Transfusion Practice Archives - Blood Bank Guy: Recent Episodes
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Continuing Education Episode!Continuing Education!“New evidence” comes at us fast in Transfusion Medicine. Rich Haspel says, “let’s look before we leap!”Dr. Rich Haspel
Advances in the practice of Transfusion Medicine happen regularly, and it can be difficult for both learners and those with more experience to keep up with the latest information. Further, many learners (and more “seasoned” types!) lack experience to evaluate strengths and weaknesses of the evidence in the medical literature. Willing to DebateDr. Rich Haspel is known for his willingness to speak frankly about the quality of published data, and for cautioning, “not so fast,” when questions still need to be answered before widespread acceptance of new practice principles. In this interview, Dr. Haspel outlines his approach to evaluating the literature and gives practical steps to help learners do the same. The second half of the interview involves a discussion on the state of the evidence on a particularly “hot” topic: The use of “Low-titer Group O Whole Blood (LTOWB)” in trauma transfusion.
Full DisclosureThis interview, frankly, puts me in a very interesting position as a host. As long-time listeners know, I have discussed LTOWB previously on this podcast, especially with Dr. Mark Yazer (episodes 040 and 091). I respect both of these physicians enormously, and consider them friends, and yet, there is some pretty strong disagreement between them about the LTOWB issue. My advice to you as a learner: Focus on the evidence, take time to read it, and decide what you think for yourself! I mention where I land at the end of the episode, but that’s beside the point: We all need to learn to evaluate the evidence and not just accept things blindly.
Dr. Rich Haspel
Advances in the practice of Transfusion Medicine happen regularly, and it can be difficult for both learners and those with more experience to keep up with the latest information. Further, many learners (and more “seasoned” types!) lack experience to evaluate strengths and weaknesses of evidence in the medical literature. Willing to DebateDr. Rich Haspel is known for his willingness to speak frankly about the quality of published data, and for cautioning, “not so fast,” when questions still need to be answered before widespread acceptance of new practice principles. In this interview, Dr. Haspel outlines his approach to evaluating the literature and gives practical steps to help learners do the same. The second half of the interview involves a discussion on the state of the evidence on a particularly “hot” topic: The use of “Low-titer Group O Whole Blood (LTOWB)” in trauma transfusion.
Full DisclosureThis interview, frankly, puts me in a very interesting position as a host. As long-time listeners know, I have discussed LTOWB previously on this podcast, especially with Dr. Mark Yazer (episodes 040 and 091). I respect both of these physicians enormously, and consider them friends, and yet, there is some pretty strong disagreement between them about the LTOWB issue. My advice to you as a learner: Focus on the evidence, take time to read it, and decide what you think for yourself! I mention where I land at the end of the episode, but that’s beside the point: We all need to learn to evaluate the evidence and not just accept things blindly.
Download the Transcript for This EpisodeAbout My Guest:Dr. Rich Haspel received his Bachelor of Science degree from Stanford University, his PhD in Molecular Cell Biology from Rockefeller University, and his MD from Cornell University. He completed an internship in medicine and a residency in clinical pathology at Brigham and Women’s Hospital in Boston. He received his fellowship training in Transfusion Medicine at Massachusetts General Hospital. Dr. Haspel is currently a Transfusion Medicine physician, Medical Director of the Stem Cell Processing Laboratory, and the Vice Chair for Medical Education in the Department of Pathology at Beth Israel Deaconess Medical Center. He is also a Professor of Pathology at Harvard Medical School. Dr. Haspel’s primary academic focus is medical education. He has received NIH funding to facilitate the work of a national committee in developing a genomics curriculum for pathology residents. He has led international studies to evaluate internal medicine resident, hematology fellow, and pediatric resident Transfusion Medicine knowledge using validated surveys and exams. He is also very interested in how best to teach critical evaluation of the medical literature and has published a transfusion medicine evidence-based curriculum.
FREE Continuing Education!This podcast episode offers a FREE continuing education activity where you can earn two different types of credit: 1 AMA PRA Category 1 CreditTM, or 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit). This activity also may be used to fulfill Lifelong Learning Continuing Certification requirements for the American Board of Pathology.
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
Please note: Continuing education credit is available for two years from the date this episode was released. In other words, you will no longer be able to claim credit for this episode after May 4, 2025.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Haspel nor I have any relevant financial disclosures.
Selected references supplied by Dr. Haspel: O’Brien KL et al. Primum, non nocere: Whole blood, prehospital transfusion and anti-D hemolytic disease of the fetus and newborn. Transfusion 2023;63:249-256 * Hill criteria: Fedak KM, Bernal A, Capshaw ZA, Gross S. Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology. Emerg Themes Epidemiol. 2015;12:14 * Correcting for “survivor bias” in plasma:RBC ratio observational studies: Snyder CW et al. The relationship of blood product ratio to mortality: survival benefit or survival bias? J Trauma. 2009;66:358-62 * PROPPR Trial: Holcomb JB et al. PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3;313(5):471-82 * Critique of PROPPR: Dzik W. Misunderstanding the PROPPR trial. Transfusion 2017;57:2056 * Study Dr. Haspel mentioned with issue related to allocation of intervention bias (looking at table 1, with fewer patients in component arm: Hazelton JP et al. Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg. 2022 Oct 1;276(4):579-588 Special thanks to: Tommy Walker and Tommy Walker Ministries for the use of his amazing song, “Get Up,” heard at the beginning and end of the episode
Additional Music CreditMusic for this episode includes “Reflejo,” by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 101CE: Look Before You Leap with Rich Haspel appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!Acute Normovolemic Hemodilution (ANH) has a weird-sounding name, but it’s a totally logical way to reduce red cell transfusions. Steve Frank shows us why.Dr. Steve Frank
Way back in the 1970’s, several bright groups of medical personnel published articles describing a new way of using “fresh autologous blood” in cardiac surgery patients. The unique aspect of the description was the combined use of drawing the blood right before surgery followed by infusion of fluids designed to keep the patient’s blood volume normal. “Acute Normovolemic Hemodilution (ANH)” was born, and ever since, we have been trying to figure out how to use it, and whether it actually helps reduce of prevent red cell transfusion.He USES It!Dr. Steve Frank and his colleagues in the Bloodless Medicine Program at Johns Hopkins believe ANH is an underutilized strategy. He joins me today to share the details of how ANH works, and whether other facilities can implement it as a part of their overall Patient Blood Management Program.
Dr. Steve Frank
Way back in the 1970’s, several bright groups of medical personnel published articles describing a new way of using “fresh autologous blood” in cardiac surgery patients. The unique aspect of the description was the combined use of drawing the blood right before surgery followed by infusion of fluids designed to keep the patient’s blood volume normal. “Acute Normovolemic Hemodilution (ANH)” was born, and ever since, we have been trying to figure out how to use it, and whether it actually helps reduce of prevent red cell transfusion.He USES It!Dr. Steve Frank and his colleagues in the Bloodless Medicine Program at Johns Hopkins believe ANH is an underutilized strategy. He joins me today to share the details of how ANH works, and whether other facilities can implement it as a part of their overall Patient Blood Management Program.
