Objective To investigate whether free heme released in hemolysis could directly damage hepatocytes and disrupt liver function. Methods The mice model of hemolytic transfusion reaction was established, and ALT, AST and other biochemical indexes were detected to analyze the liver function. In vitro, the LO2 cells were stimulated with different concentrations of lysed supernatant of red blood cells and heme respectively. Then the levels of ALT and AST were detected to analyze the liver function. Cell viability was observed by flow cytometry, and cell morphology and skeleton structure were observed by immunofluorescence. Results Abnormal liver function was observed on the mice model of hemolytic transfusion reaction. The results of in vitro experiments showed that LO2 cell viability decreased and the proportion of dead cells increased along with the incremental concentration of free heme. The biochemical indexes such as ALT and AST were aggravated significantly. And free heme could directly destroy the cytoskeleton of LO2 cells. Conclusion Free heme can directly destroy the cell structure of hepatocytes, inhibit cell vitality, induce cell death and abnormal liver function. The degree of damage is positively correlated with the concentration of free heme.

Objective To investigate the effects of platelets with different storage days and quantities on the proliferation of liver cancer cells. Methods Twelve type O platelet braids were collected from Nanning Central Blood Station and sent to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine. According to the storage days, they were divided into fresh PLT group and old PLT group, of which the fresh PLT group was platelets stored for 1 day. In the old PLT group, platelets stored for 4 days were used. The two groups of platelets were co-cultured with human liver cancer cell Huh-7. The confluence degree of Huh-7 cells in each group within 48 hours was observed by scratch test, and the invasion ability of Huh-7 cells in each group within 24 hours was observed by transwell test. Results The results of scratch test showed that the proliferation ability of Huh-7 cells was significantly enhanced after co-culture with platelets. When the same amount of PLT was added, old PLT could promote the proliferation of Huh-7 cells more strongly. When PLT with the same storage days was added, PLT with a higher number generally showed a relatively stronger ability to stimulate cell proliferation. The results of transwell experiment were similar to the results of scratch. When the number of PLT was the same, the number of Huh-7 cells invaded by old PLT group was more than that of fresh PLT group, and the difference was statistically significant (P<0.05). The more PLT was added into Huh-7 cells, the more invasive cells occurred in the fresh PLT group and the old PLT group, and the difference was statistically significant (P<0.05). Conclusion The ability of platelets to promote cell proliferation and invasion is positively correlated with the storage time of platelets and the number of platelets. The application rules of platelet products need to be analyzed according to the specific clinical conditions. In the treatment of patients with neoplastic diseases, the application of old platelets should be avoided as far as possible, and the transfusion of platelets should be minimized when platelets have to be used, so as to achieve the purpose of slowing down the proliferation and metastasis of tumor cells.

The treatment of chronic non-healing wounds remain challenging in terms of complexity. Although platelet rich plasma (PRP) therapy has been widely proven effective, the traditional method of in vitro activation of PRP leads to the rapid release of all growth factors. Due to the separation of colloid and supernatant after activation, the factor-rich supernatant is easy to flow and lose, and it is difficult to form a stable structure, which affects its therapeutic effect. To overcome this problem, researchers in recent years have explored hydrogels as carriers for PRP to improve the shortcomings of traditional PRP treatment. This article reviews the latest research on hydrogel-loaded PRP for the treatment of chronic non-healing wounds and provides a reference for optimal treatment.

Anemia leads to increased perioperative blood transfusion rate and blood transfusion volume, prolonged hospital stay in coronary artery bypass grafting patients, and is also an independent risk factor for postoperative complications and mortality.Patient blood management is a patient-centered, systematic, evidence-based approach to improve patient outcomes through the diagnosis and treatment of perioperative anemia and the protection of autologous blood.This paper reviews the research progress in the prevention and treatment of perioperative anemia in patients with coronary artery bypass grafting, which hopely improves the treatment plan and clinical outcome of patients with anemia after coronary artery bypass grafting.

Objective Marvelous advancements have been made in cancer therapies to improve clinical outcomes over last few years. However, therapeutic resistance has always been a major difficulty in cancer therapy, with extremely complicated mechanisms remain elusive. N6-methyladenosine (m6A) RNA modification, a hotspot in epigenetics, has gained growing attention as a potential determinant of therapeutic resistance. As the most prevalent RNA modification, m6A is involved in every links of RNA metabolism, including RNA splicing, nuclear export, translation and stability. Three kinds of regulators, methyltransferase (writer), demethylase (eraser) and RNA binding proteins (reader), together orchestrate the dynamic and reversible process of m6A modification. Herein, we primarily reviewed the regulatory mechanisms of m6A in therapeutic resistance, including chemotherapy and targeted therapy. Then we discussed the clinical potential of m6A modification to overcome resistance and optimize cancer therapy. Additionally, we proposed prospects of m6A modification for future research.

