1
|
Tapper EB, Warner MA, Shah RP, Emamaullee J, Dunbar NM, Sholzberg M, Poston JN, Soto RJ, Sarwar A, Pillai A, Reyner K, Mehta S, Ghabril M, Morgan TR, Caldwell S. Management of coagulopathy among patients with cirrhosis undergoing upper endoscopy and paracentesis: Persistent gaps and areas of consensus in a multispecialty Delphi. Hepatology 2024:01515467-990000000-00831. [PMID: 38557474 DOI: 10.1097/hep.0000000000000856] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Patients with cirrhosis have abnormal coagulation indices such as a high international normalized ratio and low platelet count, but these do not correlate well with periprocedural bleeding risk. We sought to develop a consensus among the multiple stakeholders in cirrhosis care to inform process measures that can help improve the quality of the periprocedural management of coagulopathy in cirrhosis. We identified candidate process measures for periprocedural coagulopathy management in multiple contexts relating to the performance of paracentesis and upper endoscopy. An 11-member panel with content expertise was convened. It included nominees from professional societies for interventional radiology, transfusion medicine, and anesthesia as well as representatives from hematology, emergency medicine, transplant surgery, and community practice. Each measure was evaluated for agreement using a modified Delphi approach (3 rounds of rating) to define the final set of measures. Out of 286 possible measures, 33 measures made the final set. International normalized ratio testing was not required for diagnostic or therapeutic paracentesis as well as diagnostic endoscopy. Plasma transfusion should be avoided for all paracenteses and diagnostic endoscopy. No consensus was achieved for these items in therapeutic intent or emergent endoscopy. The risks of prophylactic platelet transfusions exceed their benefits for outpatient diagnostic paracentesis and diagnostic endosopies. For the other procedures examined, the risks outweigh benefits when platelet count is >20,000/mm 3 . It is uncertain whether risks outweigh benefits below 20,000/mm 3 in other contexts. No consensus was achieved on whether it was permissible to continue or stop systemic anticoagulation. Continuous aspirin was permissible for each procedure. Clopidogrel was permissible for diagnostic and therapeutic paracentesis and diagnostic endoscopy. We found many areas of consensus that may serve as a foundation for a common set of practice metrics for the periprocedural management of coagulopathy in cirrhosis.
Collapse
Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew A Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh P Shah
- Section of Radiology-Veterans Affairs Palo Alto Health Care System, Department of Radiology, Stanford University, Stanford, California, USA
| | - Juliet Emamaullee
- Department of Surgery, Keck Medicine of USC/Children's Hospital-Los Angeles, Los Angeles, California, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine and Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michelle Sholzberg
- Departments of Medicine and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline N Poston
- Department of Medicine, Division of Hematology/Oncology, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology, Division of Clinical Pathology, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Robin J Soto
- Division of Gastroenterology and Hepatology, UC San Diego Health, San Diego, California, USA
| | - Ammar Sarwar
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| | - Karina Reyner
- Department of Emergency Medicine, Baylor Scott and White, Dallas, Texas, USA
| | - Shivang Mehta
- Division of Transplant Hepatology, Baylor Scott and White, Fort Worth, Texas, USA
| | - Marwan Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy R Morgan
- VA Long Beach Healthcare System-Section of Gastroenterology, Long Beach, California, USA
| | - Stephen Caldwell
- Division of Gastroenterology, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
2
|
Connelly-Smith L, Alquist CR, Aqui NA, Hofmann JC, Klingel R, Onwuemene OA, Patriquin CJ, Pham HP, Sanchez AP, Schneiderman J, Witt V, Zantek ND, Dunbar NM. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue. J Clin Apher 2023; 38:77-278. [PMID: 37017433 DOI: 10.1002/jca.22043] [Citation(s) in RCA: 70] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/06/2023]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. In the Ninth Edition, the JCA Special Issue Writing Committee has incorporated systematic review and evidence-based approaches in the grading of evidence and categorization of apheresis indications to make recommendations on the use of apheresis in a wide variety of diseases and conditions. This edition has largely maintained the general layout and concept of a fact sheet introduced in the Fourth Edition (2007). Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease or medical condition. The Ninth Edition of the JCA Special Issue comprises 91 fact sheets and 166 graded and categorized indications. This includes seven new fact sheets, nine new indications on existing fact sheets, and eight changes in the category for existing indications. The Ninth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
Collapse
Affiliation(s)
- Laura Connelly-Smith
- Department of Medicine, University of Washington Medical Center & Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Nicole A Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan C Hofmann
- Department of Laboratory Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany
- First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher J Patriquin
- Division of Medical Oncology and Hematology, University of Toronto, Toronto, Ontario, Canada
| | - Huy P Pham
- Seattle Apheresis Collection Center, National Marrow Donor Program, Seattle, Washington, USA
| | - Amber P Sanchez
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
3
|
Yazer MH, Dunbar NM, Hess JR, Tuott EE, Bahmanyar M, Campbell J, Fontaine M, Ko A, Mi J, Murphy MF, Poisson J, Raval JS, Shih AW, Sperry JL, Staves J, Wong M, Yan MTS, Ziman A, Seheult JN. Transfusion of
ABO
‐group identical red blood cells following uncrossmatched transfusion does not lead to higher mortality in civilian trauma patients. Transfusion 2023; 63 Suppl 3:S46-S53. [PMID: 36971017 DOI: 10.1111/trf.17322] [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] [Received: 12/03/2022] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Questions persist about the safety of switching non-group O recipients of group O uncrossmatched red blood cells (RBC) or low titer group O whole blood (LTOWB) to ABO-identical RBCs during their resuscitation. METHODS The database of an earlier nine-center study of transfusing incompatible plasma to trauma patients was reanalyzed. The patients were divided into three groups based on 24-h RBC transfusion: (1) group O patients who received group O RBC/LTOWB units (control group, n = 1203), (2) non-group O recipients who received only group O units (n = 646), (3) non-group O recipients who received at least one unit of group O and non-group O units (n = 562). Fixed marginal effect of receipt of non-O RBC units on 6- and 24-h and 30-day mortality was calculated. RESULTS The non-O patients who received only group O RBCs received fewer RBC/LTOWB units and had slightly but significantly lower injury severity score compared to control group; non-group O patients who received both group O and non-O units received significantly more RBC/LTOWB units and had a slightly but significantly higher injury severity score compared to control group. In the multivariate analysis, the non-O patients who received only group O RBCs had significantly higher mortality at 6-h compared to the controls; the non-group O recipients of O and non-O RBCs did not demonstrate higher mortality. At 24-h and 30-days, there were no differences in survival between the groups. CONCLUSION Providing non-group O RBCs to non-group O trauma patients who also received group O RBC units is not associated with higher mortality.
Collapse
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vitalant, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine and Pathology, Seattle, Washington, USA
| | - Mohammad Bahmanyar
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Jessica Campbell
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Magali Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ara Ko
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jian Mi
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael F Murphy
- NHS Blood & Transplant and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jessica Poisson
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michelle Wong
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vitalant, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
4
|
Ondrasik RM, Khan J, Szczepiorkowski ZM, Levy JJ, Dunbar NM. Passive order auditing associated with reductions in red blood cell utilization: National blood shortage experience. Transfusion 2022; 62:1551-1558. [PMID: 35815525 DOI: 10.1111/trf.17008] [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: 03/18/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Decreased blood collection during the Coronavirus Disease 2019 (COVID-19) pandemic resulted in long-term red blood cell (RBC) shortages in the United States. In an effort to conserve RBCs, the existing passive alert system for auditing inpatient transfusions was modified to activate at a lower hemoglobin threshold (6.5 g/dL instead of 7.0 g/dL for stable, nonbleeding inpatients) during a 9-month shortage at an academic medical center. Hemoglobin levels prior to RBC transfusions were compared for inpatients receiving RBC transfusions to determine whether RBC utilization changed during the intervention. STUDY DESIGN AND METHODS This retrospective study compared the number of single-unit RBC transfusions and hemoglobin levels prior to RBC transfusion among inpatients during the 9 months of the intervention (Period 2, 06/01/2021-2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021). RESULTS Overall full unit RBC transfusions to inpatients decreased by 15% from 5182 to 4421. Of all transfusions, 50.3% and 49.8% were single-unit RBC transfusions in Period 1 and Period 2, respectively. The incidence rate difference and incidence rate ratio of single RBC units transfused per 1000 patient days were significantly decreased (p = 0.0007). The average pre-transfusion hemoglobin level significantly decreased from 7.18 g/dL to 7.05 g/dL (p = 0.0002), largely due to significant decreases in hemoglobin transfusion triggers for adult inpatient ward transfusions. DISCUSSION Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization at centers during long-term RBC shortages.
