AbstractA “restrictive” red blood cell transfusion threshold, a hemoglobin concentration <7 to 8 g/dL, has long been recommended for most hospitalized patients including anemic patients with stable cardiovascular disease (CVD). Although no threshold recommendation is given for acute coronary syndromes (ACSs), recent evidence suggests that “liberal” rather than “restrictive” transfusion strategies are associated with significantly improved safety for hospitalized patients with stable CVD and/or ACS. This finding suggests that previously available data were misinterpreted. Conclusions drawn from earlier transfusion trigger trials have been confounded by unintentional trial design and analysis flaws that have contributed to erroneous recommendations regarding the safety of a restrictive threshold. Subsequently, these conclusions have been incorporated into widely accepted guidelines and clinical practice. Management with a restrictive vs liberal transfusion strategy (<10 g/dL) increases the risk of new-onset ACS in patients with CVD by ∼2%. We estimate that since 2019, using hospital databases and a recent meta-analysis, this practice may have resulted in ∼700 excess ACS events per year in orthopedic surgical patients. Given these findings, transfusion practices in other clinical conditions, particularly those derived from similar transfusion trigger trials, should be questioned. Restrictive and liberal transfusion policies merit a general reconsideration. Rather than a single numerical transfusion trigger, transfusion therapy should be personalized. Consideration of an individual patient’s age, clinical status, and comorbidities is integral to transfusing. To avoid making similar errors, future trials of transfusion therapy should determine common practices before study inception and incorporate them as a usual-care “control” comparator arm into the trial design. Such studies should more reliably improve current transfusion practice.

01 Aug 2024·Heliyon

Influence of irradiated dentin, biofilm and different artificial saliva formulations on root dentin demineralization

Article

Author: Araújo, Tamara Teodoro ; Vertuan, Mariele ; de Souza, Beatriz Martines ; Sassaki, Susan ; Braga, Aline Silva ; Santos, Paulo Sergio da Silva ; Magalhães, Ana Carolina ; Buzalaf, Marilia Afonso Rabelo

The aim of this study was evaluated the influence of radiation as well as of new formulations of artificial saliva on the development of root dentin lesions. Bovine root samples were divided into: irradiated (70 Gy) dentin or not; the type of biofilm (from irradiated patient-experimental or non-irradiated patient-control) and the type of artificial saliva (for the condition irradiated dentin/biofilm from irradiated patient): Control Artificial Saliva (inorganic); Control Saliva + 1 mg/ml hemoglobin; Control Saliva +0.1 mg/ml cystatin; Control Saliva + hemoglobin + cystatin; Bioextra (positive control) and deionized water (DiW, negative control) (n = 12/group). Biofilm was produced using human biofilm and McBain saliva (0.2 % of sucrose, 37^o C and 5 % CO₂); the treatments were done 1x/day, for 5 days. Colony-forming units (CFU) counting was performed; demineralization was quantified by transversal microradiography. Two-way ANOVA/Bonferroni or Sidak test for the comparison between biofilm x dentin and ANOVA/Tukey or Kruskal-Wallis/Dunn for comparing artificial saliva were done (p < 0.05). The type of biofilm had no influence on CFU and demineralization. Sound dentin under control biofilm presented the lowest Lactobacillus ssp. and Streptococcus mutans CFU and the lowest mean mineral loss (R) (25.6 ± 2.2; 23.7 ± 2.9 %) compared to irradiated dentin (26.1 ± 2.8; 28.1 ± 3.3, p < 0.004) for both types of biofilms (experimental and control, respectively). Bioextra was the only artificial saliva that reduced R (10.8 ± 2.5 %) and Lesion Depth (LD) (35 ± 15 μm) compared to DiW (17.3 ± 3.3 %, 81 ± 18 μm, p < 0.0001). Irradiation has impact on caries development; the experimental saliva were unable to reduce its occurrence.

01 Jul 2024·Transfusion Medicine Reviews

Oxygen Extraction Ratios to Guide Red Blood Cell Transfusion

Review

Author: Hess, Aaron S

Hemoglobin-based red blood cell transfusion (RBC) triggers do not clearly identify which patients with moderate anemia (hemoglobin 7-10 g/dL) will benefit from RBC transfusion. The National Heart, Lung, and Blood Institute has recognized the need for bedside oxygenation measures to enhance transfusion decision-making. This narrative review uses four studies to explore the potential of the oxygen extraction ratio (O₂ER)-the ratio of consumed oxygen to delivered oxygen in a critical tissue bed as a more physiologically relevant indicator for guiding RBC transfusions in patients with moderate anemia. The aim of this review is to present existing data on the relationship between O₂ER and responsiveness to RBC transfusion, as well as the feasibility of O₂ER as bedside measure of tissue oxygenation. This review presents a narrative appraisal of three critical papers that investigate the relationship between O₂ER and transfusion outcomes, and one paper that demonstrates proof-of-concept for a noninvasive device to measure O₂ER at the bedside. Despite limitations in the existing studies, including small sample sizes and observational designs, the evidence collectively suggests that O₂ER has the potential to enhance transfusion decision accuracy. The development of noninvasive measurement devices could facilitate widespread implementation in many kinds of care settings.

100 Deals associated with Hemoglobins stimulants(Daiichi Sankyo, Inc.)

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Indication	Highest Phase	Country/Location	Organization	Date
Anemia, Sickle Cell	Preclinical	US	Daiichi Sankyo, Inc.	18 Sep 2021
Beta-Thalassemia	Preclinical	US	Daiichi Sankyo, Inc.	18 Sep 2021

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