Download the Transcript for This EpisodeAbout My Guest:Dr. Steve Frank is a Professor in the Department of Anesthesiology and Critical Care Medicine at the Johns Hopkins Medical Institutions, where he specializes in anesthesia for vascular, thoracic, and transplant cases. He serves as Medical Director for the Johns Hopkins Health System Blood Management Program and he also directs the Center for Bloodless Medicine and Surgery, a program for patients who wish to avoid transfusion.
Dr. Frank’s recent work relates to clinical studies in the area of collection and analysis of transfusion data from electronic medical records and methods for using such data to improve practice. He is currently on the Editorial Board of the journal TRANSFUSION, and he has served on the Board of Directors for AABB and SABM. He is also Chair of the Committee on Patient Blood Management for the American Society of Anesthesiologists.
FREE Continuing Education!This podcast episode offers a FREE continuing education activity where you can earn two different types of credit: 1 AMA PRA Category 1 CreditTM, or 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit). This activity also may be used to fulfill Lifelong Learning Continuing Certification requirements for the American Board of Pathology.
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
Please note: Continuing education credit is available for two years from the date this episode was released. In other words, you will no longer be able to claim credit for this episode after June 28, 2024.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Frank nor I have any relevant financial disclosures.
Further Reading: Editorial by Dr. Frank and his group summarizing major issues in ANH: Grant MC, Resar LMS, and Frank SM. The Efficacy and Utility of Acute Normovolemic Hemodilution. Anesth Analg 2015;121(6):1412-1414. Thanks to: Dr. Daniela Hermelin, Managing Editor; Follow Daniela on Twitter for fantastic #blooducation! * Naomi Suguitan, BBGuy Assistant
Music CreditMusic for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 097CE: Acute Normovolemic Hemodilution (ANH) with Steve Frank appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Thalassemia may be too easy to overlook for those in the U.S., but it is an enormous global problem!
Dr. Sujit Sheth
When most United States-based healthcare providers think of a hemoglobinopathy, sickle cell disease is the first to come to mind. That is understandable, given how frequently that disease is present in the US. However, worldwide, the various forms of thalassemia are a MASSIVE problem. How Bad is It? Dr. Sujit Sheth, director of the New York Comprehensive Thalassemia Center in New York City, reports that “1.5% of the Earth’s population of humans carries a thalassemia mutation, at least one. That makes 80 to 90 million people!” Thalassemia differs from sickle cell disease in many ways, but both are a major international cause or morbidity and (sadly) mortality). It is essential that those involved in transfusion of this global disease understand the basic pathophysiology of thalassemia, as well as details surrounding care of those patients who become transfusion-dependent.
Expert Guidance In this interview, Dr. Sheth describes what you need to know about thalassemia. He takes special care to help us understand what those caring for patients with thalassemia are targeting when they are making transfusion decisions. The more those of us involved in providing transfusions know about this potentially devastating disease, the more we can help.
Dr. Sujit Sheth
When most United States-based healthcare providers think of a hemoglobinopathy, sickle cell disease is the first to come to mind. That is understandable, given how frequently that disease is present in the US. However, worldwide, the various forms of thalassemia are a MASSIVE problem. How Bad is It? Dr. Sujit Sheth, director of the New York Comprehensive Thalassemia Center in New York City, reports that “1.5% of the Earth’s population of humans carries a thalassemia mutation, at least one. That makes 80 to 90 million people!” Thalassemia differs from sickle cell disease in many ways, but both are a major international cause or morbidity and (sadly) mortality). It is essential that those involved in transfusion of this global disease understand the basic pathophysiology of thalassemia, as well as details surrounding care of those patients who become transfusion-dependent.
Expert Guidance In this interview, Dr. Sheth describes what you need to know about thalassemia. He takes special care to help us understand what those caring for patients with thalassemia are targeting when they are making transfusion decisions. The more those of us involved in providing transfusions know about this potentially devastating disease, the more we can help.
Image: https://thalassemia.weill.cornell.edu/about-us
Download the Transcript for This Episode
About My Guest: Sujit Sheth, MD is a Professor of Clinical Pediatrics and Chief of the Division of Pediatric Hematology and Oncology at Weill Cornell Medical College in New York. He was trained in India, both at the University of Bombay and the College of Physicians and Surgeons in Bombay (now Mumbai). Dr. Sheth has long been passionate about the care of patients with hematologic disorders, especially those requiring transfusion therapy. He is the Director of the New York Comprehensive Thalassemia Center of Weill-Cornell Medicine, one of the largest comprehensive thalassemia programs in the United States.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn two different types of credit: 1 AMA PRA Category 1 CreditTM, or 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit). This activity also may be used to fulfill Lifelong Learning Continuing Certification requirements for the American Board of Pathology.
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
Please note: The continuing education credit is available for two years from the date this episode was released; in other words, you will no longer be able to get credit for this episode after March 2, 2024.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Sheth nor I have any relevant financial disclosures.
The images below are generously provided by Dr. Sujit Sheth.
Further Reading: * Guidelines for transfusion management in thalassemia (Cooleys Anemia Foundation website) * Overview of thalassemias: Taher AT et al. β-Thalassemias. New Engl J Med 2021;384:727-743 * Broader management review for thalassemias: Khandros EK and Kwiatkowski JL. Beta Thalassemia: Monitoring and New Treatment Approaches. Hematol Oncol Clin North Am. 2019 Jun;33(3):339-353.
Thanks to: * Dr. Daniela Hermelin, Associate Editor; Follow Daniela on Twitter for fantastic #blooducation! * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 094CE: Thalassemia Essentials with Sujit Sheth appeared first on Blood Bank Guy.
Platelet transfusions are life-saving in many situations, but what do you do when they might NOT be helpful?
Dr. Ruchika Goel
Platelets have been used to save the lives of patients with low platelet counts for decades. For the most part, they are considered a safe and effective means to correct the problem of a patient not having enough platelets of their own. But What About ITP, TTP, and HIT? Despite the truth of the statements above, we have wondered for decades about whether or not platelets should be given to patients with certain diseases where their platelets are being removed from circulation. Patients with those diseases, most famously ITP (Immune Thrombocytopenic Purpura), TTP (Thrombotic Thrombocytopenic Purpura), and HIT (Heparin-induced Thrombocytopenia), might not respond at all to platelets. More concerning, some of those patients might actually be harmed by platelet transfusion!
Let’s Go to the Data My guest in this episode, Dr. Ruchika Goel, looked carefully at US data on platelet transfusion in ITP, TTP, and HIT, and she has some insights that might change the way you transfuse these patients.
Dr. Ruchika Goel
Platelets have been used to save the lives of patients with low platelet counts for decades. For the most part, they are considered a safe and effective means to correct the problem of a patient not having enough platelets of their own. But What About ITP, TTP, and HIT? Despite the truth of the statements above, we have wondered for decades about whether or not platelets should be given to patients with certain diseases where their platelets are being removed from circulation. Patients with those diseases, most famously ITP (Immune Thrombocytopenic Purpura), TTP (Thrombotic Thrombocytopenic Purpura), and HIT (Heparin-induced Thrombocytopenia), might not respond at all to platelets. More concerning, some of those patients might actually be harmed by platelet transfusion!
