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Jalink M, Yan MTS, Cohn CS, Eichbaum QG, Fung MK, Lu W, Murphy MF, Pagano MB, Stanworth SJ, Shih AW. Systematic review for the serological testing for cold agglutinins: The BEST collaborative study. Transfusion 2024. [PMID: 38642020 DOI: 10.1111/trf.17842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/16/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Marit Jalink
- Center for Clinical Transfusion Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Quentin G Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark K Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Wen Lu
- Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, and the University of Oxford, Oxford, UK
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Washington, USA
| | - Simon J Stanworth
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, and the University of Oxford, Oxford, UK
| | - Andrew W Shih
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
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Hibbs SP, Thomas S, Agarwal N, Andrews C, Eskander S, Abdalla AS, Staves J, Eckelman MJ, Murphy MF. What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England. Transfusion 2024; 64:638-645. [PMID: 38506497 DOI: 10.1111/trf.17786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Healthcare activities significantly contribute to greenhouse gas (GHG) emissions. Blood transfusions require complex, interlinked processes to collect, manufacture, and supply. Their contribution to healthcare emissions and avenues for mitigation is unknown. STUDY DESIGN AND METHODS We performed a life cycle assessment (LCA) for red blood cell (RBC) transfusions across England where 1.36 million units are transfused annually. We defined the process flow with seven categories: donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal. We used direct measurements, manufacturer data, bioengineering databases, and surveys to assess electrical power usage, embodied carbon in disposable materials and reagents, and direct emissions through transportation, refrigerant leakage, and disposal. RESULTS The central estimate of carbon footprint per unit of RBC transfused was 7.56 kg CO2 equivalent (CO2eq). The largest contribution was from transportation (2.8 kg CO2eq, 36% of total). The second largest was from hospital transfusion processes (1.9 kg CO2eq, 26%), driven mostly by refrigeration. The third largest was donation (1.3 kg CO2eq, 17%) due to the plastic blood packs. Total emissions from RBC transfusion are ~10.3 million kg CO2eq/year. DISCUSSION This is the first study to estimate GHG emissions attributable to RBC transfusion, quantifying the contributions of each stage of the process. Primary areas for mitigation may include electric vehicles for the blood service fleet, improving the energy efficiency of refrigeration, using renewable sources of electricity, changing the plastic of blood packs, and using methods of disposal other than incineration.
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Affiliation(s)
- Stephen P Hibbs
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Nikhil Agarwal
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Charlotte Andrews
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Sylvia Eskander
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | | | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew J Eckelman
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Michael F Murphy
- NHS Blood and Transplant, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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3
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Mitchinson AJ, Pogson M, Czanner G, Conway D, Wilkinson RR, Murphy MF, Siekmann I, Webb SD. A stochastic model for topographically influenced cell migration. J Theor Biol 2024; 581:111745. [PMID: 38272110 DOI: 10.1016/j.jtbi.2024.111745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024]
Abstract
Migrating cells traverse a range of topographic configurations presented by the native extracellular environment to conduct their physiologic functions. It is well documented cells can modulate their behaviour in response to different topographic features, finding promising applications in biomaterial and bioimplant design. It is useful, in these areas of research, to be able to predict which topographic arrangements could be used to promote certain patterns of migration prior to laboratory experimentation. Despite a profusion of study and interest shown in these fields by experimentalists, the related modelling literature is as yet relatively sparse and tend to focus more on either cell-matrix interaction or morphological responses of cells. We propose a mathematical model for individual cell migration based on an Ornstein-Uhlenbeck process, and set out to see if the model can be used to predict migration patterns on 2-d isotropic and anisotropic topographies, whose characteristics can be broadly described as either uniform flat, uniform linear with variable ridge density or non-uniform disordered with variable feature density. Results suggest the model is capable of producing realistic patterns of migration for flat and linear topographic patterns, with calibrated output closely approximating NIH3T3 fibroblast migration behaviour derived from an experimental dataset, in which migration linearity increased with ridge density and average speed was highest at intermediate ridge densities. Exploratory results for non-uniform disordered topographies suggest cell migration patterns may adopt disorderedness present in the topography and that 'distortion' introduced to linear topographic patterns may not impede linear guidance of migration, given its magnitude is bounded within certain limits. We conclude that an Ornstein-Uhlenbeck based model for topographically influenced migration may be useful to predict patterns of migration behaviour for certain isotropic (flat) and anisotropic (linear) topographies in the NIH3T3 fibroblast cell line, but additional investigation is required to predict with confidence migration patterns for non-uniform disordered topographic arrangements.
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Affiliation(s)
- A J Mitchinson
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom.
| | - M Pogson
- Department of Communication and Media, University of Liverpool, Liverpool, L69 7ZG, United Kingdom
| | - G Czanner
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom; PROTECT-eHealth, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom
| | - D Conway
- School of Biological Sciences, Queen's University Belfast, Belfast, BT9 5DL, United Kingdom
| | - R R Wilkinson
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom
| | - M F Murphy
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom
| | - I Siekmann
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom; PROTECT-eHealth, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom; Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom; Data Science Research Centre, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom
| | - S D Webb
- Syngenta, Crop Protection Research, Jealott's Hill, Bracknell, RG42 6EY, United Kingdom
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Chowdhury F, Estcourt L, Murphy MF. Mitigating the impact of blood shortages in England. Br J Haematol 2024. [PMID: 38419589 DOI: 10.1111/bjh.19344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The supply of blood components and products in sufficient quantities is key to any effective health care system. This report describes the challenges faced by the English blood service, NHS Blood and Transplant (NHSBT), towards the end of the COVID-19 pandemic, which in October 2022 led to an Amber Alert being declared to hospitals indicating an impending blood shortage. The impact on the hospital transfusion services and clinical users is explained. The actions taken by NHSBT to mitigate the blood supply challenges and ensure equity of transfusion support for hospitals in England including revisions to the national blood shortage plans are described. This report focuses on the collaboration and communication between NHSBT, NHS England (NHSE), Department of Health and Social Care (DHSC), National Blood Transfusion Committee (NBTC), National Transfusion Laboratory Managers Advisory Group for NBTC (NTLM), National Transfusion Practitioners Network, the medical Royal Colleges and clinical colleagues across the NHS.
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Affiliation(s)
- Fateha Chowdhury
- NHS Blood and Transplant, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Lise Estcourt
- NHS Blood and Transplant, London, UK
- University of Oxford, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, London, UK
- University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Nigam GB, Murphy MF, Travis SPL, Stanley AJ. Machine learning in the assessment and management of acute gastrointestinal bleeding. BMJ Med 2024; 3:e000699. [PMID: 38389720 PMCID: PMC10882311 DOI: 10.1136/bmjmed-2023-000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Gaurav Bhaskar Nigam
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Michael F Murphy
- Transfusion Medicine, NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simon P L Travis
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and, Biomedical Research Centre, Oxford University, Oxford, UK
| | - Adrian J Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
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Evans HG, Murphy MF, Foy R, Dhiman P, Green L, Kotze A, von Neree L, Palmer AJ, Robinson SE, Shah A, Tomini F, Trompeter S, Warnakulasuriya S, Wong WK, Stanworth SJ. Harnessing the potential of data-driven strategies to optimise transfusion practice. Br J Haematol 2024; 204:74-85. [PMID: 37964471 DOI: 10.1111/bjh.19158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023]
Abstract
No one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence-based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost-effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on 'A data-enabled programme of research to improve transfusion practices'. The overarching aim of the BTRU is to accelerate the development of data-driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice.
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Affiliation(s)
- H G Evans
- NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - M F Murphy
- NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - R Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Botnar Research Centre, Oxford, UK
| | - L Green
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
- NHS Blood and Transplant, London, UK
| | - A Kotze
- Leeds Teaching Hospitals, Leeds, UK
| | - L von Neree
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A J Palmer
- Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - S E Robinson
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Shah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - F Tomini
- Queen Mary University of London, London, UK
| | - S Trompeter
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - S Warnakulasuriya
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - W K Wong
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S J Stanworth
- NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
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7
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Singh N, Staves J, Storry JR, Dinoso J, Renard C, Doshi P, Johnson LDS, Westhoff CM, Murphy MF. Transfusion management in the era of magrolimab (Hu5F9-G4), an anti-CD47 monoclonal antibody therapy. Transfusion 2023; 63:2377-2383. [PMID: 37970740 DOI: 10.1111/trf.17597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Nirupama Singh
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie Staves
- Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Jill R Storry
- Division of Hematology and Transfusion Medicine, Lund University, Lund, Sweden
| | - Jason Dinoso
- Gilead Sciences, Inc, Foster City, California, USA
| | | | - Parul Doshi
- Gilead Sciences, Inc, Foster City, California, USA
| | | | - Connie M Westhoff
- New York Blood Center Enterprises, Immunohematology and Blood Group Genomics, New York, New York, USA
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
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8
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D'Souza R, Dhesi AS, Pendry K, Charlton A, Staples S, Watkins NA, Murphy MF. Comparing transfusion practice at multiple hospitals using electronically collected and analysed data. Transfus Med 2023; 33:453-459. [PMID: 37782004 DOI: 10.1111/tme.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/02/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Comparisons of transfusion practice between organisations are time-consuming using manual methods for data collection. We performed a feasibility study to determine whether large-scale transfusion data from three English hospitals could be combined to allow comparisons of transfusion practice. METHODS Clinical, laboratory and transfusion data from patients discharged between 1 April 2016 and 31 March 2017 were extracted from Patient Administration Systems (PAS), Laboratory Information Management Systems (LIMS), and electronic transfusion systems at three NHS hospitals, which are academic medical centres based in large cities outside London. A centralised database and business intelligence software were used to compare the data. RESULTS The dataset contained 748 982 episodes of patient care with 91 410 blood components transfused. The study confirms the results of previous studies finding peaks in the ages of transfusion in the 0-4 years age range, in women of childbearing ages, and in males over 60 years. The number of components transfused per 1000 bed days was used as a standardised comparator. Red cell utilisation was 42.4, 40.4 and 49.5 units/1000 bed days and platelet utilisation 11.69, 7.76, and 11.66 units/1000 bed days. 60.5% (6848/11 310) of Group O D negative red cell units were transfused to non-group O D negative recipients. An analysis of component usage highlighted variations in practice, for example platelet usage for cardiac surgery varied from 2.4% to 7.3% across the three hospitals. CONCLUSION This feasibility study demonstrates that large electronic datasets from hospitals can be combined to identify areas for targeted interventions to improve transfusion practice.
