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Lu W, Stephens L, Shmookler A, O'Brien K, Karp JK, Hermelin D, Bakhtary S, Almozain N, George M, Fung M. Rh immune globulin immunoprophylaxis after RhD-positive red cell exposure in RhD-negative patients via transfusion: A survey of practices. Transfusion 2024; 64:839-845. [PMID: 38534065 DOI: 10.1111/trf.17812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Current Association for the Advancement of Blood & Biotherapies (AABB) standards require transfusion services to have a policy on Rh immune globulin (RhIG) immunoprophylaxis for when RhD-negative patients are exposed to RhD-positive red cells. This is a survey of AABB-accredited transfusion services in the United States (US) regarding institutional policies and practices on RhIG immunoprophylaxis after RhD-negative patients receive RhD-positive (i.e., RhD-incompatible) packed red blood cell (pRBC) and platelet transfusions. RESULTS Approximately half of the respondents (50.4%, 116/230) have policies on RhIG administration after RhD-incompatible pRBC and platelet transfusions, while others had policies for only pRBC (13.5%, 31/230) or only platelet (17.8%, 41/230) transfusions, but not both. In contrast, 18.3% (42/230) report that their institution has no written policies on RhIG immunoprophylaxis after RhD-incompatible transfusions. Most institutions (70.2%, 99/141) do not have policies addressing safety parameters to mitigate the risk of hemolysis associated with the high dose of RhIG required to prevent RhD alloimmunization after RhD-incompatible pRBC transfusions. DISCUSSION With approximately half of US AABB-accredited institutions report having policies on RhIG immunoprophylaxis after both RhD-incompatible pRBC and platelet transfusions, some institutions may not be in compliance with AABB standards. Further, most with policies on RhIG immunoprophylaxis after RhD-incompatible pRBC transfusion do not have written safeguards to mitigate the risk of hemolysis associated with the high dose of RhIG required. CONCLUSION This survey underscores the diverse and inadequate institutional policies on RhIG immunoprophylaxis after RhD exposure in Rh-negative patients via transfusion. This observation identifies an opportunity to improve transfusion safety.
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Affiliation(s)
- Wen Lu
- Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura Stephens
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Aaron Shmookler
- Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Kerry O'Brien
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julie Katz Karp
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Daniela Hermelin
- ImpactLife, Davenport, Iowa, USA
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nour Almozain
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Melissa George
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
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Karp JK, Lofgreen A, Johnson K, George MR, Barak S, Bryant BH, Berg MP, Childs JM, Knollman-Ritschel BEC, Prieto VG, White KL, McCloskey CB. Continued Positive Job Search Experience for New Pathologists Seeking First Employment During the COVID-19 Pandemic (2020-2022). Arch Pathol Lab Med 2024:499601. [PMID: 38528091 DOI: 10.5858/arpa.2023-0408-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/27/2024]
Abstract
CONTEXT.— As pathologists retire and leave the field, it is critical to accurately capture employment trends for new-in-practice pathologists. There is always interest in the job market for newly graduated pathology trainees and prospective pathology trainees, but it is unclear how the COVID-19 pandemic may have affected the job search experience. OBJECTIVE.— To provide an update on trends gleaned from a survey of pathology graduates' job search experiences during the COVID-19 pandemic. DESIGN.— We analyzed data from an annual job search survey sent by the College of American Pathologists Graduate Medical Education Committee between 2020 and 2022 to College of American Pathologists junior members and fellows in practice 3 years or less actively looking for a nonfellowship position. Various indicators of the job search experience were compared year to year and with the data previously published 2017 to 2019 and 2012 to 2016. RESULTS.— Analysis revealed continued positive trends between the 2020 to 2022 data and the data from 2017 to 2019 and 2012 to 2016. This includes continued ease in finding positions, continued availability of jobs in the subspecialty of choice, continued satisfaction with the positions accepted, and, notably, higher starting salaries. CONCLUSIONS.— Despite the many challenges of the COVID-19 pandemic, job market trends for newly graduated pathology trainees continue to be favorable with respect to multiple indicators compared with 2 prior periods, 2017 to 2019 and 2012 to 2016.