Collapse
Affiliation(s)
- Regina M Ondrasik
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Division of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Joshua J Levy
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| |
Collapse
|
5
|
Lu W, Yazer M, Li N, Ziman A, Wendel S, Tang H, Tsang H, Titlestad K, Thibodeaux SR, Shih AW, Poisson JL, Pham T, Pandey S, Pagano MB, Shan H, Murphy M, Murphy C, Savioli ML, Kutner JM, Hess AS, Fontaine MJ, Fachini R, Dunbar NM, Kaufman RM. Hospital red blood cell and platelet supply and utilization from March to December of the first year of the COVID-19 pandemic: The BEST Collaborative Study. Transfusion 2022; 62:1559-1570. [PMID: 35808950 PMCID: PMC9349645 DOI: 10.1111/trf.17023] [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: 03/22/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Background At the start of the coronavirus disease 2019 (COVID‐19) pandemic, widespread blood shortages were anticipated. We sought to determine how hospital blood supply and blood utilization were affected by the first wave of COVID‐19. Study Design and Methods Weekly red blood cell (RBC) and platelet (PLT) inventory, transfusion, and outdate data were collected from 13 institutions in the United States, Brazil, Canada, and Denmark from March 1st to December 31st of 2020 and 2019. Data from the sites were aligned based on each site's local first peak of COVID‐19 cases, and data from 2020 (pandemic year) were compared with data from the corresponding period in 2019 (pre‐pandemic baseline). Results RBC inventories were 3% lower in 2020 than in 2019 (680 vs. 704, p < .001) and 5% fewer RBCs were transfused per week compared to 2019 (477 vs. 501, p < .001). However, during the first COVID‐19 peak, RBC and PLT inventories were higher than normal, as reflected by deviation from par, days on hand, and percent outdated. At this time, 16% fewer inpatient beds were occupied, and 43% fewer surgeries were performed compared to 2019 (p < .001). In contrast to 2019 when there was no correlation, there was, in 2020, significant negative correlations between RBC and PLT days on hand and both percentage occupancy of inpatient beds and percentage of surgeries performed. Conclusion During the COVID‐19 pandemic in 2020, RBC and PLT inventories remained adequate. During the first wave of cases, significant decreases in patient care activities were associated with excess RBC and PLT supplies and increased product outdating.
Collapse
Affiliation(s)
- Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Na Li
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, USA
| | | | - Hongying Tang
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Hamilton Tsang
- Department of Laboratory Medicine and Pathology, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University, South Danish Transfusion Services, Odense, Denmark
| | - Suzanne R Thibodeaux
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tho Pham
- Stanford Blood Center, Palo Alto, CA, USA
| | | | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
| | - Hua Shan
- Transfusion Medicine Service, Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mike Murphy
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Colin Murphy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mariana Lorenzi Savioli
- Hemotherapy and Cell therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - José Mauro Kutner
- Hemotherapy and Cell therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Magali J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine and Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | |
Collapse
|
6
|
Seheult JN, Callum J, Delaney M, Drake R, Dunbar NM, Harm SK, Hess JR, Jackson BP, Javanbakht A, Moore SA, Murphy MF, Raval JS, Staves J, Tuott EE, Wendel S, Ziman A, Yazer MH. Rate of D-alloimmunization in trauma does not depend on the number of RhD-positive units transfused: The BEST collaborative study. Transfusion 2022; 62 Suppl 1:S185-S192. [PMID: 35748692 DOI: 10.1111/trf.16952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence indicates the life-saving benefits of early blood product transfusion in severe trauma resuscitation. Many of these products will be RhD-positive, so understanding the D-alloimmunization rate is important. METHODS This was a multicenter, retrospective study whereby injured RhD-negative patients between 18-50 years of age who received at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB) during their resuscitation between 1 January, 2010 through 31 December, 2019 were identified. If an antibody detection test was performed ≥14 days after the index RhD-positive transfusion then basic demographic information was collected, including whether the patient became D-alloimmunized. The overall D-alloimmunization rate, and the rate stratified by the number of units transfused, were calculated. RESULTS Data were collected from nine institutions. Five institutions reported fewer than 10 eligible patients each and were excluded. From the remaining four institutions, all from the USA, there were 235 eligible patients; 77 (random effects estimate: 32.7%; 95% CI: 19.1-50.1%) became D-alloimmunized. Three of the institutions reported D-alloimmunization rates ≥38.6%, while the remaining institution's rate was 12.2%. In both random and fixed-effects models, the rate of D-alloimmunization was not significantly different between those who received one RhD-positive unit and those who received multiple RhD-positive units. CONCLUSION In this large, multicenter study of injured patients, the overall rate of D-alloimmunization fell within the range previously reported. The rate of D-alloimmunization did not increase as the number of transfused RhD-positive units increased. These data can help to inform RhD type selection decisions.
Collapse
Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
| | - Rosanna Drake
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah K Harm
- Department of pathology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - John R Hess
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bryon P Jackson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ayda Javanbakht
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah A Moore
- Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Michael F Murphy
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Julie Staves
- National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Erin E Tuott
- Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
7
|
Meshkin D, Yazer MH, Dunbar NM, Spinella PC, Leeper CM. Low titer Group O whole blood utilization in pediatric trauma resuscitation: A National Survey. Transfusion 2022; 62 Suppl 1:S63-S71. [PMID: 35748128 DOI: 10.1111/trf.16979] [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: 12/06/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renewed interest in low titer group O whole blood (LTOWB) transfusion has led to increased utilization in adult trauma centers; little is known regarding LTOWB use in pediatric centers. STUDY DESIGN AND METHODS A survey of LTOWB utilization at American pediatric level 1 trauma centers. RESULTS Responses were received from 43/72 (60%) centers. These institutions were primarily urban (84%) and pediatric-specific (58%). There were 16% (7/43) centers using LTOWB, 7% (3/43) imminently initiating an LTOWB program, 47% (20/43) with interest but no current plan to develop a LTOWB program, and 30% (13/43) with no immediate interest in an LTOWB program. For the hospitals actively or imminently using LTOWB, 70% (3/10) have a minimum recipient weight criterion, 60% (6/10) have a minimum age criterion, and 70% (7/10) restrict the maximum volume transfused. Before the patient's RhD type becomes known, 30% (3/10) use RhD negative LTOWB for males and females, 40% (4/10) use RhD positive LTOWB for males and RhD negative LTOWB for females, 20% (2/10) use RhD positive LTOWB for males and RhD negative RBCs for females, and 10% (1/10) use RhD positive LTOWB for both males and females. Maximum LTOWB storage duration was 14-35 days and units nearing expiration were used for non-trauma patients (40%), processed to RBC (40%), and/or discarded (40%). The most common barriers to implementation were concerns about inventory management (37%), wastage (35%), infrequent use (33%), cost (21%) and unclear efficacy (14%). CONCLUSION LTOWB utilization is increasing in pediatric level 1 trauma centers in the United States.
Collapse
Affiliation(s)
- Dana Meshkin
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Philip C Spinella
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christine M Leeper
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
8
|
Ruby KN, Khan J, Martin IW, Dunbar NM. Application of Standardized Residual Component Culture Criteria for Suspected Septic Transfusion Reactions Would Increase the Component Culturing Rate at a Single Academic Medical Center. Am J Clin Pathol 2022; 158:216-220. [PMID: 35311936 DOI: 10.1093/ajcp/aqac032] [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: 12/27/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The 2019 SCARED study developed the Biomedical Excellence for Safer Transfusion (BEST) criteria in an effort to standardize the decision to culture residual units in the context of suspected septic transfusion reactions (STRs). The goal of this study was to apply the BEST criteria to determine the effect on the transfusion reaction decision to culture. METHODS This retrospective, single-center, cross-sectional study assessed adult transfusion reactions identified in calendar years 2013 to 2020. Reactions following transfusion of RBCs, platelets, and plasma were included, and the decisions to culture following strict application of BEST criteria were compared with decisions to culture in actual practice. RESULTS In total, 1,068 transfusion reactions were reported and 200 (19%) suspected STRs were cultured, all with negative results; 303 (28%) reactions would have been cultured per strict application of the BEST criteria. Concordance between actual culture decision and BEST criteria recommendation was 62% for cultured components and 79% for components that were not cultured. CONCLUSIONS BEST criteria provide objective recommendations of when to culture residual units implicated in suspected STRs, but strict application of these criteria may result in increased culture rates. Clinical correlation to aid in the decision to culture is recommended.
