It is a pleasure and an honor to prepare this third edition of Transfusion Medicine. It is a pleasure because of exciting developments that have occurred since the last edition and an honor because the previous editions have been sufficiently popular to warrant this new one.
A wonderful benefit of writing another edition is the perspective it provides on changes in our field. For instance, there is little new discussion on leukodepletion and not as much new on hematologic growth factors in transfusion medicine as I expected. The biologic mechanism of transfusion-related immune modulation (TRIM) is still not understood, nor is the clinical effect, if any, of long stored red cells.Transfusion-related acute lung injury (TRALI) is still a problem, although apparently decreased by the use of plasma from male donors. The platelet transfusion trigger has been settled at 10,000 and the red cell transfusion trigger is lower than in the past, but there is still no physiologic key to red cell transfusion decisions. Quality has not fallen out of vogue but is less visible because it has taken its rightful place in operations. Apheresis technology continues to improve, enabling the collection of multiple combinations of components directly from the donor, and thus progressing toward elimination of the component laboratory.
The technology is widely available to detect the genes for many red cell antigens, and it will be interesting to see how this is incorporated into practice when the next edition of this book is prepared. Production of novel cellular products is increasing, and these are used to treat conditions such as hematologic malignancies, immune diseases, myocardial damage, peripheral vascular disease, and to facilitate engraftment of stem cells or solid organs. The first novel cellular therapy product is now commercially available.While we have been extremely successful in reducing the transfusion-related risks of traditional agents such as HIV, HBV, HCV, and syphilis, this raises visibility of remaining risks such as Chagas’ disease, babesiosis, dengue, and bacterial contamination along with short-lived concern about the XMRV agent that did not prove to be a clinical problem. However, these infectious agents illustrate that the approach to blood safety that has been so effective for the last 30 years may not cope with the future. The logical approach going forward is pathogen inactivation, which is being widely adopted for plasma and platelets outside the United State.
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