Let’s Go to the Data My guest in this episode, Dr. Ruchika Goel, looked carefully at US data on platelet transfusion in ITP, TTP, and HIT, and she has some insights that might change the way you transfuse these patients.
Download the Transcript for This Episode
About My Guest: Dr. Ruchika Goel is an Associate Professor of Internal Medicine and Pediatrics, Division of Hematology/Oncology at the Simmons Cancer Institute at Southern Illinois University School of Medicine and an Adjunct Assistant Professor of Pathology in the Division of Transfusion Medicine at Johns Hopkins University. In addition, she serves as the Medical Director of ImpactLife, formerly known as the Mississippi Valley Regional Blood Center.
Dr. Goel is a practicing hematologist/oncologist as well as a transfusion medicine physician, and she is actively engaged in research in Big Data applications in Transfusion Medicine and Pediatric and Neonatal Transfusions. She is the current chair of the Pediatric Subgroup of the International Society of Blood Transfusion (ISBT) and a participating member of the AABB Standards committee. She also serves as an invited consultant for REDS IV-pediatric longitudinal studies.
Dr. Goel has multiple accolades and awards to her name including the AABB Fenwal Annual Transfusion Medicine Scholarship Award, Paul J Stranjford Young Investigator award by the American College of Laboratory Physician and Scientists and has also received international recognition with the ISBT 2016 Harold Gunsen fellowship award.
Dr. Goel has over 70 peer reviewed publications to her name including key first author publications in some leading journals including JAMA, JAMA Surgery, Blood, Transfusion and Vox Sanguinis and has been invited to lecture nationally and internationally on topics of her research focus.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Goel nor I have any relevant financial disclosures.
Further Reading: * Main article discussed, on transfusion in ITP: Goel R et al. Platelet transfusion practices in immune thrombocytopenia related hospitalizations. Transfusion 2019;59:169-176. * MedPage Today Article: MedPage Today discussion of the above article regarding overuse of platelets in ITP. * 2015 article outlining possible danger from platelet transfusion in TTP and HIT: Goel R et al. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood (2015) 125 (9): 1470–1476. * 2019 American Society of Hematology ITP Treatment Guidelines: Neunert C et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 2019;.
Thanks to: * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 092: When Platelet Transfusion Might Not Be Wise with Ruchika Goel appeared first on Blood Bank Guy.
What’s new with Low-titer Group O Whole Blood? Dr. Mark Yazer returns to give us the latest.
Dr. Mark Yazer
In 2017, Dr. Mark Yazer appeared on this podcast to discuss the burgeoning interest in “Low-titer Group O Whole Blood (LTOWB)” for massive transfusions, particularly in trauma settings (check out that interview here). Since then, Dr. Yazer has continued to advocate for the use of LTOWB both locally in Pittsburgh and internationally through his work with the THOR-AABB Working Group. So What’s New? Since our previous interview, more data and experience are available to guide the use of whole blood for trauma transfusion. Dr. Yazer discusses why crystalloids are now frowned upon by trauma transfusion experts, updates us on the use of group A plasma in emergency transfusions, then takes a deep dive into the most up-to-date data on LTOWB in trauma transfusion. After this interview, you will understand much more about why so many trauma surgeons are excited about whole blood! There just might be a few hockey references in there, too!
Thanks to CBBS! This interview was recorded for the California Blood Bank Society’s Annual Meeting, held virtually May 21-22, 2021. I am grateful to CBBS, and especially to Elizabeth Cardwell (Executive Director), Dr. James Burner (CBBS President) and Dr. Suchi Pandey (incoming CBBS President) for allowing me to use this recording. If you live in California, you should join CBBS! If you don’t, you should really think about it (and they did not pay me anything to say so!).
Dr. Mark Yazer
In 2017, Dr. Mark Yazer appeared on this podcast to discuss the burgeoning interest in “Low-titer Group O Whole Blood (LTOWB)” for massive transfusions, particularly in trauma settings (check out that interview here). Since then, Dr. Yazer has continued to advocate for the use of LTOWB both locally in Pittsburgh and internationally through his work with the THOR-AABB Working Group. So What’s New? Since our previous interview, more data and experience are available to guide the use of whole blood for trauma transfusion. Dr. Yazer discusses why crystalloids are now frowned upon by trauma transfusion experts, updates us on the use of group A plasma in emergency transfusions, then takes a deep dive into the most up-to-date data on LTOWB in trauma transfusion. After this interview, you will understand much more about why so many trauma surgeons are excited about whole blood! There just might be a few hockey references in there, too!
Thanks to CBBS! This interview was recorded for the California Blood Bank Society’s Annual Meeting, held virtually May 21-22, 2021. I am grateful to CBBS, and especially to Elizabeth Cardwell (Executive Director), Dr. James Burner (CBBS President) and Dr. Suchi Pandey (incoming CBBS President) for allowing me to use this recording. If you live in California, you should join CBBS! If you don’t, you should really think about it (and they did not pay me anything to say so!).
Download the Transcript for This Episode
About My Guest: Dr. Mark Yazer graduated from medical school at the University of Ottawa in 2000 and completed his residency in hematological pathology at the University of Alberta in 2004. He is currently a Professor of Pathology at the University of Pittsburgh, and an associate medical director of the centralized transfusion service in Pittsburgh. He is also an adjunct Professor of Clinical Immunology at the University of Southern Denmark, and a visiting Professor of Pathology at Tel Aviv University. He has published over 250 peer reviewed papers, and is an associate editor of the journals Transfusion Medicine and Hematology. He is on the editorial board of 4 other journals. He is the co-chairman of the THOR-AABB working group. He has received grant funding from the American National Institutes of Health, the American Department of Defense, and the American military based DARPA group. He is currently a co-principal investigator of NIH R01 and R34 grants and is a collaborator on two Department of Defense grants.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Yazer nor I have any relevant financial disclosures.
Further Reading: * PAMPer Trial: Sperry JL et al. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med 2018;379:315-326 * STAT Study: Dunbar NM and Yazer MT on behalf of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative and the STAT Study Investigators. Safety of the use of group A plasma in trauma: the STAT study. Transfusion 2017;57:1879-1884. * MENGO Study: Seheult JN et al. Transfusion of blood components containing ABO-incompatible plasma does not lead to higher mortality in civilian trauma patients. Transfusion 2020;60:2517-2528 * Yazer MH et al. 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
Thanks to: * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 091: Wholly Whole Blood, the Sequel! with Mark Yazer appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
What do you do when things turn SCARY? Two expert Transfusion Medicine docs help guide you through some tough situations.