Collapse
Affiliation(s)
- Kristen N Ruby
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Isabella W Martin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| |
Collapse
|
9
|
Yazer MH, Spinella PC, Bank EA, Cannon JW, Dunbar NM, Holcomb JB, Jackson BP, Jenkins D, Levy M, Pepe PE, Sperry JL, Stubbs JR, Winckler CJ. THOR-AABB Working Party Recommendations for a Prehospital Blood Product Transfusion Program. PREHOSP EMERG CARE 2021; 26:863-875. [PMID: 34669564 DOI: 10.1080/10903127.2021.1995089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The evidence for the lifesaving benefits of prehospital transfusions is increasing. As such, emergency medical services (EMS) might increasingly become interested in providing this important intervention. While a few EMS and air medical agencies have been providing exclusively red blood cell (RBC) transfusions to their patients for many years, transfusing plasma in addition to the RBCs, or simply using low titer group O whole blood (LTOWB) in place of two separate components, will be a novel experience for many services. The recommendations presented in this document were created by the Trauma, Hemostasis and Oxygenation Research (THOR)-AABB (formerly known as the American Association of Blood Banks) Working Party, and they are intended to provide a framework for implementing prehospital blood transfusion programs in line with the best available evidence. These recommendations cover all aspects of such a program including storing, transporting, and transfusing blood products in the prehospital phase of hemorrhagic resuscitation.
Collapse
|
10
|
Dunbar NM, Kaufman RM. Factors associated with wrong blood in tube errors: An international case series - The BEST collaborative study. Transfusion 2021; 62:44-50. [PMID: 34726274 DOI: 10.1111/trf.16716] [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: 07/28/2021] [Revised: 09/03/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A wrong blood in tube (WBIT) error signifies a blood sample that does not match the patient identified on the sample label. WBIT errors can result in ABO mistransfusions. STUDY DESIGN AND METHODS In this international, multicenter, descriptive study, healthcare facilities provided detailed information on WBIT errors occurring from 1/1/2019 to 12/31/2020. Factors contributing to WBIT errors were classified as protocol violations, knowledge gaps, and slips/lapses. RESULTS 331 WBIT errors were compiled from 36 centers in 11 countries. WBIT errors were most frequently detected through pretransfusion sample testing (191, 58%), with 38 (20%) detected by a second ("check") sample. WBIT errors were divided almost evenly between intended patient drawn/wrong label applied (166, 50%) and wrong patient drawn/intended label applied (158, 48%). Information on contributing factors was available for 260 WBIT errors; most involved a combination of protocol violations and slips/lapses (139, 53%). The most frequent contributing factor was another patient's sample labels or tubes being available during phlebotomy (61%). Protocol violations were more likely to result in wrong patient being drawn (p = .0007). In 43 WBIT errors, electronic positive patient identification (ePPID) was not used when available or was used incorrectly. CONCLUSIONS Protocol violations and slips/lapses frequently contribute to WBIT errors. Sample collection processes should be designed to minimize error opportunities; staff should be educated on why protocol compliance is critical for patient safety. Using ePPID does not eliminate all WBIT errors. Institutions using ePPID may elect to require check sample verification as an added safety measure.
Collapse
Affiliation(s)
- Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
11
|
Yazer MH, Dunbar NM, Delaney M. Survey of the RhD selection and issuing practices for uncrossmatched blood products at pediatric trauma hospitals in the United States: The BEST collaborative study. Transfusion 2021; 61:3328-3334. [PMID: 34595764 DOI: 10.1111/trf.16692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND As evidence demonstrating the importance of early transfusions in trauma resuscitation accumulates, when RhD-negative products might not be available, it is important to understand the nature of the RhD-type of products provided to bleeding pediatric patients of potentially unknown RhD-type. METHODS A survey link was electronically sent to the transfusion service medical director and/or laboratory manager at American pediatric Level I and Level II hospitals inquiring about their practices for selecting RhD-type of uncrossmatched red blood cells (RBC) or low titer group O whole blood (LTOWB) for boys and girls. RESULTS There were 55/117 (47.0%) analyzable responses; 43/55 (78.2%) from Level I and 12/55 (21.8%) from Level II hospitals. For in hospital transfusions, 51/55 (92.7%) of centers use only RhD-negative blood products to resuscitate girls ≤18 years old while 30/55 (54.5%) of centers do the same for boys ≤18 years old. Most centers 41/55(74.5%) store RBCs and/or LTOWB in in-hospital remote refrigerators; 27 store only RhD-negative RBCs and 2 store only RhD-negative LTOWB units in these refrigerators. A total of 24/55 (43.6%) centers have RBCs and/or LTOWB available on road ambulances or helicopters for prehospital transfusion; 12 transport only RhD-negative RBCs and two transport only RhD-negative LTOWB. Most centers, 35/55 (63.6%), address the prophylaxis of an RhD-negative female recipient of RhD-positive transfusion on a case-by-case basis. CONCLUSION While there is some variability, most of the responding pediatric trauma centers routinely utilized RhD-negative RBCs for emergency transfusion for patients ≤18 years old of unknown RhD-type.
Collapse
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
| | | |
Collapse
|
12
|
Ruby KN, Harm SK, Dunbar NM. Risk of ABO-Incompatible Plasma From Non-ABO-Identical Components. Transfus Med Rev 2021; 35:118-122. [PMID: 34544619 DOI: 10.1016/j.tmrv.2021.06.006] [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: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 01/16/2023]
Abstract
The last several decades have seen significant changes in the approach to resuscitation of bleeding patients. These include the adoption of ABO-incompatible plasma transfusion in the form of group A plasma and/or low titer group O whole blood for trauma patients of unknown ABO group. Studies to date have examined the impact of these practices on patient outcomes and clinical markers of hemolysis in recipients of ABO-incompatible plasma compared to those for whom the plasma is ABO-compatible. Risk for increased mortality and/or overt hemolysis appear to be low among recipients of ABO-incompatible plasma; however, nearly all of studies are retrospective and most have focused only on adult trauma patients so results may not be generalizable to other bleeding patients. Work continues to evaluate the role of various titer thresholds in decreasing hemolytic risk and opportunities remain to improve our understanding of anti-A and anti-B antibody interactions with complement/endothelium and identify strategies to minimize risk.
Collapse
Affiliation(s)
- Kristen N Ruby
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sarah K Harm
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA; University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| |
Collapse
|
13
|
Allen ES, Cohn CS, Bakhtary S, Dunbar NM, Gniadek T, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Murphy C, Prochaska MT, Raval JS, Shan H, Storch EK, Pagano MB. Current advances in transfusion medicine 2020: A critical review of selected topics by the AABB Clinical Transfusion Medicine Committee. Transfusion 2021; 61:2756-2767. [PMID: 34423446 DOI: 10.1111/trf.16625] [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: 04/02/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM), which has been made available as a manuscript published in Transfusion since 2018. METHODS CTMC committee members reviewed original manuscripts including TM-related topics published electronically (ahead) or in print from December 2019 to December 2020. The selection of topics and manuscripts was discussed at committee meetings and chosen based on relevance and originality. Next, committee members worked in pairs to create a synopsis of each topic, which was then reviewed by two additional committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is extensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: COVID-19 effects on the blood supply and regulatory landscape, COVID convalescent plasma, adult transfusion practices, whole blood, molecular immunohematology, pediatric TM, cellular therapy, and apheresis medicine. CONCLUSIONS This synopsis provides easy access to relevant topics and may be useful as an educational tool.
Collapse
Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Thomas Gniadek
- Department of Pathology, NorthShore University Health System, Chicago, Illinois, USA
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
| | - Parvez M Lokhandwala
- American Red Cross, Biomedical Services, Baltimore, Maryland, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Colin Murphy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Micah T Prochaska
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Emily K Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
14
|
Dunbar NM, Delaney M, Murphy MF, Pagano MB, Saifee NH, Seheult J, Yazer M, Kaufman RM. Emergency departments are higher-risk locations for wrong blood in tube errors. Transfusion 2021; 61:2601-2610. [PMID: 34268775 DOI: 10.1111/trf.16588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/29/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Wrong blood in tube (WBIT) errors can lead to ABO mistransfusions. It is unknown if WBIT errors are more likely in specific healthcare locations or if specific collection practices influence the commission of WBIT errors. STUDY DESIGN AND METHODS Data on pretransfusion samples from calendar year 2019 were collected retrospectively by 39 transfusion services in nine countries. We compared the proportion of WBIT errors made in emergency departments (EDs), inpatient wards, and outpatient clinics. RESULTS In total, 143 WBIT errors were detected among 1,394,862 samples for an unadjusted aggregate WBIT proportion of 1.03/10,000 samples. Using a pooled random effects model, the WBIT proportion was estimated to be significantly higher in EDs (1.23/10,000 samples, 95% CI 0.62-2.43) than inpatient wards (0.71/10,000, 95% CI 0.44-1.14; p < .001) or outpatient clinics (0.24/10,000, 95% CI 0.08-0.65; p < .001) and significantly higher in inpatient wards than outpatient clinics (p = .043). The use of electronic positive patient identification (ePPID) systems was associated with a significantly lower WBIT proportion in the ED (odds ratio, OR: 0.32, 95% CI: 0.11-0.96, p = .041), but not in inpatient wards (OR: 0.45, 95% CI: 0.20-1.01, p = .054) or outpatient clinics (OR: 1.95, 95% CI: 0.39-9.74, p = .415). DISCUSSION Normalized for the number of samples drawn per location, the WBIT proportion in EDs was 1.7 times higher than inpatient wards and 5.1 times higher than outpatient clinics. EDs represent higher-risk clinical locations for WBIT errors, and electronic positive patient identification (ePPID) may provide a greater impact on safety in EDs relative to other clinical areas.
