搜索结果：Transfusion medicine reviews

Artificial intelligence (AI) and machine learning (ML) are increasingly promoted to enhance transfusion and patient blood management, yet real-world implementation remains rare. We reviewed recent exemplar studies reporting prospective deployment with workflow integration to examine translational features, barriers, and enablers of AI/ML integration. On June 18, 2025, we searched PubMed and Web of Science for articles from January 2022 onward. Of 1243 records screened and 31 full texts reviewed, 3 studies met inclusion criteria. The exemplars comprised: (1) a laboratory-embedded tool predicting low ferritin in anemic adults, which during a 21-day deployment identified additional iron deficiency relevant to pretransfusion optimization; (2) a patient-facing smartphone application estimating hemoglobin from fingernail images, adopted nationally by >200,000 users with potential implications for anemia screening; and (3) a clinician-facing smartphone decision support tool predicting resuscitation needs in trauma, piloted across 5 centers with acceptable feasibility and user satisfaction in a transfusion-intensive setting. Common enablers included alignment with clinical need, use of existing data infrastructure, interpretable tree-based models, and early stakeholder engagement. Persistent barriers were data quality and governance, limited generalizability, and absence of economic evaluation. Importantly, no study demonstrated improvement in clinical outcomes or cost. For clinical adoption, AI tools must integrate into routine workflows with clear safety, monitoring, and regulatory plans. Future research should apply implementation frameworks from the outset, evaluate downstream impact on transfusion practice and outcomes, and prioritize scalable approaches such as laboratory-embedded analytics, interoperable decision support, and patient-centered digital tools.

Large-scale combat operations (LSCO) pose unique logistical and clinical challenges to haemorrhagic casualty management. The existing French military transfusion doctrine, originally designed for low-intensity conflicts (LIC), does not meet the demands of LSCO. This work aimed to develop a revised, consensus-based transfusion doctrine integrating operational, medical, and safety requirements for LSCO environments. At the request of the Central Directorate of the Military Health Service, a Delphi-based consensus process was conducted between November 2024 and April 2025. Eight senior military physicians—anaesthesiologist-intensivists, emergency and operational clinicians, and medical biologists with over five years of specialty experience—reviewed eleven thematic domains identified for revision. Drafts, developed from doctrinal texts, operational feedback, and international literature (including systematic reviews), were iteratively refined through three Delphi cycles until full consensus (100%) was reached. This consensus reflects expert doctrinal guidance for LSCO operational preparedness under limited/heterogeneous evidence rather than proof of clinical efficacy. The resulting doctrine was compared with the previous LIC framework and international LSCO transfusion strategies. The new doctrine establishes a scalable, safety-focused system integrating forward whole-blood resuscitation, enhanced logistical autonomy, and reinforced haemovigilance. Cold-stored whole blood will be prioritised as the primary resuscitation product for Roles 1 and 2, while Role 3 will employ component therapy. A new dedicated operational medical unit will oversee in-theatre collection, testing, and distribution. Forward transfusion by trained nurses using universal blood products under predefined criteria will be authorised, with strict traceability and targeted training ensuring transfusion safety in LSCO. This consensus defines the modern French transfusion doctrine for LSCO, combining operational flexibility with rigorous safety oversight and alignment with international standards.

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The increasing availability of digital health data heralds a new era in transfusion research. These data can be assembled into large databases integrating donor, component, and recipient information, enabling studies across the transfusion continuum ("vein-to-vein"). However, establishing and maintaining such databases requires significant resources, and few investigators currently have access to them. To guide future efforts, we reviewed published vein-to-vein databases, focusing on their research use, data scope, limitations, and technical design considerations. Several studies have used vein-to-vein databases to examine determinants of transfusion effectiveness and safety. These studies would benefit from more international collaboration to explore variation and validate findings. Such collaborations could be facilitated through public protocol and data sharing, adherence to recognized standards, or the development of new, widely accepted ones. Investigators who develop vein-to-vein databases must consider the need for data quality and validation checks. Where feasible, investigators should also consider linking vein-to-vein data with prospective cohort studies that include donation and recipient biospecimens to evaluate novel or emerging exposures and explore epidemiological and mechanistic associations. They should also recognize the limitations of vein-to-vein database studies, including residual confounding, data quality issues, and missing data due to outpatient transfusions, home transfusions, or patients without health insurance. Despite these limitations, vein-to-vein databases should be developed, enhanced, and leveraged to provide insights into transfusion efficacy and support pragmatic or emulated randomized controlled trials (RCTs), especially where traditional RCTs are not feasible (eg, platelet thresholds to prevent bleeding complications after lumbar puncture).

