1
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Moore SA, Rollins-Raval MA, Gillette JM, Kiss JE, Triulzi DJ, Yazer MH, Paul JS, Leeper CM, Neal MD, Raval JS. Therapeutic plasma exchange is feasible and tolerable in severely injured patients with trauma-induced coagulopathy. Trauma Surg Acute Care Open 2024; 9:e001126. [PMID: 38196934 PMCID: PMC10773431 DOI: 10.1136/tsaco-2023-001126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/11/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives Trauma-induced coagulopathy (TIC) occurs in a subset of severely injured trauma patients. Despite having achieved surgical hemostasis, these individuals can have persistent bleeding, clotting, or both in conjunction with deranged coagulation parameters and typically require transfusion support with plasma, platelets, and/or cryoprecipitate. Due to the multifactorial nature of TIC, targeted interventions usually do not have significant clinical benefits. Therapeutic plasma exchange (TPE) is a non-specific modality of removing and replacing a patient's plasma in a euvolemic manner that can temporarily normalize coagulation parameters and remove deleterious substances, and may be beneficial in such patients with TIC. Methods In a prospective case series, TPE was performed in severely injured trauma patients diagnosed with TIC and transfusion requirement. These individuals all underwent a series of at least 3 TPE procedures performed once daily with plasma as the exclusive replacement fluid. Demographic, injury, laboratory, TPE, and outcome data were collected and analyzed. Results In total, 7 patients received 23 TPE procedures. All patients had marked improvements in routine coagulation parameters, platelet counts, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activities, inflammatory markers including interleukin-6 concentrations, and organ system injuries after completion of their TPE treatments. All-cause mortality rates at 1 day, 7 days, and 30 days were 0%, 0%, and 43%, respectively, and all patients for whom TPE was initiated within 24 hours after injury survived to the 30-day timepoint. Surgical, critical care, and apheresis nursing personnel who were surveyed were universally positive about the utilization of TPE in this patient population. These procedures were tolerated well with the most common adverse event being laboratory-diagnosed hypocalcemia. Conclusion TPE is feasible and tolerable in severely injured trauma patients with TIC. However, many questions remain regarding the application of TPE for these critically ill patients including identification of the optimal injured population, ideal time of treatment initiation, appropriate treatment intensity, and concurrent use of adjunctive treatments. Level of evidence Level V.
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Affiliation(s)
- Sarah A Moore
- Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Marian A Rollins-Raval
- Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jennifer M Gillette
- Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Joseph E Kiss
- Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Darrell J Triulzi
- Pathology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Mark H Yazer
- Pathology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Jasmeet S Paul
- Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Matthew D Neal
- Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jay S Raval
- Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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2
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Wang Y, Rao Q, Li X. Adverse transfusion reactions and what we can do. Expert Rev Hematol 2022; 15:711-726. [PMID: 35950450 DOI: 10.1080/17474086.2022.2112564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Transfusions of blood and blood components have inherent risks and the ensuing adverse reactions. It is very important to understand the adverse reactions of blood transfusion comprehensively for ensuring the safety of any future transfusions. AREAS COVERED According to the time of onset, adverse reactions of blood transfusion are divided into immediate and delayed transfusion reactions. In acute transfusion reactions, timely identification and immediate cessation of transfusion is critical. Vigilance is required to distinguish delayed responses or reactions that present non-specific signs and symptoms. In this review, we present the progress of mechanism, clinical characteristics and management of commonly encountered transfusion reactions. EXPERT OPINION The incidence of many transfusion-related adverse events is decreasing, but threats to transfusion safety are always emerging. It is particularly important for clinicians and blood transfusion staff to recognize the causes, symptoms and treatment methods of adverse blood transfusion reactions to improve the safety. In the future, at-risk patients will be better identified and can benefit from more closely matched blood components.