Drs Mark Fung and Jay Hudgins
Every now and then, the routine practice of Blood Banking/Transfusion Medicine gets intimidating. A difficult patient situation arises here, an impossible choice looms there. What do you do when there are no easy answers? Ask the Pros Drs Mark Fung and Jay Hudgins are expert Transfusion Medicine practitioners who have years of experience dealing with these “scary” situations! They have worked through situations tough enough to make a jack-o-lantern turn green, and they have come out stronger on the other side. They are here to help learners with ideas on how to approach some seemingly impossible situations. You will hear their thoughts on things like dealing with severe blood shortages, transfusing RhD negative females when there’s no RhD negative blood to be found, ITP patients with intracranial hemorrhage, and urgent notification of an IgA deficient patient needing transfusion (and more!). Let their experience be your opportunity to learn.
Disclaimer The opinions expressed here are just that, opinions. This educational podcast interview is not a medical consultation nor is it meant to represent the only possible options available. Please follow the guidance of local transfusion experts and regulations.
Drs Mark Fung and Jay Hudgins
Every now and then, the routine practice of Blood Banking/Transfusion Medicine gets intimidating. A difficult patient situation arises here, an impossible choice looms there. What do you do when there are no easy answers? Ask the Pros Drs Mark Fung and Jay Hudgins are expert Transfusion Medicine practitioners who have years of experience dealing with these “scary” situations! They have worked through situations tough enough to make a jack-o-lantern turn green, and they have come out stronger on the other side. They are here to help learners with ideas on how to approach some seemingly impossible situations. You will hear their thoughts on things like dealing with severe blood shortages, transfusing RhD negative females when there’s no RhD negative blood to be found, ITP patients with intracranial hemorrhage, and urgent notification of an IgA deficient patient needing transfusion (and more!). Let their experience be your opportunity to learn.
Disclaimer The opinions expressed here are just that, opinions. This educational podcast interview is not a medical consultation nor is it meant to represent the only possible options available. Please follow the guidance of local transfusion experts and regulations.
Download the Transcript for This Episode
About My Guests: Dr. Mark Fung is professor of pathology and laboratory medicine at the University of Vermont (UVM). Dr. Fung has served in various leadership capacities within the AABB and related organizations. He is the immediate past chair of the AABB Hemovigilance Committee, and a past chair of the AABB Clinical Transfusion Medicine Committee. He also serves in leadership positions in the Biomedical Excellence for Safer Transfusion (BEST) research collaborative, and in the International Collaborative for Transfusion Medicine Guidelines (ICTMG). He was the editor-in-chief for the 18th and 19th editions of the AABB Technical Manual, and is on the editorial board for the journal Transfusion.
Dr. Jay Hudgins is the medical director of the tissue and transfusion medicine service at Los Angeles County Medical Center at USC and an assistant professor of clinical pathology at Keck School of Medicine. Jay graduated from Philadelphia College of Osteopathic Medicine. He then went on to complete his training in clinical Pathology at Rutgers-Robert Wood Johnson Medical Center, followed by a transfusion medicine fellowship at The Cleveland Clinic. He Joined the faculty at USC in 2015 and has served in his current post since 2018.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guests and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither my guests nor I have any relevant financial disclosures.
Further Reading: * Is IgA anaphylaxis a real thing?: Sandler SG et al. The entity of immunoglobulin A-related anaphylactic transfusion reactions is not evidence-based. Transfusion 2015;55:199-204. * Platelet transfusion practice in ITP: Goel R et al. Platelet transfusion practices in immune thrombocytopenia related hospitalizations. Transfusion 2019;59:169-176. * Using Rh Immune Globulin after RhD-incompatible RBC transfusion: Ayache S and Herman JH. Prevention of D sensitization after mismatched transfusion of blood components: Toward optimal use of RhIG. Transfusion 2008;48:1990-1999. * It’s ok to use group A plasma in trauma settings: Dunbar, NM et al. Safety of the use of group A plasma in trauma: the STAT study. Transfusion 2017;57:1879-1884.
Thanks to: * Dr. Daniela Hermelin, Assistant Editor; Follow Daniela on Twitter for fantastic #blooducation! * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 086CE: Scary Stories from the Transfusion Service with Mark Fung & Jay Hudgins appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Platelet transfusion decisions are too important to be made by looking at just one number. Joe Sweeney wants to show you a better way!
Dr. Joe Sweeney
Far too many platelet transfusion decisions are made by evaluating a single laboratory value (the platelet count). Dr. Joe Sweeney believes we need more information to make better choices. Better Information Means Better Decisions Platelet transfusion decisions can be complex, and there is wide practice variability both within institutions and among different subspecialty services. In this wide-ranging, very practical interview, Dr. Sweeney describes current platelet transfusion guidelines and a more thorough approach to caring for thrombocytopenic patients. More importantly, he helps us understand the questions we should be asking, whether we are in charge of transfusing a patient or reviewing someone else’s transfusion decisions.
Dr. Joe Sweeney
Far too many platelet transfusion decisions are made by evaluating a single laboratory value (the platelet count). Dr. Joe Sweeney believes we need more information to make better choices. Better Information Means Better Decisions Platelet transfusion decisions can be complex, and there is wide practice variability both within institutions and among different subspecialty services. In this wide-ranging, very practical interview, Dr. Sweeney describes current platelet transfusion guidelines and a more thorough approach to caring for thrombocytopenic patients. More importantly, he helps us understand the questions we should be asking, whether we are in charge of transfusing a patient or reviewing someone else’s transfusion decisions.
I think it’s really important as we try to manage all blood components to shift transfusion culture, and part of that is talking to our colleagues, not the morning of the procedure when it becomes a bit of an emergency, but actually long in advance of that, you know, weeks or months in advance to go to their meetings and to talk to them about these issues and that helps a lot. It may not solve every problem, but it helps in many, many situations.
Joseph Sweeney, MD
Download the Transcript for This Episode
About My Guest: Dr. Joseph Sweeney received his Medical Degree from the National University of Ireland and trained in Internal Medicine and Hematology in Dublin, Ireland. He subsequently trained in New York in Clinical Hematology, Blood Banking and Medical Oncology. He is a former Medical Director of the Hemophilia Center and Medical Director of the Blood Bank at Roswell Park Cancer Center in Buffalo and former Chief Medical Officer and Head of Research at the American Red Cross in Norfolk, Virginia. He is now Professor of Pathology and Laboratory Medicine and Director of Transfusion Medicine and Coagulation at Brown University.
Dr Sweeney is Board Certified in Internal Medicine, Hematology and Blood Banking. He is a Fellow of the American College of Physicians; a Fellow of the Royal College of Pathologists (UK) and a Fellow of the Royal College of Physicians of Ireland in the Faculty of Pathology. Dr. Sweeney has extensive experience and expertise in Transfusion Medicine: He has edited two books, written several book chapters and over 230 scientific papers and abstracts. He has served as a member of the Technical Committee of the AABB, and currently serves on the editorial board of Transfusion, and is a reviewer for several Journals including the American Journal of Clinical Pathology and Vox Sanguinis.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Sweeney nor I have any relevant financial disclosures.
