John Roback

..In this article, the author discusses the process of developing the recently published guidelines for plasma transfusion using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology...

..Surprisingly, and despite the widespread penetration of EBM in health care, there has been no empirical research to date investigating the impact of quality of evidence on the strength of recommendations made by guidelines panels...

..If confirmed, the INOBA hypothesis may lead to improved methods for blood storage and collection, as well as new screening and matching tools for blood donors and transfusion recipients...

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..To address this issue, the AABB commissioned the development of clinical practice guidelines to help direct appropriate transfusion of plasma...

..quot; However, there is currently no consensus on the optimal assay method for accurate detection of CMV DNA in donors...

..Because PCT is a technology that targets nucleic acids, it also offers a proactive process for the inactivation of a broad range of viral, bacterial, and protozoan pathogens in addition to CMV...

..Thus, amotosalen treatment rapidly eliminates the GVHD activity of polyclonal T cells, while preserving long-term antiviral and graft facilitation effects, and may be clinically useful for routine adoptive immunotherapy...

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..Nevertheless, the use of vacuum filtration to wash RBCs and a standard-flow cytometer for data acquisition hindered efforts to incorporate this method into an automated platform...

..NAT of blood components for CMV DNA has been proposed to further reduce the risks of TT-CMV. However, large-scale studies to determine the utility of validated CMV NAT assays for donor screening have not been reported...

..Furthermore, current automated and semiautomated workstations cannot accommodate many other tests relevant to blood transfusion...

..These results indicate that cGvHD causes an intrinsic immunosuppression and explain, in part, the functional immunodeficiency in allogeneic transplant recipients...

..Moreover, these data suggest that the inflammatory status of human transfusion recipients may regulate the immunogenicity of transfused RBCs...

..These results suggest that PCT of human PLTs with amotosalen/UVA should also effectively abrogate TT-CMV in the clinical setting...

..Thus, adoptive immunotherapy with treated T cells is a novel therapeutic approach that facilitates hematopoietic engraftment and permits antiviral immunity of both donor and host T cells without graft-vs-host disease...

..Specific attention is given to the perioperative management of patients with HAE...

..To determine whether a different subtype of inflammation also enhances RBC alloimmunization, we investigated the effects of the bacterial endotoxin lipopolysaccharide (LPS) on alloimmunization...

..The scientific basis, existing evidence, approaches to testing, and predicted biology of this hypothesis are presented...

..Because the increased rate of appearance of WPM was a transient phenomenon, it is not clear whether this is a newly noticed or a new and different phenomenon from "aggregates" observed in the past...

..Emphasis is placed on whether these approaches can simultaneously transfer broad-spectrum immunity to the recipient without producing GVHD...

..This is a novel approach to adoptive immunotherapy in allogeneic BMT...

..Unlike other strategies, veto cells promote long-term allograft survival in primates. Accordingly, the authors hypothesized that veto cells are resistant to the effects of innate immune activation...

..These studies provide mechanistic insight into the phenomenon of antigen loss during incompatible transfusion in humans...

..A planned clinical phase 1 trial of adoptive therapy utilizing ex vivo psoralen-treated donor T-cells in recipients of T-cell-depleted haploidentical HPCT is presented...

..A prospective clinical trial to further evaluate the role of CMV NAT in UCB transplantation appears warranted...

..Thus, underlying CMV infection can alter mucosal immunity, potentially increasing the tendency of CMV-infected hosts to develop colitis...

..Together, these data provide additional insight into the nature of transfused RBCs as an immunogen and provide a mechanism by which viral-like inflammation enhances alloimmunization to transfused RBCs...

..These donor kinetics suggest that the experimental MCMV system can be used to effectively model the mechanisms of TT-CMV infections in humans...

..This review concludes with a discussion of different approaches to screening blood units for sickle cell trait...

..It was observed that several HHV-8-seronegative patients were unexpectedly HHV-8 seropositive after blood transfusion...

..In this review, we discuss a mouse blood transfusion model, which can be used to investigate these issues as well as to validate methods to prevent TT-CMV in at-risk patients...

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..This review summarizes these advances in an historical context, describes new methodologies on the horizon, and discusses residual infectious risks associated with blood transfusion...

..Postchemotherapy mobilization results were reviewed in patients undergoing apheresis before planned autologous hematopoietic progenitor cell (HPC) transplantation to improve the timing of collection procedures...

..However, transfusions are associated with adverse effects. These studies will seek to determine why adverse outcomes happen after transfusion, and develop ways to improve blood collection and storage to minimize these outcomes. ..

..This application proposes to develop a test that could be used to screen blood donors for these antibodies, thus preventing TRALI and improving patient outcomes. ..

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..Furthermore, these investigations will provide an improved understanding of the defects that render allogeneic HPCT recipients susceptible to lethal infections. ..

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..The results of the multi-center trial (to be completed during Phase Ill) will lead to an FDA 510(k) application. ..

..However, transfusions are associated with adverse effects. These studies will seek to determine why adverse outcomes happen after transfusion, and develop ways to improve blood collection and storage to minimize these outcomes. ..