Collapse
Affiliation(s)
- Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meghan Delaney
- Division Pathology & Laboratory Medicine, Children's National Hospital and Department of Pathology and Pediatrics, The George Washington University, Washington, District of Columbia, USA
| | - Michael F Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Nabiha Huq Saifee
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Bloodworks Northwest, Seattle, Washington, USA
| | - Jansen Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
15
|
Martin IW, Cohn CS, Delaney M, Fontaine MJ, Shih AW, Dunbar NM. Limitations of current practices in detection of bacterially contaminated blood products associated with suspected septic transfusion reactions. Transfusion 2021; 61:2414-2420. [PMID: 34181247 DOI: 10.1111/trf.16545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/22/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the setting of suspected septic transfusion reactions, bacterial culture of both the transfused patient and the residual blood component is recommended. Primary bacterial contamination can occur at the time of component collection. Clinically insignificant "secondary contamination" can occur during post-transfusion component discard, retrieval for culture, or manipulation of the bag at the time of culture sampling. STUDY DESIGN AND METHODS This retrospective, multi-center study analyzes positive residual component culture results and companion patient blood cultures from 15 hospitals, 1 blood center, and all cultured transfusion reactions within the province of Quebec, Canada, over a 5-year period. Imputability was assigned as "definite" (concordant growth), "possible" (discordant growth or lack of growth in patient culture), or "unable to assess" (patient not cultured). RESULTS There were 373 positive component cultures from 360 unique transfusion reactions, with 276 (76.7%) companion patient blood cultures performed, of which 10 (2.8%) yielded the pathogen detected in the positive component. Of these 10 definite pathogens, 7 (2 Staphylococcus aureus, 3 other staphylococci, and 1 Streptococcus pyogenes and 1 Bacillus sp.) were associated with platelet and 3 (Aeromonas veronii, Staphylococcus epidermidis, and Enterococcus faecalis) with RBC transfusions. RBC and plasma components comprised 70% of positive component cultures. DISCUSSION The process of performing residual component culture is vulnerable to secondary contamination. The significance of microorganisms recovered from component culture cannot be interpreted in isolation. In the context of low prevalence of primary contamination of blood components, the positive predictive value of a positive component culture result is very low.
Collapse
Affiliation(s)
- Isabella W Martin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Meghan Delaney
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Laboratory Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Magali J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | |
Collapse
|
16
|
Khan J, Dunbar NM. Time to stop worrying about ABO incompatible cryoprecipitate transfusions in adults. Transfusion 2021; 61:1-4. [PMID: 33616962 DOI: 10.1111/trf.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
17
|
Yazer MH, Spinella PC, Anto V, Dunbar NM. Survey of group A plasma and low-titer group O whole blood use in trauma resuscitation at adult civilian level 1 trauma centers in the US. Transfusion 2021; 61:1757-1763. [PMID: 33797100 DOI: 10.1111/trf.16394] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recently revisited products like low-titer group O whole blood (LTOWB) and novel applications of group A as a universal donor of plasma are being used for trauma resuscitation. A survey of American Level 1 trauma centers was performed to elucidate the extent to which these products are currently employed. METHODS A survey was written that probed into the current use of blood products in trauma resuscitation with specific emphasis on LTOWB and group A plasma. A list of adult civilian Level 1 trauma centers in the continental USA was obtained from two public surgery and trauma focused websites. An email was then sent to each center's transfusion service medical director or laboratory manager providing them with a link to the online survey. RESULTS Responses were received from 103/187 (55%) adult civilian Level 1 trauma centers. For the resuscitation of trauma patients, group A plasma was used at 94/103 (91%) centers, while LTOWB was used at 43/103 (42%) centers. There were 39/103 (38%) centers that used both products. At 62/94 (66%) of the centers that used group A plasma, there was no limit on the number of units that could be administered, while an unlimited number of LTOWB units could be used at 5/43 (12%) of the centers that used LTOWB. RhD-positive LTOWB could be transfused to RhD-negative or RhD-type unknown females of childbearing potential at 22/43 (51%) of centers. CONCLUSION The use of group A plasma and LTOWB in trauma is increasing at American Level 1 trauma centers.
Collapse
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Vincent Anto
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
18
|
Goldman M, Townsend M, Magnussen K, Lozano M, Nissen-Meyer LSH, Lee CK, Leung JNS, Takanashi M, McKay J, Kvist M, Robitaille N, Deschênes J, Di Angelantonio E, McMahon A, Roberts D, Maghsudlu M, Castrén J, Tiberghien P, Woimant G, Morel P, Kamel H, Bravo M, Shinar E, Gendelman V, Raz H, Wendel S, Fachini R, Quee F, van den Hurk K, Wiersum J, Grima KM, Speedy J, Bruun MT, Dunbar NM. International Forum on Mitigation Strategies to Prevent Faint and Pre-faint Adverse Reactions in Whole Blood Donors: Responses. Vox Sang 2021; 116:e1-e24. [PMID: 33754360 DOI: 10.1111/vox.13038] [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: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | - Cheuk Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong SAR
| | | | - Minoko Takanashi
- Japanese Red Cross Society, Blood Service Headquarters, Tokyo, Japan
| | | | | | | | | | | | - Amy McMahon
- National Health Service Blood and Transplant (NHSBT), Cambridge, UK
| | - David Roberts
- National Health Service Blood and Transplant (NHSBT), Cambridge, UK
| | | | | | | | | | - Pascal Morel
- Etablissement Français du Sang, La Plaine St-Denis, France
| | | | | | | | | | | | | | | | | | | | | | | | - Joanna Speedy
- Australian Red Cross Lifeblood, Melbourne, Vic., Australia
| | | | | |
Collapse
|
19
|
Cohn CS, Estcourt L, Grossman BJ, Pagano MB, Allen ES, Bloch EM, Casadevall A, Devine DV, Dunbar NM, Foroutan F, Gniadek TJ, Goel R, Gorlin J, Joyner MJ, Metcalf RA, Raval JS, Rice TW, Shaz BH, Vassallo RR, Winters JL, Beaudoin G, Tobian AAR. COVID-19 convalescent plasma: Interim recommendations from the AABB. Transfusion 2021; 61:1313-1323. [PMID: 33586160 PMCID: PMC8014606 DOI: 10.1111/trf.16328] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lise Estcourt
- NHS Blood and Transplant, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Brenda J Grossman
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Evan M Bloch
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Dana V Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Nancy M Dunbar
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Farid Foroutan
- University Health Network, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Ruchika Goel
- Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Jed Gorlin
- Division of New York Blood Center Enterprises, Innovative Blood Resources, Saint Paul, Minnesota, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Todd W Rice
- Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care Medicine, Nashville, Tennessee, USA
| | - Beth H Shaz
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | | | - Jeffrey L Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aaron A R Tobian
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
20
|
Mindiola Romero AE, Shepherd KS, Cusack WF, Dunbar NM. Transfusion medicine illustrated: Anomalous blood separation identified specimen contamination. Transfusion 2021; 61:1012-1013. [PMID: 33565615 DOI: 10.1111/trf.16287] [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: 10/25/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andres E Mindiola Romero
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kimberly Shane Shepherd
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - William F Cusack
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| |
Collapse
|
21
|
Abstract
Platelets express ABO antigens and are collected in plasma, which contains ABO antibodies as would be consistent with the donor ABO group. Platelet ABO antigens that are incompatible with recipient ABO antibodies may have accelerated clearance from circulation and result in lower count increments. ABO antibodies that are passively transferred from donor plasma may result in hemolysis of recipient red blood cells. Although platelets do not express Rh antigens, they contain small numbers of intact red blood cells or fragments, which can lead to alloimmunization in the recipient. Alloimmunization to the RhD antigen may occur when platelets obtained from RhD-positive donors are transfused to RhD-negative recipients. All of these compatibility considerations must be balanced against the available supply, which may be limited due to the 5- to 7-day shelf life of platelets. This articles describes considerations for platelet ABO and RhD selection for platelet transfusions, including the impact of major ABO incompatibility on count increments, the risks of hemolysis associated with minor ABO incompatibility, and the risk of RhD alloimmunization when RhD-negative patients receive platelets obtained from RhD-positive donors.