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Affiliation(s)
- Yajie Wang
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Quan Rao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiaofei Li
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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3
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Holmqvist J, Brynolf A, Zhao J, Halmin M, Hollenberg J, Mårtensson J, Bell M, Block L, Edgren G. Patterns and determinants of blood transfusion in intensive care in Sweden between 2010 and 2018: A nationwide, retrospective cohort study. Transfusion 2022; 62:1188-1198. [PMID: 35638740 PMCID: PMC9328318 DOI: 10.1111/trf.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Background Intensive care unit (ICU) patients are transfused with blood products for a number of reasons, from massive ongoing hemorrhage, to mild anemia following blood sampling, combined with bone marrow depression due to critical illness. There's a paucity of data on transfusions in ICUs and most studies are based on audits or surveys. The aim of this study was to provide a complete picture of ICU‐related transfusions in Sweden. Methods We conducted a register based retrospective cohort study with data on all adult patient admissions from 82 of 84 Swedish ICUs between 2010 and 2018, as recorded in the Swedish Intensive Care Register. Transfusions were obtained from the SCANDAT‐3 database. Descriptive statistics were computed, characterizing transfused and nontransfused patients. The distribution of blood use comparing different ICUs was investigated by computing the observed proportion of ICU stays with a transfusion, as well as the expected proportion. Results In 330,938 ICU episodes analyzed, at least one transfusion was administered for 106,062 (32%). For both red‐cell units and plasma, the fraction of patients who were transfused decreased during the study period from 31.3% in 2010 to 24.6% in 2018 for red‐cells, and from 16.6% in 2010 to 9.4% in 2018 for plasma. After adjusting for a range of factors, substantial variation in transfusion frequency remained, especially for plasma units. Conclusion Despite continuous decreases in utilization, transfusions remain common among Swedish ICU patients. There is considerable unexplained variation in transfusion rates. More research is needed to establish stronger critiera for when to transfuse ICU patients.
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Affiliation(s)
- Jacob Holmqvist
- Department of Anaestesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Anne Brynolf
- Department of Medicine, Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Jingcheng Zhao
- Department of Medicine, Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Märit Halmin
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Center for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Johan Mårtensson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.,Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Bell
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.,Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Linda Block
- Department of Anaestesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf Edgren
- Department of Medicine, Solna, Clinical Epidemiology Division, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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4
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Sun L, Liu Y. Clinical Factors of Blood Transfusion-Related Acute Lung Injury and Changes in Levels of Treg-Related Cytokines. Emerg Med Int 2022; 2022:7344375. [PMID: 35669166 PMCID: PMC9167010 DOI: 10.1155/2022/7344375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Analysis of clinical factors and changes in regulatory T cell (Treg)-related cytokine levels in transfusion-associated acute lung injury (TRALI). Methods 62 patients who underwent blood transfusion and developed TRALI (TRALI group) in our hospital between January 2018 and December 2021 and 58 patients who did not develop TRALI (non-TRALI group) from blood transfusion were selected to collect clinical data from patients and construct a logistic regression model to analyze clinical risk factors for TRALI. Based on the prognosis of TRALI patients, they were divided into survival group (50 cases) and death group (12 cases), and serum CD4 + CD25 + Treg and Treg-related cytokines (interleukin 10 (IL-10), transforming growth factor-β (TGF-β)) levels were compared between the two groups, and the correlation between CD4 + CD25 + Treg and IL-10 and TGF-β was analyzed by Pearson. Results The differences in smoking history, human leukocyte antigen (HLA) antibody II, pretransfusion shock, and CD4 + CD25 + Treg between the TRALI group and non-TRALI group were statistically significant (P < 0.05). Logistic regression analysis showed that HLA antibody II and increased CD4 + CD25 + Treg were independent risk factors of TRALI (P < 0.05). The levels of CD4 + CD25 + Treg, IL-10, and TGF-β in the death group were significantly higher than those in the survival group (P < 0.05). CD4 + CD25 + Treg was positively correlated with levels of IL-10 and TGF-β (P < 0.05). Conclusion Elevated HLA antibody II and CD4 + CD25 + Treg are the main clinical risk factors for TRALI, and CD4 + CD25 + Treg may be involved in immunosuppression by increasing the expression levels of IL-10 and TGF-β. Early clinical monitoring of changes in Treg-related cytokine levels can provide some guidance for prognostic assessment of TRALI patients.
