Transfusion
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Red cell (RBC) transfusions are a potentially life-saving therapy employed during the care of many critically ill patients to replace losses in hemoglobin to maintain oxygen delivery to vital organs. During storage, RBCs undergo a series of biochemical and biomechanical changes that reduce their survival and function. Additionally, accumulation of other biologic by-products of RBC preservation may be detrimental to recipients of blood transfusions. ⋯ In this article, the laboratory and animal experiments evaluating changes to RBCs during prolonged storage are reviewed. Subsequently, the clinical studies that have evaluated the clinical consequences of prolonged RBC storage are reviewed. These data suggest a possible detrimental clinical effect associated with the transfusion of stored RBCs; randomized clinical trials further evaluating the clinical consequences of transfusing older stored RBCs are required.
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The research process is a balance between the inherent risks of new discoveries and the risks of research participant safety. Conflicts of interest, inherent to the research process, as well as those introduced by emerging cellular therapies, have the potential to compromise safety. The relationship of trust between the researcher and the clinical trial participant facilitates objective decision making, in the best interest of both parties. ⋯ In addition, the increasing role of emerging biotechnology start-up companies and pharmaceutical companies in clinical research introduces additional financial considerations. Administrative policies are needed to address these possible conflicts and ensure research participant safety as cellular therapies progress from the research laboratories to the patient's bedside. Administrative policies to ensure minimum standards of quality for emerging products before human clinical trials, policies to enforce consistent reporting requirements for private and public cellular research, policies to minimize financial conflicts of interest, policies to strengthen implementation of the existing IRB process and to structure into the process a consistent, systematic review of these identified conflicts, and policies to limit private litigation will help to preserve the objectivity of the review process and ultimately increase participant safety.
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The transfusion medicine profession can be easily compared and contrasted with an early 1900 ironclad ship operating in the rough seas of the 21st century. Without modifying the old ship to today's standards, even the captain and crew will begin to expect the ship to meet its demise. The unfortunate passengers, on the other hand, do not expect that they are on an old obsolete ship and, instead, are innocent victims stuck on a doomed course. ⋯ The primary purpose of this article is to focus on the educational needs that affect all personnel involved in transfusion medicine. In addition, this article will address potential adverse outcomes and investigate possible resolutions to avoid the "sinking ship." Within the next 5 to 7 years, without a corrective course of action, our profession will be at the bottom of the clinical ladder, remembered more for its demise and tragic ending than for its accomplishments. It is hoped, successful implementation of changes in educational paradigms in transfusion medicine may lead to a renaissance within our workforce-generations working together, each sharing and learning from one another.