Further Reading: * Gaydos LA et al. The Quantitative Relation between Platelet Count and Hemorrhage in Patients with Acute Leukemia. N Engl J Med 1962;266:905-909 * Kaufman RM et al. Platelet Transfusion: A Clinical Practice Guideline from the AABB Platelet Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med 2015;162(3):205-213 * Schiffer CA et al. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Practice Guideline Update. J Clin Oncol 2018;36(3):283-299 * Gehrie EA et al. One-unit compared to two-unit transfusions for adult oncology outpatients. Vox Sanguinis 2019;114:517-522 * Wallace MJ et al. Transjugular Liver Biopsy in Patients with Hematologic Malignancy and Severe Thrombocytopenia. J Vasc Interv Radiol 2003;14:323-327 * Patel IJ et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations. J Vasc Interv Radiol 2019;30:1168-1184 * Baharoglu MI et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016;25:2605-2613
Thanks to: * Dr. Daniela Hermelin, Assistant Editor; Follow Daniela on Twitter for fantastic #blooducation! * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 078CE: Does That Patient REALLY Need Platelets? with Joe Sweeney appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Irradiation prevents TA-GHVD, a lethal transfusion complication. But does it really do what you think it does?
Dr. Chris Tormey
Transfusion-associated Graft-versus-Host Disease (TA-GVHD) is a notoriously deadly but thankfully rare transfusion complication. Blood banks have used irradiation of cellular blood products for decades to prevent TA-GVHD, but clinicians and laboratorians still sometimes misunderstand what irradiation does and does not do. Irradiation Made Simple Dr. Chris Tormey, co-author of an incredibly helpful 2018 article in Archives of Pathology and Laboratory Medicine on this topic, is my guest on today’s interview (I’m not kidding about it being a great article! See the reference below because you really need this one). Chris details the past, present, and future of blood product irradiation in this practical and timely interview. Learners will benefit from the “exam-worthy” details, and even “seasoned pros” will be reminded of important facts about irradiation to improve what you do today!
Dr. Chris Tormey
Transfusion-associated Graft-versus-Host Disease (TA-GVHD) is a notoriously deadly but thankfully rare transfusion complication. Blood banks have used irradiation of cellular blood products for decades to prevent TA-GVHD, but clinicians and laboratorians still sometimes misunderstand what irradiation does and does not do. Irradiation Made Simple Dr. Chris Tormey, co-author of an incredibly helpful 2018 article in Archives of Pathology and Laboratory Medicine on this topic, is my guest on today’s interview (I’m not kidding about it being a great article! See the reference below because you really need this one). Chris details the past, present, and future of blood product irradiation in this practical and timely interview. Learners will benefit from the “exam-worthy” details, and even “seasoned pros” will be reminded of important facts about irradiation to improve what you do today!
Download the Transcript for This Episode
About My Guest: Chris Tormey, MD, is a pathologist who is board-certified in Clinical Pathology as well as Blood Banking/Transfusion Medicine. He is an Associate Professor in the Department of Laboratory Medicine at Yale University in New Haven, CT. He serves as Medical Director of Transfusion Services at both Yale-New Haven Hospital in New Haven, CT and VA Connecticut Healthcare in West Haven, CT; he also provides clinical pathology and laboratory hematology services at Yale-New Haven Hospital. Dr. Tormey is the Director of the Transfusion Medicine fellowship program at Yale, and teaches students, residents, and fellows at the Yale School of Medicine.
Chris has several investigative interests, including alloimmunization to non-ABO antigens in the settings of transfusion or pregnancy. He is widely published, and has won several awards for his research and teaching efforts. In 2014, the American Society for Clinical Pathology named him to the prestigious “40 under Forty” list of outstanding young leaders in pathology.
Dr. Tormey is a graduate of New York Medical College and trained in Clinical Pathology and Blood Banking/Transfusion Medicine at Yale.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Tormey nor I have any relevant financial disclosures.
Further Reading: * Irradiation article discussed in this episode: Bahar B and Tormey CA. Prevention of Transfusion-Associated Graft-Versus-Host Disease with Blood Product Irradiation: The Past, Present, and Future. Arch Pathol Lab Med 2018;142:662-667. * British Guidelines on Irradiation: Treleaven J et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Brit J Haem 2011;152:35-51. * UPDATED British Guidelines on Irradiation: Foukaneli T et al. Guidelines on the use of irradiated blood components. Brit J Haem 2020;191:704-724. * Canadian Review article mentioned during the interview: Kopolovic I et al. A systematic review of transfusion-associated graft-versus-host disease. Blood 2015;126(3):406-414.
Image courtesy of LifeStream Blood Bank, San Bernardino, CA. Thanks to: * Dr. Daniela Hermelin, Assistant Editor; Follow Daniela on Twitter for fantastic #blooducation! * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 074CE: Radioactive! with Chris Tormey appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
What if everything we THOUGHT we knew about neonatal platelet transfusion is wrong?
Dr. Martha Sola-Visner
Neonates are one of the most heavily transfused populations in the hospital. In fact, the more premature the baby, the more likely that neonate will have thrombocytopenia. A low platelet count makes it more likely that neonate will bleed into his/her head (i.e., intracranial hemorrhage), with potentially disastrous results. For decades, our response to this problem has been simple: Give the baby platelets! But what if that’s NOT the right answer? A recent large trial on neonatal platelet transfusion was published in the New England Journal of Medicine in early 2019 (co-authors Anna Curley and Simon Stanworth and group; see reference below). This study, known as “PlaNet-2,” should make us all question old ideas about when neonates need platelet transfusion. My guest on this episode, Dr. Martha Sola-Visner, has made studying the effect of “adult” platelet transfusions on neonates the focus of much of her extensive research as a neonatologist. Martha is here to explain key takeaways from PlaNet-2, and discuss where we need to go next. Get ready to have some assumptions challenged!
Dr. Martha Sola-Visner
Neonates are one of the most heavily transfused populations in the hospital. In fact, the more premature the baby, the more likely that neonate will have thrombocytopenia. A low platelet count makes it more likely that neonate will bleed into his/her head (i.e., intracranial hemorrhage), with potentially disastrous results. For decades, our response to this problem has been simple: Give the baby platelets! But what if that’s NOT the right answer? A recent large trial on neonatal platelet transfusion was published in the New England Journal of Medicine in early 2019 (co-authors Anna Curley and Simon Stanworth and group; see reference below). This study, known as “PlaNet-2,” should make us all question old ideas about when neonates need platelet transfusion. My guest on this episode, Dr. Martha Sola-Visner, has made studying the effect of “adult” platelet transfusions on neonates the focus of much of her extensive research as a neonatologist. Martha is here to explain key takeaways from PlaNet-2, and discuss where we need to go next. Get ready to have some assumptions challenged!
Download the Transcript for This Episode
About My Guest: Martha Sola-Visner, MD is an Associate Professor of Pediatrics at Harvard and Boston Children’s Hospital, and Director of Newborn Medicine Clinical Research at Boston Children’s Hospital. She is board-certified in Neonatal-Perinatal Medicine, and serves as an editorial board member for the journal JAMA Pediatrics.
Martha has spent her career focusing on studying neonatal hematologic disorders, with an emphasis on platelet disorders. Her laboratory has been responsible for breakthrough studies describing differences between adult and neonatal platelet production and lifespan, and her recent work has shed new light on the problems that can ensue when “adult” platelets are transfused to neonates.