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Affiliation(s)
| | | | - Kate Pendry
- NHS Blood and Transplant, Liverpool, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Charlton
- NHS Blood and Transplant, Liverpool, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Sophie Staples
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Michael F Murphy
- NHS Blood and Transplant, Liverpool, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Lloyd TD, Geneen LJ, Bernhardt K, McClune W, Fernquest SJ, Brown T, Dorée C, Brunskill SJ, Murphy MF, Palmer AJ. Cell salvage for minimising perioperative allogeneic blood transfusion in adults undergoing elective surgery. Cochrane Database Syst Rev 2023; 9:CD001888. [PMID: 37681564 PMCID: PMC10486190 DOI: 10.1002/14651858.cd001888.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Concerns regarding the safety and availability of transfused donor blood have prompted research into a range of techniques to minimise allogeneic transfusion requirements. Cell salvage (CS) describes the recovery of blood from the surgical field, either during or after surgery, for reinfusion back to the patient. OBJECTIVES To examine the effectiveness of CS in minimising perioperative allogeneic red blood cell transfusion and on other clinical outcomes in adults undergoing elective or non-urgent surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two clinical trials registers for randomised controlled trials (RCTs) and systematic reviews from 2009 (date of previous search) to 19 January 2023, without restrictions on language or publication status. SELECTION CRITERIA We included RCTs assessing the use of CS compared to no CS in adults (participants aged 18 or over, or using the study's definition of adult) undergoing elective (non-urgent) surgery only. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 106 RCTs, incorporating data from 14,528 participants, reported in studies conducted in 24 countries. Results were published between 1978 and 2021. We analysed all data according to a single comparison: CS versus no CS. We separated analyses by type of surgery. The certainty of the evidence varied from very low certainty to high certainty. Reasons for downgrading the certainty included imprecision (small sample sizes below the optimal information size required to detect a difference, and wide confidence intervals), inconsistency (high statistical heterogeneity), and risk of bias (high risk from domains including sequence generation, blinding, and baseline imbalances). Aggregate analysis (all surgeries combined: primary outcome only) Very low-certainty evidence means we are uncertain if there is a reduction in the risk of allogeneic transfusion with CS (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.59 to 0.72; 82 RCTs, 12,520 participants). Cancer: 2 RCTs (79 participants) Very low-certainty evidence means we are uncertain whether there is a difference for mortality, blood loss, infection, or deep vein thrombosis (DVT). There were no analysable data reported for the remaining outcomes. Cardiovascular (vascular): 6 RCTs (384 participants) Very low- to low-certainty evidence means we are uncertain whether there is a difference for most outcomes. No data were reported for major adverse cardiovascular events (MACE). Cardiovascular (no bypass): 6 RCTs (372 participants) Moderate-certainty evidence suggests there is probably a reduction in risk of allogeneic transfusion with CS (RR 0.82, 95% CI 0.69 to 0.97; 3 RCTs, 169 participants). Very low- to low-certainty evidence means we are uncertain whether there is a difference for volume transfused, blood loss, mortality, re-operation for bleeding, infection, wound complication, myocardial infarction (MI), stroke, and hospital length of stay (LOS). There were no analysable data reported for thrombosis, DVT, pulmonary embolism (PE), and MACE. Cardiovascular (with bypass): 29 RCTs (2936 participants) Low-certainty evidence suggests there may be a reduction in the risk of allogeneic transfusion with CS, and suggests there may be no difference in risk of infection and hospital LOS. Very low- to moderate-certainty evidence means we are uncertain whether there is a reduction in volume transfused because of CS, or if there is any difference for mortality, blood loss, re-operation for bleeding, wound complication, thrombosis, DVT, PE, MACE, and MI, and probably no difference in risk of stroke. Obstetrics: 1 RCT (1356 participants) High-certainty evidence shows there is no difference between groups for mean volume of allogeneic blood transfused (mean difference (MD) -0.02 units, 95% CI -0.08 to 0.04; 1 RCT, 1349 participants). Low-certainty evidence suggests there may be no difference for risk of allogeneic transfusion. There were no analysable data reported for the remaining outcomes. Orthopaedic (hip only): 17 RCTs (2055 participants) Very low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, or if there is any difference between groups for mortality, blood loss, re-operation for bleeding, infection, wound complication, prosthetic joint infection (PJI), thrombosis, DVT, PE, stroke, and hospital LOS. There were no analysable data reported for MACE and MI. Orthopaedic (knee only): 26 RCTs (2568 participants) Very low- to low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, and whether there is a difference for blood loss, re-operation for bleeding, infection, wound complication, PJI, DVT, PE, MI, MACE, stroke, and hospital LOS. There were no analysable data reported for mortality and thrombosis. Orthopaedic (spine only): 6 RCTs (404 participants) Moderate-certainty evidence suggests there is probably a reduction in the need for allogeneic transfusion with CS (RR 0.44, 95% CI 0.31 to 0.63; 3 RCTs, 194 participants). Very low- to moderate-certainty evidence suggests there may be no difference for volume transfused, blood loss, infection, wound complication, and PE. There were no analysable data reported for mortality, re-operation for bleeding, PJI, thrombosis, DVT, MACE, MI, stroke, and hospital LOS. Orthopaedic (mixed): 14 RCTs (4374 participants) Very low- to low-certainty evidence means we are uncertain if there is a reduction in the need for allogeneic transfusion with CS, or if there is any difference between groups for volume transfused, mortality, blood loss, infection, wound complication, PJI, thrombosis, DVT, MI, and hospital LOS. There were no analysable data reported for re-operation for bleeding, MACE, and stroke. AUTHORS' CONCLUSIONS In some types of elective surgery, cell salvage may reduce the need for and volume of allogeneic transfusion, alongside evidence of no difference in adverse events, when compared to no cell salvage. Further research is required to establish why other surgeries show no benefit from CS, through further analysis of the current evidence. More large RCTs in under-reported specialities are needed to expand the evidence base for exploring the impact of CS.
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Affiliation(s)
- Thomas D Lloyd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | | | | | - Scott J Fernquest
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tamara Brown
- School of Health, Leeds Beckett University, Leeds, UK
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
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Hassan S, Mumford L, Robinson S, Foukanelli D, Torpey N, Ploeg RJ, Mamode N, Murphy MF, Brown C, Roberts DJ, Regan F, Willicombe M. Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival-it is time for rigorous patient blood management. Front Nephrol 2023; 3:1236520. [PMID: 37675353 PMCID: PMC10479650 DOI: 10.3389/fneph.2023.1236520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
Background Patient Blood Management (PBM), endorsed by the World Health Organisation is an evidence-based, multi-disciplinary approach to minimise inappropriate blood product transfusions. Kidney transplantation presents a particular challenge to PBM, as comprehensive evidence of the risk of transfusion is lacking. The aim of this study is to investigate the prevalence of post-transplant blood transfusions across multiple centres, to analyse risk factors for transfusion and to compare transplant outcomes by transfusion status. Methods This analysis was co-ordinated via the UK Transplant Registry within NHS Blood and Transplant (NHSBT), and was performed across 4 centres. Patients who had received a kidney transplant over a 1-year period, had their transfusion status identified and linked to data held within the national registry. Results Of 720 patients, 221(30.7%) were transfused, with 214(29.7%) receiving a red blood cell (RBC) transfusion. The proportion of patients transfused at each centre ranged from 20% to 35%, with a median time to transfusion of 4 (IQR:0-12) days post-transplant. On multivariate analysis, age [OR: 1.02(1.01-1.03), p=0.001], gender [OR: 2.11(1.50-2.98), p<0.0001], ethnicity [OR: 1.28(1.28-2.60), p=0.0008], and dialysis dependence pre-transplant [OR: 1.67(1.08-2.68), p=0.02], were associated with transfusion. A risk-adjusted Cox proportional hazards model showed transfusion was associated with inferior 1-year patient survival [HR 7.94(2.08-30.27), p=0.002] and allograft survival [HR: 3.33(1.65-6.71), p=0.0008], and inferior allograft function. Conclusion RBC transfusions are common and are independently associated with inferior transplant outcomes. We urge that further research is needed to understand the mechanisms behind the outcomes, to support the urgent development of transplant-specific anaemia guidelines.
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Affiliation(s)
- Sevda Hassan
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
| | - Lisa Mumford
- Statistics and Clinical Studies, National Health Service (NHS) Blood and Transplant, Bristol, United Kingdom
| | - Susan Robinson
- Department of Haematology, Guys, Evelina and St Thomas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Dora Foukanelli
- Department of Haematology, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Nick Torpey
- Department of Clinical Nephrology and Transplantation, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Rutger J. Ploeg
- Department of Surgery, Nuffield Department of Surgical Science, University of Oxford, Oxford, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guys, Evelina and St Thomas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Michael F. Murphy
- National Health Service (NHS) Blood and Transplant, and Nuffield Department of Clinical and Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - Colin Brown
- Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom
| | - David J. Roberts
- Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom
| | - Fiona Regan
- Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
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11
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Dhiman P, Ma J, Gibbs VN, Rampotas A, Kamal H, Arshad SS, Kirtley S, Doree C, Murphy MF, Collins GS, Palmer AJR. Systematic review highlights high risk of bias of clinical prediction models for blood transfusion in patients undergoing elective surgery. J Clin Epidemiol 2023; 159:10-30. [PMID: 37156342 DOI: 10.1016/j.jclinepi.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Blood transfusion can be a lifesaving intervention after perioperative blood loss. Many prediction models have been developed to identify patients most likely to require blood transfusion during elective surgery, but it is unclear whether any are suitable for clinical practice. STUDY DESIGN AND SETTING We conducted a systematic review, searching MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, Scopus, and Web of Science databases for studies reporting the development or validation of a blood transfusion prediction model in elective surgery patients between January 1, 2000 and June 30, 2021. We extracted study characteristics, discrimination performance (c-statistics) of final models, and data, which we used to perform risk of bias assessment using the Prediction model risk of bias assessment tool (PROBAST). RESULTS We reviewed 66 studies (72 developed and 48 externally validated models). Pooled c-statistics of externally validated models ranged from 0.67 to 0.78. Most developed and validated models were at high risk of bias due to handling of predictors, validation methods, and too small sample sizes. CONCLUSION Most blood transfusion prediction models are at high risk of bias and suffer from poor reporting and methodological quality, which must be addressed before they can be safely used in clinical practice.
