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Outcomes in patients with thrombotic microangiopathy associated with a trigger following plasma exchange: A systematic literature review.

Transfus Apher Sci

December 2024

Alexion, AstraZeneca Rare Disease, 121 Seaport Blvd, Boston, MA 02210, USA. Electronic address:

Plasma exchange (PE) outcomes in patients with trigger-associated thrombotic microangiopathy (TMA) have not been comprehensively reviewed. Embase and MEDLINE® were searched on 03/14/2022 for English language articles published after 2007, alongside a congress materials search (2019-2022; PROSPERO: CRD42022325170). Studies with patients with trigger-associated TMA (excluding thrombotic thrombocytopenic purpura, 'typical' hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli, post-partum TMA, and TMAs with known genetic cause) who received PE or plasma infusion (PI) and reported treatment response (including measures), safety, patient-/caregiver-reported outcomes, or economic burden data were examined.

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Introduction: Acute myocardial infarction (AMI) poses a significant global health burden, warranting meticulous management strategies, particularly in patients with concurrent anemia. Blood transfusion strategies play a pivotal role in optimizing oxygen delivery while minimizing transfusion-related risks. Two contrasting approaches, liberal and restrictive transfusion strategies, have emerged, yet their comparative effectiveness remains uncertain due to conflicting evidence.

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Despite concerns about potential side effects, based both on historical experience with plasma products and more recent concerns about contemporary use of plasma, COVID-19 convalescent plasma has been shown to be a very safe product. Research early in the COVID-19 pandemic documented-among the very large population of convalescent plasma recipients in the US Convalescent Plasma Study component of the FDA-authorized Expanded Access Program-that the overall risk profile was no different than that seen for fresh frozen plasma, a product used routinely in medical practice. The safety of CCP was further demonstrated using real-world evidence, pragmatic trials, and formal randomized trials.

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Key features of the underlying pathophysiology of Transfusion-related acute lung injury.

Expert Rev Hematol

December 2024

Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Article Synopsis
  • Transfusion-related acute lung injury (TRALI) is a serious and often overlooked complication of blood transfusions, particularly in intensive care settings, contributing significantly to transfusion-related mortality.
  • The review highlights important aspects of TRALI's pathophysiology, emphasizing the role of complement activation and the involvement of immune cells like neutrophils and macrophages, as well as the pulmonary endothelium.
  • It calls for better reporting of TRALI cases and further research to identify biomarkers and potential therapies, suggesting that interleukin-10, complement inhibition, and Osteopontin blockade could be promising strategies, with a need for future clinical trials.
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