Objective To investigate the mechanism by which evodiamine alleviates blood transfusion related acute lung injury (TRALI) in rats by regulating high mobility group protein Bl (HMGB1)/ toll like receptor 4 (TLR4)/nuclear transcription factor-κB (NF-κB) signaling pathway. Methods A total of 72 SD rats were randomly divided into the model group, low-dose evodiamine group, high-dose evodiamine group, no load group, high-dose evodiamine+HMGB1 overexpression group, and control group with 12 rats in each. Except for the control group, the TRALI model was prepared by intraperitoneal injection of lipopolysaccharide (LPS) combined with infusion of human plasma. After that, we analyzed the lung function indexes such as inspiratory resistance (Ri), minute ventilation (MV) and peak expiratory flow (PEF). Then, in each group we examined the lung wet-dry ratio of rats and the pathological changes of lung tissue by hematoxylin-eosin (HE) staining; the platelet and neutrophil aggregation in lung tissue by immunofluorescence staining; the total number of cells and the percentage of neutrophils in bronchoalveolar lavage fluid (BALF); the levels of pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in BALF and serum by enzyme-linked immunosorbent assay (ELISA); as well as the expression of HMGB1/TLR4/NF-κB signaling pathway-related proteins in lung tissue by western blotting. Results Compared with the model group, the pulmonary function indexes MV and PEF in low-dose evodiamine group and high-dose evodiamine group were increased (P<0.05), while Ri, lung wet-dry ratio, lung histopathological score, platelet-neutrophil optical density in lung tissue, total number of cells in BALF, percentage of neutrophils, levels of pro-inflammatory factors TNF-α and IL-1β in BALF and serum, HMGB1 and TLR4 protein expression in lung tissue and p-NF-κB p65/NF-κB p65 were all decreased (P<0.05). Overexpression of HMGB1 attenuated the improvement of lung function by evodiamine in TRALI rats. Conclusion Evodiamine may inhibit the inflammation in TRALI rats by inhibiting the activation of HMGB1/TLR4/NF-κB signaling, thereby reducing its acute lung injury, and repairing its lung function.

Objective To study the value of serum IgG anti-A/B titer score of pregnant women with blood type O for predicting the hemolytic disease of newborn (HDN). Methods 45 blood type O pregnant women with high IgG antibody titer were selected as the research object. The IgG titer of the mother was measured by anti-human globulin test carried out by traditional tubing test. At the same time, the score of each tube were measured according to the intensity of agglutination. To obtain the antibody titer scores of the tested samples, add up the scores of the tubes. The correlations between the IgG antibody titer score of pregnant women and the possibility of HDN of newborns were analyzed. Results Of the 45 newborns, 27 were diagnosed as HDN. With the serum antibody titer of pregnant women increasing, the prevalence of HDN shows an upward trend, but the difference between different antibody titer groups was not statistically significant. There was a statistically significant correlation between the titer score and the incidence of HDN, and the correlation coefficient was -0.665. Conclusion Compared to antibody titer, the titer score of pregnant mothers is more closely related to the incidence rate of HDN of newborn. The IgG antibody titer score of pregnant women has more clinical significance in predicting the HDN of hemolytic disease.

Autoimmune hemolytic anemia (AIHA) is a hemolytic disease caused by its own red blood cell antibodies, which is mainly characterized by accelerated destruction of red blood cells. The diagnosis of AIHA is based on direct antiglobulin test (DAT) and hemolysis related indexes.And the treatment for AIHA based on the type and etiology includes blood transfusion,symptomatic supportive care and immunotherapy. In immunotherapy, glucocorticoids are the main first-line therapy, rituximab the second-line therapy, and splenectomy and cytotoxic immunosuppressants the third-line therapy for warm-antibody type; rituximab is the main first-line therapy, rituximab plus bendamustine the second-line therapy and complement inhibitor the third-line therapy for cold-antibody type. The current treatment regimens are not specific and poor efficacy, and there are side effects. New drugs including foctatinib , orilanolimab ( SYNT 001) , rozanolixizumab (UCB7665), nipocalimab (M281) , PI3K inhibitors, venetoclax, ofamulimab, alemtumab and daratumab are undergoing in clinical trials. In addition, traditional Chinese medicine treatment regimens may bring a new potential breakthrough point for the treatment of AIHA.