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Affiliation(s)
- Julie Katz Karp
- From the Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Karp)
| | - Amanda Lofgreen
- CAP Learning College of American Pathologists, Northfield, Illinois(Lofgreen, Johnson)
| | - Kristen Johnson
- CAP Learning College of American Pathologists, Northfield, Illinois(Lofgreen, Johnson)
| | - Melissa R George
- The Department of Pathology and Laboratory Medicine, Penn State Hershey Medical Center, Hershey (George)
| | - Stephanie Barak
- The Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island (Barak)
| | - Bronwyn H Bryant
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Bryant)
| | - Mary P Berg
- The Department of Pathology, Anschutz Medical Campus, University of Colorado, Aurora (Berg)
| | - John M Childs
- The Department of Pathology,Geisinger Medical Laboratories, Danville, Pennsylvania (Childs)
| | - Barbara E C Knollman-Ritschel
- The Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Knollman-Ritschel)
| | - Victor G Prieto
- The Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Prieto)
| | - Kristie L White
- The Department of Laboratory Medicine, UCSF Medical Center, San Francisco, California (White)
| | - Cindy B McCloskey
- The Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (McCloskey)
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3
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George MR, Timmons CF, Johnson K, Barak S, Berg MP, Bryant B, Childs JM, Karp JK, Knollmann-Ritschel BE, Lofgreen A, McCarthy T, Prieto VG, Procop GW, Sandersfeld T, White KL, McCloskey CB. Leadership perspectives on osteopathic medical school applicants to pathology residency training. Acad Pathol 2024; 11:100107. [PMID: 38433776 PMCID: PMC10907156 DOI: 10.1016/j.acpath.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024] Open
Abstract
The number of graduating allopathic (MD) medical students matching into pathology has declined in recent years, while the number of osteopathic (DO) medical students has increased modestly, given the rapid expansion of osteopathic medical schools. Nonscholarly publications and materials on the internet often perpetuate negative perceptions of osteopathic physicians. Anecdotally, perspectives exist that some pathology residency programs are not DO-friendly; however, the reasons and how widespread an effect this might be are unclear. Our survey queried pathology chairs and residency program directors about their perceptions of osteopathic applicants and their knowledge of osteopathic medical school/training in general. This study utilized two similar, parallel surveys of pathology chairs and residency program directors with general questions structured around the perceptions and knowledge of both allopathic and osteopathic physicians, their medical training, and the consideration of osteopathic applicants to pathology residency. Pathology residency leaders acknowledge some negative perceptions of osteopathic physicians in the medical profession, the news, and social media. They also have some knowledge and perception gaps regarding osteopathic training and applicants, although experience with training osteopathic physicians as residents has been equivalent to that with allopathic physicians, and consideration appears to be fairly equal for osteopathic applicants. Even though negative perceptions of osteopathic physicians persist in news and social media, our surveys demonstrate that the leadership of pathology residency programs does not hold the same degree of bias and that DOs perform well in allopathic pathology residency programs without evidence of inferior outcomes.
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Affiliation(s)
- Melissa R. George
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Charles F. Timmons
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Johnson
- CAP Learning, College of American Pathologists, Northfield, IL, USA
| | - Stephanie Barak
- Department of Pathology, George Washington University Hospital, Washington, DC, USA
| | - Mary P. Berg
- University of Colorado, Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - Bronwyn Bryant
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | | | - Julie Katz Karp
- Department of Pathology & Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Amanda Lofgreen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Victor G. Prieto
- The Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Kristie L. White
- Department of Laboratory Medicine, UCSF Medical Center, San Francisco, CA, USA
| | - Cindy B. McCloskey
- The Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Gammon RR, Meena-Leist C, Al Mozain N, Cruz J, Hartwell E, Lu W, Karp JK, Noone S, Orabi M, Tayal A, Bocquet C, Tanhehco Y. Whole blood in civilian transfusion practice: A review of the literature. Transfusion 2023; 63:1758-1766. [PMID: 37465986 DOI: 10.1111/trf.17480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Richard R Gammon
- OneBlood, Scientific, Medical, Technical Direction, Florida, USA
| | - Claire Meena-Leist
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicinee, Louisville, Kentucky, USA
| | - Nour Al Mozain
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julie Katz Karp
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Susan Noone
