Transfusion
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Mesenchymal stromal cells (MSCs) originally isolated from marrow have multipotent differentiation potential and favorable immunomodulatory and anti-inflammatory properties that make them very attractive for regenerative cellular therapy. Cells with similar phenotypic characteristics have now been derived from almost all fetal, neonatal, and adult tissues; furthermore, more recently similar cells have also been generated from human embryonic stem cells (ESCs). Generation of MSCs from human ESCs provides an opportunity to study the developmental biology of human mesenchymal lineage generation in vitro. ⋯ MSCs from adult sources are being investigated in numerous Phase I-III clinical trials for a wide variety of indications, mainly based on their immunomodulatory properties. Our group and others have shown MSCs derived from human ESCs possess immunomodulatory properties similar to marrow-derived MSCs. Immunomodulatory properties of ESC-derived MSCs could prove to be highly valuable for their potential clinical applications in the future as derivatives of human ESCs have already entered clinical arena in the context of Phase I clinical trials.
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Patients with severe thrombocytopenia are at risk for bleeding during insertion of central venous catheters (CVCs). Although most guidelines recommend preprocedural platelet (PLT) transfusions at a threshold of less than 50 × 10(9) /L, there is only weak evidence supporting such recommendations. ⋯ CVC placements can safely be performed in patients with PLT counts of 20 × 10(9) /L or more without preprocedural PLT transfusions.
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In 2005, The Joint Commission set about assessing the need for performance measures associated with the provision of blood products. Through a rigorous process, seven patient blood management performance measures were created. These measures incorporated a measure requiring transfusion consent; three measures requiring the combination of a laboratory value and a rationale for transfusion of plasma, platelets, or red blood cells; a measure requiring standard documentation about a transfusion; a measure evaluating preoperative anemia screening; and a measure of preoperative type screening and antibody testing before the start of major blood loss surgery. This article describes the process of this measure development and summarizes the final measures and some of the evidence supporting the measures.
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Blood transfusion is the most common procedure performed in American hospitals, and transfusions are commonly ordered by physicians without formal training in transfusion medicine. Several transfusion medicine curricula have been proposed, including those developed through the Transfusion Medicine Academic Awards (TMAA). To our knowledge, no comprehensive study has assessed how transfusion medicine is incorporated into undergraduate medical education. ⋯ Transfusion medicine content in American undergraduate medical education is variable and the influence of the TMAA program on contemporary medical school curricula is questionable. Future efforts in this area should focus on standardizing and improving undergraduate medical education in transfusion medicine.