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Affiliation(s)
- Paula Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Jie Ma
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Victoria N Gibbs
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexandros Rampotas
- Systematic Review Initiative, NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
| | - Hassan Kamal
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland DD1 9SY
| | - Sahar S Arshad
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Shona Kirtley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
| | - Michael F Murphy
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Systematic Review Initiative, NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK; NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK; NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK
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12
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Yazer MH, Dunbar NM, Hess JR, Tuott EE, Bahmanyar M, Campbell J, Fontaine M, Ko A, Mi J, Murphy MF, Poisson J, Raval JS, Shih AW, Sperry JL, Staves J, Wong M, Yan MTS, Ziman A, Seheult JN. Transfusion of
ABO
‐group identical red blood cells following uncrossmatched transfusion does not lead to higher mortality in civilian trauma patients. Transfusion 2023; 63 Suppl 3:S46-S53. [PMID: 36971017 DOI: 10.1111/trf.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Questions persist about the safety of switching non-group O recipients of group O uncrossmatched red blood cells (RBC) or low titer group O whole blood (LTOWB) to ABO-identical RBCs during their resuscitation. METHODS The database of an earlier nine-center study of transfusing incompatible plasma to trauma patients was reanalyzed. The patients were divided into three groups based on 24-h RBC transfusion: (1) group O patients who received group O RBC/LTOWB units (control group, n = 1203), (2) non-group O recipients who received only group O units (n = 646), (3) non-group O recipients who received at least one unit of group O and non-group O units (n = 562). Fixed marginal effect of receipt of non-O RBC units on 6- and 24-h and 30-day mortality was calculated. RESULTS The non-O patients who received only group O RBCs received fewer RBC/LTOWB units and had slightly but significantly lower injury severity score compared to control group; non-group O patients who received both group O and non-O units received significantly more RBC/LTOWB units and had a slightly but significantly higher injury severity score compared to control group. In the multivariate analysis, the non-O patients who received only group O RBCs had significantly higher mortality at 6-h compared to the controls; the non-group O recipients of O and non-O RBCs did not demonstrate higher mortality. At 24-h and 30-days, there were no differences in survival between the groups. CONCLUSION Providing non-group O RBCs to non-group O trauma patients who also received group O RBC units is not associated with higher mortality.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vitalant, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine and Pathology, Seattle, Washington, USA
| | - Mohammad Bahmanyar
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Jessica Campbell
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Magali Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ara Ko
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jian Mi
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael F Murphy
- NHS Blood & Transplant and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jessica Poisson
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michelle Wong
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vitalant, Pittsburgh, Pennsylvania, USA
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13
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Neuberger J, Brailsford SR, Mallinson G, Murphy MF, Simmonds P. Challenges for the maintaining the microbiological safety of the UK blood supply. Clin Med (Lond) 2023; 23:151-156. [PMID: 38614546 DOI: 10.7861/clinmed.2022-0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The supply of blood, blood products and components in the UK, as elsewhere, is safe, although there is no cause for complacency. Use of blood, blood products and components is not without risk of morbidity and mortality. Transfusion-transmitted infections (TTIs) continue to occur and may severely affect the health and welfare of recipients. As indicated by recent and current inquiries, public interest in these TTIs is huge. The risk of TTI can be mitigated but not abolished. Measures to reduce risk include screening of donors, testing of donations and, where appropriate, treatment of donations. The introduction of newer screening tests might identify some infectious donations but come at a cost, which could exceed a justifiable limit. Thus, the recognition, detection, reporting and investigation of cases of possible TTIs need to be improved. Recipients of blood should understand that, although transfusion in the UK is safe, it is not free of risk and so should be provided with full information so that properly informed consent can be given.
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Affiliation(s)
| | | | - Gary Mallinson
- Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC), NHS Blood and Transplant, Bristol
| | - Michael F Murphy
- NHS Blood & Transplant, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford
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14
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Yeung KCY, Kapitany C, Chargé S, Callum J, Cserti-Gazdewich C, D'Empaire PP, Khandelwal A, Lieberman L, Lee C, Pavenski K, Pendergrast J, Shehata N, Hsia CC, Lavoie M, Murphy MF, Prokopchuk-Gauk O, Rahmani M, Trudeau J, Zeller MP, Lin Y. Transfusion camp: A retrospective study of self-reported impact on postgraduate trainee transfusion practice. Transfusion 2023; 63:839-848. [PMID: 36811164 DOI: 10.1111/trf.17278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The optimal method of postgraduate transfusion medicine (TM) education remains understudied. One novel approach is Transfusion Camp, a longitudinal 5-day program that delivers TM education to Canadian and international trainees. The purpose of this study was to determine the self-reported impact of Transfusion Camp on trainee clinical practice. STUDY DESIGN AND METHODS A retrospective analysis of anonymous survey evaluations from Transfusion Camp trainees over three academic years (2018-2021) was conducted. Trainees were asked, "Have you applied any of your learning from Transfusion Camp into your clinical practice?". Through an iterative process, responses were categorized into topics according to program learning objectives. The primary outcome was the rate of self-reported impact of Transfusion Camp on clinical practice. Secondary outcomes were to determine impact based on specialty and postgraduate year (PGY). RESULTS Survey response rate was 22%-32% over three academic years. Of 757 survey responses, 68% of respondents indicated that Transfusion Camp had an impact on their practice, increasing to 83% on day 5. The most frequent areas of impact included transfusion indications (45%) and transfusion risk management (27%). Impact increased as PGY increased with 75% of PGY-4+ trainees reporting impact. In multivariable analysis, the impact of specialty and PGY varied depending on the objective. DISCUSSION The majority of trainees report applying learnings from Transfusion Camp to their clinical practice with variations based on PGY and specialty. These findings support Transfusion Camp as an effective means of TM education and help identify high-yield areas and gaps for future curriculum planning.
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Affiliation(s)
- Katie C Y Yeung
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | | | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada
| | - Christine Cserti-Gazdewich
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program) and Blood Disorders Clinic (Division of Medical Oncology and Hematology), University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez D'Empaire
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aditi Khandelwal
- Canadian Blood Services, Ottawa, Ontario, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christie Lee
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Jacob Pendergrast
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program) and Blood Disorders Clinic (Division of Medical Oncology and Hematology), University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Marianne Lavoie
- Department of Medicine, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Michael F Murphy
- NHS Blood & Transplant and the Oxford University Hospitals, Oxford, UK.,Department of Medicine, University of Oxford, Oxford, UK
| | - Oksana Prokopchuk-Gauk
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Mahboubeh Rahmani
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pathology and Lab Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.,Beatrice Hunter Cancer Research Institute Halifax, Nova Scotia, Canada
| | - Jacqueline Trudeau
- Departments of Anesthesiology, Pharmacology and Therapeutics and Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle P Zeller
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yulia Lin
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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15
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Nightingale N, Zou G, Murphy MF, Jairath V. Revisiting Triggers: Optimal Thresholds for Transfusion in Gastrointestinal Bleeding May Be Higher Than Restrictive Guidelines. Clin Gastroenterol Hepatol 2022:S1542-3565(22)00641-3. [PMID: 35840062 DOI: 10.1016/j.cgh.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Natalie Nightingale
- Affiliation at time of study: Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Michael F Murphy
- Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Vipul Jairath
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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16
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Seheult JN, Callum J, Delaney M, Drake R, Dunbar NM, Harm SK, Hess JR, Jackson BP, Javanbakht A, Moore SA, Murphy MF, Raval JS, Staves J, Tuott EE, Wendel S, Ziman A, Yazer MH. Rate of D-alloimmunization in trauma does not depend on the number of RhD-positive units transfused: The BEST collaborative study. Transfusion 2022; 62 Suppl 1:S185-S192. [PMID: 35748692 DOI: 10.1111/trf.16952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence indicates the life-saving benefits of early blood product transfusion in severe trauma resuscitation. Many of these products will be RhD-positive, so understanding the D-alloimmunization rate is important. METHODS This was a multicenter, retrospective study whereby injured RhD-negative patients between 18-50 years of age who received at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB) during their resuscitation between 1 January, 2010 through 31 December, 2019 were identified. If an antibody detection test was performed ≥14 days after the index RhD-positive transfusion then basic demographic information was collected, including whether the patient became D-alloimmunized. The overall D-alloimmunization rate, and the rate stratified by the number of units transfused, were calculated. RESULTS Data were collected from nine institutions. Five institutions reported fewer than 10 eligible patients each and were excluded. From the remaining four institutions, all from the USA, there were 235 eligible patients; 77 (random effects estimate: 32.7%; 95% CI: 19.1-50.1%) became D-alloimmunized. Three of the institutions reported D-alloimmunization rates ≥38.6%, while the remaining institution's rate was 12.2%. In both random and fixed-effects models, the rate of D-alloimmunization was not significantly different between those who received one RhD-positive unit and those who received multiple RhD-positive units. CONCLUSION In this large, multicenter study of injured patients, the overall rate of D-alloimmunization fell within the range previously reported. The rate of D-alloimmunization did not increase as the number of transfused RhD-positive units increased. These data can help to inform RhD type selection decisions.
