BBGuy Podcast Archives - Blood Bank Guy: Recent Episodes
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Supporting HPC transplant patients can be challenging and confusing to learners.Dr. Brian Adkins
More and more patients are undergoing hematopoietic progenitor cell transplant (aka, “hematopoietic stem cell transplant”) for a wide variety of conditions and diseases. Managing their transfusion needs can be challenging, and especially when the HPC transplant donor is of a different ABO type than the recipient, things can get really confusing.Let’s clear it all up!I asked Dr. Brian Adkins, lead author of an excellent review of transfusion before and after HPC transplant (article linked below) to guide us to better understanding, In this episode, Brian discusses things like the different types of stem cell transplants (autologous and allogeneic), the importance of HLA and ABO matching, and the steps involved in collecting and preparing grafts. We also describe the various sources of stem cells (peripheral blood, bone marrow, and umbilical cord blood) and the pros and cons of each. Additionally, Brian addresses practical issues like pre-transfusion testing, the management of ABO incompatible transplants, and the inevitable need for transfusion support during the engraftment period. Near the end, we even describe how to make decisions following an ABO-incompatible HPC transplant.
Dr. Brian Adkins
More and more patients are undergoing hematopoietic progenitor cell transplant (aka, “hematopoietic stem cell transplant”) for a wide variety of conditions and diseases. Managing their transfusion needs can be challenging, and especially when the HPC transplant donor is of a different ABO type than the recipient, things can get really confusing.Let’s clear it all up!I asked Dr. Brian Adkins, lead author of an excellent review of transfusion before and after HPC transplant (article linked below) to guide us to better understanding, In this episode, Brian discusses things like the different types of stem cell transplants (autologous and allogeneic), the importance of HLA and ABO matching, and the steps involved in collecting and preparing grafts. We also describe the various sources of stem cells (peripheral blood, bone marrow, and umbilical cord blood) and the pros and cons of each. Additionally, Brian addresses practical issues like pre-transfusion testing, the management of ABO incompatible transplants, and the inevitable need for transfusion support during the engraftment period. Near the end, we even describe how to make decisions following an ABO-incompatible HPC transplant.
About My Guest:Dr. Brian Adkins is an Assistant Professor of Pathology at the University of Texas Southwestern Medical Center. He serves as the Medical Director of Transfusion and Tissue Services at Children’s Health Dallas. He attended medical school at the Joan C. Edwards School of Medicine at Marshall University and completed his Anatomic Pathology/Clinical Pathology residency at Vanderbilt University Medical Center. He went on to complete fellowship training in Blood Banking/Transfusion Medicine and Hematopathology at University of Virginia Health. He is board- certified in Anatomic Pathology and Clinical Pathology with subspecialty certification in Blood Banking/Transfusion Medicine and Hematopathology. His interests include resident and fellow education as well as clinical research.
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. Adkins nor I have any relevant financial disclosures.
Further Reading: Excellent review article mentioned in the episode: Adkins BD et al. Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review. Clinical Hematology International 2024;6(1):128-140. * AABB RBC transfusion guidelines mentioned in episode: Carson JL et al. Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA 2023;330(19):1892-1902. 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.Music Credit*Music for this episode includes “Reflejo” by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
The post 104: Essentials of Transfusion Support in HPC Transplant with Brian Adkins appeared first on Blood Bank Guy.
It’s a “no blood banking episode!” Let’s have fun with the Glaucomfleckens!Will and Kristin Flanary
OK, I’ll tell you right up front: This is NOT an episode that will increase your knowledge of blood banking/transfusion medicine in any way! Instead, this one is about taking ourselves a little less seriously, and hey, laughing a little!Glaucomflecken TimeDr. Will Flanary is an ophthalmologist who moonlights as the hilarious “Dr. Glaucomflecken” on social media (TikTok in particular). In a series of short videos that many of you have surely seen, he pokes gentle fun at physicians of many specialties, including pathologists. Will and his wife Kristin (aka “Lady Glaucomflecken”) have quite a story that I think you will really enjoy hearing. So, for today, turn off those “blood bank learning” ears and sit back and enjoy a fun conversation with one of the funniest doctors you will ever hear and his heroic wife!
Helpful Links
Glaucomflecken web site
Dr. Glaucomflecken videos about pathologists and the lab:* First Day of Pathology (Med student visit)
* How to Ace your Pathology Residency Interview
* The Pathologist Goes to Therapy
* Bill Visits the Lab
“Knock Knock, Hi!” Podcast on Apple Podcasts, Spotify, or Google Podcasts
Will and Kristin Flanary
OK, I’ll tell you right up front: This is NOT an episode that will increase your knowledge of blood banking/transfusion medicine in any way! Instead, this one is about taking ourselves a little less seriously, and hey, laughing a little!Glaucomflecken TimeDr. Will Flanary is an ophthalmologist who moonlights as the hilarious “Dr. Glaucomflecken” on social media (TikTok in particular). In a series of short videos that many of you have surely seen, he pokes gentle fun at physicians of many specialties, including pathologists. Will and his wife Kristin (aka “Lady Glaucomflecken”) have quite a story that I think you will really enjoy hearing. So, for today, turn off those “blood bank learning” ears and sit back and enjoy a fun conversation with one of the funniest doctors you will ever hear and his heroic wife!
