The production of safe red cell transfusion units to alleviate anaemia is a core activity of Sanquin. Transfusions are often lifesaving but they also carry risks for transfusion-related complications such as alloimmunisation, iron accumulation, infection, or transfusion related lung injury, the extent of which may depend on the transfusion product, the nature of the anaemia, and the condition of the patient. Research within the medical priority (MP) anaemia aims to understand and predict donor health, cognition, and behaviour, to improve the safety of the transfusion product and the transfusion protocol, to optimize the transfusion efficiency, to innovate transfusion products, and to find alternative treatments for anaemia.
Overall, the MP Anaemia aims to support the transfusion of high-quality blood products derived from dedicated healthy donors to patients with the least possible risk for transfusion related complications, while alternative strategies to alleviate anaemia are also developed.
Coordinators: Robin van Bruggen PhD, Cynthia So-Osman MD PhD, Marieke von Lindern PhD
Research in the erythrocyte transfusion line starts with the donor. Our aim is to study and improve donor availability, wellbeing, and health, which is essential to supply high quality transfusion products. Thereto we optimize the efficiency of blood collection paired to maximum donor convenience and wellbeing. We investigate whether donor characteristics affect the quality of the transfusion product and examine how to best predict and manage individual donors’ iron status. Novel biomarkers may relate to product quality and optimize data acquisition for tailored donor management and disease prediction. Social and cognitive science studies are employed to examine how specific donor populations can be recruited, managed and retained, such as ethnic minority groups with different blood group antigen frequencies or young donors.
The transfusion product
Safety of transfusion products requires anticipation and prevention of novel bloodborne diseases, and the prevention of allo-immunisation, particularly in recurrently transfused patients. The risk of allo-immunisation increases in a multi-ethnic society and complicates matching donor and patient to prevent transfusion reactions. We are implementing donor genotyping to change transfusion policy from preventing transfusion reactions after alloimmunization has occurred, to the prevention of alloimmunization itself. Concurrently, we establish a protocol to produce cultured red blood cells (cRBC) from an immortal, infinite source that is almost free of blood group antigens and can be widely employed. Such cRBC can also be employed as carriers for therapeutic molecules. Babies may require tailored product specifications or alternative sources, such as cord blood.
Transfusion of erythrocyte concentrates instantly relieves anemia. However, transfusions are not without risks, and this risk/benefit balance differs between patient groups. Therefore, we aim to develop tailor-made transfusion protocols for specific patient groups, with a focus on elderly patients and babies. We perform national and international clinical studies and state of the art epidemiological analyses of existing databases to optimize transfusion practices. This has already resulted in a remarkably low use of transfusion units per Dutch citizen. In addition, we aim to optimise the efficacy of transfused erythrocytes, by limiting the damage that erythrocytes sustain during their storage, which leads to unwanted degradation of these cells in the spleen.
Transfusion in chronic anemia relieves the symptoms, but does not cure the disease. Therefore, we also aim to find transfusion-independent solutions, for example by reducing degradation of patient’s own erythrocyte or stimulating the production of red blood cells within the patient. Congenital chronic anemia may be due to genetic defects, we also investigate the effects of potential therapeutic drugs, or genetic modification in hematopoietic stem cells using footprint free CRISPR/Cas9. This methodology is being established such that protocols can be transferred to the Laboratory for Cell Therapy (LCT).