2023-11-06 15:05:05
In recent decades, there have been extraordinary advances in transfusion medicine, both from the point of view of theoretical knowledge and technological aspects and their application in clinical practice.
José Luis Arroyo, responsible for Quality Management at the Cantabria Blood and Tissue Bank, has participated in the Educational Program of the National Congress of Hematology, Hemotherapy, Thrombosis and Haemostasis, #Hemato2023, reviewing the scientific and technological advances that have taken place in the last decades in the field of transfusion medicine, and its implication in the activity of current transfusion centers and services.
“As in other branches of Hematology, extraordinary advances have been made in transfusion medicine in recent years, both from the point of view of theoretical knowledge and technological aspects and their application in clinical practice,” says Dr. Arroyo. “These advances revolve around three lines of research: the availability of blood and blood components, greater quality and safety of the available components, and optimal use of blood.”
In the field of safety, the specialist highlights the “pathogen attenuation techniques (also known as inactivation techniques), because they have represented a paradigm shift in the approach to the infectious risk associated with transfusion, moving from a reactive model to a proactive model. Thanks to this strategy, programs to obtain COVID-19 convalescent plasma could be developed from the earliest phase of the pandemic.”
In this sense, Arroyo explains that, “without a doubt, blood is safer than ever, largely thanks to improvements in the detection of communicable viral diseases.” Recently, efforts are focusing on bacterial contamination of platelets and non-infectious risks, errors during the transfusion process or actions against emerging diseases.
Regarding the future, “transfusion centers and services have been looking beyond their traditional functions and activities for years to develop their activity and expand their mission. In fact, cell therapy represents a natural field for this expansion, as is becoming evident with the arrival of CAR-T. Another great challenge in this area is to improve the sufficiency of plasma-derived medicines.”
Jose Luis Arroyo
For her part, Virginia Callao, from the Valencia Transfusion Center, and one of the coordinators of the symposium “Safe transfusion medicine, a matter of care”, defends that “the care of the donor, the blood component and the recipient are the secret of success of our work and, as a consequence, the basis of transfusion safety.” The entire process begins with the donor. “These people take the step out of their generosity and, therefore, it is our obligation to take extreme protection measures to avoid causing any harm.” These measures include several procedures: a correct selection interview, taking into account those aspects that protect the donor, performing an adequate venipuncture, and addressing possible adverse reactions immediately, if necessary.
However, the weakest points of the process are at the patient’s bedside, both at the time of extraction of the pre-transfusion sample and during the transfusion, and are often associated with human errors. “Our obligation is to also take care of the patient, putting in place defense mechanisms against possible errors that could have serious consequences,” says Dr. Callao.
Virginia Callao
Gene therapy in congenital anemias
In #Hemato2023, congenital anemias have also been discussed, specifically, one of the official symposiums has focused on the application of gene therapy to modify the patient’s stem cells through an autotransplant, after correcting the damaged gene that causes the disease. “There are different ways to carry out gene therapy, and where we have the most experience is in the use of viral vectors,” comments Rafael del Orbe, hematologist at the Cruces de Barakaldo University Hospital (Vizcaya).
“The main advantages of gene therapy are that the patient does not depend on a donor, because his or her own cells are self-transplanted. In addition, it avoids the long-term side effects of the transplant, which are, above all, immunological (graft versus recipient disease), ”he adds.
During the symposium coordinated by Rafael del Orbe, the benefits of gene therapy in pathologies such as Fanconi anemia, pyruvate kinase deficiency and Blackfan-Diamond anemia, all three monogenic and of very low prevalence, were explained. In addition, different gene therapy strategies have been made known, such as lentivirus or CRISPR, in the treatment of hereditary hemopathies. “These ‘super innovative’ therapies were born in Spain, a pioneering country worldwide. Spanish research groups have promoted a series of studies that are already underway, achieving good results,” says Dr. Del Orbe. In fact, gene therapy has achieved positive results, including cure, in patients with Fanconi anemia and pyruvate kinase deficiency.
One of the six finalists for the best communication of the Congress, presented by Mayka Sánchez, from the International University of Catalonia, dealt with the discovery of a new gene involved in autosomal recessive congenital dyserythropoietic anemia type IIIb. As Mayka explains, “we have located three patients with this rare disease, studied the mutations and created a zebrafish model, thanks to the collaboration of doctors and researchers from Seville, Madrid and the United States. In addition, we have detected several similar cases in Argentina and we hope to be able to collaborate with specialists there to continue advancing our knowledge of this hematological disease.”
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