Helpful Links
Glaucomflecken web site
Dr. Glaucomflecken videos about pathologists and the lab:* First Day of Pathology (Med student visit)
* How to Ace your Pathology Residency Interview
* The Pathologist Goes to Therapy
* Bill Visits the Lab
“Knock Knock, Hi!” Podcast on Apple Podcasts, Spotify, or Google Podcasts
Download the Transcript for This EpisodeAbout My Guests:Dr. Will Flanary is an ophthalmologist and part-time comedian who has parlayed his personal health scares into medical-themed comedy shorts across his multiple social media platforms and has gathered a robust and engaged following of 4M+. During his 3rd year of med school, he was diagnosed with testicular cancer, and he began using humor as a coping mechanism. Following a second bout with cancer three years into his medical career, he created a Twitter account under the pseudonym “Dr. Glaucomflecken”—because it is arguably the funniest word in ophthalmology. A cardiac event and near-death experience in 2020 only fueled his creativity. Will’s comedy has evolved over time to incorporate biting satire of the US healthcare system, academic publishing, and interpersonal conflicts pervasive in the medical system. During the pandemic, his jokes and videos became a welcome reprieve from the horrors of working in healthcare for him, and for the millions of followers living through it. During that he expanded his comedy repertoire to include short skits incorporating a wide range of characters who worked at a fictional hospital called “Glaucomflecken General.” As Dr. Glaucomflecken, Dr. Flanary has collaborated with the US Surgeon General, given the 2022 Yale Medical School commencement address, and is a frequent keynote speaker worldwide where he encourages medical audiences to embrace humor in everyday life.
Kristin Flanary, MA was formally trained in cognitive neuroscience and social psychology and now works in marketing and communications. She and her ophthalmologist husband, Dr. Will Flanary, met in college at Texas Tech University before both earning advanced degrees at Dartmouth College. Kristin is best known internationally as her social media alter ego,”‘Lady Glaucomflecken,” where she shares wisdom and misadventures with her 65,000+ followers. Her stories come from her unique perspective of the healthcare system. She has been a patient, “married to medicine” through the entire medical training journey and beyond, a lay responder and CPR provider to her husband, and a caregiver and “co-survivor” of his two cancer occurrences and a sudden cardiac arrest.
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.
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 * Jessica Murray, BBGuy Assistant
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 103: Glaucomflecken! with Will and Kristin Flanary appeared first on Blood Bank Guy.
Continuing Education Episode!Continuing Education!Understanding reference lab techniques like adsorption, elution, and enzymes feels like learning a new language! Jan Hamilton is here to help you learn to speak “reference lab.”Jan Hamilton, MS, MT(ASCP)SBB
Most of the routine testing done in hospital transfusion services is quickly mastered by those learning transfusion medicine. However, when things start to get complicated, more advanced testing may be necessary, and words like “adsorption,” “elution,” and “enzymes” are spoken by the local reference laboratory.We Need a Translator!This interview will introduce some of you to Jan Hamilton, who is the manager of the Immunohematology Reference Laboratory at the American Red Cross-Southeastern Michigan Region in Detroit, Michigan (I say “some of you” because Jan’s work is pretty widely known, and many of you are already aware of how awesome she is!). Jan will help you understand more clearly how to “speak reference lab” and understand these more advanced serologic techniques. The interview also includes answers to the commonly asked question, “which testing platform is best?”
Wait, a FREE BOOK?You read that right! Jan is one of the authors of the incredibly helpful book from AABB Press, “Antibody Identification: Art or Science?”, and the AABB, along with Wiley Health Learning and Transfusion News, have arranged for you to have the chance to win a free copy of the book. See details below in the Continuing Education box!
Jan Hamilton, MS, MT(ASCP)SBB
Most of the routine testing done in hospital transfusion services is quickly mastered by those learning transfusion medicine. However, when things start to get complicated, more advanced testing may be necessary, and words like “adsorption,” “elution,” and “enzymes” are spoken by the local reference laboratory.We Need a Translator!This interview will introduce some of you to Jan Hamilton, who is the manager of the Immunohematology Reference Laboratory at the American Red Cross-Southeastern Michigan Region in Detroit, Michigan (I say “some of you” because Jan’s work is pretty widely known, and many of you are already aware of how awesome she is!). Jan will help you understand more clearly how to “speak reference lab” and understand these more advanced serologic techniques. The interview also includes answers to the commonly asked question, “which testing platform is best?”
Wait, a FREE BOOK?You read that right! Jan is one of the authors of the incredibly helpful book from AABB Press, “Antibody Identification: Art or Science?”, and the AABB, along with Wiley Health Learning and Transfusion News, have arranged for you to have the chance to win a free copy of the book. See details below in the Continuing Education box!
Download the Transcript for This EpisodeAbout My Guest:Jan Hamilton, MS, MT(ASCP)SBB is the Manager of the Immunohematology Reference Laboratory (IRL) at the American Red Cross-Southeastern Michigan Region in Detroit, Michigan. She is a member of the ISBT Immunohaematology Working Party and recently joined the journal Immunuhematology as an Associate Editor. She is past chair of the AABB IRL Accreditation Program Unit and the ACSP Board of Registry Blood Bank Examination Committee. Jan co-authored the chapter “Identification of Antibodies to Red Cell Antigens” in the 18th and 19th editions of the AABB Technical Manual. She also is co-author of “Antibody Identification: Art or Science? A Case Study Approach ,”and “Investigating Positive DAT Results: A Case Study Approach.” Her special interest is performing and teaching serological problem solving. She has been part of the Indian Immunohematology Initiative which focuses on hands-on immunohematology education in India and neighboring South Asian countries.
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 22, 2025.