Dr. Sola-Visner has authored or co-authored over 70 publications in peer-reviewed journals, and her research has been supported by numerous NIH/NHLBI grants throughout her career.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
Quick quiz:
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Sola-Visner nor I have any relevant financial disclosures.
Further Reading: * PlaNet-2 Trial discussed in this interview: Curley A, Stanworth S et al. Randomized Trial of Platelet-Transfusion Thresholds in Neonates. N Engl J Med 2019;380:242-251 (journal access required). * Dr. Sola-Visner’s editorial accompanying PlaNet-2: Sola-Visner M. Platelet Transfusions in Neonates — Less Is More. N Engl J Med 2019;380:287-288 (journal access required). * Josephson CD et al. Platelet Transfusion Practices Among Neonatologists in the United States and Canada: Results of a Survey. Pediatrics 2009:123(1):278-285. * Cremer M et al. Platelet transfusions in neonates: practices in the United States vary significantly from those in Austria, Germany, and Switzerland. Transfusion 2011;51:2634-2641 (journal access required). * Sparger KA, et al. Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants. JAMA Pediatr. 2016;170(7):687–694. * Stanworth SJ, et al. Prospective, Observational Study of Outcomes in Neonates With Severe Thrombocytopenia. Pediatrics 2009:124(5):e826-e834 (journal access required). * Patel RM et al. Platelet transfusions and mortality in necrotizing enterocolitis. Transfusion 2019;59(3):981-988 (journal access required).
Thanks to: * Dr. Daniela Hermelin, Assistant Editor; Please follow Daniela on Twitter for fantastic #blooducation! * Samantha Chaffin, Design and content consultant
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 072CE: Neonatal Platelet Transfusion with Martha Sola-Visner appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Despite “matching,” harmful RBC alloantibodies sickle cell disease patients still happen. Are we doing enough?
Dr. Stella Chou
Alloimmunization after red blood cell (RBC) transfusion presents an ongoing challenge in the treatment of sickle cell disease (SCD). Even when donors and patients are matched using traditional serologic strategies, anti-Rh antibodies in patients with sickle cell disease are formed way often than we would like or expect! A Pediatric Hematologist Weighs In Dr. Stella Chou, an expert pediatric hematologist, has spent most of her career improving methods to match red cells in patients with SCD. She noted early on that some of her patients who she didn’t think should make Rh antibodies did so! For example, she saw E-negative patients with SCD form anti-E antibodies even though they had received blood from donors who were also E-negative. This happened despite her patients receiving blood from “matched” African-American blood donors. Most importantly, in many cases, these antibodies led to delayed hemolytic transfusion reactions. This is a big problem, and we should all wonder, “Are we doing enough?”
Preventing Alloantibodies in Sickle Cell Patients Stella and her co-authors (including Connie Westhoff, who has spoken about Rh genotyping on this podcast in the past), reported these surprising finding in 2013 (reference below). In this interview, she discusses how incredibly common variant RH alleles are in patients with SCD and minority blood donors, and how those variants contribute to Rh alloimmunization. She also describes innovative strategies that may hold the key to reducing alloimmunization using RH genetic matching of donors and patients in the future.
Dr. Stella Chou
Alloimmunization after red blood cell (RBC) transfusion presents an ongoing challenge in the treatment of sickle cell disease (SCD). Even when donors and patients are matched using traditional serologic strategies, anti-Rh antibodies in patients with sickle cell disease are formed way often than we would like or expect! A Pediatric Hematologist Weighs In Dr. Stella Chou, an expert pediatric hematologist, has spent most of her career improving methods to match red cells in patients with SCD. She noted early on that some of her patients who she didn’t think should make Rh antibodies did so! For example, she saw E-negative patients with SCD form anti-E antibodies even though they had received blood from donors who were also E-negative. This happened despite her patients receiving blood from “matched” African-American blood donors. Most importantly, in many cases, these antibodies led to delayed hemolytic transfusion reactions. This is a big problem, and we should all wonder, “Are we doing enough?”
Preventing Alloantibodies in Sickle Cell Patients Stella and her co-authors (including Connie Westhoff, who has spoken about Rh genotyping on this podcast in the past), reported these surprising finding in 2013 (reference below). In this interview, she discusses how incredibly common variant RH alleles are in patients with SCD and minority blood donors, and how those variants contribute to Rh alloimmunization. She also describes innovative strategies that may hold the key to reducing alloimmunization using RH genetic matching of donors and patients in the future.
Download the Transcript for This Episode
About My Guest: Dr. Stella Chou is an Associate Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She practices Pediatric Hematology and Transfusion Medicine at The Children’s Hospital of Philadelphia with a particular interest in patients with Sickle Cell Disease. Her work has demonstrated that inheritance of variant blood group antigens in patients with Sickle Cell Disease contributes to their high rate of red cell antibody formation.
Dr. Chou’s research interests include improving red blood cell matching for patients using innovative tools. Her research laboratory uses induced pluripotent stem cells (iPSCs) and primary human cells to model blood diseases and study their underlying pathophysiology. Her ongoing work focuses on creating customized iPSCs with rare blood group antigen combinations as renewable sources of red cell reagents to improve antibody identification and donor red cell matching. Since transfusion therapy remains a critical treatment for hemoglobinopathies, her goal is to identify new approaches to minimize alloimmunization, reduce complications and improve therapy.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Chou nor I have any relevant financial disclosures.
Further Reading: * 2013 study showing shockingly high rates of antibodies in patients with sickle cell disease transfused with matched RBCs from minority blood donors: Chou ST et al. High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood 2013;122(6):1062-1071. * 2018 study reporting on rates of RH variants in African-American blood donors AND feasibility of a genotype-matched donor pool: Chou ST et al. RH genotype matching for transfusion support in sickle cell disease. Blood 2018;132(11):1198-1207. * 2019 study detailing the underrecognition of delayed hemolytic reactions in patients with sickle cell disease after alloimmunization: Coleman S et al. Alloimmunization in patients with sickle cell disease and underrecognition of accompanying delayed hemolytic transfusion reactions. Transfusion 2019 (early view).
Thanks to: * Dr. Daniela Hermelin, Assistant Editor; Please follow Daniela on Twitter for fantastic #blooducation!
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 070CE: Preventing Alloantibodies in Sickle Cell Disease with Stella Chou appeared first on Blood Bank Guy.
Cardiac surgery can be scary for blood banks! A busy cardiac surgeon pulls back the curtain on what is really happening in the OR for your ears only.
Dr. Pierre Tibi
Most blood bankers will tell you that cardiac surgery can lead to some of the most intense interactions between a transfusion service and an operating room. Over the decades, we have seen wide variations in how much blood heart surgeons transfuse, even among those practicing in the same hospital! Those times are changing, however. Can Blood Management and Heart Surgery Coexist? Pierre Tibi is a busy cardiac surgeon in Arizona who also happens to be a patient blood management champion! In addition to his practice, he is also president of an international organization dedicated to patient blood management that you have heard of if you’ve listened to this podcast before: The Society for the Advancement of Blood Management (SABM). Pierre has been incorporating blood management principles into his practice for a couple of decades now (since before there even was a patient blood management “movement”), and he is a firm believer that cardiac surgery absolutely CAN be done using a respectful approach to transfusion.