Collapse
|
22
|
Azizgolshani NM, Porter ED, Fay KA, Dunbar NM, Hasson RM, Millington TM, Finley DJ, Phillips JD. Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy. J Surg Res 2020; 255:411-419. [PMID: 32619855 PMCID: PMC10750229 DOI: 10.1016/j.jss.2020.05.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 05/24/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures. MATERIALS AND METHODS A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules. RESULTS Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P < 0.001), and longer operative time (291 versus 217 min, P = 0.003) than nontransfused patients. Based on current volumes, eliminating TS in these patients would save at least an estimated $60,100 per year. CONCLUSIONS Emergent transfusion in ALR and esophagectomy is rare. Routine preoperative TS is most likely unnecessary for these cases. These results will be used in a quality improvement initiative to change practice at our institution.
Collapse
Affiliation(s)
- Nasim M Azizgolshani
- Geisel School of Medicine, Hanover, New Hampshire; Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eleah D Porter
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Rian M Hasson
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Timothy M Millington
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David J Finley
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph D Phillips
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| |
Collapse
|
23
|
Dunbar NM. The ASFA therapeutic apheresis guidelines – 8th edition – overview with focus on hematology/oncology indications. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
24
|
Seheult JN, Dunbar NM, Hess JR, Tuott EE, Bahmanyar M, Campbell J, Fontaine M, Khan J, Ko A, Mi J, Murphy MF, Nykoluk T, Poisson J, Raval JS, Shih A, Sperry JL, Staves J, Wong M, Yan MTS, Ziman A, Yazer MH. Transfusion of blood components containing ABO-incompatible plasma does not lead to higher mortality in civilian trauma patients. Transfusion 2020; 60:2517-2528. [PMID: 32901965 DOI: 10.1111/trf.16008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/10/2020] [Accepted: 07/09/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study investigated the effect on mortality of transfusing ABO-incompatible plasma from all sources during trauma resuscitation. METHODS Demographic, transfusion, and survival data were retrospectively extracted on civilian trauma patients. Patients were divided by receipt of any quantity of ABO-incompatible plasma from any blood product (incompatible group) or receipt of solely ABO-compatible plasma (compatible group). The primary outcome was 30-day mortality, while other outcomes included 6- and 24-hour mortality. Mixed-effects logistic regression was used to model the effect of various predictor variables, including receipt of incompatible plasma, on mortality outcomes. RESULTS Nine hospitals contributed data on a total of 2618 trauma patients. There were 1282 patients in the incompatible group and 1336 patients in the compatible group. In both the unadjusted and adjusted models, the 6-hour, 24-hour, and 30-day mortality rates were not significantly different between these groups. The patients in the incompatible group were then divided into high volume (>342 mL) and low volume (≤342 mL) incompatible plasma recipients. In the adjusted model, the high-volume group had higher 24-hour mortality when the Trauma Injury Severity Score survival prediction was >50%. Mortality at 6 hours and 30 days was not higher in this model. The low-volume group did not have increased mortality at any of the time points in this adjusted model. CONCLUSION The transfusion of incompatible plasma in civilian trauma resuscitation does not lead to higher 30-day mortality. The finding of higher mortality in a select group of recipients in the secondary analysis warrants further study.
Collapse
Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - John R Hess
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mohammad Bahmanyar
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Jessica Campbell
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Magali Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ara Ko
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jian Mi
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael F Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Tara Nykoluk
- Department of Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Jessica Poisson
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew Shih
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Staves
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michelle Wong
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
25
|
Balogun RA, Sanchez AP, Klingel R, Witt V, Aqui N, Meyer E, Padmanabhan A, Pham HP, Schneiderman J, Schwartz J, Wu Y, Zantek ND, Connelly-Smith L, Dunbar NM. Update to the ASFA guidelines on the use of therapeutic apheresis in ANCA-associated vasculitis. J Clin Apher 2020; 35:493-499. [PMID: 32770558 DOI: 10.1002/jca.21820] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 06/02/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/23/2022]
Abstract
Since 1986, the American Society for Apheresis (ASFA) has published practice guidelines on the use of therapeutic apheresis in the Journal of Clinical Apheresis (JCA) Special Issue. Since 2007, updated guidelines have been published every 3 years to reflect current evidence based apheresis practice with the most recent edition (8th) published in 2019. With each edition, the guidelines are reviewed and updated based on any newly published literature since the last review. The PEXIVAS study, an international, randomized controlled trial comparing therapeutic plasma exchange (TPE) vs no TPE and standard vs reduced dose steroid regimen on the primary composite outcome of end stage renal disease or death in patients with ANCA-associated vasculitis (AAV), was published in February 2020. This study represents the largest study on the role of therapeutic apheresis in AAV published to date and prompted the JCA Special Issue Writing Committee to reassess the current AAV fact sheet for updates based on this newly available evidence. This interim fact sheet summarizes current ASFA recommendations for the evidence-based use of therapeutic apheresis in AAV and supersedes the recommendations published in the 2019 guidelines.
Collapse
Affiliation(s)
- Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Amber P Sanchez
- Department of Medicine, Division of Nephrology, University of California, and Therapeutic Apheresis Program, UCSD Medical Center, San Diego, California, USA
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany.,First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Anand Padmanabhan
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Yanyun Wu
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, Florida, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
26
|
Lozano M, Dunbar NM, Devine DV. 50 years of Vox Sanguinis International Forums. Vox Sang 2020; 115:483-484. [DOI: 10.1111/vox.12985] [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: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Miquel Lozano
- University Clinic Hospital University of Barcelona Barcelona Spain
| | | | | |
Collapse
|
27
|
Cohn CS, Pagano MB, Allen ES, Frey KP, Gniadek T, Lokhandwala PM, Murphy CH, Raval JS, Dunbar NM. How do I manage long-term blood component shortages in a hospital transfusion service? Transfusion 2020; 60:1897-1904. [PMID: 32643156 DOI: 10.1111/trf.15857] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Monica B Pagano
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Kathrine P Frey
- Department of Pathology, Fairview Southdale Hospital, Minneapolis, Minnesota, USA
| | - Thomas Gniadek
- Department of Pathology and Laboratory Medicine, North Shore University Health System, Evanston, Illinois, USA
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colin H Murphy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
28
|
Pagano MB, Dunbar NM, Stanworth SJ. How do we design and report a high-quality survey? Transfusion 2020; 60:2178-2184. [PMID: 32643205 DOI: 10.1111/trf.15861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
Every day, new surveys are planned, distributed, or reported by health care professionals. Surveys are an inexpensive and convenient research tool used with increasing frequency as an approach to gather and collate information on attitudes and behaviors for a specific topic. However, surveys can squander the valuable time of respondents who may derive little, if any, benefit from participation. Similar to any other research methodology, a careful design is needed to avoid introducing bias and to obtain meaningful information. A recent study evaluating the quality of surveys addressing clinical topics in transfusion medicine (TM) identified common deficiencies in the quality and design, including the failure to report validity and reliability, to address nonresponse error, to report funding and ethics/consent considerations, and to discuss the generalizability of results. Instructions to authors for reporting survey results are lacking in most journals. Inadequate survey design, analysis, and reporting can prevent accurate data collection and compromise the interpretation of the results, which is of critical relevance considering the high citation rates for some of these surveys. Further, survey results might be used to inform policies when no higher level of evidence is available. In this article, the authors seek to provide practical recommendations for designing high-quality surveys based on personal experience and published literature and to address frequently missing key elements in survey-based studies related to clinical TM.