Win a Free Book!!For this episode only, all those who complete the continuing education module at the links above are automatically entered into a drawing for a free book co-written by Jan Hamilton, my guest for this episode. This is true even if you are student, resident, or other learner, and you don’t yet NEED continuing education! Simply follow the directions at Transfusion News Continuing Education on Wiley Health Learning, and you may win one of two copies of “Antibody Identification: Art or Science” from AABB Press we are giving away (giveaway courtesy of AABB). The drawing will take place on Friday, July 14, 2023, and winners will be notified directly.
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 Ms. Hamilton nor I have any relevant financial disclosures.
Further Reading: Hamilton JR, Johnson ST, and Rudmann SV, eds. “Antibody Identification: Art or Science: A Case Study Approach.” AABB Press 2013 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 * Jessica Murray, BBGuy Assistant
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 102CE: Learn to Speak “Reference Lab” with Jan Hamilton appeared first on Blood Bank Guy.
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!A long time ago, on a podcast far, far away…!On March 30, 2016, almost exactly 7 years ago today, episode 1 of the Blood Bank Guy Essentials Podcast appeared! Dr. Mark Yazer was the guest, and he shared his then somewhat controversial view that whole blood platelets were not something to be avoided.Seven Years, Dozens of ExpertsSince that day, I have been incredibly honored to have dozens of experts as my guests on the podcast. These incredible folks have helped me teach the essentials of Transfusion Medicine to learners everywhere, and I am so grateful for all of them (and each of you!).
A Celebration Episode!To honor seven years of learning, I’ve invited 8 previous guests (and one “rookie”) to join me in a special “Pearls of Wisdom” episode. Each guest shares about a five minute, compact nugget of information that learners can use in practical ways. Enjoy, and please come back soon for more episodes of Blood Bank Guy Essentials!
On March 30, 2016, almost exactly 7 years ago today, episode 1 of the Blood Bank Guy Essentials Podcast appeared! Dr. Mark Yazer was the guest, and he shared his then somewhat controversial view that whole blood platelets were not something to be avoided.Seven Years, Dozens of ExpertsSince that day, I have been incredibly honored to have dozens of experts as my guests on the podcast. These incredible folks have helped me teach the essentials of Transfusion Medicine to learners everywhere, and I am so grateful for all of them (and each of you!).
A Celebration Episode!To honor seven years of learning, I’ve invited 8 previous guests (and one “rookie”) to join me in a special “Pearls of Wisdom” episode. Each guest shares about a five minute, compact nugget of information that learners can use in practical ways. Enjoy, and please come back soon for more episodes of Blood Bank Guy Essentials!
Download the Transcript for This EpisodeAbout My Guests:Here are the nine guests, in the order they speak in this episode:
- Steve Frank, MD
- Sue Johnson, MSTM, MT(ASCP)SBBCM
- Cassandra Josephson, MD
- Mark Fung, MD
- Yulia Lin, MD
- Mark Yazer, MD
- Connie Westhoff, PhD
- Chris Tormey, MD
- Nancy Dunbar, MD 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 March 28, 2025.
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 any of us is affiliated. Disclosure information is available at Wiley Health Learning.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 100CE: Pearls of Wisdom (Centennial Episode!) appeared first on Blood Bank Guy.
Rh Immune Globulin helps prevent Hemolytic Disease of the Fetus/Newborn, but why is it so hard to decide how much to give?Dr. Jessica Hudson
There is no doubt that the development and use of Rh Immune Globulin (RhIG) is one of the medical triumphs of the 20th century! It almost seems magical, really. The basic idea, if you don’t know, is that RhD-negative pregnant patients are at high risk of developing an antibody against the RhD antigen carried by their baby. The antibody, anti-RhD (or just “anti-D”) can cause hemolysis in that mom’s future RhD-positive babies, since the antibody crosses the placenta. The hemolysis has a long, awkward name: “Hemolytic Disease of the Fetus/Newborn” (HDFN). RhIG to the Rescue!The good news: RhIG, when given at the right time and in the right dose, does a wonderful job at preventing formation of anti-D in at-risk moms. In fact, in 99% of RhD-negative moms, the process is really, really simple. That mom gets RhIG at two times: First, at her 28 week OB visit, when we give her the contents of one prefilled syringe (or “vial”) of RhIG, and second, when we give her a second vial after she delivers an RhD-positive baby. Easy, right?
The BAD NewsThe bad news is what happens in the 1% of moms when things are not so simple. These are the RhD-negative moms who have a larger-than-normal exposure to their baby’s blood, and as a result, might need more than one vial of RhIG. Numerous studies have shown that those calculations (yes, there will be math in this situation!) are not always done accurately. This podcast is an attempt to simplify the calculations and make them memorable for learners.
This Episode is a New StartTwo things are unique about this episode. First, you are going to get to hear me in a live teaching session with one of my residents, Dr. Jessica Hudson, a third-year pathology resident at Loma Linda University. Second, this is the first episode where I am using a previous “Transfusion Medicine Question of the Day” from TransfusionNews.com as a starting point. If you aren’t signed up for the thrice-weekly, totally FREE Question of the Day series, you really should be! In fact, go there now and sign up!
The question you see below was written by Lorraine Blagg, MA, MLS(ASCP), SBB from Johns Hopkins, and is displayed here courtesy of TransfusionNews.com.
