood components is regarded a safe procedure used for prevention of transfusion associated graft-versus-host disease. However, reports showed that irradiation can cause erythrocyte haemolysis and damage to the RBC membrane. In University Kebangsaan Malaysia Medical Centre (UKMMC), a number of suspected transfusion reactions (TR) featured unusual isolated episodes of red-coloured-urine or haemoglobinuria among paediatric patients without clinical features of acute haemolytic TR. Haemolysis of irradiated red cells was suspected as a cause. This study was conducted to evalua

The risk of an overt hemolytic transfusion reaction following the use of an immediate spin crossmatch.

The major crossmatch must include an anti-human globulin test, unless the transfusion recipient has no apparent significant unexpected antibodies, in which case the use of only an immediate spin crossmatch method is considered acceptable. However, a minority of laboratories utilize only an immediate spin crossmatch as their routine major crossmatch, possibly because contemporary antibody screening tests occasionally miss detecting some unexpected antibodies, and these missed antibodies are more often detected by the anti-human globulin crossmatch than by the immediate spin crossmatch. In the p

Hepatitis "C" antigen in non-A, non-B post-transfusion hepatitis.

Evidence for a new hepatitis-specific antigen has been obtained from double immunodiffusion assays between acute and convalescent sera obtained from patients with non-A, non-B post-transfusion hepatitis. The designation hepatitis C (HC) antigen is proposed. HC was found in the acute-phase sera of all 13 non-A, non-B post-transfusion hepatitis patients with longer incubation and duration periods (type 2) tested, but only transiently in 4 out of 10 acutephase sera obtained from patients with type 1 non-A, non-B hepatitis, with shorter incubation and duration periods. The antigen was also detecte

TRansfusion strategies in Acute brain INjured patients (TRAIN): a prospective multicenter randomized interventional trial protocol.

BACKGROUND: Although blood transfusions can be lifesaving in severe hemorrhage, they can also have potential complications. As anemia has also been associated with poor outcomes in critically ill patients, determining an optimal transfusion trigger is a real challenge for clinicians. This is even more important in patients with acute brain injury who were not specifically evaluated in previous large randomized clinical trials. Neurological patients may be particularly sensitive to anemic brain hypoxia because of the exhausted cerebrovascular reserve, which adjusts cerebral blood flow to tissue…

Low-dose erythropoietin in anemic arthroplasty patients within contemporary patient blood management pathways.

BACKGROUND: Preoperative anemia remains a major determinant of transfusion risk in total joint arthroplasty (TJA), even within contemporary … esulted in higher Hb levels at hospital admission, postoperative day 1, and postoperative day 7. No blood transfusions were administered during the observation period. BI-7 values were low and comparable between groups (2.1 vs. 2.3; p = 0.30). No thromboembolic events were observed. CONCLUSIONS: Within a contemporary PBM framework, selective low-dose preoperative …

Expression of Immune Checkpoints LAG-3, CTLA-4, TIM-3, and PD-1 in Beta-Thalassemia Patients Treated Using HbF Augmentation Therapy and Regular Transfusions.

OBJECTIVE: Beta-thalassemia is an inherited hemoglobin disorder caused by mutations in the HBB gene encoding beta-globin chains. Severe anem … , and PD-1 were quantified using real-time polymerase chain reaction in patients being managed with blood transfusions (n=33) or HbF-augmenting drugs (n=140) compared to healthy controls (n=27). RESULTS: This study revealed increased expression of LAG-3 in patients regardless of treatment, whereas increased CTLA-4 was observed in patients receiving regular transfu …

The effect of storage time of human red cells on intestinal microcirculatory oxygenation in a rat isovolemic exchange model.

OBJECTIVE: To determine whether the storage time of human leukodepleted red blood cell concentrates compromises intestinal microvascular oxygen concentration oxygen (muPo(2)) during isovolemic exchange transfusion at low hematocrit. DESIGN: Prospective, randomized, controlled study. SETTING: University research institute laboratory. SUBJECTS: Male Wistar rats. INTERVENTIONS: Intestinal muPo(2) was determined by Pd-porphyrin phosphorescence life-time measurements. MEASUREMENTS AND MAIN RESULTS: Rats were brought near to a state of oxygen supply dependency by hemodilution with a pasteurized

Restrictive vs. liberal transfusion strategy in patients with chronic kidney disease: A retrospective cohort study.