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Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
| | - Rosanna Drake
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah K Harm
- Department of pathology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - John R Hess
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bryon P Jackson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ayda Javanbakht
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah A Moore
- Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Michael F Murphy
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Julie Staves
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Erin E Tuott
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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18
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Affiliation(s)
- Michael F Murphy
- NHS Blood & Transplant, Oxford, UK.,National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals and the University of Oxford, Oxford, UK
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19
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Dunbar NM, Delaney M, Murphy MF, Pagano MB, Saifee NH, Seheult J, Yazer M, Kaufman RM. Emergency departments are higher-risk locations for wrong blood in tube errors. Transfusion 2021; 61:2601-2610. [PMID: 34268775 DOI: 10.1111/trf.16588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Wrong blood in tube (WBIT) errors can lead to ABO mistransfusions. It is unknown if WBIT errors are more likely in specific healthcare locations or if specific collection practices influence the commission of WBIT errors. STUDY DESIGN AND METHODS Data on pretransfusion samples from calendar year 2019 were collected retrospectively by 39 transfusion services in nine countries. We compared the proportion of WBIT errors made in emergency departments (EDs), inpatient wards, and outpatient clinics. RESULTS In total, 143 WBIT errors were detected among 1,394,862 samples for an unadjusted aggregate WBIT proportion of 1.03/10,000 samples. Using a pooled random effects model, the WBIT proportion was estimated to be significantly higher in EDs (1.23/10,000 samples, 95% CI 0.62-2.43) than inpatient wards (0.71/10,000, 95% CI 0.44-1.14; p < .001) or outpatient clinics (0.24/10,000, 95% CI 0.08-0.65; p < .001) and significantly higher in inpatient wards than outpatient clinics (p = .043). The use of electronic positive patient identification (ePPID) systems was associated with a significantly lower WBIT proportion in the ED (odds ratio, OR: 0.32, 95% CI: 0.11-0.96, p = .041), but not in inpatient wards (OR: 0.45, 95% CI: 0.20-1.01, p = .054) or outpatient clinics (OR: 1.95, 95% CI: 0.39-9.74, p = .415). DISCUSSION Normalized for the number of samples drawn per location, the WBIT proportion in EDs was 1.7 times higher than inpatient wards and 5.1 times higher than outpatient clinics. EDs represent higher-risk clinical locations for WBIT errors, and electronic positive patient identification (ePPID) may provide a greater impact on safety in EDs relative to other clinical areas.
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Affiliation(s)
- Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meghan Delaney
- Division Pathology & Laboratory Medicine, Children's National Hospital and Department of Pathology and Pediatrics, The George Washington University, Washington, District of Columbia, USA
| | - Michael F Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Nabiha Huq Saifee
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Bloodworks Northwest, Seattle, Washington, USA
| | - Jansen Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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20
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Reading CL, Ahlem CN, Murphy MF. NM101 Phase III study of NE3107 in Alzheimer's disease: rationale, design and therapeutic modulation of neuroinflammation and insulin resistance. Neurodegener Dis Manag 2021; 11:289-298. [PMID: 34251287 DOI: 10.2217/nmt-2021-0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recently, the roles of inflammation and insulin resistance in neurodegeneration have become better appreciated. NE3107, an oral small molecule, blood-brain permeable anti-inflammatory insulin sensitizer that binds extracellular signal-regulated kinase, has been shown to selectively inhibit inflammation-driven ERK- and NF-κB-stimulated inflammatory mediators, including TNF-α, without inhibiting their homeostatic functions. We describe the rationale and design of NM101, the first randomized, multicenter Phase III clinical study to examine the safety and efficacy of 30 week treatment with NE3107 versus placebo in elderly adults with mild-to-moderate Alzheimer's disease. Patients (316) will be randomized in a 1:1 ratio. The co-primary end points measure cognitive function (ADAS Cog12), and functional and behavioral characteristics (ADCS CGIC). Trial registration number: NCT04669028 (Clinicaltrials.gov).
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21
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Rampotas A, Prodger CF, Murphy MF. An assessment of the management of anaemia in acute care settings in the United Kingdom: The value of a collaborative approach. Transfus Med 2021; 31:322-327. [PMID: 34056763 DOI: 10.1111/tme.12789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/13/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Patients presenting to acute care settings with anaemia are at risk of inadequate investigation and inappropriate blood transfusion. In collaboration with Haematology Specialty Trainee Audit and Research (HaemSTAR), this study set out to assess current red blood cell (RBC) transfusion practice and anaemia management in acute care settings across the United Kingdom. METHODS AND RESULTS Fifteen different hospitals participated in the study over a period of a month beginning 01 January 2020. Eight-hundred and twenty-eight eligible patients presenting to acute care settings with anaemia received RBC transfusions during this period. Of these, 159 (19.2%) received inappropriate transfusions according to National Institute for Health and Care Excellence guidelines, and 257 (31%) could have been treated with alternatives to transfusion. One-hundred and fifty-four (18.6%) did not have a cause for their anaemia identified by the time they were discharged from hospital, and in over 50% of these cases that was because of inadequate investigation with blood tests, specialist investigation or referral, or both. CONCLUSION This study found that the appropriateness of transfusion and investigation of anaemia in acute care settings warrant improvement and also demonstrates the value of HaemSTAR in facilitating time-efficient collection of high-quality data.
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Affiliation(s)
- Alexandros Rampotas
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford University Graduate Academic School, Oxford, UK
| | - Catherine F Prodger
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford, UK.,National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford, UK
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22
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Murphy MF, Harris A, Neuberger J. Consent for blood transfusion: summary of recommendations from the Advisory Committee for the Safety of Blood, Tissues and Organs (SaBTO). Clin Med (Lond) 2021; 21:201-203. [PMID: 34001570 DOI: 10.7861/clinmed.2020-1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) decided that its 2011 recommendations on consent for blood transfusion needed to be reviewed and revised due to evidence of poor compliance and recent legal guidance on consent. The recommendations are to ensure that patients are informed about and understand the purpose, benefits and potential risks of transfusion, and have an opportunity to discuss their treatment options. They should be incorporated into local practices for all patients.
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Affiliation(s)
- Michael F Murphy
- NHS Blood and Transplant and Oxford NIHR Biomedical Research Centre, Oxford, UK
| | | | - James Neuberger
- NHS Blood and Transplant and University of Birmingham, Birmingham, UK
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23
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Affiliation(s)
- Nishila Mehta
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Wendy Levinson
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Choosing Wisely Canada, Toronto, Ontario, Canada
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24
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Sramek JJ, Murphy MF, Adcock S, Stark JG, Cutler NR. Phase 1 Clinical Trials of Small Molecules: Evolution and State of the Art. Rev Recent Clin Trials 2021; 16:232-241. [PMID: 33563172 DOI: 10.2174/1574887116666210204125844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Phase 1 studies comprise the first exposure of a promising new chemical entity in healthy volunteers or, when appropriate, in patients. To assure a solid foundation for subsequent drug development, this first step must carefully assess the safety and tolerance of a new compound and often provide some indication of potential effect, so that a safe dose or dose range can be confidently selected for the initial Phase 2 efficacy study in the target patient population. METHODS This review was based on a literature search using both Google Scholar and PubMed, dated back to 1970, using search terms including "healthy volunteers", "Phase 1", and "normal volunteers", and also based on the authors' own experience conducting Phase 1 clinical trials. This paper reviews the history of Phase 1 studies of small molecules and their rapid evolution, focusing on the critical single and multiple dose studies, their designs, methodology, use of pharmacokinetic and pharmacodynamic modeling, application of potentially helpful biomarkers, study stopping criteria, and novel study designs. RESULTS We advocate for determining the safe dose range of a new compound by conducting careful dose escalation in a well-staffed inpatient setting, defining the maximally tolerated dose (MTD) by reaching the minimally intolerated dose (MID). The dose immediately below the MID is then defined as the MTD. This is best accomplished by using appropriately screened patients for the target indication, as patients in many CNS indications often tolerate doses differently than healthy non-patients. Biomarkers for safety and pharmacodynamic measures can also assist in further defining a safe and potentially effective dose range for subsequent clinical trial phases. CONCLUSION Phase 1 studies can yield critical insights into the pharmacology of a new compound in man and offer perhaps the only development period in which the dose range can be safely and thoroughly explored. Phase 1 studies often contain multiple endpoint objectives, the reconciliation of which can present a dilemma for drug developers and study investigators alike, but which can crucially determine whether a compound can survive to the next step in the drug development process.
