Transfusion

Background Retaining repeat blood donors is essential for maintaining a safe and sustainable blood supply. While pain during venepuncture has been linked to lower donor return, the influence of donor-perceived needle quality on future donation remains unclear, particularly in low- and middle-income countries. This study examined whether perceived needle quality was associated with willingness to donate again among blood donors in Bangladesh. Methods We conducted a cross-sectional analytical study among 100 consecutively recruited whole-blood donors from participating blood donation centres in Bangladesh. Participants completed a structured questionnaire assessing demographic characteristics, donation history, procedural pain using a 10-point Visual Analogue Scale (VAS), pre-donation fear, perceived needle quality, vasovagal symptoms, overall satisfaction, and willingness to donate again on a five-point ordinal scale. Univariable ordinal logistic regression was used for variable screening, followed by multivariable proportional-odds ordinal logistic regression with purposeful variable selection. Statistical significance was set at p < 0.05. Results The mean donor age was 35.8 +/- 11.8 years, and 88% of participants were male. High procedural pain (VAS >= 4) was reported by 73% of donors, whereas 48% expressed high willingness to donate again. After adjustment, procedural pain was the only independent predictor of future donation intention. Each one-point increase in pain score reduced the odds of greater willingness to donate again by 54% (adjusted OR 0.46, 95% CI 0.37-0.57; p < 0.001). Donor-perceived needle quality was not associated with willingness to donate again (adjusted OR 1.09, 95% CI 0.47-2.56; p = 0.840) and showed no association with procedural pain. Conclusions Procedural pain, rather than donor-perceived needle quality, was the principal determinant of willingness to donate again. Interventions that improve donor comfort and minimise venepuncture pain may strengthen donor retention. Larger prospective studies using actual donor return behaviour are warranted.

BACKGROUND: The transport and storage conditions of thawed plasma are not strictly regulated by the FDA and applying red blood cell transport standard of 1-10 degrees Celcius to recently thawed plasma often results in high discard rates. This study evaluated the extended 120-hour (5-day) coagulation factor stability and sterility of thawed plasma frozen within 24 hours (PF24) following a 6-hour transport cooler simulation. STUDY DESIGN AND METHODS: Fourteen PF24 units (8 group O, 6 group B) were thawed at 30-37 degrees Celcius and assigned as control (n=7, direct 1-6 degrees Celcius refrigeration) or experiment (n=7) units. Experiment units were held at room temperature for 30 minutes, stored in validated transport coolers for 6 hours, and then transferred to 1-6 degrees Celcius refrigeration. Measurements of temperature, prothrombin time (PT), Factor V (FV) activity, and Factor VIII (FVIII) activity were conducted at 0-, 6-, 24-, and 120-hour post-thaw. Sterility testing was performed at 0-hour and 120-hour using automated aerobic and anaerobic blood cultures. RESULTS: No statistically significant differences were observed between control and experiment units at 120-hour for mean PT (15.09 vs. 15.16 seconds, p = .44), FV activity (81.14 vs. 74.57%, p = .23), or FVIII activity (61.86 vs. 53.00%, p = .22). Delta analysis (120h-0h) confirmed equivalent factor decay rates between groups. All bacterial cultures showed no growth at 120-hour. CONCLUSION: A 6-hour cooler time of thawed PF24 does not accelerate coagulation factor degradation or compromise sterility over an extended 5-day shelf life. These findings validate flexible inventory return policies, allowing blood banks to reduce product waste.