- Administration, Vitalant, Ventura, California, USA
| | - Mustafa Orabi
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicinee, Louisville, Kentucky, USA
| | | | | | - Yvette Tanhehco
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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McCloskey CB, Brissette M, Childs JM, Lofgreen A, Johnson K, George MR, Holloman AM, Bryant B, Berg MP, Dixon LR, Karp JK, Knollmann-Ritschel BE, Prieto VG, Timmons CF, Hoffman RD. How influential are medical school curriculum and other medical school characteristics in students' selecting pathology as a specialty? Acad Pathol 2023; 10:100073. [PMID: 37124364 PMCID: PMC10139853 DOI: 10.1016/j.acpath.2023.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 05/02/2023] Open
Abstract
There has been a significant decline in the number of United States allopathic medical students matching to pathology residency programs. Data acquired from the American Association of Medical Colleges (AAMC) show sustained variation in the medical school production of students who go on to pathology residency. When divided into groups based on the medical school's historical volume of graduates entering pathology, the schools in groups labeled Group 1 and Group 2 produced significantly higher and lower proportions of pathology residents, respectively. This study aimed to identify what medical school curriculum elements and other medical school characteristics might explain the differences observed in the AAMC data. The Dean or another undergraduate medical education contact from the Group 1 and Group 2 schools was invited to participate in an interview. Pathology Program Directors and Pathology Department Chairs were also included in communications. Thirty interviews were completed with equal numbers from each group. Interview questions probed pathology experiences, existence, and structure of a pathology interest group, options for post-sophomore fellowships, recent curriculum changes, and the extent of mentoring programs. Surprisingly, the curriculum does not appear to be a predictor of a medical school's production of students who enter pathology residency. A significantly greater percentage of Group 1 schools are public institutions compared to Group 2 schools. Other factors that may increase the number of students who go into pathology include mentoring, active learning versus observation, and post-sophomore fellowships or other opportunities to work in the capacity of a new pathology resident.
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Affiliation(s)
- Cindy B. McCloskey
- The University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
- Corresponding author. The University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA.
| | - Mark Brissette
- University of Colorado, Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - John Michael Childs
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | - Melissa R. George
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Ashley M. Holloman
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Bronwyn Bryant
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Mary P. Berg
- University of Colorado, Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - Lisa Ross Dixon
- Graduate Medical Education, Physician Services Group, Gainesville, FL, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Victor Gerardo Prieto
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles F. Timmons
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert D. Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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6
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Holloman AM, Berg MP, Bryant B, Dixon LR, George MR, Karp JK, Knollmann-Ritschel BEC, Prieto VG, Timmons CF, Childs JM, Lofgreen A, Johnson K, McCloskey CB. Experiential exposure as the key to recruiting medical students into pathology. Acad Pathol 2023; 10:100074. [PMID: 37124363 PMCID: PMC10139861 DOI: 10.1016/j.acpath.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 05/02/2023] Open
Abstract
Medical student interest and pursuit of a career in pathology have been steadily declining since 2015. We conducted three separate surveys of medical students to better understand these trends. In our first survey, we focused on assessing U.S. allopathic medical students understanding and perceptions of pathology. We later surveyed U.S. osteopathic medical students as a companion to the allopathic medical student survey, in which many similarities were discovered with some key differences. In our final survey, we specifically looked at curriculum differences between the U.S. allopathic medical schools that graduate the most students who enter pathology training programs (Group 1) versus those schools that graduate the fewest future pathologists (Group 2) to determine if the curriculum had an impact on medical student matriculation into pathology. Together, through these surveys, we were able to identify several remarkable recurring trends, presenting areas of targetable action. Here, we summarize themes from the three studies as well as a review of pertinent literature to offer best practices for exposing and engaging medical students to pathology and possibly recruiting students to consider pathology as a career.