Thrombocytopenia is a frequent hematological disorder associated with an increased risk of bleeding across diverse clinical settings. Supportive management aims to prevent hemorrhagic complications, relieve symptoms, and address underlying causes. This narrative review summarizes evidence from randomized trials, systematic reviews, and international guidelines on the supportive management of thrombocytopenia in hematological, oncological, surgical, and critical care settings. Platelet transfusion remains the cornerstone of supportive treatment in patients with severe thrombocytopenia or active bleeding. Prophylactic transfusion is generally recommended in high-risk patients with bone marrow suppression, although thresholds vary according to clinical context and bleeding risk. Therapeutic transfusion is indicated in the presence of active bleeding or prior to urgent procedures. Adjunctive hemostatic therapies may provide additional benefit in selected scenarios. In many clinical situations, recommendations are based on limited evidence, supporting an individualized and restrictive transfusion approach.

As in previous years, 2025 was marked by significant scientific progress. This article focuses on three current topics in emergency medicine. First, it reviews the available evidence on vascular access during cardiac arrest and highlights that intra-osseous access is not superior to peripheral venous access. Second, it summarizes recent advances in trauma management, including the prognostic value of sternal capillary refill time in polytrauma patients, as well as the benefits of maintaining a transfusion target of 90 g/l in patients with brain injury. Finally, this article underscores the current limitations of thrombectomy for distal vessel strokes and discusses its promising perspectives in the treatment of pulmonary embolism. Comme les années précédentes, 2025 a été une année riche sur le plan scientifique. Cet article aborde trois thèmes majeurs en médecine d’urgence. Il fait d’abord le point sur l’abord vasculaire lors d’un arrêt cardiorespiratoire et souligne la non supériorité de la voie intra-osseuse par rapport à la voie veineuse périphérique. Il présente ensuite les avancées récentes en traumatologie, notamment l’intérêt du temps de recoloration capillaire sternal comme marqueur pronostique chez les polytraumatisés, ainsi que l’avantage d’une cible transfusionnelle de 90 g/l chez les patients neurolésés. Enfin, il souligne les limites de la thrombectomie dans le traitement des accidents vasculaires cérébraux distaux, tout en évoquant son potentiel prometteur dans le traitement de l’embolie pulmonaire.

Transfusion-dependent thalassemia (TDT) is a major health problem across the thalassemia belt. Although regular transfusions extend survival, they cause cardiac iron overload (CIO). Cardiac magnetic resonance imaging T2-star (MRI T2*) is the gold standard for detecting myocardial siderosis, but it remains costly and has limited availability. QT and corrected QT (QTc) intervals have been proposed as simple, inexpensive alternatives, yet pediatric evidence is limited. This systematic review aims to assess the association between QT and QTc prolongation and CIO in pediatric TDT. We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines (PROSPERO ID: CRD420251051029). Searches were performed in PubMed, EBSCO, Scopus, ProQuest, ScienceDirect, and Google Scholar for studies published between January 2015 and January 2025. Keywords included "&#x3b2;-thalassemia," "transfusion-dependent thalassemia," "pediatric,", "iron overload," "QT interval," "QTc interval," "cardiac MRI T2*," and "serum ferritin." Eligible studies reported QT/QTc intervals in pediatric TDT with CIO confirmed by MRI T2* and/or serum ferritin. Study quality was evaluated using the Newcastle-Ottawa Scale. Data were pooled using a random-effects model, with subgroup and sensitivity analyses. Seven studies involving 619 children were included; six provided data for meta-analysis. Both QT (mean difference [MD] 18.23 ms; 95% confidence interval [CI] 12.05-24.41; P < 0.00001) and QTc intervals (MD 21.15 ms; 95% CI 15.88-26.42; P < 0.00001) were significantly prolonged in the CIO group. Subgroup analyses confirmed consistent findings with low heterogeneity. QT and QTc prolongation are strongly associated with CIO in pediatric TDT.