BackgroundComplement-mediated hemolysis assays are essential for assessing immune function and diagnosing complement-related disorders. Conventional human erythrocyte derivatization with 2,4,6-trinitrobenzene sulfonic acid (TNBS) can induce nonspecific hemolysis and optical interference, complicating interpretation. Identifying a more biocompatible electrophile could improve assay specificity and reliability. MethodsA panel of aldehydes was screened for electrophilicity using a nucleophile consumption assay with glycine as a model nucleophile. Glyoxylic acid was selected based on reactivity, solubility, and visual neutrality, then neutralized with sodium bicarbonate to minimize baseline hemolysis. Human erythrocytes were sequentially treated with pancreatin and glyoxylic acid to generate glyoxylic acid-pancreatin-treated erythrocytes (GxPEs). Complement-mediated hemolysis was assessed using normal human serum, heat-inactivated serum, and pathway-specific conditions, with CH50 values calculated for total, alternative, and non-alternative pathways. ResultsGxPEs exhibited robust complement-specific hemolysis (maximum 93.56%) with negligible background activity in heat-inactivated serum. CH50 analysis confirmed activation via both alternative (0.9514 L) and non-alternative (1.963 L) pathways. Reconstitution experiments with factor B-depleted cryoprecipitate and cryosupernatant fractions demonstrated dependence on small complement components such as C2 and C4. ConclusionsGlyoxylic acid derivatization yields a reproducible, optically quiet, and complement-specific erythrocyte substrate suitable for functional hemolysis assays. This method offers a practical platform for complement diagnostics, research applications, and therapeutic evaluation.

Background and Objectives: Preterm infants are commonly transfused, yet direct cardiorespiratory effects of red blood cell (RBC) transfusions remain poorly understood. We explored the feasibility of using multicentre electronic health data (EHD) to study such cardiorespiratory responses. Methods: Highly granular routine EHD were collected from preterm infants born <32 weeks gestational age at three European centres. Heart rate, oxygen saturation, and respiratory rate were evaluated 12 hours before and after the RBC transfusion. Results: A total of 321 transfusions in 164 infants were analysed. Overall, there was no significant change in the rate of bradycardia and apnoea following transfusion. Cardiorespiratory parameters varied substantially between infants; e.g. 20% of transfusions were associated with an unexpected, significant increase in heart rate. Respiratory rate and oxygen saturation exhibited similarly heterogenous patterns following transfusion. In sub-group analysis, the proportion of transfusions with increased heart rate was significantly higher within the first two weeks than later (32% vs 13%, p=0.0019). Conclusions: Multicentre EHD extraction allows to identify otherwise masked short-term effects of RBC transfusions on cardiorespiratory parameters, possibly indicating cardiac or pulmonary overload. Such effects may vary with adaptation to anaemia. Analysing EHD may ultimately enable personalized transfusion practice.

Expanding access to cellular immune analysis is essential for decentralized clinical care, clinical trials, and population-based research. However, current flow cytometry workflows require rapid processing of fresh blood, proximity to a centralized laboratory, and cold chain logistics. Although dried blood spots (DBS) have transformed decentralized molecular diagnostics, no comparable approach has enabled robust flow cytometric analysis of immune cells. Here, we present FlowSpot, a novel platform that enables recovery of leukocytes from DBS and preserves their immunophenotypic characteristics, allowing downstream flow cytometric analysis following ambient-temperature storage and shipment. FlowSpot recovers intact leukocytes while preserving immune cell subset frequencies with strong concordance to fresh whole blood. We demonstrate its clinical utility by enabling remote CD4 T cell immunophenotyping in people living with HIV, showing high agreement with routine clinical measurements across a broad range of CD4 T cell frequencies. Beyond cellular phenotyping, FlowSpot extends immune monitoring to functional profiling by enabling detection of intracellular cytokine responses, including IFN{gamma}, IL-2, and TNF production by CD4 and CD8 T cells following ex vivo PMA/ionomycin stimulation. By overcoming a longstanding barrier to leukocyte recovery from DBS, FlowSpot extends flow cytometry beyond specialized laboratories, expanding access to cellular immune analysis for clinical care, decentralized clinical trials, and population-scale immunology.

