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Biomedical subjects

Darrell J Triulzi

Publications and source records attributed to Darrell J Triulzi.

8 recordsLinked to original sources
PubMed2026

Design, rationale, and baseline patient characteristics for the Sickle Cell Disease and CardiovAscular Risk-Red cell Exchange (SCD-CARRE) trial.

BACKGROUND: Despite wide utilization of automated red blood cell exchange (RBCX) transfusion in adult patients with sickle cell disease (SCD), no consensus or quality efficacy data exist on its use. The Sickle Cell Disease and CardiovAscular Risk- Red cell Exchange (SCD-CARRE) trial tests the hypothesis that an automated chronic RBCX transfusion strategy reduces acute health care encounters and death while improving quality of life and end-organ function (cardiac, pulmonary and renal) in participants with SCD that are at high risk of death. METHODS: Adult patients with SCD with elevated tricuspid regurgitant jet velocity (TRV) and/or chronic kidney disease were considered to be at high risk of death and were randomly assigned to RBCX plus standard of care vs standard of care alone. Participants assigned to RBCX received 12 months of exchange transfusions to maintain target pretransfusion hemoglobin S% < 30%, post-transfusion hemoglobin S% < 20%, and post-transfusion hemoglobin concentration &#x2265;10 g/dL. All study participants were managed according to NHLBI/ASH/ATS Expert Panel guidelines. The primary endpoint was the number of SCD acute health care encounters or death over 13 months. Secondary endpoints included measures of cardiovascular and renal function, exercise capacity, patient reported outcomes (all collected at baseline, and months 4, 8, and 12), and transfusion-related adverse events (collected monthly). RESULTS: Between 2020 and 2025, the SCD-CARRE trial randomized 173 participants at 23 sites across 3 countries. Enrolled participants had mean (SD) age of 45.8 (11.8) years and 54% were female. At baseline, participants had average TRV of 2.8 (0.5) m/s such that 45.9% had a TRV between 2.5 to 2.9 m/sec and 28.1% had a TRV &#x2265; 3.0 m/sec. The median (Q1, Q3) eGFR in this cohort was 60 (36, 110) mL/min/1.73 m2. The median (Q1, Q3) 6-minute walk test distance was 375 meters (309, 439), the median daily steps were 3,728 (2,187, 5,821), and participants experienced a median (Q1, Q3) of 2 (1, 5) pain episodes in the year prior to randomization. The trial results are pending. CONCLUSIONS: The SCD-CARRE trial successfully enrolled a cohort of n = 173 adults with SCD. This study highlights a rationale to evaluate the effect of automated chronic RBCX transfusion strategy plus standard of care as compared to standard of care alone in SCD patients at high risk of death with a focus on patient centered outcomes, preservation of cardiovascular function, end-organ complications and death. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT04084080, https://clinicaltrials.gov/study/NCT04084080.

Adult↗
PubMed2006

Clinical effects of reverting from leukoreduced to nonleukoreduced blood in cardiac surgery.

BACKGROUND: A reduction in postoperative length of stay (PLOS) was recently demonstrated with the use of leukoreduced (LR) blood in cardiac surgery patients compared to a historical cohort who received non-LR blood. Follow-up data are now presented in a similar population after a 12-month period in which LR blood was no longer routinely used. STUDY DESIGN AND METHODS: This is an extension of a study in which all patients admitted over a 12-month period for open heart surgery were given LR blood (Group 2) and were compared against a historical cohort given non-LR blood (Group 1). This study measures the outcomes of a new cohort of patients admitted during a 12-month period where LR blood was no longer routinely used (Group 3). RESULTS: PLOS increased in patients who received transfusions with non-LR blood (Group 3, n = 595) versus patients with LR blood (Group 2, n = 645; p = 0.045 by nonparametric rank U test). Mean PLOS increased from 9.5 days (95% confidence interval [CI], 8.9-10.0) to 10.8 days (95% CI, 10.0-11.6). In comparison, an earlier cohort who received non-LR blood (Group 1, n = 501) had a mean PLOS of 10.1 days (95% CI, 9.4-10.7). With the exception of decreased red blood cell (RBC) usage in Group 3, there were no significant differences in non-RBC blood usage, estimated blood loss, bypass time, mediastinitis rates, operative mortality rate, or overall mix of cases. CONCLUSIONS: The use of non-LR blood for cardiac surgery was associated with an increased PLOS compared to the use of LR blood and supports our previous demonstration of the benefits of LR blood in cardiac surgery.

Aged↗
PubMed2006

Transfusion-related acute lung injury: an update.