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Affiliation(s)
- Ashley M. Holloman
- Baylor College of Medicine, Department of Pathology & Immunology, Houston, TX, USA
- Corresponding author. Baylor College of Medicine, Department of Pathology & Immunology, Houston, TX, USA.
| | - Mary P. Berg
- University of Colorado, Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - Bronwyn Bryant
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Lisa Ross Dixon
- Graduate Medical Education, Physician Services Group, Gainesville, FL, USA
| | - Melissa R. George
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Victor Gerardo Prieto
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles F. Timmons
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - John Michael Childs
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | - Cindy B. McCloskey
- The University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
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Vivero A, Peedin AR, Gao Y, Karp JK. Successful treatment of pure red cell aplasia using therapeutic plasma exchange after ABO-incompatible hematopoietic stem cell transplant. J Clin Apher 2023. [PMID: 36703597 DOI: 10.1002/jca.22041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell transplants (HSCTs) are widely used in the treatment of hematologic malignancies and bone marrow failure syndromes. ABO compatibility is typically of secondary importance, and up to 50% of HSCT are performed in ABO-incompatible pairings. In the literature, pure red cell aplasia (PRCA) occurs in 1% to 50% of all major/bidirectional ABO-incompatible stem cell transplants, but treatment of PRCA remains heterogeneous. Here, we report two cases in which patients with transfusion-dependent PRCA following HSCT were successfully treated with therapeutic plasma exchange (TPE). Case 1: A 52-year-old type O-positive male with acute myeloid leukemia underwent HSCT using apheresis-derived HSCs from a fully human leukocyte antigen (HLA)-matched, related type A-positive male donor. He developed PRCA that was refractory to multiple therapies, so a series of 10 TPE was performed over 3 weeks. Case 2: A 21-year-old type A-positive male with aplastic anemia underwent HSCT using bone marrow-derived HSCs from a fully HLA-matched related type B-positive female donor. He developed PRCA that was refractory to multiple therapies, so a series of 5 TPE was performed over 2 weeks. Case 1: The patient has been transfusion independent since TPE #7, and type A red blood cells (RBCs) were seen on the ABO type after TPE #9. Case 2: The patient has been transfusion independent since after TPE #1, and type B RBCs were seen on the ABO type after TPE #5. TPE was successful in treating two patients with PRCA after ABO-incompatible HSCT transplants. Isoagglutinin titers decreased below the level of detection for both our patients. Ultimately both patients became transfusion independent and showed evidence of erythroid cell recovery.
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Affiliation(s)
- Angelica Vivero
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis R Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yuanzheng Gao
- Department of Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Binder AF, Loos K, Xu A, Peedin AR, Gergis U, Karp JK, Wilde L. Optimizing Utilization of Blood Products in the Hematologic Malignancy Clinic: Less Is More. JCO Oncol Pract 2022; 18:e1016-e1022. [PMID: 35192410 DOI: 10.1200/op.21.00575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE There are no universal guidelines for blood product transfusions in patients with hematologic malignancies (HMs). Excess utilization of platelet and RBC transfusion in patients with HM increases the cost of care and likelihood of adverse events. We aim to decrease the total number of transfused units and multiunit orders of platelets and RBCs in the HM clinic by 25% from March 2020 to December 2020. METHODS A multidisciplinary, interprofessional team was formed. Baseline rates of blood product utilization were determined using Qlik Analytic software. Strategies to improve utilization were developed, and three interventions were initiated. Data were collected on monthly intervals. Data for total number of platelet and RBC units ordered, total multiunit orders, average number of units ordered per encounter, and pretransfusion hemoglobin thresholds were collected from May 2019 to December 2020. RESULTS Through our Plan-Do-Study-Act cycles from March 2020 to December 2020, the total number of platelet transfusion orders per month decreased from 164 to 98, multiunit platelet orders decreased from 63 to 2, and the average number of platelet transfusions per encounter decreased from 1.62 to 1.03. The total number of RBC transfusion orders decreased from 172 to 141, multiunit RBC orders decreased from 25 to 16, and the average number of RBC transfusions per encounter decreased from 1.21 to 1.18. CONCLUSION Implementation of our multidisciplinary interventions led to more appropriate use of blood products in the outpatient setting. Ongoing efforts are underway to continue to improve utilization in the inpatient and outpatient setting.