Pierre outlines how he has transfused less than 10% of his cardiac surgery patients for a number of years. Yes, you read that right, and yes, that does include “re-do” operations (to be fair, Pierre does not perform cardiac transplant surgery). He explains steps that surgeons can take both before, during, and after heart surgery to allow for wiser transfusion choices. This interview is stuffed with great information!
Dr. Pierre Tibi
Most blood bankers will tell you that cardiac surgery can lead to some of the most intense interactions between a transfusion service and an operating room. Over the decades, we have seen wide variations in how much blood heart surgeons transfuse, even among those practicing in the same hospital! Those times are changing, however. Can Blood Management and Heart Surgery Coexist? Pierre Tibi is a busy cardiac surgeon in Arizona who also happens to be a patient blood management champion! In addition to his practice, he is also president of an international organization dedicated to patient blood management that you have heard of if you’ve listened to this podcast before: The Society for the Advancement of Blood Management (SABM). Pierre has been incorporating blood management principles into his practice for a couple of decades now (since before there even was a patient blood management “movement”), and he is a firm believer that cardiac surgery absolutely CAN be done using a respectful approach to transfusion.
Pierre outlines how he has transfused less than 10% of his cardiac surgery patients for a number of years. Yes, you read that right, and yes, that does include “re-do” operations (to be fair, Pierre does not perform cardiac transplant surgery). He explains steps that surgeons can take both before, during, and after heart surgery to allow for wiser transfusion choices. This interview is stuffed with great information!
Download the Transcript for This Episode
About My Guest: Pierre Tibi, MD received his Bachelors of Science in Neurosciences from the University of Rochester and his MD from the University of Pittsburgh. He is board-certified in General and Cardiothoracic Surgery after completing both residencies at The University of Rochester.
Dr. Tibi began practice in Phoenix, AZ, and was Managing Partner of Phoenix Cardiac Surgery (PCS) and Chief of Cardiothoracic Surgery at Good Samaritan Medical Center from 1996-2007. In 2007, Pierre founded the open-heart program at Yavapai Regional Medical Center in Prescott, AZ, and is currently Chair of the Cardiovascular Department there. He remains President of PCS, which provides cardiothoracic services throughout Arizona.
Dr. Tibi has had a long interest in Patient Blood Management (PBM) and has developed such programs in hospitals throughout Arizona. He lectures both nationally and internationally on PBM and is currently President of The Society for the Advancement of Blood Management.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Tibi nor I have any relevant financial disclosures.
Further Reading: * TITRe-2 Study: Murphy GJ et al. Liberal or Restrictive Transfusion after Cardiac Surgery. New Engl J Med 2015;372:997-1008. * TRICS III Study Initial Report: Mazer CD et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. New Engl J Med 2017;377:2133-2144. * TRICS III Study Follow-up Report: Mazer CD et al. Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery. New Engl J Med 2018;379:1224-1233.
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 068: Transfusion in Cardiac Surgery with Pierre Tibi appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Your Patient Blood Management program can be so much more! Carolyn Burns shows you how to make wiser PBM choices today.
Dr. Carolyn Burns
It feels like everyone is talking about patient blood management (PBM) nowadays! While that’s a very good thing, many facilities may be missing the mark with their programs by focusing on only one or two aspects of PBM. In 2018, the Society for the Advancement of Blood Management (SABM) published “Five Things Physicians and Patients Should Question” about blood and transfusion through the “Choosing Wisely” campaign from the ABIM Foundation. This document (which you should download now. Seriously. Get it now!) outlines five really common hospital practices that should be addressed in any PBM program (and I’m willing to bet that most facilities are not addressing all of them). Backing Up For a Second There’s a pretty good chance that whatever your PBM program looks like, it could do much MORE. If you are monitoring transfusions for appropriateness, for example, how about diagnosing anemia earlier so that transfusion isn’t needed at all? Or what about using antifibrinolytics to stop bleeding before a patient even gets to the point of transfusion? Or, and this is a big one, does that patient REALLY need those daily lab draws? All of these issues (and more) are things that SABM believes all facilities should do better, and that’s the point of this interview.
My friend Dr. Carolyn Burns is a SABM Board Member, and an independent consultant for Patient Blood Management initiatives. She was intimately involved in developing the Choosing Wisely document. Carolyn joins me for a quick-moving discussion of some overall philosophies of PBM, and discusses each of the five questionable practices in detail.
Dr. Carolyn Burns
It feels like everyone is talking about patient blood management (PBM) nowadays! While that’s a very good thing, many facilities may be missing the mark with their programs by focusing on only one or two aspects of PBM. In 2018, the Society for the Advancement of Blood Management (SABM) published “Five Things Physicians and Patients Should Question” about blood and transfusion through the “Choosing Wisely” campaign from the ABIM Foundation. This document (which you should download now. Seriously. Get it now!) outlines five really common hospital practices that should be addressed in any PBM program (and I’m willing to bet that most facilities are not addressing all of them). Backing Up For a Second There’s a pretty good chance that whatever your PBM program looks like, it could do much MORE. If you are monitoring transfusions for appropriateness, for example, how about diagnosing anemia earlier so that transfusion isn’t needed at all? Or what about using antifibrinolytics to stop bleeding before a patient even gets to the point of transfusion? Or, and this is a big one, does that patient REALLY need those daily lab draws? All of these issues (and more) are things that SABM believes all facilities should do better, and that’s the point of this interview.
My friend Dr. Carolyn Burns is a SABM Board Member, and an independent consultant for Patient Blood Management initiatives. She was intimately involved in developing the Choosing Wisely document. Carolyn joins me for a quick-moving discussion of some overall philosophies of PBM, and discusses each of the five questionable practices in detail.
To me, the use of plasma outside of an exsanguinating hemorrhage protocol or for therapeutic plasma exchange for TTP…isolated orders for plasma should be questioned. They should be thought about very, very carefully, because most often they’re not needed.
Carolyn Burns, MD
Download the Transcript for This Episode
About My Guest: Carolyn Burns, MD is a Board-certified Anatomic and Clinical Pathologist. After earning her Microbiology degree from the University of Kansas, and her MD from the University of Missouri, Dr. Burns completed an internship in General Surgery followed by Pathology residency at the University of Louisville. She was Chief of Pathology for the Jewish Hospital Healthcare System Department of Pathology in Louisville, KY from 1991-2011. She has previously been an Assistant Clinical Professor in the Dept. of Pathology at the University of Louisville and on the Advisory Board and guest lecturer for the Bellarmine University Clinical Laboratory Science Program. Carolyn currently serves as a physician advisor for the American Red Cross Blood Center, River Valley Region.
Dr. Burns is an active member of several medical societies including AABB, College of American Pathologists, American Society of Clinical Pathologists (where she serves on the Education Committee), and the Society for the Advancement of Blood Management (SABM) where she serves on the Board as Treasurer and is the editor of the SABM Newsletter. Dr. Burns is a board member, as well, for the Kentucky Association of Blood Banks.