Objective To investigate the expression of CD38 on erythrocyte surface of ABO with different blood groups and different preservation periods, in order to clarify the blood selection problem of daretuzumab in m ultiple myeloma (MM) patients. Methods Donor blood samples collected from the Blood Collection and Supply Centers of the Whole Army from May 25, 2022 to June 30, 2022 were selected. The four blood groups of type A, B, O and AB were divided into 5 preservation cycles from the date of blood collection. There were 15 normal specimens in different preservation periods of the four blood groups, totaling 300 specimens. For each preservation cycle, 5 people with different blood types were randomly mixed into a group and divided into three groups of specimens. The concentration gradient of CD38 monoclonal antibody was determined by diluting 100 mg/5 mL of CD38 monoclonal antibody with normal saline. Standard pre-transfusion tests were used for detection. Red blood cells and different levels of CD38 antibodies were added to anti-human globulin card in proportion (50 μL for red blood cells and 25 μL for CD38 antibodies), incubated for 15 min, and centrifuged for 10 min to observe the results. Results The monoanticoagulant strength of red blood cells was consistent with that of CD38 for blood groups A, B, O and AB, and there was no statistical significance (P>0.05). The concentration of CD38 monoclonal antibody of the four blood groups ranged from 200 μg to 256 μg, and the red blood cells of different preservation periods all showed 2+ agglutination, with no statistical significance (P=0.062). When the concentration of CD38 mab was 128 ng and 64 ng, erythrocyte agglutination was weakened in five preservation cycles, and the difference was statistically significant (P<0.05). Conclusion The expression of CD38 in different ABO blood groups is basically the same without significant difference. Red blood cells with different storage periods will not increase hemolysis in patients with m ultiple myeloma.

Objective To analyze the quality control indexes of national clinical blood use in 2020 and provide reference for the management of clinical blood use. Methods A retrospective investigation was carried out to collect and analyze the data of blood quality control indexes of medical institutions in 2020. Results We collected 438 clinical blood quality control data, 1 673 (68.62%) of which were from tertiary hospitals, 594 (24.37%) from secondary hospital, and 171 (7.01%) from the hospitals below secondary or other ungraded ones. There were significant differences in clinical blood quality control indexes such as the number of professional and technical personnel for blood transfusion per thousand units, reported cases of adverse transfusion reactions per thousand transfusion times, average blood consumption of third and fourth level operating tables, and average blood consumption of discharged patients among hospitals at all levels (P<0.05). Except for the indoor quality control rate of transfusion compatibility test items and the autotransfusion rate of surgical patients, the other quality control index data had significant differences between regions (P<0.05). Conclusion The quality control indexes of blood for clinical use vary in different grades of hospitals and in different regions, suggesting that there is still room for improvement in the management of blood for clinical use.

More recently, novel monoclonal antibodies targeting immune checkpoints related signaling pathways have shown promise in the field of cancer immunotherapy. Hu5F9-G4, IBI188, and Daratumumab, designed specifically to target CD47 and CD38, have demonstrated clinical efficacy in patients with lymphoma, multiple myeloma, and other malignancies. Because CD38 and CD47 molecules are expressed not only on tumor cells, but also on red blood cells, anti-CD38 or anti-CD47 antibodies are specifically bound to red blood cells in the blood of patients treated with anti-CD38 and anti-CD47 monoclonal drugs. This leads to false positives in compatibility testing, such as blood typing, cross-matching and irregular antibody screening etc., which poses a risk to transfusion safety. In this paper, the interference problems of anti-CD38 and anti-CD47 on blood transfusion compatibility testing and the existing elimination strategies are described to provide reference for minimizing the impact of anti-CD38 and anti-CD47 on blood transfusion safety.

Objective To analyze a phenomenon in 3 cases of HDN, the false negative of D antigen due to D antigen masking. Methods Blood type and antibody titers of maternal and newborn specimens were detected by blood group serology, and antibody screening and identification were carried out. DAT, free antibody and released antibody tests were performed on the samples of the children, and genotyping was carried out. Results DAT, free antibody and released antibody were positive in 3 neonates. The results of maternal and neonatal antibody screening and identification were anti-D antibody, and the titers were all greater than 512. The blood type test of the child was negative for RhD, and the red blood cells of the child were weakly positive after heat release at 56℃. The gene result of the 3 cases was positive for RhD antigen, and the effect of blood exchange treatment was good. Conclusion The high titer of maternal anti-D antibody can lead to D antigen masking phenomenon, which makes the newborn RhD antigen false negative and further increases HDN. It is necessary to give newborn treatment as soon as possible and accurately detect the newborn blood type.