Objective: To investigate the distribution frequencies of Rh blood group antigens (C, c, D, E, e) and phenotypes in the population of Hengyang, Hunan Province, and to analyze the production of Rh alloantibodies in repeatedly transfused patients, thereby providing a basis for developing precise transfusion strategies. Methods: Rh phenotyping, antibody screening, and antibody identification were performed on 3,635 hospitalized patients and 5,326 blood donors using Rh blood group typing cards. A blood transfusion management system was used to identify and track patients' historical specific antibodies, with automatic alerts for inconsistent results. Results: The antigen frequency distribution in patients was D (99.56%) > e (94.69%) > C (91.64%) > c (48.06%) > E (38.79%). The phenotypic distribution frequencies among Rh(D)-positive patients were as follows: CCDee (51.31%) > CcDEe (30.01%) > CcDee (9.37%) > ccDEE (5.00%) > ccDEe (2.79%) > CCDEe (0.80%) > ccDee (0.39%) > CcDEE (0.28%) > CCDEE (0.05%). From March to October 2023, after implementing Rh phenotyping and antigen-matched compatible transfusions for five antigens, the antibody screening positivity rate decreased to 0.97%, compared to 1.14% during the same period in 2022 (p < 0.05). Antibody identification in 276 antibody-positive samples revealed that alloantibodies against the Rh system accounted for the highest proportion (46.01%, 127/276), which was lower than the 55.21% observed in 2022 (p < 0.05). Unexpected antibodies in the Rh system were the primary cause of crossmatch incompatibility in clinical transfusions, accounting for 46.01%. Conclusion: Rh phenotyping and sustained antigen-matched compatible transfusions in repeatedly transfused patients can effectively prevent and reduce alloantibody production. Continuous tracking of specific antibodies and transfusion efficacy evaluation can be achieved through an efficient blood transfusion management system.

Background aimsThe development of next-generation therapies for sickle cell disease (SCD) and beta thalassemia (beta thal), including fetal globin-inducing small molecules and gene therapy approaches, depends on patient-derived CD34+ hematopoietic stem and progenitor cells (HSPCs) for discovery and preclinical validation, but commercial vendors stock only healthy donor material and disease-specific banks hold limited inventories. Recent US Food and Drug Administration and National Institutes of Health guidance favoring human cell-based methods over animal testing underscores the value of authentic patient cells. Methods: Over 14 months we recovered, purified, and biobanked CD34+ HSPCs from clinical apheresis product waste and mobilized peripheral blood (PB) otherwise discarded after clinical procedures, using immunomagnetic selection adapted for hemoglobinopathy specimens; a microfluidic technology was evaluated separately. We quantified yield and purity for bead-selected material and cell number and viability for the microfluidic pilot; engraftment was tested in NBSGW mice. Results: Immunomagnetic selection recovered a median of 4.71 x 106 CD34+ cells from just 1 to 2 mL of apheresis product waste, comparable to the 6.0 x 106 cells from a 10 to 40 fold larger volume of PB waste, with similar purity across sources and diagnoses. Because apheresis product waste is far more concentrated, it reaches equivalent yields without the density-gradient steps required for PB waste, approximately halving processing time. Recovered cells engrafted NBSGW mice, confirming preserved repopulating capacity. The microfluidic pilot (two patients, 11 specimens) recovered 2.17 x 106 CD34+ cells per specimen at greater than 90% viability and purity. Conclusions: A center with existing apheresis infrastructure can reproducibly recover, bank, and distribute research-grade patient CD34+ HSPCs, addressing a recognized gap in the hemoglobinopathy pipeline. HighlightsO_LIClinical apheresis waste is used to generate a single-center biobank of high-quality, research-grade CD34+ HSPCs from patients with sickle cell disease and beta-thalassemia. C_LIO_LIConcentrated apheresis waste matches large-volume PB waste in CD34+ yield and purity. C_LIO_LIMicrofluidic enrichment recovers CD34+ cells at >90% viability and purity across 2 patients. C_LIO_LIRecovered CD34+ HSPCs engraft mice and form erythroid cells, preserving function. C_LI