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Affiliation(s)
- John J Sramek
- Worldwide Clinical Trials, 401 N Maple Dr, Beverly Hills, CA90210, United States
| | - Michael F Murphy
- Worldwide Clinical Trials, 480 E. Swedesford Rd, Suite 200, Wayne, PA19087, United States
| | - Sherilyn Adcock
- Worldwide Clinical Trials, San Antonio, TX78217, United States
| | - Jeffrey G Stark
- Worldwide Clinical Trials, 8609 Cross Park Dr, Austin, TX78754, United States
| | - Neal R Cutler
- Worldwide Clinical Trials, 401 N Maple Dr, Beverly Hills, CA90210, United States
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25
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Dempke WCM, Fenchel K, Reuther S, Murphy MF. Durvalumab plus novel agents in non-small cell lung cancer—a new COAST on the horizon? Transl Lung Cancer Res 2021; 11:697-701. [PMID: 35529785 PMCID: PMC9073750 DOI: 10.21037/tlcr-21-1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wolfram C. M. Dempke
- Worldwide Clinical Trials, Research Triangle Park, North Carolina, USA
- Department of Haematology and Oncology, University Medical School Munich, Munich, Germany
| | | | - Susanne Reuther
- Department of Haematology and Oncology, University Medical School Munich, Munich, Germany
| | - Michael F. Murphy
- Worldwide Clinical Trials, Research Triangle Park, North Carolina, USA
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26
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Nuttall Musson E, Donovan K, Murphy MF. Lost in transfusion: Patient awareness of receiving blood transfusion on the intensive care unit. Transfusion 2020; 60:3064-3066. [PMID: 33285004 DOI: 10.1111/trf.16024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ellen Nuttall Musson
- Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Killian Donovan
- Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael F Murphy
- Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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27
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Doughty H, Green L, Callum J, Murphy MF. Triage tool for the rationing of blood for massively bleeding patients during a severe national blood shortage: guidance from the National Blood Transfusion Committee. Br J Haematol 2020; 191:340-346. [PMID: 32436251 PMCID: PMC7280686 DOI: 10.1111/bjh.16736] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
The emerging COVID-19 pandemic has overwhelmed healthcare resources worldwide, and for transfusion services this could potentially result in rapid imbalance between supply and demand due to a severe shortage of blood donors. This may result in insufficient blood components to meet every patient's needs resulting in difficult decisions about which patients with major bleeding do and do not receive active transfusion support. This document, which was prepared on behalf of the National Blood Transfusion Committee in England, provides a framework and triage tool to guide the allocation of blood for patients with massive haemorrhage during severe blood shortage. Its goal is to provide blood transfusions in an ethical, fair, and transparent way to ensure that the greatest number of life years are saved. It is based on an evidence- and ethics-based Canadian framework, and would become operational where demand for blood greatly exceeds supply, and where all measures to manage supply and demand have been exhausted. The guidance complements existing national shortage plans for red cells and platelets.
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Affiliation(s)
| | - Laura Green
- NHS Blood & TransplantWatfordUK
- Barts HealthLondonUK
- Blizard InstituteQueen Mary University of LondonLondonUK
| | - Jeannie Callum
- Sunnybrook Health Sciences CentreTorontoONCanada
- University of TorontoTorontoONCanada
| | - Michael F. Murphy
- NHS Blood & TransplantWatfordUK
- Oxford University HospitalsOxfordUK
- University of OxfordOxfordUK
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28
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Seheult JN, Dunbar NM, Hess JR, Tuott EE, Bahmanyar M, Campbell J, Fontaine M, Khan J, Ko A, Mi J, Murphy MF, Nykoluk T, Poisson J, Raval JS, Shih A, Sperry JL, Staves J, Wong M, Yan MTS, Ziman A, Yazer MH. Transfusion of blood components containing ABO-incompatible plasma does not lead to higher mortality in civilian trauma patients. Transfusion 2020; 60:2517-2528. [PMID: 32901965 DOI: 10.1111/trf.16008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/10/2020] [Accepted: 07/09/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study investigated the effect on mortality of transfusing ABO-incompatible plasma from all sources during trauma resuscitation. METHODS Demographic, transfusion, and survival data were retrospectively extracted on civilian trauma patients. Patients were divided by receipt of any quantity of ABO-incompatible plasma from any blood product (incompatible group) or receipt of solely ABO-compatible plasma (compatible group). The primary outcome was 30-day mortality, while other outcomes included 6- and 24-hour mortality. Mixed-effects logistic regression was used to model the effect of various predictor variables, including receipt of incompatible plasma, on mortality outcomes. RESULTS Nine hospitals contributed data on a total of 2618 trauma patients. There were 1282 patients in the incompatible group and 1336 patients in the compatible group. In both the unadjusted and adjusted models, the 6-hour, 24-hour, and 30-day mortality rates were not significantly different between these groups. The patients in the incompatible group were then divided into high volume (>342 mL) and low volume (≤342 mL) incompatible plasma recipients. In the adjusted model, the high-volume group had higher 24-hour mortality when the Trauma Injury Severity Score survival prediction was >50%. Mortality at 6 hours and 30 days was not higher in this model. The low-volume group did not have increased mortality at any of the time points in this adjusted model. CONCLUSION The transfusion of incompatible plasma in civilian trauma resuscitation does not lead to higher 30-day mortality. The finding of higher mortality in a select group of recipients in the secondary analysis warrants further study.
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Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - John R Hess
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mohammad Bahmanyar
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Jessica Campbell
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Magali Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ara Ko
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jian Mi
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael F Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Tara Nykoluk
- Department of Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Jessica Poisson
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew Shih
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Staves
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michelle Wong
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | | | | | - Michael F Murphy
- NHS Blood and Transplant and Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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30
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Staples S, O'Callaghan C, Pavord S, Staves J, Murphy MF. How to verify patient identity and blood product compatibility using an electronic bedside transfusion system. Transfusion 2020; 60:2153-2155. [PMID: 32830320 DOI: 10.1111/trf.16028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Transfusion of an incorrect blood component is an important avoidable serious hazard of transfusion resulting from process errors. Our group and others have taken advantage of new technology and developed electronic transfusion systems for safe transfusion practice in a previous studies. They allow the clinical staff to correctly identify the patient and the blood product at the bedside, ensuring the right blood product is given to the right patient. This video is to demonstrate the process and not to promote any specific product. It is a follow up our previous video clip on electronic remote blood issue in a previous study. The process for correct patient identification originates from the wristband, which contains the patient identification details in a 2D barcode and is printed from the electronic patient record system. These details are associated with the blood sample through using a portable printer to produce a label for the sample tube. The patient details are scanned into the blood bank laboratory information system (LIS) and are then printed on a compatibility label by the LIS, which also contains a 2-dimensional barcode, and is then attached to the blood product. Following an initial visual check of these details by the clinical staff, the electronic bedside system requires that both the patient wristband barcode and the blood product compatibility barcode are scanned. This will electronically verify at the patient's bedside that the right unit is to be given to the right patient. This is the final step in ensuring end-to-end electronic control and safe transfusion practice.
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Affiliation(s)
- Sophie Staples
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NHS Blood & Transplant (NHSBT), Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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31
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Staples S, Salisbury RA, King AJ, Polzella P, Bakhishli G, Staves J, Murphy MF. How do we use electronic clinical decision support and feedback to promote good transfusion practice. Transfusion 2020; 60:1658-1665. [DOI: 10.1111/trf.15864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sophie Staples
- Oxford University Hospitals NHS Foundation Trust (OUH) Oxford UK
| | | | - Andrew J. King
- Oxford University Hospitals NHS Foundation Trust (OUH) Oxford UK
| | - Paolo Polzella
- Oxford University Hospitals NHS Foundation Trust (OUH) Oxford UK
| | | | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust (OUH) Oxford UK
| | - Michael F. Murphy
- Oxford University Hospitals NHS Foundation Trust (OUH) Oxford UK
- NHS Blood & Transplant, John Radcliffe Hospital Oxford UK
- Radcliffe Department of MedicineUniversity of Oxford Oxford UK
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32
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Palmer AJR, Lloyd TD, Gibbs VN, Shah A, Dhiman P, Booth R, Murphy MF, Taylor AH, Kendrick BJL. The role of intra-operative cell salvage in patient blood management for revision hip arthroplasty: a prospective cohort study. Anaesthesia 2020; 75:479-486. [PMID: 32037522 DOI: 10.1111/anae.14989] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 12/29/2022]
Abstract
Cell salvage is an important component of blood management in patients undergoing revision hip arthroplasty surgery. However concerns regarding efficacy and patient selection remain. The aims of this study were to describe intra-operative blood loss, cell salvage re-infusion volumes and red blood cell transfusion rates for revision hip procedures and to identify factors associated with the ability to salvage sufficient blood intra-operatively to permit processing and re-infusion. Data were collected from a prospective cohort of 664 consecutive patients undergoing revision hip surgery at a single tertiary centre from 31 March 2015 to 1 April 2018. Indications for revision surgery were aseptic (n = 393 (59%)) fracture (n = 160 (24%)) and infection (n = 111 (17%)). Salvaged blood was processed and re-infused when blood loss exceeded 500 ml. Mean (SD) intra-operative blood loss was 1038 (778) ml across all procedures. Salvaged blood was re-infused in 505 of 664 (76%) patients. Mean (SD) re-infusion volume was 253 (169) ml. In total, 246 of 664 (37%) patients received an allogeneic red blood cell transfusion within 72 h of surgery. Patients undergoing femoral component revision only (OR (95%CI) 0.41 (0.23-0.73)) or acetabular component revision only (0.53 (0.32-0.87)) were less likely to generate sufficient blood salvage volume for re-infusion compared with revision of both components. Compared with aseptic indications, patients undergoing revision surgery for infection (1.87 (1.04-3.36)) or fracture (4.43 (2.30-8.55)) were more likely to generate sufficient blood salvage volume for re-infusion. Our data suggest that cell salvage is efficacious in this population. Cases where the indication is infection or fracture and where both femoral and acetabular components are to be revised should be prioritised.
