Citations

ABSTRACT The HLA‐C*06:358 allele is characterised by a single nucleotide substitution in codon 95 in exon 3.

Importance Patients undergoing cardiac surgery with cardiopulmonary bypass often require platelet transfusions for bleeding. Platelets are routinely stored at room temperature (20-24 °C) for up to 5 to 7 days; however, cold storage (1-6 °C) may allow for increased storage duration without loss of hemostatic function. Objective To determine the maximum cold-storage duration, up to 21 days, for which cold-stored platelets (CSPs) are noninferior or superior in hemostatic efficacy to room-temperature platelets (RTPs) when transfused in actively bleeding patients undergoing cardiac surgery with cardiopulmonary bypass. Design, Setting, and Participants A phase 3, multicenter, randomized, partially blinded, adaptive, noninferiority, storage duration–ranging trial conducted in pediatric and adult patients undergoing cardiac surgery with planned cardiopulmonary bypass at 27 sites in the US and Australia from December 2021 to March 2025. Statistical analysis was conducted from September 9 to October 3, 2025. Intervention Patients were randomized 2:1 to receive CSPs with a maximum of 21 days of storage vs RTPs with a maximum of 7 days of storage. Main Outcomes and Measures The primary outcome was a hemostatic efficacy score with values ranging from 1 to 5 and higher values indicating greater bleeding. The noninferiority margin was 1 point. The success criterion was met if at least 1 cold-storage duration of 7 days or more had a posterior probability of noninferiority of at least 97.5%. The secondary outcome was 24-hour chest tube output. Results Of the 1000 patients who underwent platelet transfusion, 989 were included in the primary analysis (650 CSPs and 339 RTPs). The cohort had a mean (SD) age of 42.1 (30.1) years and 67.8% were male. CSPs were noninferior to RTPs for the primary outcome, with a probability of greater than 99.9% for all cold-storage durations. Pooled across storage durations, CSPs had a mean difference from RTPs of 0.09 (95% credible interval, −0.06 to 0.23). Median (IQR) chest tube output at 24 hours (8.9 mL/kg [5.2-15.4] for CSPs vs 8.4 mL/kg [5.5-15.9] for RTPs; difference in medians, 0.4 [95% CI, −1.0 to 1.5]) was not statistically different between study groups. In a post hoc analysis, as all storage durations were noninferior, considering the CSPs as a single group, the hemostatic efficacy score was similar between both groups: mean (SD) of 3.08 (1.15) CSPs vs 2.99 (1.10) RTPs. There were no differences in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, and mortality between the study groups, except for increased reexploration rates in the CSP group. Conclusions and Relevance For patients undergoing cardiac surgery, CSPs stored up to 21 days are noninferior to RTPs for the control of active surgical bleeding. Use of CSPs may allow for increased availability of platelets by reducing wastage and shortages and may allow for incorporation of platelets into inventory at locations where platelets cannot be maintained due to the 5- to 7-day shelf life of RTPs. Trial Registration ClinicalTrials.gov Identifier: NCT04834414

ABSTRACT HLA‐DRB1*10:52 is characterised by a single nucleotide substitution in codon 133 in exon 3.

ABSTRACT The HLA‐DQA1*01:205N allele is characterised by a nonsense mutation in codon 114 in exon 3.

ABO incompatibility is frequent in haematopoietic stem cell transplantation (HSCT), yet the clinical impact of non-ABO red blood cell (RBC) alloimmunisation remains less defined. We describe the clinical course of a man in his 50s with chronic eosinophilic leukaemia who underwent a mismatched unrelated donor (MMUD) HSCT. Despite a major ABO mismatch and high-titre pre-existing anti-E antibodies against an E-antigen positive donor, the patient achieved successful trilineage engraftment without haemolysis. Six months after the transplant, he developed severe pancytopenia and a positive direct antiglobulin test (DAT) with anti-E elution. These serologic findings coincided with disease relapse rather than isolated immune-mediated haemolysis. This case illustrates that successful engraftment is possible across RhE-incompatibility and underscores the need to interpret late serologic abnormalities within the broader context of graft function and disease status.

ABSTRACT HLA‐DQA1*01:67:01 is characterised by a single nucleotide substitution in codon 100 in Exon 3.

ABSTRACT HLA‐DPA1*01:49 is characterised by a single nucleotide substitution in codon 119 in exon 3.

ABSTRACT HLA‐B*15:591 is characterised by a single nucleotide substitution in codon 219 in exon 4.

ABSTRACT HLA‐C*01:155 is characterised by a single nucleotide substitution in codon 225 in exon 4.

ABSTRACT The novel HLA‐A*26:268 allele is characterised by a single nucleotide substitution in exon 7.