Background: Endovenous techniques are considered the gold standard for treating great saphenous vein (GSV) insufficiency, but access remains limited in low- and middle-income countries. In such contexts, simplified conventional surgeries may represent viable alternatives. This study aimed to compare outcomes of isolated GSV stripping with conventional surgery (stripping plus varicose vein resection) in patients with varicose veins (VV) associated with GSV insufficiency. Methods: A prospective interventional study was conducted including 34 patients with VV (CEAP C2-C6), divided into two groups: Conventional (C, n=17) and Isolated Saphenectomy (IS, n=17). Quality of life was assessed preoperatively and at 2 and 6 months postoperatively using the Venous Clinical Severity Score (VCSS) and VEINES-QoL/Sym questionnaires. Varicose vein evolution in the IS group was quantified using a standardized visual scoring system. Statistical analyses included Students t-test, chi-square, and generalized estimating equations (p[&le;]0.05). Results: Both groups were demographically comparable. Surgical treatment significantly improved VCSS and VEINES scores in both groups (p<0.005), with no intergroup difference at 6 months. In the IS group, the mean reduction in visible VV was 46% (range 20-90%). CEAP classification improved in both groups, with migration toward less severe categories postoperatively. No major complications were reported. Conclusion: Isolated GSV stripping yields comparable short- and mid-term improvements in symptoms and quality of life to conventional surgery, while reducing operative extent. In resource-limited settings, this abbreviated technique may expand access to treatment for VV, improving patient outcomes and reducing healthcare costs without compromising clinical efficacy.

Background: The saphenous vein (SV) remains the most widely used graft in coronary artery bypass grafting (CABG). However, graft failure over the years has compromised long-term outcomes. Preservation of the vascular endothelium is fundamental for vein graft patency, and hydrogen sulfide (H2S) a protective gasotransmitter, plays a significant role in vascular homeostasis. This study evaluated how different intraoperative preservation solutions modulate H2S-synthesizing enzymes and endothelial integrity. Methods: SV segments from 20 CABG patients were subdivided into five groups: Control (immediate fixation), normal saline (NS; 0.9% NaCl), autologous heparinized arterial blood (AHB), histidine-tryptophan-ketoglutarate (HTK) solution, and a damage group (no solution for 30 minutes). Structural integrity was evaluated by measuring endothelial coverage using light microscopy, and the expression of eNOS, CD31, and H2S pathway enzymes (CSE, CBS, and 3-MPST) was assessed by immunofluorescence (IF) and confocal microscopy to determine mean fluorescence intensity (MFI). Results: LM analysis revealed that AHB (89.66% {+/-} 3.02) and HTK (88.72% {+/-} 3.07) preserved endothelial coverage significantly better than NS (78.06% {+/-} 4.48) and the Damage Group (76.82% {+/-} 4.90; p < 0.001). In IF, all interventions reduced eNOS and CD31 expression compared to the control, but AHB and HTK maintained significantly higher levels than NS (p < 0.001). All three H2S-producing enzymes were detected in the GSV endothelium, with CSE being the most expressed isoform. The use of NS caused a marked depletion of these enzymes, while AHB and HTK showed specific superiority in preserving H2S synthesizing enzymes. Conclusions: The choice of preservation solution significantly affects endothelial integrity and the modulation of enzymatic H2S synthesis. NS proved to be deleterious to the endothelium, whereas AHB and HTK better preserved vascular structure and function, suggesting their clinical superiority for the preparation of venous grafts during CABG.

Background A persistent gap between motivation and action threatens voluntary blood supply. This study examined the publics knowledge, attitudes, and practices (KAP) regarding blood donation, with a particular focus on identifying the different determinants of past blood donation behavior and future willingness to donate. Methods Convenience sampling was used to conduct a cross-sectional survey among 1,058 eligible people in Qingdao, China, between July and November 2025. Data were collected via a self-designed KAP questionnaire. To find independent characteristics linked to previous behavior and future intention, respectively, multivariable binary logistic regression was used. Results Overall, 37.0% of participants (n=391) had a lifetime donation history, while 39.2% (n=415) intended to donate in the next 12 months. Past behavior was positively associated with older age (36-45 years: OR=6.84; 95% CI: 3.21-14.58), higher education (OR=2.06; 95% CI: 1.33-3.17), and interpersonal interaction channels (OR=1.45; 95% CI: 1.01-2.09) but hindered by safety concerns (OR=0.23; 95% CI: 0.16-0.34). Conversely, future intention was positively correlated with male sex (OR=1.69; 95% CI: 1.24-2.29), prior donation history (OR=2.69; 95% CI: 1.87-3.86), having family members or friends in need of blood (OR=2.75; 95% CI: 1.96-3.85), and traditional media exposure (OR=3.33; 95% CI: 2.18-5.10). Higher education was adversely correlated with future intention (OR=0.55; 95% CI: 0.38-0.79). Conclusion There is a substantial disparity between donation motivation and action. The determinants of past behavior and future intention are asymmetric, suggesting that stage-specific interventions are required, using social mobilization for initiating first-time donations, while employing family reciprocity and authoritative communication to sustain long-term engagement.