Dr. Burns is a passionate advocate for Patient Blood Management, has been published in peer-reviewed journals and textbooks, and is often sought as an engaging speaker on diverse transfusion topics.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Burns nor I have any relevant financial disclosures.
Further Reading: * SABM Choosing Wisely List: From the SABM site. * Consensus statement on pre-operative iron-deficiency anemia: Muñoz M et al. International consensus statement on the peri‐operative management of anaemia and iron deficiency. Anaesthesia 2017;72:233-247. * CRASH-2 Trial: Summary in pdf book form * WOMAN Trial: WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017;389:2105-2116. * Article in 2002 Forming foundation of Choosing Wisely: Medical Professionalism in the New Millennium: A Physician Charter. Ann Intern Med. 2002;136:243-246.
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 067CE: Wiser Blood Management Choices with Carolyn Burns appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Blood shortages and inventory problems occur all too often. Nancy Dunbar says we need a few simple adjustments to “the rules” about O-negative RBCs, AB plasma, and apheresis platelets.
Dr. Nancy Dunbar
In many ways, the patient blood management movement has made a large difference in how blood banks transfuse products. Clinicians are making evidence-based choices to avoid transfusion for patients without a clear indications to transfuse. In fact, it seems like the U.S. and other countries report every other year or so that use is down another 10 to 15%. Such a decrease would have to make our lives as blood bankers much easier, wouldn’t it? Declining Donations The story is not that simple. In the face of the overall decline in blood product usage, there has been a parallel decline in blood donations. The reasons for this change are unclear. Most blood collectors are NOT saying, “Hey, we don’t need as much as before, so let’s try to collect less!” Rather, blood centers are scrambling to even keep up with the decreased demand.
When Less is More In addition to declining collections, the proportion of “special” blood products requested by hospitals has actually increased. Blood centers see this with O-negative red cell and AB plasma orders especially. For example, a hospital may ask for 10% fewer red blood cells than in previous years (good news), but the proportion of O-negative RBCs might be increased, say to 12% of the total RBC order (not so good news). Unfortunately, the percentage of U.S. O-negative blood donors hovers at just over 8%. This “disconnect” between supply and demand sets us up for frequent, recurring “shortages” of those products in everyday practice.
So, What Can We Do? Nancy Dunbar is medical director of a large, very busy academic transfusion service that happens to be quite rural in location. She has learned to be creative with managing her inventory by necessity. Nancy is here to share some tips on how transfusion services everywhere can make simple adjustments to “the rules” and significantly increase the efficiency with which we use O-negative RBCs, AB plasma, and apheresis platelets.
Dr. Nancy Dunbar
In many ways, the patient blood management movement has made a large difference in how blood banks transfuse products. Clinicians are making evidence-based choices to avoid transfusion for patients without a clear indications to transfuse. In fact, it seems like the U.S. and other countries report every other year or so that use is down another 10 to 15%. Such a decrease would have to make our lives as blood bankers much easier, wouldn’t it? Declining Donations The story is not that simple. In the face of the overall decline in blood product usage, there has been a parallel decline in blood donations. The reasons for this change are unclear. Most blood collectors are NOT saying, “Hey, we don’t need as much as before, so let’s try to collect less!” Rather, blood centers are scrambling to even keep up with the decreased demand.
When Less is More In addition to declining collections, the proportion of “special” blood products requested by hospitals has actually increased. Blood centers see this with O-negative red cell and AB plasma orders especially. For example, a hospital may ask for 10% fewer red blood cells than in previous years (good news), but the proportion of O-negative RBCs might be increased, say to 12% of the total RBC order (not so good news). Unfortunately, the percentage of U.S. O-negative blood donors hovers at just over 8%. This “disconnect” between supply and demand sets us up for frequent, recurring “shortages” of those products in everyday practice.
So, What Can We Do? Nancy Dunbar is medical director of a large, very busy academic transfusion service that happens to be quite rural in location. She has learned to be creative with managing her inventory by necessity. Nancy is here to share some tips on how transfusion services everywhere can make simple adjustments to “the rules” and significantly increase the efficiency with which we use O-negative RBCs, AB plasma, and apheresis platelets.
I tell clinicians, “You’re going to get group O uncrossmatched blood when you have a patient who’s exsanguinating, and it might be Rh-negative and it might be Rh-positive. That’s really my call, and so just trust me to do my job.” Nancy Dunbar, MD
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About My Guest: Nancy Dunbar, MD, is Medical Director of the Blood Bank at Dartmouth-Hitchcock Medical Center in Lebanon, NH. She is an Associate Professor of Pathology and Laboratory Medicine at Dartmouth, and she is the associate Program Director for both the Pathology Residency Program and the Transfusion Medicine Fellowship.
Dr. Dunbar is a very active researcher, and has received numerous honors for her scholarly activities. She has published over 50 original articles and reviews in Transfusion Medicine journals, and has authored several chapters in standard textbooks (including the AABB Technical Manual). She teaches regularly to learners at Dartmouth and numerous other facilities.
FREE Continuing Education! This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E.® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
To receive credit and review the accreditation information and related disclosures, please visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Dunbar has received honoraria from Verax Biomedical for service on their medical advisory board. Dr. Chaffin has no relevant financial disclosures.
Further Reading: * O negative Red Blood Cell Use: + Zeller MP et al. An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study. Transfusion 2017;57;2329–2337. + Dunbar NM et al. O– product transfusion, inventory management, and utilization during shortage: the OPTIMUS study. Transfusion 2018;58:1348-1355.
- Group A Plasma Use:
- Dunbar NM et al. A possible new paradigm? A survey-based assessment of the use of thawed group A plasma for trauma resuscitation in the United States. Transfusion 2016;56;125–129.
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Dunbar NM, Yazer MH, et al. Safety of the use of group A plasma in trauma: the STAT study. Transfusion 2016;56;125–129.
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Platelet Use Strategies:
- Dunbar NM et al. Easier said than done: ABO compatibility and D matching in apheresis platelet transfusions. Transfusion 2015;55;1882–1888.
- Dunbar NM et al. ABO incompatible platelets: risks versus benefit. Curr Opin Hematol 2012;19:475–479.
- Lozano M et al. Practices associated with ABO-incompatible platelet transfusions: a BEST Collaborative international survey. Transfusion 2010;50:1743-1748.
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Ruby KN et al. Bacterial screening of apheresis platelets with a rapid test: a 113‐month single center experience. Transfusion 2018;58:1665-1669.
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Counter-arguments Against ABO Incompatible Platelets:
- Blumberg N et al. ABO matching of platelet transfusions – “Start Making Sense.” Blood Transfus 2015;13:347-50.
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Henrichs KF et al. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Transfusion 2012;52:635-640.
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One of my Favorite Articles on Blood Supply & Demand:
- Beckman N et al. Blood banks meet the paradox of Gabriel’s Horn: what are the options to maintain supply as demand decreases? Transfusion Med 2016;26;170-176.
Music Credit Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
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