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Download Practical Transfusion Medicine Fifth Edition PDF free

Download Practical Transfusion Medicine Fifth Edition PDF free

Haemostasis and Transfusion No area of transfusion medicine has seen such explosive recent innovation as the field of haemostasis. A wide range of anticoagulants is now available and the balance between anticoagulation, haemostasis and thrombophilia has become more complex. Transfusion therapy continues a long evolution from plasma replacement to the targeted use of a growing number of plasma‐derived or recombinant products that influence haemostasis. Tools and treatments used in the past and then put aside, such as viscoelastic testing and antifibrinolytics, have made a strong resurgence and are finding new positions in the evaluation and treatment of bleeding. Additional haemostasis agents, which we will need to clinically master, are on the way. Chapters 25, 28 and 31 address these topics and will give readers new information on the important role of transfusion in the care of patients with disorders of haemostasis and thrombosis. Cellular Therapies, Transplantation, Apheresis Cellular therapy is a major growth area in transfusion medicine. The ability to mobilise haematopoietic progenitor cells, then harvest them safely in bulk numbers, process, freeze and successfully reinfuse them as a stem cell tissue transplant has completely revolutionised the field of bone marrow transplantation (Figure 1.13). Other therapeutic areas, such as treatment with harvested and manipulated dendritic cells, mesenchymal cells, T‐cells and antigen‐presenting cells, have progressed far more slowly. Nevertheless, with advances in gene engineering, the potential to treat illnesses with autologous reengineered cellular therapies is very bright. Chapters 38–44 present a detailed account of the current state of the art in cellular therapies as well as a glimpse of where this field is heading.

Download Practical Transfusion Medicine Fifth Edition PDF free

The Future This fifth edition of this textbook concludes, as have previous editions, with reflections on the future of the field. While speculation on the future is never easy, our own view is that the ability to perform targeted gene editing is one of the most promising current research endeavours. CRISPR (clustered regularly interspaced short palindromic repeats) technology allows for the targeted excision of DNA at any known sequence (Figure 1.14). Short tandem repeat DNA sequences (eventually renamed as CRISPR) were originally discovered as part of normal bacterial defence against viruses. Several genes in bacteria, called CRISPR‐ associated genes (cas), were found to code for nucleases specific for these repeat sequences, thereby disrupting viral genomes within bacteria. One of these cas genes, Cas9, was found to work efficiently within eukaryotic cells as a nuclease that could be guided by RNA to a specific DNA target. This RNA guide can be synthesised to match the cellular DNA area of choice. By delivering the Cas9 nuclease and the guiding RNA into a cell, the genome of that cell can be disrupted or edited in a controlled manner. One example of the application of CRISPR technology has focused on haemoglobin F production [8]. The BCL11A gene is the natural suppressor of haemoglobin F. BCL11A is turned on after birth, resulting in active downregulation of haemoglobin F transcription. CRISPR technology has been used to disrupt the promoter region of the BCL11A gene, thus removing its suppression with a resulting increase in haemoglobin F production. This approach has an obvious potential application in sickle cell disease where even a small increase in haemoglobin F expression can ameliorate clinical symptoms. One can imagine the ex vivo manipulation of autologous CD34‐positive cells using CRISPR technology followed by their transplantation into the sickle cell patient so as to produce a posttransplant phenotype with higher haemoglobin F expression (Figure 1.15)

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