Objectives: Capturing adequate blood volume for blood cultures is critical for accurate detection of bloodstream infections. Pediatric volume targets vary by age and weight, whereas adult targets are standardized. The BD BACTEC FXI Culture System (FXI) contains an integrated calibrated load cell capable of automatically reporting blood volume measurements for each vial loaded onto the system. This study evaluated the accuracy of the FXI's blood volume measurements in simulated pediatric and adult patients. Methods: Mock pediatric and adult blood draws were performed, using bagged whole blood, to replicate real-world collection protocols. Syringe-collected blood volumes ranged from 2.0 to 15.0 mL for pediatric patients, depending on mock patient weight, and were fixed at 40.0 mL for adults. Samples were inoculated into BD BACTEC Peds Plus/F, Plus Aerobic/F, and Lytic/10 Anaerobic/F Culture Vials, with a target volume of 2.0 to 10.0 mL per bottle. Reference blood volumes were determined gravimetrically using manually obtained pre- and post-inoculation weights with a blood-specific gravity of 1.055 g/mL and were compared to the automatically measured, gravimetric-based blood volumes reported by the BACTEC FXI Culture System. Results: Automated volume estimates were accurate to a mean error of -0.03 mL per bottle (SD, 0.40 mL; n=168; 95% CI, -0.09 mL, 0.03 mL) and -0.08 mL (SD, 0.79 mL; n=72; 95% CI, -0.26 mL, 0.10 mL) when assessing total volume collected per patient. Conclusions: Our findings demonstrate that the automated system can quantify blood volumes in BACTEC culture vials and support blood volume monitoring for pediatric and adult collections. The gravimetric approach is also amenable to full automation for efficient and accurate blood volume determination.

ProblemComplement, a system of over 30 interacting proteins, functions as a critical immune mediator at mucosal surfaces including the intestine, airway, and nasal mucosae, where it orchestrates complement-dependent cytotoxicity (CDC), complement-dependent phagocytosis (CDP), and inflammatory responses. While complement components have been detected at low levels in genital tract fluids, including cervical mucus, the physiologic dynamics of complement in the female reproductive tract remain poorly characterized. Notably, systematic quantification of complement component levels across the menstrual cycle has not been conducted, limiting our understanding of how hormonal fluctuations may influence complement-mediated protection at the vaginal mucosa. Method of studyTen healthy women of reproductive age were recruited to provide paired samples of cervical mucus (CM) and serum (S) during each phase of the menstrual cycle: follicular, ovulatory, and luteal. Samples were analyzed using bead-based multiplex assays to quantify 13 primary complement components. ResultsAll 13 complement proteins tested were detectable in CM and S; C3b/iC3b was the predominant complement component in CM followed by C4 and C3. In contrast, C4 was the dominant component in S followed by C1q and C3. There were significantly higher levels of C2 in CM during the follicular phase of the menstrual cycle vs. the ovulatory phase (1.15{+/-}0.80 vs 0.24{+/-}0.22{micro}g/mL), C4b (0.56{+/-}0.35 vs 0.22{+/-}0.36 {micro}g/mL), C5a (1.45{+/-}1.09 vs 0.38{+/-}0.48 {micro}g/mL) In contrast, no differences were found in serum complement levels were during the menstrual cycle. Complement concentrations were on average 308-fold (median= 84) lower in CM than in S, except for C3b/iC3b which was only 5 to 7.5-fold lower in CM, and C2 which was higher in CM at the luteal and follicular phases. Midcycle cervical mucus was capable of inducing complement-mediated hemolysis at about 1/3 the potency of serum. ConclusionCervical mucus contains detectable and functional levels of complement proteins. These normative values can provide a foundation for future studies on immune mechanisms in the FRT.