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Affiliation(s)
- Adam F Binder
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplant, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Katy Loos
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA
| | | | - Alexis R Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA
| | - Usama Gergis
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplant, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA
| | - Lindsay Wilde
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplant, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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9
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Karp JK, Eichbaum Q, Lu W. Fellowship training programs in blood banking/transfusion medicine in the United States, 2016-2020. Transfusion 2021; 61:2801-2802. [PMID: 34519080 DOI: 10.1111/trf.16601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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10
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Babariya SP, Vivero A, Peedin A, Karp JK. Therapeutic plasma exchange in patients with severe obesity (BMI >40): A survey of practices in the United States. J Clin Apher 2021; 36:802-807. [PMID: 34355813 DOI: 10.1002/jca.21931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of obesity in the United States is estimated at 42.4% and expected to increase over the next decade. Therefore, understanding how to best perform certain medical procedures on severely obese (SO) patients is a necessity. This study presents results on the current methods of performing therapeutic plasma exchange (TPE) on SO patients. This paper aims to contribute to the existing literature by providing new insights into calculating plasma volume (PV) for TPE in SO patients. METHODS Blood Bank/Apheresis Directors at all institutions with pathology residency and/or blood banking/transfusion medicine fellowship programs were asked to complete a 5-question online survey about their institutional policies regarding TPE in SO patients. Survey data were analyzed to determine if institutions have policies in place to calculate PV in SO patients. RESULTS Out of the 144 institutions contacted, 45 (31%) completed the survey. Nine (20%) institutions had a policy to calculate PV differently for SO patients, 7 (16%) reported a specific body mass index (BMI) above which they alter PV calculation, and 7 (16%) reported a maximum volume exchanged in SO patients. CONCLUSION A minority of responding institutions had specific policies in place to calculate PV for TPE in SO patients. Practice patterns for calculating PV for TPE in SO patients varied, with some institutions adjusting PV calculations and others setting a maximum volume to be exchanged regardless of BMI. These findings highlight the need for establishing a clear method of calculating PV in SO patients.
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Affiliation(s)
| | - Angelica Vivero
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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11
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George MR, Johnson KA, Childs JM, Dixon LR, Gratzinger DA, Hoffman RD, Holloman A, Karp JK, Knollmann-Ritschel BEC, Lofgreen A, Prieto VG, Timmons CF, McCloskey CB. The Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on the 2019-2020 Job Search for Newly Trained Pathologists. Arch Pathol Lab Med 2021; 145:261-262. [PMID: 33179038 DOI: 10.5858/arpa.2020-0688-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Melissa R George
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | | | - John Michael Childs
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Lisa R Dixon
- Graduate Medical Education, Physician Services Group, Gainesville, Florida
| | | | - Robert D Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley Holloman
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Julie Katz Karp
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Amanda Lofgreen
- Education, College of American Pathologists, Northfield, Illinois
| | | | | | - Cindy B McCloskey
- Department of Pathology, University of Oklahoma College of Medicine, OU Medical Center, Oklahoma City
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12
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Guarente J, Palladino M, Babariya S, Hayes C, Blumhof B, Peedin AR, Karp JK. Iatrogenic arteriovenous fistula in patient with sickle cell disease undergoing red blood cell exchange. Transfusion 2021; 61:1361-1362. [PMID: 33733455 DOI: 10.1111/trf.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Juliana Guarente
- Department of Pathology, Anatomy & Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michele Palladino
- Department of Pathology, Anatomy & Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Shraddha Babariya
- Biomedical Services, American Red Cross, Penn-Jersey Region, Philadelphia, Pennsylvania, USA
| | - Chelsea Hayes
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brian Blumhof
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis R Peedin
- Department of Pathology, Anatomy & Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy & Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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13
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Abstract
BACKGROUND Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting. METHODS Patients who require TP are not infrequently told by their health-care providers to "just go donate blood," but TP should always be offered in the context of a prescribed course of therapy. Providers can prescribe a course of TP for a number of indications, including hereditary hemochromatosis, polycythemia vera, iron overload, and testosterone replacement therapy. RESULTS A course of prescribed TP specifies that patients can be phlebotomized more frequently than volunteer blood donors and reassures patients that TP is being performed per the orders of their provider. Prescribed TP also facilitates two-way communication between the referring provider and the transfusion medicine (TM) physician overseeing the TP. The College of American Pathologists TM checklist describes several requirements regarding the documentation and performance of TP, and electronic medical record systems can be used to demonstrate compliance with these requirements. CONCLUSIONS TM physicians should discuss the advantages of prescribing TP with providers who mutually care for patients requiring this intervention.