Objective To analyze the risk factors of massive blood transfusion in adolescent scoliosis surgery, establish a nomogram early warning model, and verify the predictive effect of the model. Method The clinical data of 292 adolescent scoliosis patients treated in our hospital from March 2015 to February 2020 were retrospectively analyzed and used as a modeling set. The patients were divided into a massive blood transfusion group and a non-massive blood transfusion group according to the occurrence of massive intraoperative blood transfusion (Within 4 hours, the infusion volume of allogeneic red blood cells is ≥ 1 time the total circulating blood volume, which is 40 mL/kg), and the independent risk factors of intraoperative massive blood transfusion were screened out by Logistic regression. An early nomogram warning model for predicting massive intraoperative bleeding was established based on independent risk factors, the Bootstrap method was used for internal validation of the model, and the receiver operating curve (ROC) and calibration curve were used to evaluate the discrimination and calibration of the model. In addition, 68 cases of adolescent scoliosis orthopedics treated in our hospital from March 2020 to February 2023 were selected as the validation set for external validation. Results The incidence of massive intraoperative blood transfusion in 292 adolescent scoliosis patients was 20.89% (61/292). Multivariate logistic regression analysis showed that BMI≤18kg/m ² (OR=2.584, 95%CI: 1.314~5.081), preoperative Cobb angle>48° (OR=3.680, 95%CI: 1.808~7.491), number of vertebral fusion segments>10 (OR=4.543, 95%CI: 2.210~9.340) and intraoperative blood loss >960 mL (OR=3.817, 95%CI: 1.805~8.070) were independent risk factors for massive intraoperative blood transfusion (P<0.05), and cyclic acid (OR=0.393, 95%CI: 0.193~0.803) was a protective factor (P<0.05). Based on this result, a nomogram prediction model was established. The area under the receiver operating characteristic of the modeling set was 0.841 (95%CI: 0.784~0.899), the sensitivity was 82.68%, the specificity was 75.41%, the risk threshold corresponding to the maximum Youden's J statistic 0.58 was 25%, and the predictive critical value score was 220 points, that is, those with predicted nomogram scores ≥ 220 points were high-risk groups for massive blood transfusion during surgery. The area under the Receiver operating characteristic of the validation set is 0.790 (95%CI: 0.720~0.850); The slope of the correction curve approximates the ideal curve; The probability of predicting the risk of massive intraoperative blood transfusion using the column chart warning model is consistent with the actual probability of occurrence. The Pt ranges were 0.38~0.9 and 0.42~0.9, respectively, and the patients could obtain positive net income. Conclusion The column chart warning model established based on the risk factors of massive blood transfusion during adolescent scoliosis correction surgery has good fitting and predictive effect. Those with a column chart score of ≥ 220 are high-risk groups for massive blood transfusion during surgery. Medical staff should prepare for large-scale blood transfusion plans in advance and provide timely blood transfusion treatment.

Objective To evaluate the impact of X-ray irradiation on the quality of suspended red blood cells by comparing and analyzing the change in quality control indicators and some physicochemical indicators related to suspended red blood cells treated with X-ray irradiation and g-ray irradiation. Methods Totally 49 bags of 2 U suspended red blood cells that failed the glutamate aminotransferase (ALT) test were randomly collected and divided into the γ group (21 bags) and X group (28 bags) according to the irradiation source. Group γ and group X were subjected to corresponding irradiation treatments on the 13th day after collection, and the irradiated blood samples were stored in a 2~6 ℃ blood refrigerator. Quality indicators of irradiated bloods were measured on the 1st and 22nd days after irradiation, respectively. Results The hemolysis rate, K ⁺ concentration, Na ⁺ concentration, Cl ^- concentration, and Ca ²⁺ concentration of group X and group γ were (0.10± 0.03) % vs. (0.09±0.06) %, (46.50±7.94) mmol/L vs. (45.03±4.65) mmol/L, (99.44±3.86) mmol/L vs. (100.83±4.79) mmol/L, (68.35±2.79) mmol/L vs. (67.59±1.26) mmol/L, and (0.40±0.11) mmol/L vs. (0.43±0.08) mmol/L on the first day after irradiation, and (0.29±0.07)% vs. (0.27±0.06)%, (64.22±4.58) mmol/L vs. (63.05±3.57) mmol/L, (81.50±5.56) mmol/L vs. (81.76±3.91) mmol/L, (68.72±1.97) mmol/L vs. (68.28±1.36) mmol/L, (0.39±0.10) mmol/L vs. (0.41±0.04) mmol/L on the 22nd day after irradiation. No significant difference (P>0.05) was observed between group X and group g in terms of the same quality indicator at the same storage time. With the prolonged storage time, the hemolysis rate and K ⁺ concentration of group X and group γ significantly increased, while the Na ⁺ concentration significantly decreased and the concentration of Cl ^- and Ca ²⁺ remained unchanged. Conclusion There is no significant difference in the quality control and physicochemical indicators of suspended red blood cells treated with either X-ray or γ-ray irradiation. With safety completely considered, X-ray irradiator could replace γ-ray irradiator for the preparation of irradiated blood.