Introduction to a How I Treat series on transfusion medicine

Abstract

Transfusions are part of standard care in many areas across medicine and are the “bread and butter” of practice for many hematologists, yet high-quality evidence is lacking in many areas. Consequently, expert opinion that sifts through lower-quality evidence to provide guidance for those who only are infrequently faced with the following scenarios is invaluable. Associate Editor Erica M. Wood introduces this 6-piece How I Treat series commissioned from leaders in the field. Callum and colleagues illustrate how coordination between diagnosis and therapy is essential when dealing with major hemorrhage and that a multidisciplinary team approach is most effective. Patients with sickle cell disease may receive large numbers of blood products, and challenges are common. Chou and Hendrickson take us through their approach to management and prevention of the real-world problems posed in this group of patients. van ’t Oever et al discuss how to optimally use prenatal testing for cell-free fetal DNA in maternal plasma to reduce the impact of alloimmunization in pregnancy, and Savoia and coauthors further explore the issues that arise in the management of women and babies where pregnancies are affected by red cell alloimmunization. Distinguishing between the various causes of cardiorespiratory distress after transfusion can be very difficult, so Vlaar et al provide a practical approach to address this situation. Finally, we all know that refractoriness to platelet transfusion is common, but how to identify and deploy the most appropriate and effective solution is not widely understood. To assist, Nahirniak and colleagues address their approach to treat a range of immune and nonimmune causes.