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Affiliation(s)
- Alexis R Peedin
- Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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14
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Karp JK, Koenig G, Barber G, Girardeau RP, Harach M, Gould JM. Regulatory requirements need to specifically address prehospital transfusion programs. Transfusion 2020; 59:2175-2176. [PMID: 31161670 DOI: 10.1111/trf.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - George Koenig
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Guy Barber
- JeffSTAT Critical Care Transport, Philadelphia, PA
| | | | - Mary Harach
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Joy M Gould
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA
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15
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Karp JK, Piacentino M, Gould JM, Peedin AR. Intravenous vitamin K as a cause of bright yellow plasma discoloration. Transfusion 2019; 59:2502-2503. [PMID: 31374147 DOI: 10.1111/trf.15342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/10/2019] [Accepted: 04/28/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michele Piacentino
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Joy M Gould
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexis R Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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16
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Prioli KM, Karp JK, Lyons NM, Chrebtow V, Herman JH, Pizzi LT. Economic Implications of Pathogen Reduced and Bacterially Tested Platelet Components: A US Hospital Budget Impact Model. Appl Health Econ Health Policy 2018; 16:889-899. [PMID: 30062464 PMCID: PMC6244623 DOI: 10.1007/s40258-018-0409-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND US FDA draft guidance includes pathogen reduction (PR) or secondary rapid bacterial testing (RT) in its recommendations for mitigating risk of platelet component (PC) bacterial contamination. An interactive budget impact model was created for hospitals to use when considering these technologies. METHODS A Microsoft Excel model was built and populated with base-case costs and probabilities identified through literature search and a survey of US hospital transfusion service directors. Annual costs of PC acquisition, testing, wastage, dispensing/transfusion, sepsis, shelf life, and reimbursement for a mid-sized hospital that purchases all of its PCs were compared for four scenarios: 100% conventional PCs (C-PC), 100% RT-PC, 100% PR-PC, and 50% RT-PC/50% PR-PC. RESULTS Annual total costs were US$3.64, US$3.67, and US$3.96 million when all platelets were C-PC, RT-PC, or PR-PC, respectively, or US$3.81 million in the 50% RT-PC/50% PR-PC scenario. The annual net cost of PR-PC, obtained by subtracting annual reimbursements from annual total costs, is 6.18% above that of RT-PC. Maximum usable shelf lives for C-PC, RT-PC, and PR-PC are 3.0, 5.0, and 3.6 days, respectively; hospitals obtain PR-PC components earliest at 1.37 days. CONCLUSION The model predicts minimal cost increase for PR-PC versus RT-PC, including cost offsets such as elimination of bacterial detection and irradiation, and reimbursement. Additional safety provided by PR, including risk mitigation of transfusion-transmission of a broad spectrum of viruses, parasites, and emerging pathogens, may justify this increase. Effective PC shelf life may increase with RT, but platelets can be available sooner with PR due to elimination of bacterial detection, depending on blood center logistics.
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Affiliation(s)
- Katherine M. Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ 08854 USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107 USA
| | - Nina M. Lyons
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107 USA
| | - Vera Chrebtow
- Global Marketing and Communications, Cerus Corporation, 2550 Stanwell Drive, Concord, CA 94520 USA
| | - Jay H. Herman
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107 USA
| | - Laura T. Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ 08854 USA
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17
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Abstract
Babesiosis is most commonly caused by Babesia microti and is transmitted via the bite of an infected Ixodes spp tick. However, Babesia is also transmitted via blood transfusion. In the United States, the first case of transfusion-transmitted babesiosis was recognized in 1979, and in recent years, the incidence has rapidly increased. Because most of the infected blood donors do not experience any symptoms, they pose a significant risk to the blood supply. Donor deferral for a history of babesiosis is currently performed but is ineffective. In March 2018, the FDA licensed a DNA PCR and antibody assay that were used in tandem in pivotal trials for screening blood donors for B microti; with other assays still being evaluated under investigational new drug protocols. Blood donation screening is essential to reducing the risk of transfusion-transmitted babesiosis, which is why blood centers collecting in geographic regions of highest risk have been testing since approximately 2010. Investigational NAT assays of higher sensitivity are pending FDA review. Further, in July 2018, the FDA issued a draft guidance for reducing the risk of transfusion-transmitted babesiosis. Release of the final guidance may be postponed until sensitivities and specificities of all current and potential strategies have been properly evaluated.