Clustered Regularly Interspaced Short Palindromic Repeats-CRISPR associated protein 9 (CRISPR/Cas9) technology has become a revolutionary tool in medicine, offering substantial potential for treating a wide range of diseases, including hematological disorders, cancers, genetic conditions, and ophthalmological diseases. This systematic review evaluates the efficacy, safety, and applicability of CRISPR/Cas9 in clinical trials. A comprehensive search of the PubMed, Scopus, Web of Science, and Cochrane databases was conducted. All studies, up to November 2024, meeting the eligibility criteria assessing the application of CRISPR for the treatment of diseases were included. A quality assessment of the included studies was conducted using the Cochrane risk of bias tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement for systematic reviews and meta-analyses was followed, and a total of 17 studies were included. This systematic review of CRISPR/Cas9 technology focused on its effectiveness and safety across various diseases. In nonmalignant hematological disorders, CRISPR successfully treated &#x3b2;-thalassemia and sickle cell disease, resulting in high transfusion independence and the&#xa0;elimination of disease crises. In malignant hematological disorders, B-cell acute lymphoblastic leukemia, CRISPR-engineered chimeric antigen receptor T (CAR-T) cells achieved an 83.3% complete remission rate. Furthermore, CRISPR-based CAR-T cells showed promising results in B-cell non-Hodgkin's lymphoma. In oncology, lung cancer and other solid tumors are among the diseases that have been safely engineered using CRISPR gene editing technology. For genetic disorders, CRISPR improved vision in retinal degeneration and reduced symptoms in hereditary angioedema and transthyretin amyloidosis with mild side effects. The results demonstrated CRISPR's potential across a wide range of conditions. In conclusion, the findings underscore the potential role of CRISPR/Cas9 technology across a wide range of diseases. However, challenges remain, including optimizing delivery systems, minimizing off-target effects, addressing immunogenicity concerns, and ethical considerations.

Tick bites may expose individuals to a carbohydrate not found in humans, galactose-alpha-1,3-galactose (alpha-gal). A spectrum of disorders may result from IgE-mediated hypersensitivity reactions to alpha-gal, including alpha-gal syndrome (AGS), an allergy to meat or meat-derived products usually presenting 2-6&#xa0;h after consuming the product plus positive alpha-gal specific IgE testing for the oligosaccharide. Reports of anaphylaxis in group O recipients of group B plasma in the absence of other risk factors for severe allergic reactions to blood transfusion could be alpha-gal sensitization; the allergen galactose-alpha-1,3-galactose (Gal-alpha-1-3Gal&#x3b2;1-(3)4GlcNAc-R) is&#xa0;antigenically similar to the B blood group antigen (Gal-alpha-1-3(Fuc-alpha-1,2)Gal). The potential cross-reactivity of alpha-gal specific IgE to B type red blood cells may pose a safety consideration for blood donation and transfusion. This scoping review protocol will be used to research all publications on alpha-gal sensitization to (1) describe characteristics of all known cases of transfusion-related alpha-Gal syndrome (TRAGS) and hypersensitivity reactions to infusions of mammalian red meat-derived medical products besides blood components that may resemble TRAGS; (2) identify studies that explore possible relationships between alpha-gal sensitization and blood group that may be relevant to understanding TRAGS; (3) describe which clinical, laboratory, and epidemiologic parameters used to diagnose AGS food allergy are also appropriate to diagnose TRAGS; and (4) identify which diagnostic assays exist for AGS and how they are used for AGS and/or TRAGS. Using peer-reviewed search strategies, our study team will perform a scoping review with no date or language limit of all literature relevant to the research objectives in PubMed, Scopus, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, including title, abstract, full-text screening, and data collection using Covidence. This study involves published data predominantly from humans (and, rarely, animal) studies of diagnostic assays in development for use in humans. It does not require institutional review board or ethics approval. We intend to disseminate our findings to specialists in allergy, immunology, hematology, and blood banking and to patients or blood donors experiencing symptoms of alpha-gal sensitization. Open Science Framework (osf.io)&#xa0;(DOI:&#xa0; https://doi.org/10.17605/OSF.IO/WDZT6 ).

