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  1. Article ; Online: How well do platelets prevent bleeding?

    Triulzi, Darrell J

    Hematology. American Society of Hematology. Education Program

    2020  Volume 2020, Issue 1, Page(s) 518–522

    Abstract: Prophylactic platelet transfusions are used to reduce the risk of spontaneous bleeding in patients with treatment- or disease-related severe thrombocytopenia. A prophylactic platelet-transfusion threshold of <10 × 103/µL has been shown to be safe in ... ...

    Abstract Prophylactic platelet transfusions are used to reduce the risk of spontaneous bleeding in patients with treatment- or disease-related severe thrombocytopenia. A prophylactic platelet-transfusion threshold of <10 × 103/µL has been shown to be safe in stable hematology/oncology patients. A higher threshold and/or larger or more frequent platelet doses may be appropriate for patients with clinical features associated with an increased risk of bleeding such as high fevers, sepsis, disseminated intravascular coagulation, anticoagulation therapy, or splenomegaly. Unique factors in the outpatient setting may support the use of a higher platelet-transfusion threshold and/or dose of platelets. A prophylactic platelet-transfusion strategy has been shown to be associated with a lower risk of bleeding compared with no prophylaxis in adult patients receiving chemotherapy but not for autologous transplant recipients. Despite the use of prophylactic platelet transfusions, a high incidence (50% to 70%) of spontaneous bleeding remains. Using a higher threshold or larger doses of platelets does not change this risk. New approaches to reduce the risk of spontaneous bleeding, including antifibrinolytic therapy, are currently under study.
    MeSH term(s) Blood Platelets ; Female ; Hemorrhage/epidemiology ; Hemorrhage/etiology ; Hemorrhage/prevention & control ; Humans ; Middle Aged ; Platelet Transfusion
    Language English
    Publishing date 2020-12-04
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2084287-9
    ISSN 1520-4383 ; 1520-4391
    ISSN (online) 1520-4383
    ISSN 1520-4391
    DOI 10.1182/hematology.2020000136
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  2. Article ; Online: Another piece of the hemolytic disease of the fetus and newborn puzzle after RhD-positive transfusion in trauma resuscitation: the proportion of pregnant women who produce high titer anti-D.

    Yazer, Mark H / Emery, Stephen P / Triulzi, Darrell J / Spinella, Philip / Leeper, Christine

    Trauma surgery & acute care open

    2024  Volume 9, Issue Suppl 1, Page(s) e001252

    Abstract: Background: After the transfusion of RhD-positive red blood cell (RBC)-containing products to an RhD-negative woman of childbearing potential (WCP) during trauma resuscitation, there are several events that must occur for that WCP to have a future ... ...

    Abstract Background: After the transfusion of RhD-positive red blood cell (RBC)-containing products to an RhD-negative woman of childbearing potential (WCP) during trauma resuscitation, there are several events that must occur for that WCP to have a future pregnancy affected by hemolytic disease of the fetus and newborn (HDFN). This study identified and quantitated the frequency of a novel event in the sequence from RhD-positive transfusion during trauma resuscitation to an HDFN outcome, that is, the development of a high titer anti-D among women who were D-alloimmunized.
    Methods: The transfusion service records at one maternity hospital were searched to locate all anti-D titers that had been performed on pregnant women between 1996 and 2022. The highest titer score during each pregnancy was recorded for this study. The critical titer threshold at this institution was ≥16. Passive anti-D caused by Rh immunoglobulin were excluded from analysis.
    Results: There were 97 pregnancies in 85 patients who had an immune-stimulated anti-D; in 60 of 97 (62%) pregnancies, the highest titer score was ≥16. There were 12 patients who had titers performed in two pregnancies during the study period; the correlation between the maximum titer in each pregnancy was not statistically significant (Spearman rank correlation r=0.42, p=0.17).
    Conclusion: In this single center study, 62% of D-alloimmunized pregnant women had a high titer antibody. When considering all of the events that must occur for HDFN to happen, the rate of perinatal mortality was calculated to be 0.04% and the rate of perinatal death or serious adverse event from HDFN was 0.24%.
    Language English
    Publishing date 2024-01-05
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2023-001252
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  3. Article ; Online: How do we…consistently provide high-dose granulocyte products for transfusions in neutropenic patients?

