Mark H. Yazer

The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC.

BACKGROUND:  Febrile non‐hemolytic transfusion reactions (FNHTRs) are a common complication of platelet concentrate (PC) and RBC transfusions, usually ascribed to cytokines released by WBCs and perhaps the platelets themselves during storage. Prestorage WBC reduction should abrogate the accumulation of these cytokines reducing the number of FNHTRs.

Transfusion-associated circulatory overload after plasma transfusion.

BACKGROUND: In 2010, transfusion‐associated circulatory overload (TACO) was the second most common cause of transfusion‐related mortality reported to the Food and Drug Administration. We sought to determine the rate of TACO caused by plasma transfusion.

Detection of anti-D in D– recipients transfused with D+ red blood cells

BACKGROUND: The D antigen is highly immunogenic, requiring only a small quantity of transfused red blood cells (RBCs) to cause alloimmunization in D– immunocompetent recipients. The relatively low sensitization rate in oncology patients transfused with D+ platelets is well documented. A study of the alloimmunization rate of primarily nononcology D– recipients transfused with D+ RBCs was undertaken.

Blood salvage and cancer surgery: a meta‐analysis of available studies

BACKGROUND: Intraoperative blood salvage (IBS) is a technique that is frequently used in major blood loss surgery. Classically, it is avoided during cancer surgery where a fear exists of entraining cancer cells into the shed blood. In this study, all reports of this practice were collected to determine if this fear is warranted.

Immune hemolysis following ABO-mismatched stem cell or solid organ transplantation.

Purpose of reviewLimitations in donor availability for stem cell or organ transplantation require that ABO-incompatible donors be used. Crossing ABO lines can have immune consequences characterized by immediate or delayed hemolysis. Recent findingsThe use of peripheral blood as a stem cell source has essentially eliminated the risk for ABO-mediated hemolysis during infusion. Delayed red cell engraftment is expected after a major ABO-incompatible transplant and may be associated with pure red cell aplasia. The incidence of hemolysis associated with minor ABO incompatibility, the passenger lymphocyte syndrome, is waning because anti-B-cell immunosuppressive therapy is increasingly a component of graft versus host disease prophylaxis. The impact of ABO mismatching on stem cell recipient survival remains an area of active investigation. Although major ABO-incompatible organs are not used routinely for transplantation, minor ABO-incompatible organs are frequently used to meet the demand for organs. Passenger lymphocyte syndrome in this setting is a common complication, and has now been observed with every organ type and increasingly with non-ABO antibodies. Hemolysis can occur, but it is uncommonly severe. SummaryABO-mismatched donors are commonly used for transplantation, and immune hemolysis remains the main complication. Clinicians must be vigilant in order to recognize hemolysis and implement appropriate therapy.

Transfusion practice and safety: current status and possibilities for improvement.

Audits of practice and incident reporting, most notably to national haemovigilance schemes, indicate that poor hospital transfusion practice is frequent and occasionally results in catastrophic consequences for patients. Improvements in practice are needed and depend on a combined approach including a better understanding of the causes of errors; a reduction in the complexity of routine procedures taking advantage of new technology systems, which enforce agreed guidelines and policies; the setting and regular monitoring of performance standards for key aspects of the hospital transfusion process, improved organisation of transfusion in hospitals and staff training; and further research on the safe and effective use of blood and alternatives to donor blood. There needs to be a greater recognition that ‘transfusion safety’ applies to the hospital transfusion process as well as the contents of blood bags and that resources need to be provided for the improvement of transfusion safety and management in hospitals commensurate to their importance.

Transfusion reactions: prevention, diagnosis, and treatment

Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.

The use of the mechanical fragility test in evaluating sublethal RBC injury during storage

Background  The mechanical fragility index (MFI) is an in vitro measurement of the extent of RBC sublethal injury. Sublethal injury might constitute a component of the RBC storage lesion, thus the MFI was determined serially during routine RBC storage.

Hepatic Function After Genetically Engineered Pig Liver Transplantation in Baboons

Background. If “bridging” to allo-transplantation (Tx) is to be achieved by a pig liver xenograft, adequate hepatic function needs to be assured. Methods. We have studied hepatic function in baboons after Tx of livers from &agr;1,3-galactosyltransferase gene-knockout (GTKO, n=1) or GTKO pigs transgenic for CD46 (GTKO/CD46, n=5). Monitoring was by liver function tests and coagulation parameters. Pig-specific proteins in the baboon serum/plasma were identified by Western blot. In four baboons, coagulation factors were measured. The results were compared with values from healthy humans, baboons, and pigs. Results. Recipient baboons died or were euthanized after 4 to 7 days after internal bleeding associated with profound thrombocytopenia. However, parameters of liver function, including coagulation, remained in the near-normal range, except for some cholestasis. Western blot demonstrated that pig proteins (albumin, fibrinogen, haptoglobin, and plasminogen) were produced by the liver from day 1. Production of several pig coagulation factors was confirmed. Conclusions. After the Tx of genetically engineered pig livers into baboons (1) many parameters of hepatic function, including coagulation, were normal or near normal; (2) there was evidence for production of pig proteins, including coagulation factors; and (3) these appeared to function adequately in baboons although interspecies compatibility of such proteins remains to be confirmed.

Does a febrile reaction to platelets predispose recipients to red blood cell alloimmunization

BACKGROUND: A variable effect of inflammation on alloimmunization to transfused red blood cells (RBCs) in mice has been recently reported. We investigated whether RBC alloimmunization in humans was affected by transfusion of blood products in temporal proximity to experiencing a febrile transfusion reaction (FTR) to platelets (PLTs), an event predominantly mediated by inflammatory cytokines.