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Affiliation(s)
- Tatiana Villatoro
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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18
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Cushing MM, Kelley J, Klapper E, Friedman DF, Goel R, Heddle NM, Hopkins CK, Karp JK, Pagano MB, Perumbeti A, Ramsey G, Roback JD, Schwartz J, Shaz BH, Spinella PC, Cohn CS, Cohn CS, Cushing MM, Kelley J, Klapper E. Critical developments of 2017: a review of the literature from selected topics in transfusion. A committee report from the AABB Clinical Transfusion Medicine Committee. Transfusion 2018. [PMID: 29520794 DOI: 10.1111/trf.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of Transfusion Medicine. For the first time, an abridged version of this work is being made available in TRANSFUSION, with the full-length report available as an Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in 2016 and early 2017 are included, as well as earlier papers cited for background. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are covered: duration of red blood cell storage and clinical outcomes, blood donor characteristics and patient outcomes, reversal of bleeding in hemophilia and for patients on direct oral anticoagulants, transfusion approach to hemorrhagic shock, pathogen inactivation, pediatric transfusion medicine, therapeutic apheresis, and extracorporeal support. CONCLUSION This synopsis may be a useful educational tool.
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Affiliation(s)
| | - James Kelley
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Nancy M Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | | | - James Kelley
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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19
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Affiliation(s)
| | - Julie Katz Karp
- From the Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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20
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Prioli KM, Pizzi LT, Karp JK, Galanis T, Herman JH. Cost of Purchased Versus Produced Plasma from Donor Recruitment Through Transfusion. Appl Health Econ Health Policy 2016; 14:609-617. [PMID: 27392967 DOI: 10.1007/s40258-016-0255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Plasma is used to treat acquired coagulopathy or thrombotic thrombocytopenic purpura, or to reverse warfarin effect. Scant data are available, however, about its costs. OBJECTIVE To estimate total costs of plasma from production through administration, from the perspective of a US hospital blood donor center (BDC). STUDY DESIGN AND METHODS Six sequential decision analytic models were constructed and informed by primary and secondary data on time, tasks, personnel, and supplies for donation, processing, and administration. Expected values of the models were summed to yield the BDC's total cost of producing, preparing, and transfusing plasma. Costs ($US 2015) are reported for a typical patient using three units of plasma. Models assume plasma was obtained from whole blood donation and transfused in an inpatient setting. Univariate sensitivity analyses were performed to test the impact of changing inputs for personnel costs and adverse event (AE) rates and costs. RESULTS BDC production cost of plasma was $91.24/patient ($30.41/unit), a $30.16/patient savings versus purchased plasma. Administration and monitoring costs totaled $194.64/patient. Sensitivity analyses indicated that modifying BDC personnel costs during donation and processing has little impact on total plasma costs. However, the probability and cost of transfusion-associated circulatory overload (TACO) have a significant impact on costs. CONCLUSION Plasma produced by our BDC may be less costly than purchased plasma. Though plasma processes have multiple tasks involving staff time, these are not the largest cost driver. Major plasma-related AEs are uncommon, but are the biggest driver of total plasma costs.
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Affiliation(s)
- Katherine M Prioli
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA, 19107, USA.
| | - Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA, 19107, USA
| | - Julie Katz Karp
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Taki Galanis
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Jay H Herman
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
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21
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Olischar M, Stavroudis T, Karp JK, Kaufmann WE, Theda C. Medical and ethical challenges in the case of a prenatally undiagnosed massive congenital brain tumor. J Perinatol 2015; 35:773-5. [PMID: 26310316 DOI: 10.1038/jp.2015.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/25/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022]
Abstract
Fetal and neonatal brain tumors are rare. Prenatal ultrasound aids early tumor detection. Nonetheless, we encountered a preterm neonate born at 32 weeks gestation with a massive supratentorial glioma, which was undetected on ultrasound at 19-6/7 weeks gestation. The patient presented at birth with unanticipated massive macrocephaly. Resuscitation and stabilization were difficult, but the medical team felt that futility of care was not established and opted to transfer the baby to an academic center for further imaging and specialist consultations. Diagnosis of an extensive, inoperable tumor was confirmed and support withdrawn. Postmortem histologic examination and immunohistochemical stains identified the majority of tumor cells as glial in origin. This case report illustrates well how a severe and potentially fatal anomaly, which remained undetected prenatally, presented the medical team and family with multiple medical, ethical and emotional challenges at birth; decisions regarding futility of care in the neonatal transport setting are difficult.