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Affiliation(s)
- Lifang Sun
- Department of Blood Transfusion, Tianshui First People's Hospital, Tianshui, Gansu 741000, China
| | - Yu Liu
- Department of Laboratory, Tianshui First People's Hospital, Tianshui, Gansu 741000, China
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5
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Tian X, Kong Y, Wang J, He R, Li L, Liu Z. Development of the Chinese Haemovigilance Network and reporting of adverse transfusion reactions from 2018 to 2020. Vox Sang 2022; 117:1027-1034. [PMID: 35560059 DOI: 10.1111/vox.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To advance blood transfusion safety, the Chinese Haemovigilance Network (CHN) was put into operation in 2018. This report describes the development of the CHN and evaluates its role by analysing reported adverse transfusion reactions (ATRs) from 2018 to 2020. MATERIALS AND METHODS All data in this study were obtained from the CHN online reporting platform. A timeline of CHN development is presented, and the activities of CHN-enrolled facilities are analysed by year. The reported ATRs were analysed in detail for ATR types, blood components involved and adherence to case definition, severity and imputability criteria. Incidence rates were calculated and compared with international examples. RESULTS During 2018-2020, a total of 3061 ATRs were reported through the CHN online reporting system. The rate of reported ATRs in all facilities and the 10 highest reporting facilities was 0.7‰ and 1.8‰, respectively. When analysed by year, the incidence rate showed an increasing trend from 2018 to 2020. Allergic (68.2%) and febrile non-haemolytic transfusion reaction (27.1%) were the most common. The vast majority of ATRs (92.0%) were not serious, but serious cases of transfusion-associated circulatory overload, transfusion-associated dyspnoea and hypotensive reaction were common. Most (86.0%) of reported cases were definitely or probably associated with transfusion. CONCLUSION Under-reporting of ATRs occurs in many Chinese hospitals, but the establishment of CHN has increased ATR recognition and management. More effort will be needed in the future to detect transfusion problems and improve transfusion practice in China.
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Affiliation(s)
- Xue Tian
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Yujie Kong
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Jue Wang
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Rui He
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Ling Li
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Zhong Liu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
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6
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Graham CA, DuBois D, Gleason C, Kumagai J, Sanford J. Identifying and Understanding Transfusion Reactions in the Oncology Population. Semin Oncol Nurs 2021; 37:151137. [PMID: 33745801 DOI: 10.1016/j.soncn.2021.151137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide an overview of transfusion reactions, their underlying pathophysiology, clinical presentation, and recommendations for nursing management. DATA SOURCES We researched peer-reviewed journal articles, book chapters, Internet, and lecture proceedings. CONCLUSION Transfusion reactions are adverse reactions to blood products frequently seen in the oncology population and can significantly vary in severity and etiology. Oncology nurses are in a critical position to assist with prevention, early detection, and time-sensitive treatment of transfusion reactions. IMPLICATIONS FOR NURSING PRACTICE The oncology nurse's comprehensive understanding of possible transfusion reactions and management recommendations is key for optimal care of the oncology patient.
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Affiliation(s)
- Carrie A Graham
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Danielle DuBois
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Christine Gleason
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Joy Kumagai
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jeannine Sanford
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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7
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McVey MJ, Cohen R, Arsenault V, Escorcia A, Tasmin F, Pendergrast J, Lieberman L, Lin Y, Callum J, Cserti-Gazdewich C. Frequency and timing of all-cause deaths in visits involving suspected transfusion reactions, and the significance of cardiopulmonary disturbances. Vox Sang 2021; 116:898-909. [PMID: 33634884 DOI: 10.1111/vox.13086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Transfusion reactions (TRs) may cause or contribute to death. Cardiopulmonary TRs are distressing, and collectively account for most transfusion fatalities, though the degree to which they alter survival more broadly is unclear. Deaths (and their timing) after TRs may provide further insights. MATERIALS/METHODS Adult (tri-hospital network) haemovigilance data (2013-2016) recorded referrals with conclusions ranging from unrelated to transfusion (UTR) to entities such as: septic TRs, serologic/haemolytic reactions, transfusion-associated circulatory overload (TACO), transfusion-associated dyspnoea (TAD), transfusion-related acute lung injury (TRALI), allergic transfusion reaction (ATR), and others. For (in- or out-patient) visits involving suspected TRs (VISTRs), all-cause mortalities (% [95% confidence interval]) and associated time-to-death (TTD) (median days, [interquartile range]) were compared. Diagnoses were defined inclusively (possible-to-definite) or strictly (probable-to-definite). RESULTS Of 1144 events, rank order VISTR mortality following (possible-to-definite) TRs, and associated TTDs, were led by: DHTR 33% [6-19], 1 death at 123d; TRALI 32% [15-54], 6 deaths: 3d [2-20]; BaCon 21% [14-31], 17 deaths: 10d [3-28]; TACO 18% [12-26], 23 deaths: 16d [6-28]; TAD 17% [11-26]: 18 deaths, 6d [3-12]. Higher-certainty TRs ranked similarly (DHTR 50% [9-91]; BaCon 29% [12-55], 4 deaths: 12d [3-22]; and TACO 25% [16-38], 15 deaths: 21d [6-28]). VISTR mortality after TACO or TRALI significantly exceeded ATR (3·3% [2·4-5·8], P < 0·00001) but was not different from UTR events (P = 0·3). CONCLUSIONS Only half of cardiopulmonary TRs constituted high certainty diagnoses. Nevertheless, cardiopulmonary TRs and suspected BaCon marked higher VISTR mortality with shorter TTDs. Short (<1 week) TTDs in TAD, BaCon or TRALI imply either contributing roles in death, treatment refractoriness and/or applicable TR susceptibilities in the dying.