To evaluate the characteristics and outcomes of pregnancies with a prenatally detected fetal or placental tumor with associated fetal anemia that underwent intrauterine transfusion (IUT). We searched PubMed, EMBASE, Web of Science, Scopus and Google Scholar databases for studies reporting on singleton pregnancies with a prenatally detected fetal or placental tumor complicated by fetal anemia that underwent IUT, published from inception to October 2024. Only articles written in the English language were considered eligible for inclusion. We excluded multiple gestations, fetuses with concomitant structural anomaly, cases that underwent IUT to treat fetal anemia secondary to intraoperative tumor bleeding and cases that received blood products other than red blood cells. Cases in which the tumor was detected postnatally, cases that underwent termination of pregnancy, studies with incomplete data and systematic reviews were also excluded. The primary outcome was perinatal death, defined as intrauterine fetal demise (IUFD) >&#x2009;22&#x2009;weeks' gestation or neonatal death within 28&#x2009;days after birth. Secondary outcomes included IUFD, neonatal death, preterm labor (PTL), preterm prelabor rupture of membranes (PPROM), placental abruption, and spontaneous or medically indicated live preterm birth (PTB). We performed exploratory subgroup analyses, including differences in tumor size according to the presence or absence of additional non-structural complications, as well as differences in baseline characteristics according to perinatal death status and differences in obstetric and perinatal outcomes according to whether the patient underwent prenatal tumor resection, embolization or ablation in addition to IUT. We included 43 cases in our analysis, including 42 cases from 34 articles identified in the literature search and an additional case managed at our institution. The median hemoglobin level before the initial IUT was 7.0 (interquartile range, 6.0-8.8)&#x2009;g/dL. Most cases (92.5%) had an additional non-structural complication at baseline. Prenatal tumor resection, embolization or ablation was performed as an adjunct to IUT in 40.0% of cases. PTL, PPROM or placental abruption complicated 43.2% of cases. PTB occurred in 81.1% of cases. Perinatal death occurred in 11 (25.6%) cases. We identified a higher likelihood of perinatal death in cases with fetal hydrops (odds ratio (OR), 6.3 (95%&#x2009;CI, 1.1-37.7); P&#x2009;=&#x2009;0.04) or cardiomegaly (OR, 6.3 (95%&#x2009;CI, 1.1-36.9); P&#x2009;=&#x2009;0.04), and a lower likelihood of perinatal death was associated with higher fetal hemoglobin after the initial IUT (OR, 0.4 (95%&#x2009;CI, 0.2-0.8), P&#x2009;=&#x2009;0.01). Perinatal death rates were similar regardless of management strategy (12.5% for IUT as a standalone therapy vs 31.3% for IUT as an adjunct to tumor resection, embolization or ablation; P&#x2009;=&#x2009;0.1). Pregnancies with a prenatally detected fetal or placental tumor, complicated by fetal anemia that underwent IUT, have a high rate of additional non-structural complications. The rate of perinatal death in this population is high, likely due to the severity of the fetal condition at baseline and high rates of obstetric complications and PTB. IUT as a standalone therapy may be reasonable in selected cases. However, ideal candidates for this approach and the best management strategies remain to be determined. &#xa9; 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Cryoprecipitated-AHF is a blood derivative produced from plasma donations. It is been used to treat Hemophilia A, von Willebrand disease, and congenital/acquired hypofibrinogenemia, and historically implicated with transmission of serious infectious diseases. As testing and treatment modalities have improved, treatment indications have narrowed considerable, but it still carries the highest potential risk of transfusion-transmitted infection (TTI). Pathogen-reduced cryoprecipitate availability has virtually eliminated the risk of pathogen transmission and extended the shelf-life to minimize waste in clinical practice. This article reviews methods of pathogen reduction, their effectiveness at reducing TTIs, and examine real-world experience of its implementation on inventory management.

Perioperative blood loss during dental and oral and maxillofacial surgical (OMFS) procedures often necessitates red blood cell (RBC) transfusion. However, associated risks, cost, and supply limitations have prompted the exploration of alternatives and evidence-based transfusion strategies. A systematic search was performed in PubMed, Scopus, and Web of Science using PRISMA guidelines. Studies were included if they focused on RBC transfusion or alternatives in surgical settings with relevance to OMFS. Data were extracted on study design, findings, and applicability to dental surgery. Fifteen studies met the inclusion criteria. These included guidelines, reviews, randomized trials, and observational studies. Key findings emphasized the benefits of restrictive transfusion thresholds, preoperative anemia management, intraoperative cell salvage, and adjunct therapies like erythropoietin and antifibrinolytics. Complications, such as transfusion-related acute lung injury, immunomodulation, and procedural errors, were highlighted. Only one study directly addressed OMFS, though others offered applicable insights. Emerging practices in transfusion medicine can enhance safety and efficacy in OMFS. Adoption of patient blood management strategies and transfusion alternatives should be prioritized in dental surgical planning.

Tactical Emergency Medical Services (TEMS) encompasses the skillset of prehospital care that is required to support all phases of operations performed by tactical law-enforcement personnel. High-risk operations can result in critical injuries to those involved. Although TEMS clinicians have been taught to address critical hemorrhage, airway, and breathing issues, there is a benefit in incorporating the use of prehospital blood to reverse hemorrhagic shock. Given the unique environment in which TEMS clinicians operate, this does require forethought, planning, and modification of civilian prehospital blood protocols. This narrative review discusses the unique considerations for this area of prehospital care and reviews current examples of successful blood incorporation from four separate law-enforcement agencies, identifying variations that agencies can adopt to successfully incorporate prehospital blood into TEMS operations. We demonstrate that civilian prehospital blood protocols can be modified to allow incorporation into TEMS operations. Future research should review outcomes when blood is administered within the TEMS environment.

