Eric Abraham Gehrie

Alloimmunization to minor red blood cell antigens has been linked to patient morbidity and mortality, especially among people living with sickle cell disease and transfusion‐dependent thalassaemia. Prophylactic antigen matching is commonly used to prevent alloimmunization, but the evidence supporting this common practice is very limited. The report by Wolf et al. summarizes the latest literature on this topic and importantly finds that there is insufficient evidence to recommend prophylactic extended antigen matching (beyond ABO, RhD, RhCcEe and K). In an era of chronic blood shortages, this approach may help to assure patient access to elective surgery and cellular therapies, while preserving the supply of extensively antigen‐matched red cells for patients with specific needs.Commentary on: Wolf et al. Red cell specifications for blood group matching in patients with haemoglobinopathies: An updated systematic review and clinical practice guideline from the International Collaboration for Transfusion Medicine Guidelines. Br J Haematol 2025; 206:94‐108.

Sickle cell disease (SCD) is an inherited haemoglobinopathy associated with significant morbidity and mortality. Automated red blood cell exchange (aRCE) plays a key role in managing SCD, eliciting both therapeutic and prophylactic effects. The ideal post‐apheresis Ht target for chronic aRCE treatment is not yet unanimously recognized, as well as iron homeostasis can be different among patients. Ross et al. reported their experience on the chronic management of SCD patients undergoing aRCE with a final post‐exchange Ht higher than the value commonly adopted, analysing red blood cell transfusion requirements and iron‐related outcomes in the study population.Commentary on: Ross et al. Automated red blood cell exchange with a post‐procedure haematocrit targeted at 34% in the chronic management of sickle cell disease. Br J Haematol 2024; 205:1556‐1564.

Background: Transfusion of red blood cells (RBC) is an important component of treatment for myelodysplastic syndromes (MDS). Patients receiving frequent transfusions are more likely to develop alloimmunization, an immune reaction to minor RBC antigens that increases the risk of complications including delayed hemolysis. Phenotypic matching is believed to reduce alloimmunization although rigorous evidence is lacking. This study examines the association of alloimmunization with clinical and economic outcomes and may give insight into the potential benefit of phenotypic matching in MDS.Study Design and Methods: This study used data from 1054 hospitals included in the Premier hospital chargemaster dataset. Alloimmunized MDS patients (January 2015 to June 2019) were indirectly identified by ICD‐10 codes (antiglobulin crossmatch and RBC antibody identification). The primary objective was assessment of the association between incremental cost per patient encounter and alloimmunization in MDS patients. Secondary objectives were assessment of the association of length of stay, intensive care unit (ICU) admission, and inpatient mortality for alloimmunized versus non‐alloimmunized MDS patients.Results: Worse clinical and economic outcomes were observed for the alloimmunized group. Higher costs (14%), more ICU admissions (38%), longer hospital (21%) and ICU stays (55%), and greater mortality (30%) were observed among alloimmunized MDS patients compared to non‐alloimmunized (p < .0001 for all comparisons).Discussion: Alloimmunization may be associated with higher costs and greater risk of ICU admission and death in patients with MDS. While further mechanistic research is needed, it seems that MDS patients may benefit substantially from practices that limit risk of alloimmunization, including providing prophylactic antigen matching.

Objectives: To investigate if time to initiate a blood transfusion after an informative laboratory test could feasibly be used by the transfusion medicine service as a metric to monitor for transfusion delays.Background: Delayed transfusions may result in patient morbidity and mortality, but no standards for timely transfusion have been developed. Information technology tools could be implemented to identify gaps in provision of blood and to recognise areas of improvement.Materials and Methods: Data obtained from a children's hospital's data science platform and time from the release of laboratory results to the initiation of transfusions were calculated and weekly medians were used for trend analyses. Outlier events were obtained using locally estimated scatterplot smoothing and generalised extreme studentized deviate test.Results: Overall, the number of outlier events on the timing of transfusions based on patients' haemoglobin level and platelet count were small (n = 1 and n = 0 for 139 weeks, respectively). Investigation of these events for adverse clinical outcomes was non‐significant.Conclusions: Herein, we propose that the trends and outlier events could be further investigated and used to make decisions and implement protocols to improve patient care.

Delayed transfusions may result in patient morbidity and mortality, but no standards for timely transfusion have been developed. Information technology tools could be implemented to identify gaps in provision of blood and to recognize areas of improvement. Herein, we propose that the time to initiate a blood transfusion after an informative laboratory test could feasibly be used by the transfusion medicine service as a metric to monitor for transfusion delays. Trends and outlier events could be further investigated and used to make decisions and implement protocols to improve patient care.