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Affiliation(s)
- A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - T D Lloyd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - V N Gibbs
- NHS Blood and Transplant, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Dhiman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - R Booth
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M F Murphy
- NHS Blood and Transplant and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A H Taylor
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - B J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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33
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Swart N, Morris S, Murphy MF. Economic value of clinical decision support allied to direct data feedback to clinicians: blood usage in haematology. Vox Sang 2020; 115:293-302. [DOI: 10.1111/vox.12880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas Swart
- Department of Applied Health Research University College London London UK
| | - Stephen Morris
- Department of Applied Health Research University College London London UK
- Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - Michael F Murphy
- NIHR Biomedical Research Centre Blood Theme Oxford University Hospitals University of Oxford Oxford UK
- NHS Blood & Transplant Oxford UK
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Jung-König M, Füllenbach C, Murphy MF, Manzini P, Laspina S, Pendry K, Mühling J, Wikman A, Humbrecht C, Rigal JC, Lasocki S, Folléa G, Seifried E, Müller MM, Geisen C, Aranko K, Zacharowski K, Meybohm P. Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) Working Group. Vox Sang 2019; 115:182-191. [PMID: 31877577 DOI: 10.1111/vox.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Preoperative anaemia is an independent risk factor for a higher morbidity and mortality, a longer hospitalization and increased perioperative transfusion rates. Managing preoperative anaemia is the first of three pillars of Patient Blood Management (PBM), a multidisciplinary concept to improve patient safety. While various studies provide medical information on (successful) anaemia treatment pathways, knowledge of organizational details of diagnosis and management of preoperative anaemia across Europe is scarce. MATERIALS AND METHODS To gain information on various aspects of preoperative anaemia management including organization, financing, diagnostics and treatment, we conducted a survey (74 questions) in ten hospitals from seven European nations within the PaBloE (Patient Blood Management in Europe) working group covering the year 2016. RESULTS Organization and activity in the field of preoperative anaemia management were heterogeneous in the participating hospitals. Almost all hospitals had pathways for managing preoperative anaemia in place, however, only two nations had national guidelines. In six of the ten participating hospitals, preoperative anaemia management was organized by anaesthetists. Diagnostics and treatment focused on iron deficiency anaemia which, in most hospitals, was corrected with intravenous iron. CONCLUSION Implementation and approaches of preoperative anaemia management vary across Europe with a primary focus on treating iron deficiency anaemia. Findings of this survey motivated the hospitals involved to critically evaluate their practice and may also help other hospitals interested in PBM to develop action plans for diagnosis and management of preoperative anaemia.
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Affiliation(s)
- Mona Jung-König
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Christoph Füllenbach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael F Murphy
- NHS Blood & Transplant, Oxford University Hospitals NHS Foundation Trust, National Institute of Health Research Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Paola Manzini
- Banca del Sangue e del Plasma, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefan Laspina
- Hospital Blood Bank, Mater Dei University Hospital, Msida, Malta
| | - Kate Pendry
- Department of Transfusion, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jörg Mühling
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, LUNAM Université d'Angers, Angers, France
| | - Gilles Folléa
- Société Française de Transfusion Sanguine, Paris, France
| | - Erhard Seifried
- German Red Cross, Institute for Transfusion Medicine and Immunohematology, German Red Cross Baden-Wuertemberg - Hessen, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Markus M Müller
- German Red Cross, Institute for Transfusion Medicine and Immunohematology, German Red Cross Baden-Wuertemberg - Hessen, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christof Geisen
- German Red Cross, Institute for Transfusion Medicine and Immunohematology, German Red Cross Baden-Wuertemberg - Hessen, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kari Aranko
- European Blood Alliance, Amsterdam, The Netherlands
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,Department of Anesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany
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Abstract
Blood transfusion is one of the most common hospital procedures in developed countries. However, inappropriate use of blood transfusion is common, and this is of considerable concern because transfusion is known to be associated with adverse events and is costly. Reductions in blood use have resulted from recent evidence indicating that restrictive use of red blood cell transfusions is associated with similar patient outcomes to liberal strategies and from a focus on patient blood management (PBM), which recognizes the importance of conserving the patient's own blood alongside the judicious use of transfusion. A recent Consensus Conference in Frankfurt developed practice and research recommendations for PBM but also indicated that additional studies are needed to provide better evidence for PBM interventions, including for improved patient outcomes and lower hospital costs as well as for reductions in blood utilization. In the meanwhile, it is of utmost importance to translate PBM guidelines into practical day-to-day recommendations and encourage their use to make PBM "the standard of care."
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Affiliation(s)
- Michael F Murphy
- National Health Service Blood & Transplant, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, United Kingdom; and
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
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36
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Prodger CF, Rampotas A, Estcourt LJ, Stanworth SJ, Murphy MF. Platelet transfusion: Alloimmunization and refractoriness. Semin Hematol 2019; 57:92-99. [PMID: 32892848 DOI: 10.1053/j.seminhematol.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022]
Abstract
The transfusion of platelets for both prophylaxis and treatment of bleeding is relevant to all areas of medicine and surgery. Historically, guidance regarding platelet transfusion has been limited by a lack of good quality clinical trials and so has been based largely on expert opinion. In recent years however there has been renewed interest in methods to prevent and treat hemorrhage, and the field has benefited from a number of large clinical trials. Some studies, such as platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH) and platelets for neonatal transfusion Study 2 (PLANET-2), have reported an increased risk of harm with platelet transfusion in specific patient groups. These studies suggest a wider role of platelets beyond hemostasis, and highlight the need for further clinical trials to better understand the risks and benefits of platelet transfusions. This review evaluates the indications for platelet transfusion, both prophylactic and therapeutic, in the light of recent studies and clinical trials. It highlights new developments in the fields of platelet storage and platelet substitutes, and novel ways to avoid complications associated with platelet transfusions. Lastly, it reviews initiatives designed to reduce inappropriate use of platelet transfusions and to preserve this valuable resource for situations where there is evidence for their beneficial effect.
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Affiliation(s)
- Catherine F Prodger
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK
| | - Alexandros Rampotas
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK
| | - Lise J Estcourt
- NHS Blood and Transplant, Oxford; UK; National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford; UK
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK; NHS Blood and Transplant, Oxford; UK; National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford; UK
| | - Michael F Murphy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford; UK; NHS Blood and Transplant, Oxford; UK; National Institute of Health Research Biomedical Research Centre Haematology Theme, Oxford; UK.
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37
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Murphy MF, Jayne Addison J, Poles D, Dhiman P, Bolton‐Maggs P. Electronic identification systems reduce the number of wrong components transfused. Transfusion 2019; 59:3601-3607. [DOI: 10.1111/trf.15537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/21/2019] [Accepted: 08/31/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Michael F. Murphy
- NHS Blood & Transplant (NHSBT) Watford UK
- Oxford NIHR Biomedical Research CentreOxford University Hospitals, University of Oxford Oxford UK
| | - J Jayne Addison
- NHS Blood & Transplant (NHSBT) Watford UK
- Serious Hazards of Transfusion (SHOT) scheme Manchester UK
| | - Debbi Poles
- Serious Hazards of Transfusion (SHOT) scheme Manchester UK
| | - Paula Dhiman
- Oxford NIHR Biomedical Research CentreOxford University Hospitals, University of Oxford Oxford UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research CentreUniversity of Oxford Oxford UK
| | - Paula Bolton‐Maggs
- Serious Hazards of Transfusion (SHOT) scheme Manchester UK
- University of Manchester Manchester UK
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38
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Baker JM, Shehata N, Bussel J, Murphy MF, Greinacher A, Bakchoul T, Massey E, Lieberman L, Landry D, Tanael S, Arnold DM, Baidya S, Bertrand G, Kjaer M, Kaplan C, Kjeldsen-Kragh J, Oepkes D, Savoia H, Ryan G, Hume H. Postnatal intervention for the treatment of FNAIT: a systematic review. J Perinatol 2019; 39:1329-1339. [PMID: 30971767 DOI: 10.1038/s41372-019-0360-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality. STUDY DESIGN MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018. RESULT Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 × 109/L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion. CONCLUSION Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.
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Affiliation(s)
- Jillian M Baker
- St. Michael's Hospital and The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Nadine Shehata
- Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Canada.,Center for Innovation, Canadian Blood Services, Toronto, Canada
| | | | - Michael F Murphy
- NHS Blood & Transplant, Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, UK
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Tamam Bakchoul
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany.,University Hospital of Tuebingen, Tuebingen, Germany
| | - Edwin Massey
- Diagnostic and Therapeutic Services, NHS Blood and Transplant, Bristol, UK
| | - Lani Lieberman
- University Health Network, University of Toronto, Toronto, Canada
| | - Denise Landry
- Center for Innovation, Canadian Blood Services, Ottawa, Canada
| | - Susano Tanael
- Center for Innovation, Canadian Blood Services, Toronto, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada
| | - Shoma Baidya
- Australian Red Cross Blood Service, Brisbane, QLD, Australia
| | - Gerald Bertrand
- BloodCenter of Brittany - (EFS) Établissement Français du Sang, Rennes, France
| | - Mette Kjaer
- Finnmark Hospital Trust, Hammerfest, Norway.,University Hospital of North Norway, Tromsø, Norway
| | - Cécile Kaplan
- Retired and formerly Institut National de la Transfusion Sanguine, Paris, France
| | - Jens Kjeldsen-Kragh
- University Hospital of North Norway, Tromsø, Norway.,University and Regional Laboratories Region Skåne, Lund, Sweden
| | - Dick Oepkes
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Greg Ryan
- Mount Sinai Hospital, Toronto, Canada
| | - Heather Hume
- Division of Haematology/Oncology, CHU Sainte-Justine, University of Montreal, Montreal, Canada
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39
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Musson EN, Lomas O, Murphy MF. Acute thrombocytopenia: picking a way through a paucity of platelets. Br J Hosp Med (Lond) 2019; 80:507-512. [PMID: 31498668 DOI: 10.12968/hmed.2019.80.9.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thrombocytopenia is defined as a platelet count under 150x109/litre. It may be found as a bystander to other pathology or directly related to an underlying haematological condition. Apart from laboratory artefact, it should be treated seriously as it often reflects serious underlying disease. This review uses short case histories to illustrate how to approach thrombocytopenia during the initial presentation of an adult patient to hospital. This article guides the general hospital physician through the narrow but potentially confusing differential diagnoses related to thrombocytopenia, with particular focus on immune thrombocytopenia, disseminated intravascular coagulation and thrombotic thrombocytopenic purpura. Thrombocytopenia in pregnancy deserves special consideration and will not be discussed in this article.