Dr. Jessica Hudson
There is no doubt that the development and use of Rh Immune Globulin (RhIG) is one of the medical triumphs of the 20th century! It almost seems magical, really. The basic idea, if you don’t know, is that RhD-negative pregnant patients are at high risk of developing an antibody against the RhD antigen carried by their baby. The antibody, anti-RhD (or just “anti-D”) can cause hemolysis in that mom’s future RhD-positive babies, since the antibody crosses the placenta. The hemolysis has a long, awkward name: “Hemolytic Disease of the Fetus/Newborn” (HDFN). RhIG to the Rescue!The good news: RhIG, when given at the right time and in the right dose, does a wonderful job at preventing formation of anti-D in at-risk moms. In fact, in 99% of RhD-negative moms, the process is really, really simple. That mom gets RhIG at two times: First, at her 28 week OB visit, when we give her the contents of one prefilled syringe (or “vial”) of RhIG, and second, when we give her a second vial after she delivers an RhD-positive baby. Easy, right?
The BAD NewsThe bad news is what happens in the 1% of moms when things are not so simple. These are the RhD-negative moms who have a larger-than-normal exposure to their baby’s blood, and as a result, might need more than one vial of RhIG. Numerous studies have shown that those calculations (yes, there will be math in this situation!) are not always done accurately. This podcast is an attempt to simplify the calculations and make them memorable for learners.
This Episode is a New StartTwo things are unique about this episode. First, you are going to get to hear me in a live teaching session with one of my residents, Dr. Jessica Hudson, a third-year pathology resident at Loma Linda University. Second, this is the first episode where I am using a previous “Transfusion Medicine Question of the Day” from TransfusionNews.com as a starting point. If you aren’t signed up for the thrice-weekly, totally FREE Question of the Day series, you really should be!
Download the Transcript for This EpisodeAbout My Guest:Jessica Hudson MD is, as of this recording, a third-year pathology resident at Loma Linda University in Loma Linda, CA. She is a Southern California native who loves all things adventure and Transfusion Medicine. She and her husband enjoy snowboarding, line dancing, singing in the car, as well as everything related to “the classics” (Star Wars, Lord of the Rings, and Harry Potter).
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. Hudson nor I have any relevant financial disclosures.
Further Reading: A Brief History of the Use of RhIG, by Lynsi Rahorst from the New York Blood Center (Lynsi is also a BBGuy Associate Editor). Thanks to: Dr. Jessica Hudson: For being the first resident to be a part of this podcast, and for trusting me not to embarrass her (not sure I succeeded, but I tried!).
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 099: Rh Immune Globulin (Teaching Episode) appeared first on Blood Bank Guy.
Continuing Education Episode!Continuing Education!The REDS research project has transformed transfusion medicine, and the REDS-IV-P phase co-chairs say the best is yet to come!Drs Steve Kleinman & Cassandra Josephson
If a research project has been going on for over 30 years, you would think it’s probably pretty good, right? Well, that’s how long the REDS research project, sponsored by the US National Heart, Lung, and Blood Institute (NHLBI) has been breaking new ground in Transfusion Medicine.REDS-IV-P Moves Us ForwardDrs. Steve Kleinman and Cassandra Josephson are the co-chairs of the current phase of REDS, known as “REDS-IV-P” (and don’t worry, we will explain what “REDS” stands for!). Both of these physicians feel that REDS-IV-P is ushering in a new phase, and that breakthroughs that change transfusion medicine again are just around the corner! In this interview, we will take a little bit of time to understand where REDS has been and where REDS-IV-P is taking us.
Drs Steve Kleinman & Cassandra Josephson
If a research project has been going on for over 30 years, you would think it’s probably pretty good, right? Well, that’s how long the REDS research project, sponsored by the US National Heart, Lung, and Blood Institute (NHLBI) has been breaking new ground in Transfusion Medicine.REDS-IV-P Moves Us ForwardDrs. Steve Kleinman and Cassandra Josephson are the co-chairs of the current phase of REDS, known as “REDS-IV-P” (and don’t worry, we will explain what “REDS” stands for!). Both of these physicians feel that REDS-IV-P is ushering in a new phase, and that breakthroughs that change transfusion medicine again are just around the corner! In this interview, we will take a little bit of time to understand where REDS has been and where REDS-IV-P is taking us.
Download the Transcript for This EpisodeAbout My Guest:Dr. Steve Kleinman is Clinical Professor of Pathology at the University of British Columbia. He is also President of Kleinman Biomedical Research, a transfusion medicine consulting company. He currently cochairs the Steering and Executive Committees of the NHLBI-sponsored “Recipient Epidemiology and Donor Evaluation Study-IV” (REDS-IV-P) and from 2011 through 2019 served as Chair in the predecessor program (REDS-III). He has previously served as Senior Medical Advisor to AABB from 2005 through 2019 and prior to that chaired the AABB Transfusion Transmitted Disease Committee. He has published over 175 peer-reviewed scientific articles, 20 book chapters, and co-edited two textbooks. He currently co-edits the transfusion medicine section of UpToDate, an online medical resource.
Dr. Kleinman’s main interest is the intersection of scientific investigation and policy development in the field of transfusion safety and emerging pathogens. His publications address a wide array of infectious agents (e.g., HIV, HCV, HBV, WNV, Dengue virus, Zika virus, and other emerging pathogens) and span the realm of basic science research, the epidemiology of infectious agents and modeling their transfusion transmission risk, laboratory test performance as applied to donated units of blood, and pathogen inactivation of blood components.
Dr. Cassandra Josephson is, as of July 1, 2022, the Hawkins Family Endowed Professor and Director of the Cancer and Blood Disorders Institute (CBDI), Clinical Division Director for Hematology/Oncology, Medical Director of Transfusion Medicine, at the Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. She is also Professor (PAR) in the Department of Oncology at the Johns Hopkins School of Medicine.