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Affiliation(s)
- M Olischar
- Department of Neonatology, Children's Hospital, Medical University Vienna, Vienna, Austria
| | - T Stavroudis
- Department of Neonatology, Children's Hospital of Los Angeles and Keck School of Medicine, Los Angeles, CA, USA
| | - J K Karp
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - W E Kaufmann
- Boston Children's Hospital and Harvard Medical School Boston, MA, USA
| | - C Theda
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia.,Royal Women's Hospital, Neonatal Services, Melbourne, VIC, Australia
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22
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Affiliation(s)
- John C Lavelle
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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23
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Abstract
Lymphangioma of the palatine tonsil is a rare, benign lesion that presents as a tonsillar outgrowth and causes symptoms related to irritation and airway obstruction. Histologically, the mass has abundant dilated lymphatic channels amid a fibrous stroma with lymphoid and adipose elements. There are several theories regarding the pathogenesis of these lesions, and the appropriate diagnostic classification is controversial. Because a lymphangioma may resemble a true neoplasm of the palatine tonsil clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy. Lymphangioma of the palatine tonsil is treated with surgical excision and has no recurrence once completely resected.
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Affiliation(s)
- Stacey Mardekian
- From the Department of Pathology, Thomas Jefferson University Hospital, Methodist Division, Philadelphia, Pennsylvania
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24
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Abstract
BACKGROUND Television is a beloved American pastime and a frequent American export. As such, American television shapes how the global public views the world. OBJECTIVES This study examines how the portrayal of blood transfusion and blood donation on American television may influence how domestic and international audiences perceive the field of transfusion medicine. MATERIALS AND METHODS American television programming of the last quarter-century was reviewed to identify programmes featuring topics related to blood banking/transfusion medicine. The included television episodes were identified through various sources. RESULTS Twenty-seven television episodes airing between 1991 and 2013 were identified as featuring blood bank/transfusion medicine topics. Although some accurate representations of the field were identified, most television programmes portrayed blood banking/transfusion medicine inaccurately. CONCLUSION The way in which blood banking/transfusion medicine is portrayed on American television may assist clinicians in understanding their patient's concerns about blood safety and guide blood collection organisations in improving donor recruitment.
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Affiliation(s)
- J K Karp
- Department of Pathology, Thomas Jefferson University Hospital, Methodist Division, Philadelphia, Pennsylvania, USA
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25
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Karp JK, Davis A, Read PJ, Mashayekh A, Bombonati A, Palazzo F. Pulse granuloma involving Meckel's diverticulum: a case report and literature review. Pathologica 2013; 105:59-61. [PMID: 23946983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Pulse granuloma is a rare, benign entity that most likely represents a reaction to vegetable material and is characterized by hyaline rings and foreign-body giant cells. We report a case of a pulse granuloma involving Meckel's diverticulum. The patient presented with abdominal pain and radiological findings consistent with Meckel's diverticulum. Microscopic examination of the resected tissue confirmed diagnosis of Meckel's diverticulum with small bowel mucosa. Peridiverticular foreign-body giant cells, hyaline rings and circular structures containing calcified basophilic granules were also identified, consistent with pulse granuloma. Pulse granulomas have been reported in a variety of locations, most commonly in the oral cavity. To the best of our knowledge, this is the first reported example of pulse granuloma in Meckel's diverticulum. Familiarity with pulse granuloma allows for the timely and accurate diagnosis of this entity, particularly in sites not previously described in the literature.
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Affiliation(s)
- J K Karp
- Thomas Jefferson University Hospital, Methodist Division, Philadelphia, PA 19148, USA.
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