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Roberts DJ. Expanding access to Transfusion Medicine and improving practice: guidelines, patient blood management, protocols and products. Transfus Med 2017; 27 Suppl 5:315-317. [PMID: 29076249 DOI: 10.1111/tme.12484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D J Roberts
- National Health Service Blood and Transplant, University of Oxford, John Radcliffe Hospital, Oxford, UK
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2
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D'Alessandro A, Seghatchian J. Hitchhiker's guide to the red cell storage galaxy: Omics technologies and the quality issue. Transfus Apher Sci 2017; 56:248-253. [PMID: 28343934 DOI: 10.1016/j.transci.2017.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Red blood cell storage in the blood bank makes millions of units of available for transfusion to civilian and military recipients every year. From glass bottles to plastic bags, from anticoagulants to complex additives, from whole blood to leukocyte filtered packed red blood cells: huge strides have been made in the field of blood component processing and storage in the blood bank during the last century. Still, refrigerated preservation of packed red blood cells under blood bank conditions results in the progressive accumulation of a wide series of biochemical and morphological changes to the stored erythrocytes, collectively referred to as the storage lesion(s). Approximately ten years ago, retrospective clinical evidence had suggested that such lesion(s) may be clinically relevant and mediate some of the untoward transfusion-related effects observed especially in some categories of recipients at risk (e.g. massively or chronically transfused recipients). Since then, randomized clinical trials have failed to prospectively detect any signal related to red cell storage duration and increased morbidity and mortality in several categories of recipients, at the limits of the statistical power of these studies. While a good part of the transfusion community has immediately adopted the take-home message "if it isn't broken, don't fix it" (i.e. no change to the standard of practice should be pursued), decision makers have been further questioning whether there may be room for further improvements in this field. Provocatively, we argue that consensus has yet to be unanimously reached on what makes a good quality marker of the red cell storage lesion and transfusion safety/efficacy. In other words, if it is true that "you can't manage what you can't measure", then future advancements in the field of transfusion medicine will necessarily rely on state of the art analytical omics technologies of well-defined quality parameters. Heavily borrowing from Douglas Adam's imaginary repertoire from the world famous "Hitchhiker's guide to the galaxy", we briefly summarize how some of the principles for intergalactic hitchhikers may indeed apply to inform navigation through the complex universe of red cell storage quality, safety and efficacy.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK.
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D’Alessandro A, Nemkov T, Reisz J, Dzieciatkowska M, Wither MJ, Hansen KC. Omics markers of the red cell storage lesion and metabolic linkage. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:137-144. [PMID: 28263171 PMCID: PMC5336335 DOI: 10.2450/2017.0341-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/28/2016] [Indexed: 01/28/2023]
Abstract
The introduction of omics technologies in the field of Transfusion Medicine has significantly advanced our understanding of the red cell storage lesion. While the clinical relevance of such a lesion is still a matter of debate, quantitative and redox proteomics approaches, as well quantitative metabolic flux analysis and metabolic tracing experiments promise to revolutionise our understanding of the role of blood processing strategies, inform the design and testing of novel additives or technologies (such as pathogen reduction), and evaluate the clinical relevance of donor and recipient biological variability with respect to red cell storability and transfusion outcomes. By reviewing existing literature in this rapidly expanding research endeavour, we highlight for the first time a correlation between metabolic markers of the red cell storage age and protein markers of haemolysis. Finally, we introduce the concept of metabolic linkage, i.e. the appreciation of a network of highly correlated small molecule metabolites which results from biochemical constraints of erythrocyte metabolic enzyme activities. For the foreseeable future, red cell studies will advance Transfusion Medicine and haematology by addressing the alteration of metabolic linkage phenotypes in response to stimuli, including, but not limited to, storage additives, enzymopathies (e.g. glucose 6-phosphate dehydrogenase deficiency), hypoxia, sepsis or haemorrhage.
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Affiliation(s)
- Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Julie Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Matthew J. Wither
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States of America
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Garraud O. Clinical trials in Transfusion Medicine and hemotherapy: Worth moving forward in evaluating ‘fresh’ versus ‘old’ blood cell components? Transfus Apher Sci 2017; 56:98-99. [DOI: 10.1016/j.transci.2016.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- A. D'Alessandro
- Department of Biochemistry and Molecular Genetics; University of Colorado Denver; Aurora CO USA
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Parviz Y, Hsia C, Alemayehu M, Wall S, Bagur R, AbuRomeh N, Chin-Yee I, Lavi S. The effect of fresh versus standard blood transfusion on microvascular endothelial function. Am Heart J 2016; 181:156-161. [PMID: 27823688 DOI: 10.1016/j.ahj.2016.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The duration of red blood cell (RBC) storage may have a negative impact on endothelial nitric oxide bioavailability. We tested the hypothesis that transfused fresh blood will have a more favorable effect on microvascular endothelial function as compared to older standard issue blood. METHODS Participants requiring chronic RBC transfusions were enrolled in a crossover design study to receive fresh (<7 days of storage) or standard (up to 42 days of storage) blood on 2 separate visits. Endothelial function was assessed by reactive hyperemia peripheral arterial tonometry that was measured before and after transfusions. For each participant, the difference between endothelial function pretransfusion and posttransfusion was assessed in relation to blood storage time. RESULTS Twenty-one patients (71 ± 16 years, 52% females) were enrolled. Mean age of fresh blood was 5.5 days (±1.0), and that of standard blood was 24.5 days (±7.9 days). The pretransfusion hemoglobin was 83.1 ± 2.5 g/L; and posttransfusion, 98.9 ± 2.6 g/L. An average of 2 U of packed RBCs was transfused. Microvascular endothelial function decreased more frequently after transfusion of standard blood compared to fresh blood. Standard issue blood transfusion was associated with decrease in reactive hyperemia peripheral arterial tonometry index (-0.25 ± 0.63) compared to fresh blood (+0.03 ± 0.49); P = .026. CONCLUSION Transfusions of standard issue blood are associated with less favorable effect on microvascular endothelial function as compared to fresh blood.