Dr. Josephson’s research career focuses on pediatric transfusion medicine and, more specifically, transfusion therapy in neonates, patients with sickle cell disease and thalassemia, and massive transfusion in children with hemorrhage. She currently and previously garnered grants from National Institutes of Health, CDC, industry and private foundations where she is or has been the Principal Investigator. Dr. Josephson is actively involved in teaching medical students, residency, and fellowship trainees in pathology and pediatrics. She has authored or co-authored >180 publications in peer-reviewed journals, 17 review articles, and > 15 book chapters. She is one of the Co-Chairs for the REDS IV-P Program evaluating Recipient Epidemiology and Donor Evaluation of Blood Products and Transfusion in the US and Brazil focused on Children. She also services as an Associate Editor for Transfusion, the journal of the American Association of Blood Banks (AABB).
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 July 17, 2024.
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 any of the three of us is affiliated.
Further Reading: Original REDS: Zuck, TF et al. The Retrovirus Epidemiology Donor Study (REDS): rationale and methods, Transfusion 1995;35:944-951 * REDS-II: Kleinman S et al. The National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Studies (Retrovirus Epidemiology Donor Study and Retrovirus Epidemiology Donor Study-II): Twenty Years of Research to Advance Blood Product Safety and Availability. Transf Med Rev 2012;26:281-304.e2 * REDS-III: Kleinman S et al. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): a research program striving to improve blood donor and transfusion recipient outcomes. Transfusion 2014;54:942-955 * REDS-IV-P: Josephson CD et al. The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P): A research program striving to improve blood donor safety and optimize transfusion outcomes across the lifespan. Transfusion 2022;62:982-999 Thanks to: 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 098CE: “Simply REDS” with Steve Kleinman & Cassandra Josephson 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!
Blood shortages happen. The COVID-19-related blood supply crisis, however, is unique. AABB Chief Medical Officer Claudia Cohn explains.
Dr. Claudia Cohn
Occasional blood shortages have been a routine part of life for transfusion services and blood donor centers for years. During the COVID-19 pandemic, however, U.S. blood banks have experienced persistent and severe shortages of nearly all blood components. In this interview, Dr. Claudia Cohn, Chief Medical Officer of the Association for the Advancement of Blood and Biotherapies (AABB), offers her perspective on the root causes of the current crisis, and outlines steps those involved with transfusion can take to “ease the pain.” This interview is offered as a joint educational presentation from the AABB and Blood Bank Guy, in cooperation with TransfusionNews.com. The opinions expressed here are not to be interpreted as formal positions of any of the above organizations.
Dr. Claudia Cohn
Occasional blood shortages have been a routine part of life for transfusion services and blood donor centers for years. During the COVID-19 pandemic, however, U.S. blood banks have experienced persistent and severe shortages of nearly all blood components. In this interview, Dr. Claudia Cohn, Chief Medical Officer of the Association for the Advancement of Blood and Biotherapies (AABB), offers her perspective on the root causes of the current crisis, and outlines steps those involved with transfusion can take to “ease the pain.” This interview is offered as a joint educational presentation from the AABB and Blood Bank Guy, in cooperation with TransfusionNews.com. The opinions expressed here are not to be interpreted as formal positions of any of the above organizations.
Download the Transcript for This Episode
About My Guest: Claudia Cohn, MD, PhD earned her PhD in Immunology and Infectious Diseases from the Johns Hopkins University (currently the Bloomberg School of Public Health) and subsequently earned her MD at Louisiana State University. After finishing her Transfusion Medicine fellowship at Blood Centers of the Pacific/University of California, San Francisco, Dr. Cohn joined the faculty at the University of Minnesota, in Minneapolis, where she is Medical Director of the Blood Bank. Dr. Cohn is also the Chief Medical Officer of the AABB (Association for the Advancement of Blood and Biotherapies) and the current Editor-in-Chief of the AABB Technical Manual. Dr. Cohn’s major interests include platelet support for stem cell transplant patients, advancing a national data infrastructure to track blood transfusions, and appropriate use of blood components.
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 March 29, 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. Cohn nor I have any relevant financial disclosures.
AABB Resources: * Patient Blood Management * Clinical Resources * Alliance for a Strong Blood Supply
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 096CE: Navigating Blood Shortages with Claudia Cohn appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Plasma names can be just plain confusing, and the product known as Liquid Plasma is no exception. Dr. Chris Gresens is here to explain what it is and why Liquid Plasma might be just perfect for your facility.
Dr. Chris Gresens
Plasma products are confusing! We’ve got products that change names depending on when they go into the freezer, products that change names after they come out of the freezer (but only 24 hours after they come out of the freezer!), and products with insanely long names (“Plasma Frozen Within 24 Hours of Phlebotomy Held at Room Temperature up to 24 Hours After Phlebotomy,” anyone?!). Here Comes Liquid Plasma ! Into this sea of confusing names comes another product with a far simpler name: Liquid Plasma. This is a product that has one very specific indication, but it is easily confused with other plasma products that sound similar. Dr. Chris Gresens deals with these questions all day, every day. He is will help you understand plasma products in general, and why Liquid Plasma just might be the perfect product for your transfusion service!