Collapse
Affiliation(s)
- Monica B Pagano
- Division of Transfusion Medicine, Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.,Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford and NIHR Oxford Biomedical Research Centre (Haematology), Oxford, UK
| | | |
Collapse
|
29
|
Lu W, Delaney M, Dunbar NM, Rossmann SN, Fung M. A national survey of hospital-based transfusion services on their approaches to platelet bacterial risk mitigation in response to the FDA final guidance for industry. Transfusion 2020; 60:1681-1687. [PMID: 32564352 DOI: 10.1111/trf.15851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bacterial contamination of platelets is the leading infectious risk to the United States (US) blood supply. On 30 September 2019, the US Food and Drug Administration (FDA) published a Final Guidance for Industry to reduce the risk of transfusing platelets contaminated by bacteria. A national survey was undertaken to assess readiness, attitudes, and the potential impact on hospital-based transfusion services. STUDY DESIGN AND METHODS A survey was distributed to transfusion services in all 50 US states. Summary statistics were performed along with review and categorization of email feedback and free text comments. RESULTS Eighty-three transfusion services from 48 states participated in this survey study. Currently, the most common approach is primary culture performed at manufacturing (n = 49/83, 59%). Of the bacterial risk mitigation strategies provided by the FDA, the most frequently preferred are (a) pathogen reduced platelets (PRP) for up to 5-day storage (n = 36/77, 47%), (b) large volume delayed sampling (LVDS) ≥48 hours for up to 7-day storage (n = 16/77, 21%), and (c) primary culture ≥24 hours + secondary rapid testing for up to 7-day storage (n = 7/77, 9%). The main motivating factors for the survey participants' selected strategies to comply with FDA final guidance were product availability from supplier, reducing the risk of septic transfusion reactions (STR), and complexity of implementing and performing a new or additional test. CONCLUSION While having platelets to transfuse and preventing STR are of the utmost importance, nationwide, the majority of transfusion services do not want to take on performing new or additional testing in their laboratories.
Collapse
Affiliation(s)
- Wen Lu
- Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| |
Collapse
|
30
|
Pagano MB, Allen ES, Chou ST, Dunbar NM, Gniadek T, Goel R, Harm SK, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Raval JS, Schwartz J, Shan H, Spinella PC, Storch E, Cohn CS. Current advances in transfusion medicine: a 2019 review of selected topics from the AABB Clinical Transfusion Medicine Committee. Transfusion 2020; 60:1614-1623. [PMID: 32472580 DOI: 10.1111/trf.15848] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION. STUDY DESIGN AND METHODS CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine. CONCLUSION This synopsis provides easy access to relevant topics and may be useful as an educational tool.
Collapse
Affiliation(s)
- Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ruchika Goel
- Transfusion Medicine Division, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Sarah K Harm
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jay S Raval
- Transfusion Medicine Service, Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Transfusion Medicine & Cellular Therapy, Department of Pathology & Cell Biology, Columbia University, New York, New York
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California
| | - Philip C Spinella
- Division of Pediatric Critical Care, Washington University in St Louis, St Louis, Missouri, USA
| | - Emily Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland
| | - Claudia S Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
31
|
Delaney M, Apelseth TO, Bonet Bub C, Cohn CS, Dunbar NM, Mauro Kutner J, Murphy M, Perelman I, Selleng K, Staves J, Wendel S, Ziman A. Red-blood-cell alloimmunization and prophylactic antigen matching for transfusion in patients with warm autoantibodies. Vox Sang 2020; 115:515-524. [PMID: 32249930 DOI: 10.1111/vox.12914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/28/2019] [Revised: 01/26/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Warm autoantibodies (WAA) are antibodies that react with an antigen on a patient's own red-blood-cells and can complicate compatibility testing whether or not they cause clinical haemolysis. The goal of this study was to understand the overall prevalence of WAA, the risk of RBC alloimmunization and determine whether RBC selection practices have an impact on alloimmunization. MATERIALS AND METHODS Records of patients (>1 year of age) with an indirect antibody detection test (IAT) and serologic evidence of WAA over a 10-year-period were included. Eight centres from 5 countries collectively reviewed 1 122 245 patients who had an IAT. RESULTS Of patients having IAT, 1214 had WAA (0·17%). Transfusion information for 1002 of the patients was available; 631 were transfused after identification of the WAA (63%); of the transfused patients, 390 received prophylactic antigen-matched (PAM) RBCs and 241 did not. Of the 372 patients with WAA who were transfused and had serologic testing 30+ days following transfusion (30-2765 days), 56 developed new RBC alloimmunization (15·1%). Patients who were transfused using a PAM strategy were not protected from new RBC alloimmunization [14·6% (31 of 212 patients) having PAM transfusion approach compared with those not receiving PAM approach (15·6%, 25 of 160 patients, P = 0·8837)]. CONCLUSIONS The prevalence of WAA in patients having an IAT is low (<1%). A significant portion of patients with WAA form new RBC alloimmunization (15·1%); however, the use of PAM approach for RBC selection was not found to be protective against new alloimmunization.
Collapse
Affiliation(s)
- Meghan Delaney
- Bloodworks NW, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine, Department of Clinical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Michael Murphy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Kathleen Selleng
- Institute for Immunology and Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | |
Collapse
|
32
|
Lu W, Delaney M, Flegel WA, Ness P, Ratcliffe N, Triulzi DJ, Yazer MH, Ziman A, Dunbar NM. How do you… decide which platelet bacterial risk mitigation strategy to select for your hospital-based transfusion service? Transfusion 2020; 60:675-681. [PMID: 32027394 PMCID: PMC7131880 DOI: 10.1111/trf.15693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 01/12/2023]
Abstract
The United States Food and Drug Administration Final Guidance for Industry titled, "Bacterial Risk Control Strategies for Blood Collection Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion" provides nine strategies for platelet bacterial risk mitigation. Even if it is assumed all strategies are comparable in terms of safety and efficacy, the decision of which to implement remains challenging. Some additional factors that warrant evaluation before selecting a strategy include the financial impact, process for implementation, logistics upon implementation, institutional acceptance by blood bank staff, administration and clinicians, and effect on platelet availability. To assist with this difficult choice, a panel of transfusion service physicians who have expertise on the topic and have already selected strategies for their transfusion services were recruited to provide varied perspectives. In addition, the use of a decision-making tool that objectively evaluates defined criteria for assessment of the nine strategies is described.
Collapse
Affiliation(s)
- Wen Lu
- Robert Tomsich Pathology & Laboratory Medicine
Institute, Cleveland Clinic, Cleveland, Ohio
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children’s
National Medical Center, Washington, DC
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center,
National Institutes of Health, Bethesda
| | - Paul Ness
- Department of Pathology, Johns Hopkins University School of
Medicine, Baltimore, Maryland
| | - Nora Ratcliffe
- Pathology & Laboratory Medicine, White River Junction
VA Medical Center, White River Junction, Vermont
| | - Darrell J. Triulzi
- Centralized Transfusion Service, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Mark H. Yazer
- Centralized Transfusion Service, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service,
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine,
University of California Los Angeles, Los Angeles, California
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
33
|
Dunbar NM, Yazer MH. Confusion surrounding trauma resuscitation and opportunities for clarification. Transfusion 2020; 60 Suppl 3:S142-S149. [DOI: 10.1111/trf.15710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/02/2020] [Accepted: 01/28/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Mark H. Yazer
- Department of PathologyUniversity of Pittsburgh and Vitalant Pittsburgh Pennsylvania
| |
Collapse
|
34
|
Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 740] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
Collapse
Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | |
Collapse
|
35
|
Yazer MH, Delaney M, Doughty H, Dunbar NM, Al‐Riyami AZ, Triulzi DJ, Watchko JF, Wood EM, Yahalom V, Emery SP. It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies. Transfusion 2019; 59:3794-3799. [DOI: 10.1111/trf.15569] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mark H. Yazer
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
- Vitalant Pittsburgh Pennsylvania
| | - Meghan Delaney
- Division of Pathology and Laboratory MedicineChildren's National Medical Center Washington District of Columbia
- Department of Pathology and PediatricsGeorge Washington University Medical School Washington District of Columbia
| | | | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Arwa Z. Al‐Riyami
- Department of HematologySultan Qaboos University Hospital Muscat Oman
| | - Darrell J. Triulzi
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
- Vitalant Pittsburgh Pennsylvania
| | - Jon F. Watchko
- Department of PediatricsUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Erica M. Wood
- Transfusion Research UnitSchool of Public Health and Preventive Medicine, Monash University Melbourne Australia
- Department of Clinical HaematologyMonash Health Melbourne Australia
| | - Vered Yahalom
- Rabin Medical CenterBlood Services and Apheresis Institute Petah Tiqva Israel
| | - Stephen P. Emery
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| |
Collapse
|
36
|
Yazer MH, Dunbar NM, Thomas J, Nunes E, Murphy MF. Transfusion‐associated circulatory overload risk mitigation: survey on hospital policies for compliance with AABB Standard 5.9.17. Transfusion 2019; 59:2833-2839. [DOI: 10.1111/trf.15478] [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: 04/10/2019] [Revised: 05/20/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Mark H. Yazer
- Vitalant Pittsburgh Pennsylvania
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | | | | | - Michael F. Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre Oxford United Kingdom
| | | |
Collapse
|
37
|
Cohn CS, Allen ES, Cushing MM, Dunbar NM, Friedman DF, Goel R, Harm SK, Heddle N, Hopkins CK, Klapper E, Perumbeti A, Ramsey G, Raval JS, Schwartz J, Shaz BH, Spinella PC, Pagano MB. Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee. Transfusion 2019; 59:2733-2748. [PMID: 31148175 DOI: 10.1111/trf.15348] [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] [Received: 03/13/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine. An abridged version of this work is being made available in TRANSFUSION, with the full-length report available as Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in late 2017 and 2018 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: "big data" and "omics" studies, emerging infections and testing, platelet transfusion and pathogen reduction, transfusion therapy and coagulation, transfusion approach to hemorrhagic shock and mass casualties, therapeutic apheresis, and chimeric antigen receptor T-cell therapy. CONCLUSION This synopsis may be a useful educational tool.