Primary thrombocytosis is associated with increased risk of thromboembolism and bleeding. Therapeutic plateletpheresis (TPP), capable of rapid, transient platelet (Plt) count reduction, is employed as an emergency intervention for symptomatic thrombocytosis while awaiting the therapeutic effect of medical cytoreductive therapy. Nonetheless, the effect of TPP on outcomes and optimal role for TPP remain poorly understood. Critical analytic review of highest-pertinence and -quality articles was performed with the goal of establishing current knowledge gaps to direct original case data collection. Retrospective review of TPP procedures at six United States sites over ten years was performed. Pre-TPP symptoms, medical cytoreduction, adverse events (AEs), and 30-day post-TPP outcomes were analyzed. Critical analytic review revealed no randomized controlled trial (RCT) or controlled trials (CT) of TPP versus first-line medical therapies, and insufficient information on symptoms, goals, criteria-based determination of course, and post-TPP outcomes. New data presented here details 45 adult patients receiving TPP for thrombocytosis. TPP was performed rarely (of n = 6 sites, median 4.5 TPP/10 years, range 4-20). The most frequent diagnosis was myeloproliferative neoplasm (MPN) (34, 75.6%). The most frequent symptoms were any neurologic symptoms (present pre-64.4% of TPPs). TPP goals were commonly Plt-related (n = 85, 94.4% total TPP) and were met in 72.9% of TPP with stated Plt-related goals. Often, (n = 11/50 single TPP or series) TPP was begun or continued despite resolution of the stated indication for TPP. AE occurred during 20% of TPP and were predominantly hypocalcemia related (17/18, 94.4%). Four patients died within 30 days post TPP, three of stroke, one of a non-stroke neurologic complication. All deaths were deemed unrelated to TPP. Critical analytic reviews revealed no RCTs or CTs, a paucity of data on TPP goals and prescribed courses, and significant variability in AE reporting. Little information on long-term outcomes is available. Without controlled evidence supporting clinical outcome benefit of TPP for symptomatic thrombocytosis, utilization is expected to be rare and guideline-informed, following careful consideration of known risk in the setting of unclear benefit.

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For 2 decades, U.S. combat casualty care relied on rapid evacuation, effectively outsourcing late-stage coagulopathy management to resource-laden specialists at Role 3 facilities and above. As we pivot to Large-Scale Combat Operations (LSCO) and the realities of Prolonged Casualty Care (PCC), this paradigm is no longer reliable. Our Austere Resuscitative Surgical Care (ARSC) assets, such as Forward Resuscitative and Surgical Detachments (FRSDs), will hold critically ill casualties for 24 hours or longer, making them responsible for managing the predictable, hypofibrinogenemic dilutional coagulopathy that occurs deep into massive transfusion protocols (MTP)-a condition for which their standard equipment sets lack the optimal treatment. This commentary argues for equipping ARSC assets with Fibrinogen Concentrate (FC) and proposes a pragmatic, evidence-based framework for its administration when advanced diagnostics are unavailable. The argument rests on 3 pillars. First, FC is clinically non-inferior to cryoprecipitate for treating acquired hypofibrinogenemia, as established by the FIBRES trial and confirmed by systematic reviews, while being logistically superior in every dimension critical to austere care: room-temperature storage, rapid reconstitution, standardized dosing, and a minimal logistical footprint. Second, the historical barriers to adoption-regulatory and safety concerns-have been eliminated by the 2024 FDA approval of FC for acquired fibrinogen deficiency and by large trials demonstrating no increased thromboembolic risk. Third, a synthesis of military blood-planning data with contemporary civilian transfusion research-including the largest analysis to date, nearly 50,000 massively transfused patients-demonstrates that a significant majority of combat surgical casualties will reach the transfusion volume threshold where fibrinogen supplementation is indicated, making FC a standard hemostatic tool rather than a niche rescue therapy. Standard MTPs already include cryoprecipitate in the second and subsequent batches at the Role 3. This commentary does not advocate for early empiric fibrinogen supplementation-a strategy recently tested in randomized trials that failed to demonstrate mortality benefit. It argues instead, in massively transfused patients who cannot be evacuated, to substitute the Role 3's threshold-triggered cryoprecipitate delivery with FC at ARSC platforms where cryoprecipitate is physically unavailable. This commentary proposes that FC administration in austere settings be guided by the standards that exist at the Role 3: transfusion volume triggers, validated clinical indicators of hypofibrinogenemia, and viscoelastic testing when available. FC warrants inclusion in the medical equipment sets for all ARSC assets to close a lethal capabilities gap.