Dr. Chris Gresens
Plasma products are confusing! We’ve got products that change names depending on when they go into the freezer, products that change names after they come out of the freezer (but only 24 hours after they come out of the freezer!), and products with insanely long names (“Plasma Frozen Within 24 Hours of Phlebotomy Held at Room Temperature up to 24 Hours After Phlebotomy,” anyone?!). Here Comes Liquid Plasma ! Into this sea of confusing names comes another product with a far simpler name: Liquid Plasma. This is a product that has one very specific indication, but it is easily confused with other plasma products that sound similar. Dr. Chris Gresens deals with these questions all day, every day. He is will help you understand plasma products in general, and why Liquid Plasma just might be the perfect product for your transfusion service!
Download the Transcript for This Episode
About My Guest: Dr. Chris Gresens is the Medical Director for Vitalant’s North and West Divisions. He graduated from the UCLA School of Medicine in 1991, where he remained for his residency in anatomic and clinical pathology and fellowship in blood banking/transfusion medicine. He is board certified in AP, CP, and BB/TM. In 1996, immediately after completing his residency and fellowship, Dr. Gresens joined BloodSource (which in 2016 became part of Vitalant). He holds the position of Clinical Professor at the California Northstate University College of Medicine.
Dr. Gresens has received numerous awards for work in his field. His professional interests and expertise include consultations involving complex problems related to transfusion medicine and patient blood management as well as the establishment of modernized blood banks in resource-challenged countries throughout Africa and Eastern Europe. Dr. Gresens enjoys life in Sacramento, California with his wife, son, and daughter.
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 claim credit for this episode after March 9, 2024.
Further Reading: * Feb 2019 America’s Blood Centers “Blood Bulletin”: Li M and Gresens C. The Appropriate Use of Liquid Plasma. Blood Bulletin Vol 19, No 1
Thanks to: * Dr. Daniela Hermelin, Associate Editor (Primary author, continuing education materials); Follow Daniela on Twitter for fantastic #blooducation! * Dr. Jessica Hudson, Assistant Editor (transcript review). * 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 095CE: What is Liquid Plasma? with Chris Gresens 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.
Continuing Education Episode!
Continuing Education!
Red cell antibodies should be simple, right? Not always, and the Mighty Monocyte Monolayer Assay may show the way!
Sandy Nance MS, MASCP, MT(ASCP)SBB
Usually, when a transfusion service or reference laboratory identifies a red cell antibody like anti-K or anti-Fya or anti-D, we know exactly what to do next: Find blood that is negative for the antigen target, and transfuse. Occasionally, though, we find antibodies in patients that come with two distinct problems: First, the antigen target is present on just about every blood donor, so it is hard to find compatible blood, but second, we don’t even know if we NEED compatible blood! Some people with antibodies like “anti-Yta” or “anti-Vel” will hemolyze transfused blood carrying the antigen, while others just don’t! We call these things “antibodies of variable clinical significance,” and they lead to the very important question, “Do we search the world for rare units of compatible blood, or can we just transfuse ABO-compatible red cells out of our regular inventory? The Mighty MMA Shows The Way! Back in the 1980’s, blood bankers were using many different tests to try to answer that question, but many of those tests were complex and logistically challenging. Sandy Nance and a group of other illustrious scientists at the American Red Cross developed the monocyte monolayer assay to try to help us with the choice of whether or not a patient with an antibody against a high-frequency antigen can be safely given antigen-positive blood. The MMA is simple in concept, but labor-intensive, so not very many labs do it, and you may or may not have heard of it. After today, I think you will have a much better understanding of what the test is, and how it can really help in some “no-win” situations.
Sandy Nance MS, MASCP, MT(ASCP)SBB
Usually, when a transfusion service or reference laboratory identifies a red cell antibody like anti-K or anti-Fya or anti-D, we know exactly what to do next: Find blood that is negative for the antigen target, and transfuse. Occasionally, though, we find antibodies in patients that come with two distinct problems: First, the antigen target is present on just about every blood donor, so it is hard to find compatible blood, but second, we don’t even know if we NEED compatible blood! Some people with antibodies like “anti-Yta” or “anti-Vel” will hemolyze transfused blood carrying the antigen, while others just don’t! We call these things “antibodies of variable clinical significance,” and they lead to the very important question, “Do we search the world for rare units of compatible blood, or can we just transfuse ABO-compatible red cells out of our regular inventory?” The Mighty MMA Shows The Way! Back in the 1980’s, blood bankers were using many different tests to try to answer that question, but many of those tests were complex and logistically challenging. Sandy Nance and a group of other illustrious scientists at the American Red Cross developed the monocyte monolayer assay to try to help us with the choice of whether or not a patient with an antibody against a high-frequency antigen can be safely given antigen-positive blood. The MMA is simple in concept, but labor-intensive, so not very many labs do it, and you may or may not have heard of it. After today, I think you will have a much better understanding of what the test is, and how it can really help in some “no-win” situations.
Download the Transcript for This Episode
About My Guest: Sandy Nance is the emeritus Senior Director for National Laboratories for the American Red Cross and has provided leadership to multiple programs at the Red Cross and blood bank world in general, including the American Rare Donor Program and the national American Red Cross SBB Program. She is also an emeritus Adjunct Assistant Professor at the University of Pennsylvania, Division of Transfusion Medicine & Therapeutic Pathology Department of Pathology and Laboratory Medicine. She has a master’s degree in Pathology from the University of Maryland and received her SBB from the Johns Hopkins Medical Institutions. Sandy developed of the use of polyethylene glycol or PEG for serologic testing as well as today’s topic, the monocyte monolayer assay (MMA).
