World Blood Donor Day 2025 serves as a reminder of the invaluable contribution of blood donation to global health. The ongoing demand for blood and blood products requires continuous research and innovation to ensure a safe, diverse, and effective blood supply for all patients. At Trinity College Dublin (TCD) and its affiliated clinical partners, researchers are at the forefront of understanding complex blood-related conditions, evaluating interventions, and generating evidence to support enhanced blood health policies and public practices.

Key Areas of Research at Trinity College Dublin & Impact on Blood Health:

 1. Enhancing Blood Donor Recruitment and Diversity:

◦ A significant challenge in many countries, including Ireland, is the under-representation of minority ethnic groups among blood donors. This is crucial as the demand for antigen-negative red blood cell (RBC) transfusions for patients with conditions like Sickle Cell Disease (SCD) continues to grow.

◦ TCD researchers conducted a study involving the National Sickle Cell Disease and Thalassemia service at St James’s Hospital to explore the barriers and motivators to blood donation among potential donors of diverse ethnic backgrounds in Ireland. The findings revealed that lack of information on blood donation was the most common barrier across all ethnic groups, providing valuable and actionable insights to inform future recruitment campaigns aimed at enhancing the inclusion of African donors.  It also highlighted the urgent need to adjust current malaria risk-mitigation strategies in Ireland to enable more individuals of African ethnicity to donate blood, aligning with policies in other European countries and the UK.

2. Optimising Blood Product Management and Transfusion Practices:

◦ Rising healthcare costs and the need to reduce unnecessary medical procedures are major issues for healthcare systems, with a significant proportion of these costs being attributed to blood tests. A recent study at Tallaght University Hospital shown that an excessive amount of unnecessary pre-operative blood tests have been taken using current blood ordering schedules. For instances, they found that by retrospectively applying a more pragmatic pre-operative blood policy for orthopaedic trauma patients, it could lead to potential annual cost savings of €25,960. Beyond monetary savings, reducing unnecessary blood draws also subjected patients to fewer invasive tests, minimising risks such as pain and infection, and therefore, preventing delays in patient care.

◦ Furthermore, research efforts have focused on improving the early detection of adverse events following orthopaedic trauma. Among these complications, anaemia requiring blood transfusion was identified as the most prevalent. A pilot study highlighted that implementing a well-designed adverse event assessment form can significantly improve the recording of such events, which is critical for accurate accounting of complications and optimal allocation of hospital resources.

◦ During the COVID-19 pandemic, TCD collaborated on a national survey to capture the response of Laboratory Medicine services across the Republic of Ireland. This study highlighted some of the key challenges faced by blood transfusion departments in managing and maintaining stock while ensuring minimum wastage. The pandemic’s lockdowns impacted blood donation rates, creating additional pressure on blood supplies. To address these issues, several departments implemented rerouting blood products between hospitals to prevent waste and adapting to the impact of lockdowns on blood donations. Some laboratories also adapted their delivery system to accommodate clinical users relocated offsite. Despite these obstacles, services showed extreme resilience and adaptability in maintaining critical transfusion support systems in place during the pandemic.

3. Advancing Treatment for Blood-Related Conditions and Patient Outcomes:

◦ Addressing Transfusion Dependency:

  • Gastrointestinal Angiodysplasias are vascular malformations that frequently cause red blood cell transfusion-dependent anaemia. Trinity College Dublin's Department of Clinical Medicine collaborated on a systematic review and individual patient data meta-analysis, which found that a treatment called somatostatin analogue therapy is safe and effective in most patients with this condition. The treatment significantly reduced the number of blood transfusions, correlating with an increase in haemoglobin concentrations. The study further identified that the treatment was more effective for angiodysplasias located in the small bowel and colon, and among the treatments used, octreotide appeared more effective than lanreotide. Based on these findings, a recommended dose is octreotide 10 mg long-lasting release injections every 28 days for patients whose bleeding cannot be adequately controlled with endoscopic therapy.
  • Sickle Cell Disease (SCD) is a serious inherited blood disorder affecting many children, with treatments like hydroxycarbamide (HC) and chronic blood transfusion (BT) being used in paediatric care. However, the biological mechanisms underpinning their differential efficacy for stroke prevention are not fully understood. A study comparing these treatments found that BT therapy was associated with significantly reduced activation of endothelial cells (blood vessel lining) and coagulation pathways. These children exhibited more normal levels and multimer distribution of von Willebrand factor (VWF), a blood protein critical for clotting regulation, and generated less thrombin, a central enzyme in clot formation. In contrast, children treated with HC showed persistent endothelial and coagulation activation. Notably, despite treatment, a subgroup of children had ongoing dysfunction in the VWF–ADAMTS13 axis, an enzyme system that normally regulates VWF activity. These findings underscore the need for further research to assess whether persistent blood factor abnormalities can serve as biomarkers to identify patients at continued risk and guide alternative therapeutic strategies.