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Affiliation(s)
- E Nuttall Musson
- Core Medical Trainee, Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU
| | - O Lomas
- Haematology Specialist Registrar, Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford
| | - M F Murphy
- Professor of Transfusion Medicine, Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford
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40
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Migdady Y, Goodnough LT, Murphy MF. Transfusion medicine fellowship training in the United States and the UK: a clinical Fellow's experience. Transfus Med 2019; 29:374-375. [PMID: 31418483 DOI: 10.1111/tme.12626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/27/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Y Migdady
- Haematology Oncology Fellowship Programme, National Institutes of Health, Bethesda, Maryland, USA
| | - L T Goodnough
- Department of Medicine, Stanford University Medical Centre, Stanford, California, USA.,Department of Pathology, Stanford University Medical Centre, Stanford, California, USA
| | - M F Murphy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK.,NHS Blood & Transplant, UK
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41
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Yazer MH, Dunbar NM, Thomas J, Nunes E, Murphy MF. Transfusion‐associated circulatory overload risk mitigation: survey on hospital policies for compliance with AABB Standard 5.9.17. Transfusion 2019; 59:2833-2839. [DOI: 10.1111/trf.15478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/20/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Mark H. Yazer
- Vitalant Pittsburgh Pennsylvania
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | | | | | - Michael F. Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre Oxford United Kingdom
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42
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Brierley CK, Staves J, Roberts C, Johnson H, Vyas P, Goodnough LT, Murphy MF. The effects of monoclonal anti-CD47 on RBCs, compatibility testing, and transfusion requirements in refractory acute myeloid leukemia. Transfusion 2019; 59:2248-2254. [PMID: 31183877 DOI: 10.1111/trf.15397] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND CD47 is a novel therapeutic target in the treatment of solid-organ and hematologic malignancies. CD47 is also expressed on RBCs. Here, we report our experience of the RBC effects and the impact on blood bank testing and transfusion management in a Phase 1 trial of the humanized anti-CD47 monoclonal antibody Hu5F9-G4 in relapsed or primary refractory acute myeloid leukemia (AML) (NCT02678338). STUDY DESIGN AND METHODS Nineteen patients with relapsed or primary refractory AML treated across five UK centers were included for analysis. Patients received escalating doses of Hu5F9-G4. Serial laboratory data were collected to evaluate impact on hemoglobin (Hb), markers of hemolysis (bilirubin, lactate dehydrogenase, reticulocyte count), transfusion requirements, and blood compatibility testing. RESULTS A decline in Hb was observed with drug administration (median Hb change, -1.0 g/dL; range, 0.4-1.6) with associated increase in transfusion requirements. Patients responded to transfusion with a median Hb increment per unit of 1.0 g/dL. RBC agglutination was seen in all cases without associated change in Hb, lactate dehydrogenase, bilirubin, or reticulocyte count. Nine of 19 (47%) patients developed a newly positive antibody screen with a pan-agglutinin identified in plasma. Invalid ABO blood grouping occurred in 4 of 12 (33%) non-group O patients due to anomalous reactivity in the reverse ABO-type results. CONCLUSIONS Treatment with Hu5F9-G4 in patients with AML resulted in an Hb decline and increased transfusion requirements. Problems with ABO blood typing and compatibility testing were widely observed and should be expected by centers treating recipients of Hu5F9-G4.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anemia/chemically induced
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacology
- Blood Grouping and Crossmatching
- Blood Transfusion
- CD47 Antigen/antagonists & inhibitors
- Diagnostic Errors/prevention & control
- Erythrocytes/drug effects
- Humans
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Neoplasm Recurrence, Local/therapy
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Affiliation(s)
- C K Brierley
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- MRC Molecular Haematology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - J Staves
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - H Johnson
- Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - P Vyas
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- MRC Molecular Haematology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - L T Goodnough
- Departments of Pathology and Medicine, Stanford University, Stanford, California
| | - M F Murphy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- National Health Service Blood and Transplant, Oxford, United Kingdom
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43
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Kherad O, Restellini S, Martel M, Sey M, Murphy MF, Oakland K, Barkun A, Jairath V. Outcomes following restrictive or liberal red blood cell transfusion in patients with lower gastrointestinal bleeding. Aliment Pharmacol Ther 2019; 49:919-925. [PMID: 30805962 DOI: 10.1111/apt.15158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/15/2018] [Accepted: 01/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Restrictive red blood cell (RBC) transfusion reduces mortality and rebleeding after upper gastrointestinal bleeding (UGIB). However, there is no evidence to guide transfusion strategies in lower gastrointestinal bleeding (LGIB). AIM To assess the association between RBC transfusion strategies and outcomes in patients with LGIB METHODS: This was a post hoc analysis of the UK National Comparative Audit of LGIB and the Use of Blood. The relationships between liberal RBC transfusion and clinical outcomes of rebleeding, mortality and a composite outcome for safe discharge were examined. Transfusion strategy was dichotomised and defined as "liberal" when transfusion was administered for haemoglobin (Hb) ≥80 g/L (or ≥90 g/L in patients with acute coronary syndrome) or major haemorrhage, and "restrictive" otherwise. Multivariable logistic regression models were used to assess the independent association between liberal RBC transfusion and outcomes. RESULTS Of 2528 consecutive patients enrolled from 143 hospitals in the original study, 666 (26.3%) received RBC transfusion (mean age 73.3 ± 16 years, 49% female, initial mean haemoglobin 90 ± 24 g/L, 2.3% had haemodynamic instability). The rebleeding rate in transfused patients was 42.3%. After adjusting for potential confounders, there was no difference between liberal and restrictive RBC transfusion strategies for the odds of rebleeding (OR 0.89, 95% CI 0.6-1.22), in-hospital mortality (OR 0.54, 95% CI 0.3-1.1) or of achieving the composite outcome (OR 0.72, 95% CI 0.5-1.1). CONCLUSION Although these results could be due to residual confounding, they provide an important foundation for the design of randomised trials to evaluate transfusion strategies for LGIB.
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Affiliation(s)
- Omar Kherad
- Department of Internal Medicine, La Tour Hospital and University of Geneva, Geneva, Switzerland
| | - Sophie Restellini
- Division of Gastroenterology, Geneva University Hospital and University of Geneva, Geneva, Switzerland.,Division of Gastroenterology, McGill University, Montreal, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University, Montreal, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada
| | | | - Kathryn Oakland
- Division of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University, Montreal, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada.,Division of Epidemiology and Biostatistics, Western University, London, ON, Canada
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44
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Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, Carson JL, Cichutek K, De Buck E, Devine D, Fergusson D, Folléa G, French C, Frey KP, Gammon R, Levy JH, Murphy MF, Ozier Y, Pavenski K, So-Osman C, Tiberghien P, Volmink J, Waters JH, Wood EM, Seifried E. Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA 2019; 321:983-997. [PMID: 30860564 DOI: 10.1001/jama.2019.0554] [Citation(s) in RCA: 335] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. OBJECTIVE To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. EVIDENCE REVIEW The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. FINDINGS From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. CONCLUSIONS AND RELEVANCE The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
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Affiliation(s)
- Markus M Mueller
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Kari Aranko
- European Blood Alliance (EBA), Amsterdam, the Netherlands
| | - Cécile Aubron
- Departments of Intensive Care and of Anesthesia, University Hospital of Brest, Brest, France
| | | | - Jeffrey L Carson
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | | | - Emmy De Buck
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Dana Devine
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Folléa
- Société Française de Transfusion Sanguine (SFTS), Paris, France
| | - Craig French
- Intensive Care, Western Health, Melbourne, Australia
| | | | | | - Jerrold H Levy
- Department of Cardiothoracic Intensive Care Medicine, Duke University Medical Centre, Durham, North Carolina
| | - Michael F Murphy
- National Health Service Blood and Transplant and University of Oxford, Oxford, United Kingdom
| | - Yves Ozier
- Departments of Intensive Care and of Anesthesia, University Hospital of Brest, Brest, France
| | | | - Cynthia So-Osman
- Sanquin Blood Bank, Leiden and Department of Haematology, Groene Hart Hospital, Gouda, the Netherlands
- International Society of Blood Transfusion (ISBT), Amsterdam, the Netherlands
| | | | - Jimmy Volmink
- Department of Clinical Epidemiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jonathan H Waters
- Departments of Anesthesiology and Bioengineering, University of Pittsburgh Medical Centre, Pittsburgh, Pennsylvania
| | - Erica M Wood
- International Society of Blood Transfusion (ISBT), Amsterdam, the Netherlands
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany
- European Blood Alliance (EBA), Amsterdam, the Netherlands
- International Society of Blood Transfusion (ISBT), Amsterdam, the Netherlands
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45
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Staples S, Staves J, Davies J, Polley N, Boyd JS, Lukas M, Popovsky MA, Frank SM, Ness PM, Murphy MF. Electronic remote blood issue supports efficient and timely supply of blood and cost reduction: evidence from five hospitals at different stages of implementation. Transfusion 2019; 59:1683-1691. [PMID: 30860601 DOI: 10.1111/trf.15231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/03/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This multicenter international study evaluated electronic remote blood issue (ERBI) for blood unit collection in hospitals. STUDY DESIGN AND METHODS Retrospective data were collected from the ERBI software databases and blood bank information systems. Prospective "time-and-motion" data collection methods simulated the delivery of red blood cell units to determine the staff time for each step. RESULTS The main benefit of ERBI was found in two hospitals where the blood unit was issued and collected at refrigerators remote from the blood bank (closer to the clinical area) compared with the standard process of blood bank issue (BBI) and blood unit collection in the blood bank. There was a reduction in the time for blood to reach patients (2.02 min compared to 8.43 min at one site [p ≤ 0.0001], 1.57 min compared to 6.54 min at the other [p ≤ 0.0001]). However, there was no reduction in time where ERBI was conducted in the blood bank or where a blood unit issued by the standard BBI was collected at remote refrigerators. In the three hospitals where ERBI was conducted at remote refrigerators, there was an improved issue:transfusion ratio (range of 1.02-1.09 for ERBI compared to 1.48-1.58 for BBI) and a reduction in staff time and costs of between $5,000 and $10,000/year. CONCLUSION This multicenter international study builds on findings from studies in single hospitals that ERBI at remote refrigerators improves the efficiency of transfusion by reducing the time taken for blood units to reach patients, staff time, and costs.