    Bubar, Robert / Kiss, Joseph E / Triulzi, Darrell J / D'Andrea, Pam / Zilich, Ashley / Kaplan, Alesia

    Transfusion

    2023  Volume 63, Issue 7, Page(s) 1267–1276

    Abstract: Background: The therapeutic use of granulocyte transfusions for the treatment of infections in immunocompromised patients has been a controversial practice. Randomized controlled trials suggest that benefit may be provided when a high-dose product, ... ...

    Abstract Background: The therapeutic use of granulocyte transfusions for the treatment of infections in immunocompromised patients has been a controversial practice. Randomized controlled trials suggest that benefit may be provided when a high-dose product, defined as providing a dose of at least 0.6 × 10
    Methods: A retrospective chart review was performed for apheresis granulocyte donations collected between 2018 and 2021 following implementation of combined G-CSF and dexamethasone donor stimulation at our institution. Data collected includes donor demographics, G-CSF administration timeline, pre-collection cell counts, product yields, donor adverse events, and post-transfusion ANC increments.
    Results: A total of 269 granulocyte units were collected from 184 unique donors. The median neutrophil yield (ANC) following G-CSF implementation was 7.5 × 10
    Discussion: In order to properly assess the effectiveness of granulocyte transfusions in patients, it is necessary to ensure that the products being transfused contain an adequate granulocyte dose. This study demonstrates that the combination of G-CSF and dexamethasone donor stimulation, followed by apheresis granulocyte collection, is safe and can reliably yield a high-dose product. Consistent production of high-dose units allows for better assessment of patient outcomes by reducing dosage variability.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Granulocytes ; Neutrophils ; Granulocyte Colony-Stimulating Factor/therapeutic use ; Dexamethasone/therapeutic use
    Chemical Substances Granulocyte Colony-Stimulating Factor (143011-72-7) ; Dexamethasone (7S5I7G3JQL)
    Language English
    Publishing date 2023-06-26
    Publishing country United States
    Document type Case Reports
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.17461
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  4. Article ; Online: Transfusion-Associated Circulatory Overload and Transfusion-Related Acute Lung Injury: Etiology and Prevention.

    Roubinian, Nareg H / Triulzi, Darrell J

    Hematology/oncology clinics of North America

    2019  Volume 33, Issue 5, Page(s) 767–779

    Abstract: Transfusion-related acute lung injury and transfusion-associated circulatory overload are characterized by acute pulmonary edema within 6 hours of blood transfusion. Despite recognition as the leading causes of transfusion-related mortality, they remain ... ...

    Abstract Transfusion-related acute lung injury and transfusion-associated circulatory overload are characterized by acute pulmonary edema within 6 hours of blood transfusion. Despite recognition as the leading causes of transfusion-related mortality, they remain difficult to study due to underrecognition and nonspecific diagnostic criteria. Recent study has shown that inflammatory cytokines and cardiopulmonary biomarker may be useful in differentiating pulmonary transfusion reactions and furthering our understanding of their pathogenesis. It is clear that donor / component mitigation and patient blood management strategies have decreased the incidence of pulmonary transfusion reactions. Additional clinical and translational research focused on identifying at-risk transfusion recipients is needed to further prevent these frequently severe cardiopulmonary events.
    MeSH term(s) Biomarkers ; Cytokines/metabolism ; Diagnosis, Differential ; Disease Management ; Disease Susceptibility ; Humans ; Incidence ; Inflammation Mediators/metabolism ; Risk Factors ; Symptom Assessment ; Transfusion Reaction/blood ; Transfusion Reaction/diagnosis ; Transfusion Reaction/etiology ; Transfusion Reaction/prevention & control ; Transfusion-Related Acute Lung Injury/diagnosis ; Transfusion-Related Acute Lung Injury/epidemiology ; Transfusion-Related Acute Lung Injury/etiology ; Transfusion-Related Acute Lung Injury/prevention & control
    Chemical Substances Biomarkers ; Cytokines ; Inflammation Mediators
    Language English
    Publishing date 2019-07-30
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 93115-9
    ISSN 1558-1977 ; 0889-8588
    ISSN (online) 1558-1977
    ISSN 0889-8588
    DOI 10.1016/j.hoc.2019.05.003
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  5. Article ; Online: Timing of RhD-positive red blood cell administration is associated with D-alloimmunization in injured patients.