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Affiliation(s)
- Mark J McVey
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, SickKids, Toronto, ON, Canada.,Department of Physics, Ryerson University, Toronto, ON, Canada
| | - Robert Cohen
- Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Program, University of Toronto Quality, Toronto, ON, Canada.,Transfusion Medicine and Tissue Bank, Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Valerie Arsenault
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Alioska Escorcia
- Blood Transfusion Laboratory (Laboratory Medicine Program), University Health Network, Toronto, ON, Canada
| | - Farzana Tasmin
- Blood Transfusion Laboratory (Laboratory Medicine Program), University Health Network, Toronto, ON, Canada
| | - Jacob Pendergrast
- Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Program, University of Toronto Quality, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program), University Health Network, Toronto, ON, Canada.,Department of Medicine (Medical Oncology & Hematology), University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Hematology, University of Toronto, Toronto, ON, Canada
| | - Lani Lieberman
- Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Program, University of Toronto Quality, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program), University Health Network, Toronto, ON, Canada
| | - Yulia Lin
- Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Program, University of Toronto Quality, Toronto, ON, Canada.,Transfusion Medicine and Tissue Bank, Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Hematology, University of Toronto, Toronto, ON, Canada
| | - Jeannie Callum
- Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Program, University of Toronto Quality, Toronto, ON, Canada.,Transfusion Medicine and Tissue Bank, Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Hematology, University of Toronto, Toronto, ON, Canada
| | - Christine Cserti-Gazdewich
- Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Program, University of Toronto Quality, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program), University Health Network, Toronto, ON, Canada.,Department of Medicine (Medical Oncology & Hematology), University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Hematology, University of Toronto, Toronto, ON, Canada
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8
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Saris A, Steuten J, Schrijver DP, van Schijndel G, Zwaginga JJ, van Ham SM, ten Brinke A. Inhibition of Dendritic Cell Activation and Modulation of T Cell Polarization by the Platelet Secretome. Front Immunol 2021; 12:631285. [PMID: 33737933 PMCID: PMC7961920 DOI: 10.3389/fimmu.2021.631285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
Platelet transfusions are a frequently administered therapy for especially hemato-oncological patients with thrombocytopenia. Next to their primary function in hemostasis, currently there is increased attention for the capacity of platelets to affect the function of various cells of the immune system. Here, we investigate the capacity of platelets to immuno-modulate monocyte-derived dendritic cells (moDC) as well as primary dendritic cells and effects on subsequent T cell responses. Platelets significantly inhibited pro-inflammatory (IL-12, IL-6, TNFα) and increased anti-inflammatory (IL-10) cytokine production of moDCs primed with toll-like receptor (TLR)-dependent and TLR-independent stimuli. Transwell assays and ultracentrifugation revealed that a soluble factor secreted by platelets, but not microvesicles, inhibited DC activation. Interestingly, platelet-derived soluble mediators also inhibited cytokine production by human ex vivo stimulated myeloid CD1c+ conventional DC2. Moreover, platelets and platelet-derived soluble mediators inhibited T cell priming and T helper differentiation toward an IFNγ+ Th1 phenotype by moDCs. Overall, these results show that platelets are able to inhibit the pro-inflammatory properties of DCs, and may even induce an anti-inflammatory DC phenotype, with decreased T cell priming capacity by the DC. The results of this study provide more insight in the potential role of platelets in immune modulation, especially in the context of platelet transfusions.