Sandy’s list of honors and awards is too long to detail, but they include the John Elliott, President’s, and Sally Frank awards from AABB, the National Blood Foundation Hall of Fame, the ASCP Hall of Fame. She has authored or co-authored over 45 scientific papers and 200 abstracts, and edited 9 books.
Her career positions include Lead Technologist at Johns Hopkins Medical Institutions with Dr. Paul Ness and Immunohematology Research Associate in Dr. George Garratty’s Research Laboratory. Active in education, she has been faculty for University of Maryland, Johns Hopkins Medical Institutions, University of Pennsylvania, NIH and American Red Cross.
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, and 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.
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 Sandy nor I have any relevant financial disclosures.
The images below are generously provided by Sandy Nance.
Further Reading: * Original article describing the MMA: Nance SJ et al. Predicting the clinical significance of red cell alloantibodies using a monocyte monolayer assay. Transfusion 1987;27:449-452 * Retrospective review of MMA effectiveness: Arndt PA and Garratty G. A retrospective analysis of the value of the monocyte monolayer assay results for predicting the clinical significance of blood group alloantibodies. Transfusion 2004;44:1273-1281 * Maurer JL, Nance SJ, and Nickle P. Monocyte Monolayer Assay (MMA) to Predict Clinical Significance of Alloantibodies: A 22-Year Review. Transfusion 2018;58: Supplement S2:103A
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 093CE: The Mighty MMA! with Sandy Nance 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!
An expert panel’s 6-year-old recommendations on RHD genotyping are not quite being used as intended. Let’s learn how we can do better!
Sue Johnson MSTM, MT(ASCP)SBB
Despite guidance in a 2015 publication from international experts in immunohematology and transfusion medicine (covered on this podcast in 2016), many clinicians and laboratorians have yet to integrate RHD genotyping into routine practice when a patient’s RhD serologic typing is weaker than expected (we call that “serologic weak D“). Further, we now have additional information on the safety of transfusing D-positive red blood cells to those with weak D types 4.0 and 4.1, so an update to the previous recommendations is essential. Sue is Back! In this interview, my dear friend Sue Johnson, one of the authors of the updated recommendations published in 2020, will address challenges laboratories and clinicians have faced in implementing the 2015 recommendations, outline the potential advantages to RHD genotyping, and summarize the updated recommendations.
This interview was recorded LIVE at an educational seminar jointly sponsored by the California Blood Bank Society and LifeStream Blood Bank. It is presented with minimal edits so you can experience it the way it happened. My thanks to both organizations for permission to use the recording.
Sue Johnson MSTM, MT(ASCP)SBB
Despite guidance in a 2015 publication from international experts in immunohematology and transfusion medicine (covered on this podcast in 2016), many clinicians and laboratorians have yet to integrate RHD genotyping into routine practice when a patient’s RhD serologic typing is weaker than expected (we call that “serologic weak D“). Further, we now have additional information on the safety of transfusing D-positive red blood cells to those with weak D types 4.0 and 4.1, so an update to the previous recommendations is essential. Sue is Back! In this interview, my dear friend Sue Johnson, one of the authors of the updated recommendations published in 2020, will address challenges laboratories and clinicians have faced in implementing the 2015 recommendations, outline the potential advantages to RHD genotyping, and summarize the updated recommendations.
This interview was recorded LIVE at an educational seminar jointly sponsored by the California Blood Bank Society and LifeStream Blood Bank. It is presented with minimal edits so you can experience it the way it happened. My thanks to both organizations for permission to use the recording.
Download the Transcript for This Episode
About My Guest: Sue Johnson, MSTM, MT(ASCP)SBBCM is the Director of Clinical Education at Versiti | Blood Center of Wisconsin. She also is the director of the Specialist in Blood Banking Program at Versiti and the Transfusion Medicine Program at Marquette University. Sue is Associate Director of the Indian Immunohematology Initiative, a program designed to improve general immunohematology knowledge in South Asia. She is a sought-after speaker and world-class immunohematology expert.
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). The continuing education offering expires two years from the date this episode is released.
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 Sue nor I have any relevant financial disclosures.
The images below are generously provided by Sue Johnson.
Further Reading: * Original Working Group Recommendations: Sandler SG et al. It’s time to phase in RHD genotyping for patients with a serologic weak D phenotype. Transfusion 2015;55:680-689 * Updated Recommendations: Flegel WA al. It’s time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4. Transfusion 2020;60:855-859 * ACOG Practice Bulletin. Prevention of Rh D Alloimmunization. Number 181, August 2017
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 090CE: RHD Genotyping; We Can Do Better! with Sue Johnson appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Transfusion reactions that involve the lungs and heart cause major problems; in fact, such reactions are the most common cause of transfusion-associated death!
Dr. Christine Cserti-Gazdewich
I believe that recognizing, treating, and of course, preventing transfusion reactions, especially those involving the heart and lungs, is pretty close to the most important job that a Transfusion Medicine physician like me can do. Why They Matter Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are reactions that happen more often than we would like, and they may result in significant cardiorespiratory compromise. TACO and TRALI, in fact, are the numbers 1 and 2 on the list of transfusion-related death in most countries in the world! Unfortunately for us, there is quite a bit of overlap in how these two reactions appear initially, and distinguishing between them can be tough. This interview seeks to outline clinical, radiologic, and laboratory criteria for diagnosis of both TACO and TRALI (focusing mostly on TACO), so that you can better identify, manage, and prevent these dangerous reactions.