Collapse
Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth S Allen
- Department of Pathology, University of California, San Diego, California
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Mississippi Valley Regional Blood Center, Springfield, Illinois
| | - Sarak K Harm
- University of Vermont Medical Center, Burlington, VT
| | - Nancy Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - 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
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University, and, New York, New York
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University in St Louis School of Medicine, Saint Louis, Missouri
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
38
|
Shih AW, Cohn CS, Delaney M, Fontaine MJ, Martin I, Dunbar NM, Dagger J, Fadeyi EA, Flanagan P, Gathof B, Godbey EA, Harach M, Huggins YM, Ipe TS, Jackson B, Jacquot C, Jin Z, Jones MR, Kamel H, Karp JK, Lewin A, Mo Y, Murphy M, O'Brien J, Ommer K, Pagano MB, Passwater M, Pelletier JPR, Robillard P, Schwartz J, Sham L, Shunkwiler SM, Simmons JS, Staves J, Takanaski M, Vasallo R, Weiss S, Williams SM, Yamada C, Young PP, Ziman A. The BEST criteria improve sensitivity for detecting positive cultures in residual blood components cultured in suspected septic transfusion reactions. Transfusion 2019; 59:2292-2300. [DOI: 10.1111/trf.15317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew W. Shih
- Department of Pathology and Laboratory MedicineUniversity of British Columbia Vancouver British Columbia Canada
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
| | - Meghan Delaney
- Department of Pathology and Laboratory MedicineChildren's National Health System Washington, District of Columbia
| | | | - Isabella Martin
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Harm SK, Dunbar NM. Immunologic risks of whole blood: ABO compatibility, D alloimmunization, and transfusion-related acute lung injury. Transfusion 2019; 59:1507-1511. [PMID: 30980758 DOI: 10.1111/trf.15168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah K Harm
- University of Vermont Medical Center, Burlington, Vermont
| | - Nancy M Dunbar
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
40
|
Yazer MH, Dunbar NM, Bub CB, Condict BE, Dunn R, Janoušková M, Kutner J, Landová L, Lejdarová H, Nesvačilová B, Pacasová R, Procházková R, Řehořová L, Raval JS, Ziman A, Bohonĕk M. Comparison of titer results obtained using immediate spin one‐dilution techniques to a reference method. Transfusion 2019; 59:1512-1517. [DOI: 10.1111/trf.15170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Mark H. Yazer
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
- The Institute for Transfusion Medicine Pittsburgh Pennsylvania
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Carolina Bonet Bub
- Department of Hemotherapy and Cell TerapyHospital Israelita Albert Einstein Sao Paulo Brazil
| | - Brittany E. Condict
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Robyn Dunn
- Wing‐Kwai and Alice Lee‐Tsing Chung Transfusion Service, Department of Pathology and Laboratory MedicineUCLA Health Los Angeles California
| | - Miloslava Janoušková
- Blood Transfusion DepartmentRegional Hospital Karlovy Vary Prague Czech Republic
| | - Jose Kutner
- Department of Hemotherapy and Cell TerapyHospital Israelita Albert Einstein Sao Paulo Brazil
| | - Ludmila Landová
- Department of Hematology and Blood TransfusionMilitary University Hospital Prague Prague Czech Republic
| | - Hana Lejdarová
- Blood Transfusion and Tissue DepartmentUniversity Hospital Brno Brno Czech Republic
| | - Božena Nesvačilová
- Blood Transfusion DepartmentRegional Hospital Karlovy Vary Prague Czech Republic
| | - Rita Pacasová
- Blood Transfusion and Tissue DepartmentUniversity Hospital Brno Brno Czech Republic
| | - Renata Procházková
- Department of Hematology and Blood TransfusionRegional Hospital Liberec Liberec Czech Republic
| | - Lenka Řehořová
- Department of Hematology and Blood TransfusionRegional Hospital Liberec Liberec Czech Republic
| | - Jay S. Raval
- Department of Pathology and Laboratory MedicineUniversity of North Carolina Chapel Hill North Carolina
| | - Alyssa Ziman
- Wing‐Kwai and Alice Lee‐Tsing Chung Transfusion Service, Department of Pathology and Laboratory MedicineUCLA Health Los Angeles California
| | - Miloš Bohonĕk
- Department of Hematology and Blood TransfusionMilitary University Hospital Prague Prague Czech Republic
| |
Collapse
|
41
|
Thomasson RR, Yazer MH, Gorham JD, Dunbar NM. International assessment of massive transfusion protocol contents and indications for activation. Transfusion 2019; 59:1637-1643. [PMID: 30720872 DOI: 10.1111/trf.15149] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Massive transfusion protocols (MTPs) provide blood products rapidly and in fixed amounts. MTPs are commonly used in trauma but may also be used in other clinical settings, although evidence to support fixed-ratio resuscitation in nontraumatic hemorrhage is lacking. The goals of this study were to describe the types and contents of available MTPs and the clinical indications for MTP activation. METHODS A survey was distributed to 353 transfusion medicine specialists to assess the types and contents of available MTPs. Survey participants were invited to provide the clinical indications for consecutive adult and pediatric MTP activations for at least 6 months during 2015 to 2017. RESULTS There were 125 completed surveys (35% response rate) including three from children's specialty hospitals. Most hospitals that treated adult patients (90/122, 74%) utilized only one MTP for all adult bleeding emergencies, while one hospital had no MTP. Of the 31 hospitals that provided more than one adult MTP, 20 provided MTPs specific for obstetric bleeding cases. Of these, 50% (10/20) included at least one pool of cryoprecipitate or fibrinogen concentrate in the first MTP round, compared with 14% (13/90) of the hospitals with one MTP (p = 0.0012). Fifty-seven hospitals provided the clinical indication for 4176 adult and 155 pediatric MTP activations. Although trauma was the single most common indication, the majority of adult (58%) and pediatric (65%) activations were for nontrauma indications. CONCLUSIONS The majority of hospitals use a single MTP to manage massive hemorrhage. The majority of MTP activations were for nontrauma indications.