Transfusion-associated acute lung injury (TRALI) has emerged as a leading cause of transfusion-related morbidity and mortality. TRALI is characterized by acute non-cardiogenic pulmonary edema and respiratory compromise in the setting of transfusion. The study of TRALI has been hampered by inadequate case definitions and an incomplete understanding of the pathologic mechanisms. Recent consensus conferences took an important first step by providing a framework for case definition. Recent advances in the understanding of the pathogenesis of TRALI have also occurred. TRALI has been primarily attributed to donor leukocyte antibodies that are thought to interact with recipient neutrophils, resulting in activation and aggregation in pulmonary capillaries, release of local biologic response modifiers causing capillary leak, and lung injury. An alternate mechanism termed the "two hit" or "neutrophil priming" hypothesis postulates that a pathway to neutrophil activation and aggregation can occur without leukocyte antibodies. A first event such as sepsis or trauma can induce pulmonary endothelial activation, release of cytokines, and priming of neutrophils. A subsequent second event such as exposure to lipids, cytokines or antibodies in a blood component would then cause activation of adherent neutrophils and a release of bioreactive molecules leading to lung injury. There are limited clinical and animal studies to support the "two hit" model. These proposed mechanisms are not mutually exclusive in that donor leukocyte antibody can be pathogenic in both models and have implications for new strategies to prevent TRALI.

Humans↗
PubMed2005

Use of a pH meter for bacterial screening of whole blood platelets.

BACKGROUND: Bacterial contamination of blood products is a leading cause of transfusion-related morbidity and mortality. Transfusion services are now compelled to employ methods of detecting bacteria in platelet (PLT) components. The use of pH screening of whole-blood PLTs (WBPs) was evaluated with a pH meter at the time of issue as a surrogate test for bacterial contamination. STUDY DESIGN AND METHODS: All WBPs selected for transfusion in May through September 2004 were tested individually for pH at time of issue. Those with a pH value of less than 7.0 were cultured in an automated culture system for 5 days. The white blood cell (WBC) and PLT counts in 56 representative WBP units that failed pH screening were compared to WBP units with acceptable pH values. RESULTS: Of the 37,060 WBP units that underwent pH screening, 405 had a pH value of less than 7.0 (1.1%). Four of those units were culture positive (1.0%) for Staphylococcus aureus, Bacillus subtilis, diphtheroids, and coagulase-negative Staphylococcus. Only one cocomponent red blood cell (RBC) unit was culture-positive and grew the same bacteria (S. aureus) as the WBP unit. The rate of pH failure increased with WBP storage length with the greatest rate of pH failures occurring in 5-day-old WBPs. The units that failed pH screening had significantly more WBCs and PLTs than units with acceptable pH values. CONCLUSION: pH screening of WBPs at issue prevented transfusion of bacterially contaminated WBPs and RBCs. This method, however, results in significant PLT wastage. Higher WBC and PLT content likely explains pH failures not due to bacterial contamination.

Bacillus subtilis↗
PubMed2004

Leukoreduction in the setting of open heart surgery: a prospective cohort-controlled study.

BACKGROUND: Proven clinical benefits of leukoreduced blood components include reduced febrile nonhemolytic transfusion reactions, alloimmunization against HLA antigens, and CMV transmission. Immunomodulatory effects of leukoreduction have also been postulated to play a significant role in the clinical outcome of open heart surgery. STUDY DESIGN AND METHODS: A prospective case control study was implemented in which all patients admitted over a 1-year period for open heart surgery at a single hospital were given leukoreduced blood products. Clinical outcomes were prospectively measured and compared to a historical cohort of patients from the previous year when leukoreduced blood products were not routinely used. RESULTS: A significant improvement in the mean postoperative length of stay was seen in the study group (N = 645) versus control group (N = 501; 10.1 vs. 9.5 days; p = 0.005). No significant changes were seen in the rate of mediastinitis, operative mortality, or stay in the intensive care unit. There was no difference in the postoperative length of stay among study patients who did not receive transfusion (N = 308) versus control patients who did not receive transfusion (N = 296; 6.2 vs. 6.4 days; p = 0.104). CONCLUSIONS: The use of leukoreduced blood was associated with a decrease in the postoperative length of stay in the setting of open heart surgery. The mechanisms through which these changes in clinical outcomes are generated remain unknown.

Aged↗
PubMed2004

Transfusion support in liver transplantation.

As liver transplantation becomes increasingly common and complex, the demands on the transfusion service grow. Liver transplant recipients present unique challenges not only in terms of blood supply, but requirements for specialized blood components, serologic problems, and immunologic effects of transfusion on both the allograft and the recipient. As a result of immunosuppression, liver transplant recipients are more susceptible to some transfusion complications such as cytomegalovirus (CMV) infection but not to transfusion associated graft versus host disease. The transfusion specialist must recommend the optimal approach to reducing the risk of these complications in liver transplant recipients.

Blood Component Transfusion↗
PubMed2002

Specialized transfusion support for solid organ transplantation.

As solid organ transplantation becomes increasingly common and complex, the demands on the transfusion service expand. Transplant recipients present unique challenges not only because of product availability but also because of specialized blood components, serologic problems, and immunologic effects of transfusion on the allograft and the recipient. Solid organ transplant recipients receive immunosuppressive agents that make them more susceptible to infectious or immunologic complications of transfusion such as cytomegalovirus infection and graft-versus-host disease. Other immunologic consequences of transfusion such as alloimmunization may also be severe, resulting in acute or chronic graft rejection. The transfusion specialist must recommend the optimal approach to reducing the risk of these complications in organ transplant recipients.

Blood Component Transfusion↗