Although the impact of delayed processing on gene expression in EDTA blood has been well documented using targeted assays and microarray platforms, the emergence of next-generation RNA sequencing (RNA-seq) has not yet been leveraged to systematically compare these effects against stabilized whole blood collection systems. Notably, no study has performed a time course RNA-seq analysis with human bulk RNA of matched EDTA and PAXgene blood RNA samples drawn from the same subjects. EDTA is still widely used for gene expression analysis studies. Yet, the genome-wide dynamics by which EDTA blood transcriptomes deviate from a stabilized reference over time remain poorly defined. This represents an important methodological gap, given the increasing reliance on RNA-seq for biomarker discovery, clinical transcriptomics and diagnostics.

Background: Peripartum cardiomyopathy (PPCM) is a leading cause of maternal mortality worldwide, with worse outcomes associated with African Ancestry and delayed presentation. However, the mechanisms underlying PPCM are incompletely understood. Objective: Use a large, nationwide cohort to explore associations between PPCM and underexplored perinatal risk factors and complications of childbirth. Methods: Public hospital discharge data were obtained from eleven U.S. states between 2003-2019. Delivery hospitalizations, patient characteristics and obstetric complications were identified using ICD-9 and -10 CM codes. Only cases with unique patient identifiers enabling readmission analysis were included. The primary outcome was incident PPCM coded between 30 days antepartum and 150 days postpartum. Results: Of 7,424,916 delivering patients, 5,488 patients were diagnosed with PPCM. Patients with PPCM had higher rates of anemia, anemia of chronic disease (ACD), iron deficiency anemia (IDA), sickle cell disease (SCD), sickle cell trait (SCT), red blood cell (RBC) transfusion, and postpartum hemorrhage (PPH) (p<0.001 for all). Transfusion was associated with increased risk of postpartum PPCM both with PPH (OR 2.16) and without PPH (OR 1.92). In multivariable analysis antepartum diagnosis was more common in the setting of anemia (OR 2.5, p<0.001), ACD (OR 16.31 p<0.006), SCD (9.11, p=0.002) and SCT (OR 2.96 p=0.021), while IDA was associated with peripartum and postpartum PPCM (OR 2.04 p<0.001). Conclusion: Anemia subtypes, RBC transfusion, and PPH were associated with an increased risk for PPCM. The magnitude of risk varied by race and timing of presentation. Further study of peripartum interventions directed at these risk factors is warranted.

Abstract: Background: Acute war-related traumatic wounds present significant challenges due to significant soft-tissue damage/loss, risk of contamination, limited access to antimicrobial therapy, need for delayed closure, and limited access to surgical and wound care. Negative Pressure Wound Therapy (NPWT) has been used effectively to reduce the volume of soft-tissue defects, edema, and infection in traumatic wounds, and to promote growth of healthy granulation tissue. However, conventional NPWT devices are costly and electricity-dependent, limiting their utility in conflict settings. Methods: This retrospective cohort study evaluated the use of PragmaVAC, a manually operated, electricity-independent NPWT device, in patients across three hospitals in Gaza with conflict-related wounds that were deemed by the treating surgeon to be unsuitable for primary closure. Secondary analysis was performed of clinical records of patients treated with the PragmaVac NPWT device to assess ability to achieve a primary outcome of wound bed with healthy granulation tissue, time to primary outcome, and rates of adverse effects. Secondary outcome of wound closure and closure method was also assessed. Results: Treatment with PragmaVAC manual NPWT was prescribed to 88 patients. Of those, 27 (31%) had incomplete documentation of their wound healing or were lost to follow up. The remaining 61 (69%) had complete documentation of their wound healing, complications, and final outcome with 59 (67%) successful closure and 2(2%) failure. Conclusion: The use of the PragmaVAC NPWT device provided a safe, effective wound care option to achieve wound closure for large conflict-related traumatic wounds in resource-limited settings. Future studies may further evaluate such use through prospective trials, evalutions of patients' experiences with manual NPWT, and evaluating outcomes beyond primary wound closure to include medium- and long-term complications, cosmesis, and cost of therapy.