    Yazer, Mark H / Spinella, Philip C / Sperry, Jason / Triulzi, Darrell J / Leeper, Christine

    Transfusion

    2023  Volume 63 Suppl 3, Page(s) S54–S59

    Abstract: Background: The D-alloimmunization rate in trauma patients does not appear to depend on the number of RhD-positive units transfused. The effect of the timing and pattern of RhD-positive transfusions has not been evaluated.: Methods: RhD-negative ... ...

    Abstract Background: The D-alloimmunization rate in trauma patients does not appear to depend on the number of RhD-positive units transfused. The effect of the timing and pattern of RhD-positive transfusions has not been evaluated.
    Methods: RhD-negative trauma patients who were transfused with RhD-positive red blood cells (RBC) or low titer group O whole blood (collectively called RBCs) on at least two separate calendar days and who had antibody detection tests performed at least 14 days after the second RhD-positive RBC transfusion without receiving RhIg were included in the analysis. Patients whose anti-D was detected within 14 days of the index RhD-positive RBC transfusion were excluded. Patient demographics and the dates of RhD-positive RBC transfusions and results of antibody detection tests performed after the index transfusion were collected on eligible patients.
    Results: There were 44/61 (72.1%) patients in whom anti-D was not detected (non-alloimmunized) and 17/61 (27.9%) in whom anti-D was detected (alloimmunized). The patients had similar demographics with trends towards higher median admission heart rates and lower median admission Glasgow Coma Scale values in the alloimmunized group. Both groups received statistically identical median quantities of RhD-positive RBCs (non-alloimmunized 5 vs. alloimmunized 4 units, p = .53), however, the alloimmunized group received all their RhD-positive RBCs over a significantly shorter period of time compared to the non-alloimmunized (median 4 vs. 15 days, respectively, p = .01).
    Conclusion: Receipt of all RhD-positive RBCs over a shorter period of time was associated with higher D-alloimmunization rates. These results need to be confirmed in larger studies.
    MeSH term(s) Humans ; Isoantibodies ; Erythrocytes ; Erythrocyte Transfusion/methods ; Blood Transfusion/methods ; Anemia, Hemolytic, Autoimmune
    Chemical Substances Isoantibodies
    Language English
    Publishing date 2023-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.17330
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    Zs.A 284: Show issues Location:
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  6. Article ; Online: Rate of RhD-alloimmunization after the transfusion of multiple RhD-positive primary red blood cell-containing products.

    Yazer, Mark H / Triulzi, Darrell J / Sperry, Jason L / Seheult, Jansen N

    Transfusion

    2021  Volume 61 Suppl 1, Page(s) S150–S158

    Abstract: Introduction: Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products ...