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Affiliation(s)
- Yasir Parviz
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Cyrus Hsia
- Division of Hematology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mistre Alemayehu
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Sabrina Wall
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nour AbuRomeh
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Shahar Lavi
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada.
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Bakkour S, Acker JP, Chafets DM, Inglis HC, Norris PJ, Lee TH, Busch MP. Manufacturing method affects mitochondrial DNA release and extracellular vesicle composition in stored red blood cells. Vox Sang 2016; 111:22-32. [PMID: 26918437 DOI: 10.1111/vox.12390] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Damage-associated molecular patterns (DAMPs) are found in transfusion products, but their potential impacts are not fully understood. We examined the influence of manufacturing method on levels of mitochondrial (mt) DNA and extracellular vesicle (EV) DAMPs in red cell concentrates (RCCs). MATERIALS AND METHODS Eighty-seven RCCs were prepared using nine different methods (6-15 units/method), including three apheresis, five whole blood (WB)-derived leucoreduced (LR) and one WB-derived non-LR method. On storage days 5 and 42, levels of mtDNA (by PCR) and number and cell of origin of EVs (by flow cytometry) were assessed in RCC supernatants. RESULTS There was a 100-fold difference in mtDNA levels among methods, with highest levels in non-LR, followed by MCS+ and Trima apheresis RCCs. There was a 10-fold difference in EV levels among methods. RBC-derived CD235a+ EVs were found in fresh RCCs and increased in most during storage. Platelet-derived CD41a+ EVs were highest in non-LR and Trima RCCs and did not change during storage. WBC-derived EVs were low in most RCCs; CD14+ EVs increased in several RCCs during storage. CONCLUSION DAMPs in RCCs vary by manufacturing method. MtDNA and EV could be informative quality markers that may be relevant to RCC immunomodulatory potential.
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Affiliation(s)
- S Bakkour
- Blood Systems Research Institute, San Francisco, CA, USA
| | - J P Acker
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - D M Chafets
- Blood Systems Research Institute, San Francisco, CA, USA
| | - H C Inglis
- Blood Systems Research Institute, San Francisco, CA, USA
| | - P J Norris
- Blood Systems Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | - T-H Lee
- Blood Systems Research Institute, San Francisco, CA, USA
| | - M P Busch
- Blood Systems Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
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Hsia CC, Mahon JL, Seitelbach M, Chia J, Zou G, Chin-Yee IH. Use of n-of-1 (single patient) trials to assess the effect of age of transfused blood on health-related quality of life in transfusion-dependent patients. Transfusion 2016; 56:1192-200. [PMID: 26840915 DOI: 10.1111/trf.13484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of age of red blood cells on health-related quality of life (HRQL) in patients who require chronic transfusions is not known. We assessed this using n-of-1 trials in patient populations where large randomized trials have not been done to date. STUDY DESIGN AND METHODS Chronically transfusion-dependent adult patients were randomly assigned over time to four fresh (<7 days of storage) and four standard-issue (up to 42 days of storage) blood transfusions in prospective double-blinded multicrossover studies (n-of-1 trials). HRQL questionnaires were completed before and at 24 hours after each transfusion. Hemoglobin (Hb) levels were measured before each subsequent transfusion. RESULTS Twenty transfusion-dependent patients were enrolled, of whom nine (five myelodysplastic syndromes, two myelofibrosis, one β-thalassemia major, one Diamond-Blackfan anemia) completed at least six transfusions. Mean ages of fresh and standard-issue blood transfused were 4.0 and 23.2 days, respectively. There were no significant differences in the effect of standard and fresh blood on follow-up Hb levels or the eight HRQL dimensions assessed in all analyses. CONCLUSIONS In chronically transfused patients, there were no significant differences in HRQL or Hb levels between fresh versus standard blood. While larger trials are needed, these results support current practices in hospital blood transfusion laboratories using a first-in, first-out model of blood utilization for these transfusion-dependent patients. Use of n-of-1 trials to determine the benefits of transfusions in single patients appears to be feasible.
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Affiliation(s)
- Cyrus C Hsia
- Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.,Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Jeffrey L Mahon
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario.,Department of Epidemiology & Biostatistics, Western University, London Health Sciences Centre, London, Ontario
| | - Maayan Seitelbach
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Justin Chia
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Western University, London Health Sciences Centre, London, Ontario
| | - Ian H Chin-Yee
- Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.,Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
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Triulzi DJ. A trial is a trial is a trial: the need for an evidence-based clinical approach for evaluation of stored red cell. Transfus Med 2015; 25:293-4. [PMID: 26462872 DOI: 10.1111/tme.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- D J Triulzi
- Institute for Transfusion Medicine, Centralized Transfusion Service, Pittsburgh, Pennsylvania, USA
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