Background: Intraoperative hypotension is associated with cardiovascular complications and mortality, making accurate blood pressure monitoring essential. However, the accuracy of noninvasive oscillometric cuff blood pressure (Cuff BP) during hypotension is uncertain. We examined the association between intraoperative hypotension and Cuff BP inaccuracy. Methods: A single-center retrospective cohort included 22,812 adults undergoing noncardiac surgery from April 2013 through November 2023, with 159,782 simultaneous Cuff BP and invasive arterial blood pressure (Arterial BP) pairs. Pairs with arterial systolic BP >120 mmHg or diastolic BP >80 mm Hg were excluded to focus on hypotensive range. Hypotension was defined as arterial mean arterial pressure (MAP) <65 mmHg and categorized as mild (55 to <65), moderate (45 to <55), or severe (35 to <45 mmHg). Cuff BP inaccuracy was defined as an absolute MAP difference >10 mmHg from Arterial BP. Multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% CIs. Results: Compared with normal MAP (?65 mmHg), hypotension was associated with greater odds of Cuff BP inaccuracy (adjusted OR, 1.45 [95% CI, 1.41?1.49]). Adjusted ORs increased with severity (P for trend <0.001): 1.23 (95% CI, 1.19?1.27) for mild, 2.36 (95% CI, 2.24?2.50) for moderate, and 7.39 (95% CI, 6.34?8.62) for severe hypotension. Sensitivity for correct MAP classification decreased from 87.1% for normal MAP to 32.0%, 19.6%, and 10.2% for mild, moderate, and severe hypotension. Conclusions: We found a significantly higher risk of Cuff BP inaccuracy in patients with intraoperative hypotension, supporting cautious interpretation of Cuff BP during intraoperative hypotension.

Background Thalassemia is one of the most common monogenic disorders worldwide, current screening strategies combining hematological testing with molecular assays still carry a risk of missed diagnoses and undesirable efficiency, particularly for complex structural variants and rare mutations. Methods In this prospective double-blind, multicenter cohort study of 3,842 participants (3,362 pregnant women and 480 male partners), we conducted a head-to-head comparison to systematically evaluate the incremental clinical value and detection performance of single-molecule nanopore sequencing in thalassemia (SMITH) against conventional hematological testing and next-generation sequencing (NGS). Findings The overall concordance rate between NGS and SMITH was 98.6% (3789/3842). The discrepant cases (n=53) were directly attributed to the superior detection capabilities of SMITH, which successfully identified complex structural rearrangements-including 45 -globin gene triplications and four HK alleles-that were missed by NGS. Furthermore, SMITH accurately detected four rare variants (c.134_135insT/, c.-22(C>T)/, {beta}N/{beta}c.316-290delinsAGGGCAATAATTT and {beta}3.5 kb deletion/{beta}N ) and resolved ten trans and three cis configurations within the globin gene allele. Clinically, these technical advantages translated to a 9.3% (5/54) increase in the detection rate of high-risk prenatal couples, effectively preventing one birth affected by moderate-to-severe thalassemia. Additionally, SMITH corrected a diagnostic discrepancy in one case (HK vs. -3.7), sparing the couple from an unnecessary invasive procedure. Interpretation Our findings demonstrate that SMITH provides a powerful platform for resolving globin gene rearrangements, detecting rare variants, and enabling direct haplotype phasing. By effectively eliminating diagnostic blind spots, SMITH is expected to become an optimal method for thalassemia prevention programs. Funding This study was supported by Chinese National Natural Science Foundation Projects 81760037 and 82271894.