◦ Managing Haematological Issues in Neonatal Encephalopathy (NE):

  • A recent review of haematological issues in neonates with NE treated with therapeutic hypothermia (TH) highlighted the complexity of these abnormalities and proposed a management framework tailored to this vulnerable population. NE is often associated with multi-organ dysfunction, including haematological complications such as anaemia, thrombocytopenia, systemic inflammation, hypofibrinogenemia, and coagulopathy. Although TH did not appear to significantly affect the incidence of anaemia requiring transfusion, maintaining haemoglobin levels above recommended thresholds is important for optimal oxygen delivery. The review also emphasized the role of nucleated red blood cells (nRBCs) and erythropoietin as biomarkers reflecting the degree and timing of hypoxic insult. Furthermore, NE is characterised by systemic inflammation, which contributes to ongoing brain injury but also plays roles in defence and repair. Coagulopathy, including prolonged clotting times, is frequent and correlates with disease severity and bleeding risk. Interestingly, TH can exacerbate thrombocytopenia and alter coagulation parameters, requiring close monitoring and personalised treatment when indicated. Despite these advances, the need for evidence-based guidelines for blood product use remains limited. Ongoing research will aim to refine management strategies to improve neurodevelopmental outcomes in neonates with NE.

◦ Cancer-Related Blood Health:

  • The immune response to major gastrointestinal cancer surgery and its implications for adjuvant immunotherapy have been extensively reviewed. Surgical intervention can induce immunosuppression, with factors such as haemostasis and blood transfusions potentially modulating anti-tumour immunity and influencing cancer recurrence. Although some evidence suggest that perioperative transfusions may adversely affect prognosis, separating these effects from those related to preoperative anaemia remains challenging. This further highlights the need for well-designed clinical trials to clarify these relationships.
  • A case report highlighted a very rare type of lung cancer called Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma associated with coeliac disease, a rare form of lung malignancy that accounts for less than 1% of lung cancers. The patient mainly had weight loss but no breathing problems, showing that this type of cancer often progresses slowly and with few symptoms. Scans showed unusual changes in the airways and small lung nodules, while a bronchoscopy found many small growths inside the airways (i.e., polypoid endobronchial lesions), which are rare but helpful for diagnosis. Histological and molecular testing confirmed it was a low-grade B cell MALT lymphoma. The report emphasised that doctors should consider this cancer in patients with coeliac disease who have unexplained symptoms, highlighting bronchoscopy as critical tool to obtain enough tissue samples for an accurate diagnosis and treatment procedure. Early detection and intervention are vital with over 80% of patients surviving at least five years after diagnosis.
  • A systematic review of haemostatic interventions for cleft palate repair revealed that the most commonly used way to reduce bleeding during surgery is by injecting vasoconstrictors such as adrenaline at established concentrations. Other interventions included fibrin tissue sealants and systemic tranexamic acid, though the evidence for their consistent efficacy in reducing postoperative bleeding remains limited. The review also highlighted the need for further research to understanding the cost-benefit of these haemostatic treatments. Finally, there is a lack of data from low- and middle-income countries, so including these settings in future studies is pivotal to ensure the generalisation of the findings and therefore improving global cleft care.

4. Innovations in Immunological Understanding and Therapies Related to Blood:

◦ Trained Immunity: Recent research has shown that the ChAdOx1 nCoV-19 (AstraZeneca) vaccine induces "trained immunity" in humans in vivo. This process involves the metabolic and epigenetic reprogramming of myeloid cells (e.g., monocytes), leading to heightened responses to subsequent insults. The study observed increased expression of antigen presentation molecules on monocytes for up to three months post-vaccination. Furthermore, monocytes exhibited metabolic reprogramming characterised by an increase of glycolysis, and therefore resulting in increased production of key proinflammatory cytokines. This work improved the understanding of innate immune responses to vaccine efficacy and non-specific vaccine effects, which can aid in the design of future vaccines and innovative vaccine strategies.

◦ Immunometabolism in Tuberculosis (TB) Treatment: Tuberculosis remains a global health challenge, with patients often undergoing long and complex treatment regimens. Beyond their primary bactericidal effects, researchers are exploring how TB antimicrobials directly affect cells of the immune system, particularly their immunometabolic profiles. A study demonstrated that certain TB antimicrobials, specifically clofazimine, can significantly alter oxidative phosphorylation and glycolysis and modify mitochondrial function in primary human macrophages. These findings provided further insight into the potential repurposing of current TB antimicrobials as host-directed therapies, which could enhance immune function and facilitate bacterial clearance, ultimately informing future TB treatment strategies.

Trinity College Dublin, through its various research centres and collaborations, continues to generate high-quality scientific evidence to enhance the experience of health for all, integrating diverse aspects of human biology and societal impact. This comprehensive approach to research across a multitude of disciplines underpins a commitment to advancing blood health and patient care in Ireland and globally.