    Abstract Introduction: Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products transfused.
    Methods: RhD-negative patients between 13 and 50 years who were transfused with ≥1 RhD-positive red blood cell (RBC) or whole blood units between January 1, 2000 and December 31, 2019 in a healthcare network were identified. Study patients had to have had at least one antibody detection test performed ≥14 days after the index RhD-positive transfusion and not receive RhIg. Patients were stratified into groups that received 1, 2, 3-5, 6-10, 11-20, and >20 RhD-positive transfusions and the RhD-alloimmunization rate was determined for each group.
    Results: There were 335 patients included; 52/335 (15.5%) were females. Overall, there were 117/335 (34.9%, CI: 29.8%-40.3%) recipients who became RhD-alloimmunized. There was no significant dosage effect in the RhD-alloimmunization rates as the exposure to RhD-positive units increased from one RhD-positive unit to more than 20 RhD-positive units (p = .270 for non-parametric trend test). In an exploratory analysis, patients who received 100% of their RhD-positive transfusions within 72 h of the index transfusion had a significantly higher rate of RhD-alloimmunization compared to those who were transfused over a longer period of time (42.3% vs. 21.4%, respectively; p = .001).
    Conclusion: These results suggest that there may not be an increased RhD-alloimmunization risk with transfusing multiple RhD-positive units after one RhD-positive unit has been transfused. These findings need confirmation in larger studies.
    MeSH term(s) Adult ; Erythrocyte Transfusion/adverse effects ; Erythrocytes/immunology ; Female ; Humans ; Isoantibodies/blood ; Isoantibodies/immunology ; Male ; Middle Aged ; Rh-Hr Blood-Group System/blood ; Rh-Hr Blood-Group System/immunology ; Young Adult
    Chemical Substances Isoantibodies ; Rh-Hr Blood-Group System
    Language English
    Publishing date 2021-07-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.16495
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  7. Article ; Online: Receipt of at least 4 units of low titer group O whole blood with titer <100 does not lead to hemolysis in adult trauma patients.

    Yazer, Mark H / Corcos, Alain / L Sperry, Jason / Triulzi, Darrell J / Leeper, Christine

    Transfusion

    2022  Volume 62 Suppl 1, Page(s) S72–S79

    Abstract: Background: The serological safety of transfusing low titer group O whole blood (LTOWB) with an anti-A and anti-B titer of <100 was evaluated in group O and non-group O trauma recipients.: Methods: Civilian adult trauma patients who received ≥4 units ...

    Abstract Background: The serological safety of transfusing low titer group O whole blood (LTOWB) with an anti-A and anti-B titer of <100 was evaluated in group O and non-group O trauma recipients.
    Methods: Civilian adult trauma patients who received ≥4 units of leukoreduced LTOWB during their initial resuscitation and who survived for >24 h after admission at two level 1 trauma centers were included in this retrospective study. Lactate dehydrogenase (LDH), total bilirubin, haptoglobin, potassium, creatinine were evaluated on the day of LTOWB transfusion (day 0) and on the next 3 days.
    Results: There were 77 injured recipients evaluated: 39 non-group O and 38 group O. The median (IQR) number of transfused LTOWB units was 4 (4-6) and 4 (4-5), respectively, and the maximum number of units was 8 and 11, respectively. The non-group O patients received a median (IQR) volume of 1710 ml (1368-2070) of ABO-incompatible plasma. Comparing non-group O to group O recipients, there were no significant differences in the median haptoglobin, LDH, or creatinine concentrations at any time point. The median concentration of total bilirubin was significantly higher amongst the non-group O recipients on days 1 and 2, while on day 0 the median potassium concentration was significantly higher amongst the group O recipients. All median elevated values were within the laboratory's normal range. Amongst the non-group O recipients there were no reported transfusion reactions.
    Conclusion: Receiving at least four LTOWB units (anti-A&B titer <100) was not associated with biochemical/clinical evidence of hemolysis in adult trauma patients.
    MeSH term(s) ABO Blood-Group System ; Adult ; Bilirubin ; Creatinine ; Haptoglobins ; Hemolysis ; Humans ; Potassium ; Resuscitation ; Retrospective Studies ; Transfusion Reaction ; Wounds and Injuries/therapy
    Chemical Substances ABO Blood-Group System ; Haptoglobins ; Creatinine (AYI8EX34EU) ; Bilirubin (RFM9X3LJ49) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2022-06-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.16980
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  8. Article ; Online: Wider perspectives: It's a changing world-The use of ABO-incompatible plasma for resuscitating massively bleeding patients.