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Affiliation(s)
- Anno Saris
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Infectious Disease, Leiden University Medical Center, Leiden, Netherlands
| | - Juulke Steuten
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - David P. Schrijver
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Gijs van Schijndel
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
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9
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Huang Z, Zheng J, Huang W, Yan M, Hong L, Hong Y, Jin R, Huang X, Fan H, Chen H, Yang H, Su W, Huang X. The effects and safety of omega-3 fatty for acute lung injury: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:235. [PMID: 32883303 PMCID: PMC7470437 DOI: 10.1186/s12957-020-01916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Several randomized controlled trials (RCTs) have compared the treatment of acute lung injury (ALI) with omega-3 fatty, yet the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of omega-3 fatty in the treatment of ALI patients. Methods We searched PubMed databases from inception date to October 31, 2019, for RCTs that compared the treatment of ALI with or without omega-3 fatty. Two authors independently screened the studies and extracted data from the published articles. Summary mean differences (MD) with 95% confidence intervals (CI) were calculated for each outcome by fixed- or random-effects model. Results Six RCTs with a total of 277 patients were identified, of whom 142 patients with omega-3 fatty acid treatment and 135 patients without omega-3 fatty treatment. Omega-3 fatty treatments significantly improve the PaO2 (MD = 13.82, 95% CI 8.55–19.09), PaO2/FiO2 (MD = 33.47, 95% CI 24.22–42.72), total protein (MD = 2.02, 95% CI 0.43–3.62) in ALI patients, and omega-3 fatty acid treatments reduced the duration of mechanical ventilation (MD = − 1.72, 95% CI − 2.84 to − 0.60) and intensive care unit stay (MD = − 1.29, 95% CI − 2.14 to − 0.43) in ALI patients. Conclusions Omega-3 fatty can effectively improve the respiratory function and promote the recovery of ALI patients. Future studies focused on the long-term efficacy and safety of omega-3 fatty use for ALI are needed.
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10
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Roubinian NH, Chowdhury D, Hendrickson JE, Triulzi DJ, Gottschall JL, Looney MR, Matthay MA, Kor DJ, Brambilla D, Kleinman SH, Murphy EL. NT-proBNP levels in the identification and classification of pulmonary transfusion reactions. Transfusion 2020; 60:2548-2556. [PMID: 32905629 DOI: 10.1111/trf.16059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Consensus definitions for transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) have recently been revised; however, pulmonary transfusion reactions remain difficult to diagnose. We hypothesized that N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could have utility in the identification and classification of pulmonary transfusion reactions. STUDY DESIGN AND METHODS We performed a secondary analysis of a case-control study of pulmonary transfusion reactions at four academic hospitals. We evaluated clinical data and measured NT-proBNP levels prior to and following transfusion in patients with TACO (n = 160), transfused acute respiratory distress syndrome (ARDS) [n = 51], TRALI [n = 12], TACO/TRALI [n = 7], and controls [n = 335]. We used Wilcoxon Rank-Sum tests to compare NT-proBNP levels, and classification and regression tree (CART) algorithms to produce a ranking of covariates in order of relative importance for differentiating TACO from transfused controls. RESULTS Pre-transfusion NT-proBNP levels were elevated in cases of transfused ARDS and TACO (both P < .001) but not TRALI (P = .31) or TACO/TRALI (P = .23) compared to transfused controls. Pre-transfusion NT-proBNP levels were higher in cases of transfused ARDS or TRALI with a diagnosis of sepsis compared to those without (P < .05 for both). CART analyses resulted in similar differentiation of patients with TACO from transfused controls for models utilizing either NT-proBNP levels (AUC 0.83) or echocardiogram results (AUC 0.80). CONCLUSIONS NT-proBNP levels may have utility in the classification of pulmonary transfusion reactions. Prospective studies are needed to test the predictive utility of pre-transfusion NT-proBNP in conjunction with other clinical factors in identifying patients at risk of pulmonary transfusion reactions.
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Affiliation(s)
- Nareg H Roubinian
- Kaiser Permanente Division of Research, Oakland, California, USA.,Vitalant Research Institute, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | - Mark R Looney
- University of California, San Francisco, San Francisco, California, USA
| | - Michael A Matthay
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Edward L Murphy
- Vitalant Research Institute, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
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Chandrashekar S, Kantharaj A. Risk mitigation in blood transfusion services – A practical approach at the blood center level. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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