Current opinion in hematology
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Possible adverse effects of prolonged storage of red blood cell concentrates (RBCs) are being formally assessed both by observational studies and in randomized controlled trials. New mechanisms have been put forth to explain earlier conflicting observations. This review summarizes ongoing investigations into clinical and basic science studies on RBC storage effects. ⋯ We still do not know whether older red cells have adverse effects, and if so, what determines such clinical effects after transfusion of 'old' RBCs. RBC production factors, previously seldom reported, may play an important role and should be reported.
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This review will address recent developments in the transfusion management of massively transfused trauma patients, focusing on the use of fixed blood component ratios in massive transfusion protocols. ⋯ Massive transfusion protocols with fixed ratios of red blood cells to plasma and platelets have improved survival in both civilian and military trauma patients. Continued studies of ratios as well as integration of other therapies and testing are ongoing in order to continue to improve patient outcome.
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Curr. Opin. Hematol. · Nov 2013
ReviewRed blood cell transfusion: what is the evidence when to transfuse?
This review provides a summary of the clinical trials evaluating transfusion thresholds and recommendations for red blood cell transfusion. We highlight the trial results in patients in the critical care setting, undergoing surgery, and patients with gastrointestinal bleed, acute coronary syndrome, and acute brain injury. ⋯ A restrictive transfusion strategy of administering red blood cell transfusion in patients with hemoglobin concentration of 7-8 g/dl in most patients is supported by randomized clinical trials. Further randomized clinical trials are needed to establish the optimal transfusion threshold in patients with acute coronary syndrome and brain injury, and to elucidate physiological triggers.
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Curr. Opin. Hematol. · Sep 2012
ReviewInfluence of hereditary or acquired thrombophilias on the treatment of venous thromboembolism.
Deficiency of antithrombin, protein C, and protein S increases the risk of a first venous thromboembolism (VTE) by at least 10-fold and is rare (i.e., <0.5% of population), whereas factor V Leiden and the prothrombin G20210A gene increase this risk by 2-5-fold and are common (2-5% of whites). Antiphospholipid antibodies are considered acquired thrombophilic states. Testing for these abnormalities is widespread. This review will consider if the results of testing should influence how patients with VTE are treated. ⋯ Thrombophilia should rarely influence the treatment of VTE. Therefore, routine thrombophilia testing of patients with VTE is not indicated as a way to guide treatment decisions.
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Recent work has shown that the Musashi 2 (Msi2) gene plays important roles in normal and malignant hematopoiesis. Here, we give an overview on the role of Msi2 in the regulation and function of primitive hematopoietic cells as well as in leukaemic progression. We also discuss the molecular pathways in which Msi2 acts in both normal and leukaemic blood cells. ⋯ Further studies into the molecular pathways through which Msi2 modulates primitive progenitor function will provide insight into the regulation of normal haematopoiesis and a better understanding of the mechanisms governing the leukaemic transformation process. This will be crucial for the development of effective therapies.