    Yazer, Mark H / Díaz-Valdés, José R / Triulzi, Darrell J / Cap, Andrew P

    British journal of haematology

    2022  Volume 200, Issue 3, Page(s) 291–296

    MeSH term(s) Humans ; Blood Group Incompatibility ; Platelet Transfusion ; Hemorrhage/etiology ; Hemorrhage/therapy ; ABO Blood-Group System ; Hemolysis
    Chemical Substances ABO Blood-Group System
    Language English
    Publishing date 2022-09-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 80077-6
    ISSN 1365-2141 ; 0007-1048
    ISSN (online) 1365-2141
    ISSN 0007-1048
    DOI 10.1111/bjh.18460
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  9. Article ; Online: Administration of blood products in the prehospital setting can decrease trauma patient mortality.

    Dishong, Devin / Sperry, Jason L / Spinella, Philip C / Triulzi, Darrell J / Yazer, Mark H

    Transfusion

    2022  Volume 62, Issue 4, Page(s) 725–727

    MeSH term(s) Emergency Medical Services ; Humans ; Retrospective Studies ; Shock, Hemorrhagic ; Wounds and Injuries/therapy
    Language English
    Publishing date 2022-03-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.16848
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  10. Article ; Online: Receipt of low titer group O whole blood does not lead to hemolysis in children weighing less than 20 kilograms.

    Abou Khalil, Elissa / Gaines, Barbara A / Morgan, Katrina M / Spinella, Philip C / Yazer, Mark H / Triulzi, Darrell J / Leeper, Christine M

    Transfusion

    2023  Volume 63 Suppl 3, Page(s) S18–S25

    Abstract: Objective: The safety of Low Titer Group O Whole Blood (LTOWB) transfusion has not been well-studied in small children.: Methods: This is a single-center retrospective cohort study of pediatric recipients of RhD-LTOWB (June 2016-October 2022) who ... ...

    Abstract Objective: The safety of Low Titer Group O Whole Blood (LTOWB) transfusion has not been well-studied in small children.
    Methods: This is a single-center retrospective cohort study of pediatric recipients of RhD-LTOWB (June 2016-October 2022) who weigh less than 20 kilograms. Biochemical markers of hemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, and reticulocyte count) and renal function (creatinine and potassium) were recorded on the day of LTOWB transfusion and post-transfusion days 1 and 2. Group O and non-Group O recipients were compared.
    Results: Twenty-one children were included. Their median (interquartile range [IQR]) weight was 12 kg (12-18) with minimum 2.8 kg, and median (IQR) age was 3 years (1.75-5.00) with minimum 0.08 years (29 days old). The most common indication for transfusion was trauma (17/21; 81%). The median (IQR) volume of LTOWB transfused was 30 mL/kg (20-42). There were 9 non-group O and 12 group O recipients. There were no statistically significant differences in the median concentrations of any of the biochemical markers of hemolysis or the renal function markers between the non-group O and the group O recipients at any of the three time points (p > 0.05 for all comparisons). There were also no statistically significant differences in demographic parameters or clinical outcomes including 28-day mortality, length of stay, ventilator days, and venous thromboembolism between the groups. No transfusion reactions were reported in either group.
    Conclusion: These data suggest LTOWB use is safe in children weighing less than 20 kg. Further multi-center studies and larger cohorts are needed to confirm these results.
    MeSH term(s) Humans ; Child ; Child, Preschool ; Retrospective Studies ; Hemolysis ; Blood Transfusion/methods ; Transfusion Reaction ; ABO Blood-Group System ; Resuscitation/methods ; Biomarkers ; Wounds and Injuries
    Chemical Substances ABO Blood-Group System ; Biomarkers
    Language English
    Publishing date 2023-04-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.17327
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