The glycocalyx of red blood cells (RBCs), a negatively charged surface layer rich in sialic acid residues, plays a crucial role in modulating RBC aggregation. In pathological conditions such as diabetes and sepsis, glycocalyx degradation is often observed along with abnormal RBC aggregation. However, the mechanistic relationship between these phenomena remains poorly defined. In this study, we investigate the effects of enzymatic glycocalyx degradation on RBC aggregation under physiologically relevant flow conditions. Using neuraminidase from Clostridium perfringens (C. welchii) at varying concentrations, we selectively removed sialic acid residues from the RBC glycocalyx, simulating different levels of desialylation observed in health and disease. Confocal microscopy confirmed the dose-dependent depletion of membrane sialic acid, while microfluidic experiments revealed a significant increase in both the size and stability of the RBC aggregates after enzymatic treatment. Our findings suggest that glycocalyx integrity is a crucial biophysical determinant of RBC aggregation, likely influencing both electrostatic repulsion and hydrodynamic forces. This study provides new insights into how the enzymatic modification of the glycocalyx contributes to pathological hemorheology and may inform future strategies for the diagnosis or treatment of vascular diseases.

Background Monoclonal gammopathy of thrombotic significance (MGTS) is a recently described chronic prothrombotic condition characterized by monoclonal anti-PF4 antibodies that are detected above the polyclonal antibody background in patient sera (i.e. present as monoclonal gammopathy of undetermined significance, MGUS). Due to conflicting data in the published literature on antibody clonality in heparin-induced thrombocytopenia (HIT), we evaluated clonality and abundance of anti-PF4 antibodies in HIT, including investigating whether an MGUS, if present in HIT, represents the causative anti-PF4 antibody. Methods Blood samples from 15 patients with HIT were subject to Platelet Factor 4-dependent antigen-based and functional tests. The unmanipulated serum antibody repertoire and isolated anti-PF4 antibodies were subjected to mass spectrometric evaluation. Results Two of the 15 HIT patients had an IgG MGUS. Notably, anti-PF4 antibodies were not synonymous with the MGUS antibody in either of the two patients. Eight of the 15 patients demonstrated monoclonal anti-PF4 antibodies, however, none of the anti-PF4 antibodies were detectable as an MGUS upon evaluation of the entire serum antibody repertoire, reflecting their low abundance. In the seven patients with multiple anti-PF4 antibodies, non-monoclonality was confirmed by analysis of deglycosylated antibody heavy chains. Conclusions Anti-PF4 HIT antibodies are monoclonal in approximately 50% of HIT patients, however, antibody abundance is low such that they are not detectable over the polyclonal IgG background (i.e. are MGUS-negative), differentiating HIT from MGTS. This observation helps explain the transient nature of HIT relative to the persistent prothrombotic state seen in MGTS.

Background High-risk preoperative triage remains fragmented: existing tools often estimate risk without identifying modifiable mechanisms or linking classification to postoperative monitoring, destination planning, and rescue resources. This protocol describes implementation and evaluation of a Reserve-Stress-Rescue (RSR Framework), pathway that operationalizes perioperative high risk as a mismatch among patient physiologic reserve, procedural stress, and system rescue capacity. Approach RSR is a proposed clinician-facing, modular scoring framework for adults undergoing major surgery, especially patients with frailty, multimorbidity, poor functional capacity, anemia or malnutrition, cardiopulmonary disease, or limited postoperative support. Each domain, Reserve, Stress, and Rescue, is scored from 0 to 4 and recorded as both a three-part profile and a total score from 0 to 12. Scores map to Green, Amber, Red, and Crimson triage bands that trigger escalating actions, including targeted optimization, multidisciplinary review, anesthesia and surgical planning, postoperative destination selection, monitoring intensity, and predefined escalation criteria. Validation Plan The initial phase of this study received an exemption determination from the Yale University Institutional Review Board on June 3, 2026, under IRB Protocol ID 2000042729, with exempt categories 2(ii) and 4(iii), including a waiver of HIPAA authorization for access to and use of protected health information as described in the approved protocol. Evaluation will proceed in stages, assessing feasibility, interrater reliability, completeness, acceptability, discrimination, calibration, and clinical utility. Key outcomes include postoperative complications, unplanned escalation of care, intensive care utilization, failure to rescue, mortality, length of stay, triage burden, low-yield testing cascades, and management-changing pathway activation. Conclusion The RSR pathway reframes high-risk status as a modifiable interaction between vulnerability, operative insult, and rescue capacity rather than a fixed patient label. If feasible and valid, RSR may standardize high-risk identification, align perioperative resources with anticipated physiology, improve communication, and support safer, actionable shared decision-making.