Collapse
Affiliation(s)
- Reggie R Thomasson
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - James D Gorham
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | |
Collapse
|
42
|
Kaufman RM, Dinh A, Cohn CS, Fung MK, Gorlin J, Melanson S, Murphy MF, Ziman A, Elahie AL, Chasse D, Degree L, Dunbar NM, Dzik WH, Flanagan P, Gabert K, Ipe TS, Jackson B, Lane D, Raspollini E, Ray C, Sharon Y, Ellis M, Selleng K, Staves J, Yu P, Zeller M, Yazer M. Electronic patient identification for sample labeling reduces wrong blood in tube errors. Transfusion 2018; 59:972-980. [DOI: 10.1111/trf.15102] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anh Dinh
- Department of Pathology and Laboratory MedicineChildren's Hospital of Philadelphia Philadelphia PA
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis MN
| | - Mark K. Fung
- Department of PathologyUniversity of Vermont Burlington VT
| | | | - Stacy Melanson
- Department of PathologyBrigham and Women's Hospital Boston MA
| | | | - Alyssa Ziman
- Department of Pathology and Laboratory MedicineUCLA Health Los Angeles CA
| | | | - Danielle Chasse
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | - Lynsi Degree
- Department of PathologyUniversity of Vermont Burlington VT
| | - Nancy M. Dunbar
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | - Walter H. Dzik
- Department of PathologyMassachusetts General Hospital Boston MA
| | | | - Kimberly Gabert
- Department of Pathology and the Institute for Transfusion MedicineUniversity of Pittsburgh Pittsburgh PA
| | - Tina S. Ipe
- Department of Pathology and Genomic MedicineHouston Methodist Hospital Houston TX
| | - Bryon Jackson
- Department of Pathology and Laboratory MedicineEmory University School of Medicine Atlanta GA
| | | | | | - Charles Ray
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | | | | | - Kathleen Selleng
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine Greifswald Germany
| | - Julie Staves
- Oxford University Hospitals Foundation Trust Oxford United Kingdom
| | - Philip Yu
- St. Paul's Hospital Vancouver Canada
| | | | - Mark Yazer
- Department of Pathology and the Institute for Transfusion MedicineUniversity of Pittsburgh Pittsburgh PA
| | | |
Collapse
|
43
|
Harm SK, Yazer MH, Bub CB, Cohn CS, Jacob EK, Kutner JM, Mair DC, Raval JS, Shaz BH, Ziman A, Dunbar NM. Seasonal variability is not observed in the rates of high anti‐A and anti‐B titers in plasma, apheresis platelet, and whole blood units tested by different methods. Transfusion 2018; 59:762-767. [DOI: 10.1111/trf.15083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Sarah K. Harm
- Department of Pathology and Laboratory MedicineUniversity of Vermont Medical Center Burlington Vermont
| | - Mark H. Yazer
- Department of Pathology and Laboratory MedicineUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Carolina B. Bub
- Hemotherapy and Cell Therapy DepartmentHospital Israelita Albert Einstein Sao Paulo Brazil
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
| | - Eapen K. Jacob
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Jose M. Kutner
- Hemotherapy and Cell Therapy DepartmentHospital Israelita Albert Einstein Sao Paulo Brazil
| | - David C. Mair
- Blood Services ‐ West DivisionAmerican Red Cross Minnesota
| | - Jay S. Raval
- Department of Pathology and Laboratory MedicineUniversity of North Carolina Chapel Hill North Carolina
| | | | - Alyssa Ziman
- Wing‐Kwai and Alice Lee‐Tsing Chung Transfusion Service, Department of Pathology and Laboratory MedicineDavid Geffen School of Medicine, University of California Los Angeles Los Angeles California
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | | |
Collapse
|
44
|
Pagano MB, Dunbar NM, Tinmouth A, Apelseth TO, Lozano M, Cohn CS, Stanworth SJ. A methodological review of the quality of reporting of surveys in transfusion medicine. Transfusion 2018; 58:2720-2727. [DOI: 10.1111/trf.14937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Monica B. Pagano
- Department of Laboratory Medicine, Division of Transfusion Medicine; University of Washington; Seattle Washington
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Alan Tinmouth
- Departments of Medicine and Laboratory Medicine & Pathology; University of Ottawa, University of Ottawa Centre for Transfusion Research, Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Torunn Oveland Apelseth
- Laboratory of Clinical Biochemistry and Department of Immunology and Transfusion Medicine; Haukeland University Hospital; Bergen Norway
| | - Miguel Lozano
- Department of Hemotherapy and Hemostasis; University Clinic Hospital, IDIBAPS, University of Barcelona; Barcelona Spain
| | - Claudia S. Cohn
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Simon J. Stanworth
- Department of Haematology; Oxford University Hospitals
- NHS Blood and Transplant, John Radcliffe Hospital
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | | |
Collapse
|
45
|
Slichter SJ, Dumont LJ, Cancelas JA, Jones M, Gernsheimer TB, Szczepiorkowski ZM, Dunbar NM, Prakash G, Medlin S, Rugg N, Kinne B, Macdonald VW, Housler G, Valiyaveettil M, Hmel P, Ransom JH. Safety and efficacy of cryopreserved platelets in bleeding patients with thrombocytopenia. Transfusion 2018; 58:2129-2138. [DOI: 10.1111/trf.14780] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sherrill J. Slichter
- Research Institute, Bloodworks Northwest; Seattle Washington
- University of Washington School of Medicine; Seattle Washington
| | - Larry J. Dumont
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Blood Systems Research Institute; Denver Colorado
| | - Jose A. Cancelas
- Hoxworth Blood Center; University of Cincinnati; Cincinnati Ohio
| | - MeLinh Jones
- Research Institute, Bloodworks Northwest; Seattle Washington
| | | | | | - Nancy M. Dunbar
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Gautham Prakash
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Stephen Medlin
- University of Cincinnati Health Hospital; Cincinnati Ohio
| | - Neeta Rugg
- Hoxworth Blood Center; University of Cincinnati; Cincinnati Ohio
| | - Bridget Kinne
- University of Cincinnati Health Hospital; Cincinnati Ohio
| | | | - Greggory Housler
- U.S. Army Medical Research and Materiel Command; Fort Detrick Maryland
| | | | - Peter Hmel
- Fast-Track Drugs & Biologics, LLC; North Potomac Maryland
| | | |
Collapse
|
46
|
Ruby KN, Thomasson RR, Szczepiorkowski ZM, Dunbar NM. Bacterial screening of apheresis platelets with a rapid test: a 113‐month single center experience. Transfusion 2018; 58:1665-1669. [DOI: 10.1111/trf.14629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/06/2018] [Accepted: 02/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kristen N. Ruby
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Reggie R. Thomasson
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Department of MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Geisel School of Medicine at DartmouthHanover New Hampshire
- Institute of Hematology and Transfusion MedicineWarsaw Poland
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Department of MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Geisel School of Medicine at DartmouthHanover New Hampshire
| |
Collapse
|
47
|
Yazer MH, Dunbar NM, Cohn C, Dillon J, Eldib H, Jackson B, Kaufman R, Murphy MF, O'Brien K, Raval JS, Seheult J, Staves J, Waters JH. Blood product transfusion and wastage rates in obstetric hemorrhage. Transfusion 2018. [DOI: 10.1111/trf.14571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark H. Yazer
- Department of Pathology; Pittsburgh Pennsylvania
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Jessica Dillon
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Howida Eldib
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Bryon Jackson
- Department of Pathology and Laboratory Medicine; Emory University School of Medicine; Atlanta Georgia
| | - Richard Kaufman
- Brigham and Women's Hospital Adult Transfusion Service; Boston Massachusetts
| | - Michael F. Murphy
- NHS Blood & Transplant, Oxford University Hospitals, and University of Oxford; Oxford UK
| | - Kerry O'Brien
- Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Jay S. Raval
- Department of Pathology and Laboratory Medicine; University of North Carolina, Chapel Hill, North Carolina; the McGowan Institute for Regenerative Medicine; Pittsburgh Pennsylvania
| | | | | | - Jonathan H. Waters
- Departments of Anesthesiology and Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania
| | | |
Collapse
|
48
|
Dunbar NM, Yazer MH. O- product transfusion, inventory management, and utilization during shortage: the OPTIMUS study. Transfusion 2018; 58:1348-1355. [DOI: 10.1111/trf.14547] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Mark H. Yazer
- The Institute for Transfusion Medicine and the Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania
| | | |
Collapse
|
49
|
Harm SK, Szczepiorkowski ZM, Dunbar NM. Routine use of Day 6 and Day 7 platelets with rapid testing: two hospitals assess impact 1 year after implementation. Transfusion 2018; 58:938-942. [DOI: 10.1111/trf.14473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah K. Harm
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington Vermont
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| |
Collapse
|
50
|
Maloney N, Martin I, Szczepiorkowski ZM, Dunbar NM. Therapeutic plasma exchange for thrombotic thrombocytopenic purpura with refractory thrombocytopenia. J Clin Apher 2017; 33:436-438. [PMID: 29270999 DOI: 10.1002/jca.21612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/02/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is an acute, life-threatening illness with disseminated platelet-rich thromboses of small vessels that variably presents with the classic clinical "pentad" of microangiopathic hemolytic anemia, thrombocytopenia, fever, altered mental status, and acute kidney injury. Most cases are caused by an acquired autoantibody to ADAMTS13, a metalloproteinase that cleaves large von Willebrand Factor (vWF) multimers. The mainstay of treatment is daily therapeutic plasma exchange (TPE), sometimes with adjunctive pharmacologic immunosuppression. TPE is generally continued until the platelet count is greater than 150 × 103 /µL and the lactate dehydrogenase is near normal for 2-3 consecutive days. Unfortunately, there is no clear guidance for when thrombocytopenia is refractory for a prolonged period of time. The following case describes such a scenario in which consecutive ADAMTS13 activity and inhibitor levels were used to guide the decision to stop treatment with TPE in a patient who failed to recover their platelet count.
Collapse
Affiliation(s)
- Nolan Maloney
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Isabella Martin
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|