INTRODUCTION: Chronic kidney disease (CKD) is associated with anemia, a common complication that, in severe cases, requires red blood cell (RBC) transfusion. The optimal hemoglobin (Hb) threshold for deciding when to transfuse remains a matter of debate. This study aimed to compare the effects of a restrictive transfusion strategy (Hb≤7g/dl) versus a liberal strategy (Hb>7g/dl) in hospitalized patients with CKD. METHODS: A single-center retrospective cohort study was conducted between December 2022 and December 2023, including adult patients with CKD stages G3b, G4, and G5 who received RBC tr

Transfusion Burden in Allogeneic Hematopoietic Stem Cell Transplantation over Time: Experience from a Single Institution.

IntroductionTransfusion plays a main role in supportive treatment for patients who receive an allogeneic hematopoietic stem cell transplantation (HSCT). In this study, we compare the transfusion requirements of patients undergoing different modalities of HSCT according to different time periods. The objective is to assess the evolution of HSCT transfusion requirements over time, from a single institution.MethodsThe clinical charts and transfusion records of patients who underwent HSCT of different modalities at La Fe University Hospital during a twelve-year period were reviewed (2009-2020). Fo

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… Blood transfusions and pulmonary complications after hematopoietic cell transplantation. Transfusion. 2016;56:653–661. doi: 10.1111/trf.13415. 9. Moscardó F., Sanz J., Carbonell F., Sanz M.A., Larrea L., Montesinos P., Lorenzo I., Vera B., Boluda B., Salazar C., et al. …

Linear decline of corrected platelet count increment within 24 hours after platelet transfusion in haematological patients: A prospective observational study.

OBJECTIVES: The aim of this study was to prospectively explore the detailed longitudinal development of platelet increments in patients with chemotherapy-induced bone marrow aplasia during the first 24 hours after platelet transfusion. METHODS: Patients admitted to the Haematology department during 7 months, and fulfilled inclusion criteria were divided into 4 groups: Group 1, patients with acute leukaemia; Group 2, patients after autologous stem cell transplantation (SCT); Group 3, patients after allogeneic SCT; and Group 4, patients given platelet transfusion prior to intervention. We used

Successful management of perioperative hemostasis in a patient with Glanzmann thrombasthenia who underwent a right total mastectomy.

Perioperative hemostatic management is a challenge in patients with Glanzmann thrombasthenia (GT). The standard means of preventing surgical bleeding in GT patients is platelet transfusion. However, GT patients often possess alloantibodies against GPIIb/IIIa and/or HLA, which cause resistance to platelet transfusion. HLA-matched platelet transfusion, plasmapheresis, or recombinant human-activated factor VII (rFVIIa) are alternative interventions in such cases. Monitoring of hemostasis is also critical in the management of GT patients who undergo surgery. Here, we report the case of a 56-year-o

[Transfusion-related acute lung injury].

Transfusion-related acute lung injury (TRALI) developed into the leading cause of transfusion-related morbidity and mortality after the first description by Popovsky et al. approximately three decades ago. It was the most frequent reason for transfusion-related fatalities worldwide before implementation of risk minimization strategies by donor selection. Plasma-rich blood products, such as fresh frozen plasma and apheresis platelets seem to be the leading triggers of TRALI. Hypoxemia and development of pulmonary edema within 6 h of transfusion are the diagnostic criteria for TRALI. The differe

Methicillin-resistant Staphylococcus aureus sepsis associated with the transfusion of contaminated platelets: a case report.

BACKGROUND: Platelet transfusion-associated sepsis is usually due to donor skin flora introduced into the unit during phlebotomy. An unusual case of a platelet component contaminated with methicillin-resistant Staphylococcus aureus (MRSA) is reported. CASE REPORT: A 54-year-old man, terminally ill with progressive non-Hodgkin's lymphoma, developed fever and hypotension during a platelet transfusion. He was receiving multiple antibiotics, including vancomycin. Blood cultures taken soon after transfusion were negative. An aliquot taken from the platelet pool grew MRSA at a count of 1.6 x 10(8)

Hydrostatic and osmotic pressure gradients produce manifestations of fetofetal transfusion syndrome in a computerized model of monochorial twin pregnancy.

OBJECTIVE: In spite of recent advances in the assessment and treatment of fetofetal transfusion syndrome, its underlying mechanism remains controversial. We aimed to determine whether the clinical features of fetofetal transfusion syndrome could be explained by unidirectional or bidirectional intertwin transfusion along placental vascular anastomoses. STUDY DESIGN: We constructed a dynamic computerized model of monochorial twin fetoplacental units on the basis of numerous interrelated hemodynamic, osmotic, and metabolic physiologic variables. The circulations were then linked by various combi