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Affiliation(s)
- Sophie Staples
- The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Julie Staves
- The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer Davies
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Nicola Polley
- Glan Clwyd Hospital (Betsi Cadwaladr University Health Board), Rhyl, United Kingdom
| | - Joan S Boyd
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mike Lukas
- Haemonetics Corporation, Braintree, Massachusetts, USA
| | | | | | - Paul M Ness
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael F Murphy
- The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,NHS Blood and Transplant, Oxford, United Kingdom
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46
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Lieberman L, Greinacher A, Murphy MF, Bussel J, Bakchoul T, Corke S, Kjaer M, Kjeldsen-Kragh J, Bertrand G, Oepkes D, Baker JM, Hume H, Massey E, Kaplan C, Arnold DM, Baidya S, Ryan G, Savoia H, Landry D, Shehata N. Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence-based practice, an international approach. Br J Haematol 2019; 185:549-562. [PMID: 30828796 DOI: 10.1111/bjh.15813] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) may result in severe bleeding, particularly fetal and neonatal intracranial haemorrhage (ICH). As a result, FNAIT requires prompt identification and treatment; subsequent pregnancies need close surveillance and management. An international panel convened to develop evidence-based recommendations for diagnosis and management of FNAIT. A rigorous approach was used to search, review and develop recommendations from published data for: antenatal management, postnatal management, diagnostic testing and universal screening. To confirm FNAIT, fetal human platelet antigen (HPA) typing, using non-invasive methods if quality-assured, should be performed during pregnancy when the father is unknown, unavailable for testing or heterozygous for the implicated antigen. Women with a previous child with an ICH related to FNAIT should be offered intravenous immunoglobulin (IVIG) infusions during subsequent affected pregnancies as early as 12 weeks gestation. Ideally, HPA-selected platelets should be available at delivery for potentially affected infants and used to increase the neonatal platelet count as needed. If HPA-selected platelets are not immediately available, unselected platelets should be transfused. FNAIT studies that optimize antenatal and postnatal management, develop risk stratification algorithms to guide management and standardize laboratory testing to identify high risk pregnancies are needed.
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Affiliation(s)
- Lani Lieberman
- University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Michael F Murphy
- National Health Service (NHS) Blood and Transplant and the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, United Kingdom
| | | | | | | | - Mette Kjaer
- Finnmark Hospital Trust, Hammerfest, Norway.,University Hospital of North Norway, Tromsø, Norway
| | - Jens Kjeldsen-Kragh
- University Hospital of North Norway, Tromsø, Norway.,University and Regional Laboratories Region Skåne, Lund, Sweden
| | - Gerald Bertrand
- Blood Center of Brittany - EFS L'Établissement Français du Sang, Rennes, France
| | - Dick Oepkes
- Leiden University Medical Center, Leiden, the Netherlands
| | - Jillian M Baker
- Hospital for Sick Children and St. Michael's Hospital, Toronto, Canada
| | - Heather Hume
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | | | - Cécile Kaplan
- Retired and formerly Institut National de la Transfusion Sanguine, Paris, France
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada
| | - Shoma Baidya
- Australian Red Cross Blood Service, Brisbane, Australia
| | - Greg Ryan
- University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada
| | | | | | - Nadine Shehata
- University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada.,Canadian Blood Services, Toronto, Canada
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47
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Yates SA, Murphy MF, Moore SA. The effect of malondialdehyde is modified by simian virus 40 transformation in human lung fibroblast cells. Toxicology 2019; 415:1-9. [PMID: 30658077 DOI: 10.1016/j.tox.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/18/2022]
Abstract
The effects of malondialdehyde (MDA), a product of oxidative stress, on normal lung fibroblast cells (MRC5) and transformed cells (MRC5 SV2) showed differing responses between the two cell lines. MRC5 cells showed lower viability at low MDA concentrations (<250 μM) but had better viability at higher concentrations than the transformed cells. Both cell lines showed an increase in the number of micronuclei, nuclear size and a relocation of p53 to the nucleus with increasing MDA. The expression of p53 was higher in the MRC5 cells at 24 h; 2-8 fold induction vs 1-2.5 fold in the MRC5 SV2 cells, but reduced to almost zero at 48 h in the MRC5 cells. Mutation sequencing of the PCR products of a 689 bp region (residues 4640-5328) of the TP53 gene revealed MRC5 had more mutations than MRC5 SV2 cells (n = 21 and 11 respectively) and that they were predominantly insertions (MRC5 81%, MRC5 SV2 100%). A common mutation was observed in both cell lines; a G insertion at residue 4724 (n = 7) which could prove to be a mutational hotspot. These results indicate that the transformed cells are slower to respond to oxidative stress and/or mutagenic compounds. The mutation spectrum of predominantly frameshift mutations (insertions) suggests that oxidative stress plays a minimal role in smoking related lung cancer, but could be of greater importance to other lung diseases and cancer caused by exposures such as passive smokers, passive vapers and atmospheric pollutants.
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Affiliation(s)
- S A Yates
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - M F Murphy
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - S A Moore
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
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48
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Kaufman RM, Dinh A, Cohn CS, Fung MK, Gorlin J, Melanson S, Murphy MF, Ziman A, Elahie AL, Chasse D, Degree L, Dunbar NM, Dzik WH, Flanagan P, Gabert K, Ipe TS, Jackson B, Lane D, Raspollini E, Ray C, Sharon Y, Ellis M, Selleng K, Staves J, Yu P, Zeller M, Yazer M. Electronic patient identification for sample labeling reduces wrong blood in tube errors. Transfusion 2018; 59:972-980. [DOI: 10.1111/trf.15102] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anh Dinh
- Department of Pathology and Laboratory MedicineChildren's Hospital of Philadelphia Philadelphia PA
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis MN
| | - Mark K. Fung
- Department of PathologyUniversity of Vermont Burlington VT
| | | | - Stacy Melanson
- Department of PathologyBrigham and Women's Hospital Boston MA
| | | | - Alyssa Ziman
- Department of Pathology and Laboratory MedicineUCLA Health Los Angeles CA
| | | | - Danielle Chasse
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | - Lynsi Degree
- Department of PathologyUniversity of Vermont Burlington VT
| | - Nancy M. Dunbar
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | - Walter H. Dzik
- Department of PathologyMassachusetts General Hospital Boston MA
| | | | - Kimberly Gabert
- Department of Pathology and the Institute for Transfusion MedicineUniversity of Pittsburgh Pittsburgh PA
| | - Tina S. Ipe
- Department of Pathology and Genomic MedicineHouston Methodist Hospital Houston TX
| | - Bryon Jackson
- Department of Pathology and Laboratory MedicineEmory University School of Medicine Atlanta GA
| | | | | | - Charles Ray
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | | | | | - Kathleen Selleng
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine Greifswald Germany
| | - Julie Staves
- Oxford University Hospitals Foundation Trust Oxford United Kingdom
| | - Philip Yu
- St. Paul's Hospital Vancouver Canada
| | | | - Mark Yazer
- Department of Pathology and the Institute for Transfusion MedicineUniversity of Pittsburgh Pittsburgh PA
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49
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Hibbs SP, Brunskill SJ, Donald GC, Saunders HD, Murphy MF. Setting priorities for research in blood donation and transfusion: outcome of the James Lind Alliance priority‐setting partnership. Transfusion 2018; 59:574-581. [DOI: 10.1111/trf.15077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | | | - Michael F. Murphy
- NHS Blood & Transplant
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxford University NHS Foundation Trust Oxford UK
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50
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Klanderman RB, Bosboom JJ, Migdady Y, Veelo DP, Geerts BF, Murphy MF, Vlaar APJ. Transfusion-associated circulatory overload-a systematic review of diagnostic biomarkers. Transfusion 2018; 59:795-805. [PMID: 30488959 PMCID: PMC7379706 DOI: 10.1111/trf.15068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/12/2018] [Accepted: 10/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transfusion‐associated circulatory overload (TACO) is the leading cause of transfusion‐related major morbidity and mortality. Diagnosing TACO is difficult because there are no pathognomonic signs and symptoms. TACO biomarkers may aid in diagnosis, decrease time to treatment, and differentiate from other causes of posttransfusion dyspnea such a transfusion‐related acute lung injury. STUDY DESIGN AND METHODS A systematic review of literature was performed in EMBASE, PubMed, the TRIP Database, and the Cochrane Library, from inception to June 2018. All articles discussing diagnostic markers for TACO were included. Non‐English articles or conference abstracts were excluded. RESULTS Twenty articles discussing biomarkers for TACO were included. The majority investigated B‐type natriuretic peptide (BNP) and the N‐terminal prohormone cleavage fragment of BNP (NT‐proBNP), markers of hydrostatic pressure that can be determined within 1 hour. The data indicate that a post/pretransfusion NT‐proBNP ratio > 1.5 can aid in the diagnosis of TACO. Posttransfusion levels of BNP less than 300 or NT‐proBNP less than 2000 pg/mL, drawn within 24 hours of the reaction, make TACO unlikely. Cut‐off levels that exclude TACO are currently unclear. In critically ill patients, the specificity of natriuretic peptides for circulatory overload is poor. Other biomarkers, such as cytokine profiles, cannot discriminate between TACO and transfusion‐related acute lung injury. CONCLUSION Currently, BNP and NT‐proBNP are the primary diagnostic biomarkers researched for TACO. An NT‐proBNP ratio greater than 1.5 is supportive of TACO, and low levels of BNP or NT‐proBNP can exclude TACO. However, they are unreliable in critically ill patients. Other biomarkers, including cytokines and pulmonary edema fluid‐to‐serum protein ratio have not yet been sufficiently investigated for clinical use.
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Affiliation(s)
- Robert B Klanderman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Joachim J Bosboom
- Department of Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Yazan Migdady
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Denise P Veelo
- Department of Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Bart F Geerts
- Department of Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Michael F Murphy
- NHS Blood & Transplant, Oxford University Hospitals and University of Oxford, Oxford, United Kingdom
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
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