Dr. Christine Cserti-Gazdewich
I believe that recognizing, treating, and of course, preventing transfusion reactions, especially those involving the heart and lungs, is pretty close to the most important job that a Transfusion Medicine physician like me can do. Why They Matter Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are reactions that happen more often than we would like, and they may result in significant cardiorespiratory compromise. TACO and TRALI, in fact, are the numbers 1 and 2 on the list of transfusion-related death in most countries in the world! Unfortunately for us, there is quite a bit of overlap in how these two reactions appear initially, and distinguishing between them can be tough. This interview seeks to outline clinical, radiologic, and laboratory criteria for diagnosis of both TACO and TRALI (focusing mostly on TACO), so that you can better identify, manage, and prevent these dangerous reactions.
Download the Transcript for This Episode
About My Guest: Christine Cserti-Gazdewich is a transfusion medicine specialist and consultant hematologist, originally trained in internal medicine and clinical hematology in Toronto, with fellowship training in transfusion medicine at Harvard. Based at the University Health Network for 14 years, she co-directs a large blood transfusion service through several teaching hospitals of the University of Toronto, with oversight responsibilities to a number of community/rural client sites across the province too. Her chief interests in practice, leadership, and research are in immunohematology, hemovigilance, and complex/constrained hemotherapy scenarios.
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.
Please NOTE: The continuing education offer expires two years from the date of the release of this episode!
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. Cserti-Gazdewich nor I have any relevant financial disclosures.
The images below are generously provided by Dr. Cserti-Gazdewich.
Further Reading: * Cohen R et al. Serologic assessments in acute transfusion reactions: practices and yields. Vox Sanguinis 2019;114:749-761 * Vlaar et al. A consensus redefinition of transfusion-related acute lung injury. Transfusion 2019; 59(7):2465-2476 * Parmar N et al. The association of fever with transfusion-associated circulatory overload. Vox Sanguinis 2017;112:70-78 * ISBT Working Party on Hemovigilance. Transfusion-associated circulatory overload (TACO) Definition (2018) * United States FDA: Fatality Report Fiscal Year 2018 * United Kingdom Serious Hazards of Transfusion Annual Reports * Canada Transfusion-transmitted Injuries Surveillance System; 2009—2013 Summary Results
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 089CE: The Transfused and the Breathless with Christine Cserti-Gazdewich appeared first on Blood Bank Guy.
Warm autoantibodies can be tough challenges. Two physician experts share some best practices to help guide your practices.
Drs Alyssa Ziman and Meghan Delaney
Patients with warm autoantibodies always seem to appear at the worst times! To those of us working in blood banks, navigating the path from discovery of the antibody to a safe transfusion is fraught with challenges.
They Did Their “BEST” Drs Alyssa Ziman and Meghan Delaney (in cooperation with the excellent folks at the BEST Collaborative) decided to do something to make the pathway clearer a few years ago. They embarked on a multi-year journey to discover, through a massive literature search as well as a survey of practices in numerous facilities, what people around the world are actually doing to evaluate warm autoantibodies and get to the place where a transfusion can occur that is as safe as possible. Their findings, published in a 2017 Transfusion article and a 2020 Vox Sanguinis article (see below for links), will show you tools and practices that will help you, no matter the size of your hospital. They are both here today to discuss their major findings and learning lessons from the papers.
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 Alyssa Ziman and Meghan Delaney
Patients with warm autoantibodies always seem to appear at the worst times! To those of us working in blood banks, navigating the path from discovery of the antibody to a safe transfusion is fraught with challenges. They Did Their “BEST” Drs Alyssa Ziman and Meghan Delaney (in cooperation with the excellent folks at the BEST Collaborative) decided to do something to make the pathway clearer a few years ago. They embarked on a multi-year journey to discover, through a massive literature search as well as a survey of practices in numerous facilities, what people around the world are actually doing to evaluate warm autoantibodies and get to the place where a transfusion can occur that is as safe as possible. Their findings, published in a 2017 Transfusion article and a 2020 Vox Sanguinis article (see below for links), will show you tools and practices that will help you, no matter the size of your hospital. They are both here today to discuss their major findings and learning lessons from the papers.
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. Alyssa Ziman is Division Chief of Transfusion Medicine and Medical Director of the Clinical Laboratories at Ronald Reagan UCLA Medical Center, Chief of Laboratory Medicine, and Professor of Pathology and Laboratory Medicine at the David Geffen School of Medicine at UCLA. She completed her undergraduate studies at University of California, Los Angeles (UCLA), and her medical school studies at the Sackler School of Medicine, University of Tel Aviv. She subsequently completed her anatomic and clinical pathology training, followed by a fellowship in Transfusion Medicine, at Cedars-Sinai Medical Center. Dr. Ziman’s research focuses on immunohematology, transfusion practice and patient safety, as well as donor safety and motivating factors in blood donors.
Dr. Meghan Delaney is Chief of the Department of Pathology & Laboratory Medicine at Children’s National Health System in Washington, DC, as well as Professor in the Departments of Pathology and Pediatrics at the George Washington University School of Medicine. She is board-certified in Clinical Pathology as well as in Blood Banking/Transfusion Medicine. Dr. Delaney has authored or co-authored over 60 papers in peer-reviewed journals, and 18 book chapters, and over 40 abstracts. She speaks all over the world on a wide variety of topics in adult, pediatric, obstetric, and molecular Transfusion Medicine.
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: * 2017 Transfusion Paper: Best Practices: Ziman A et al. Warm-reactive (immunoglobulin G) autoantibodies and laboratory testing best practices: review of the literature and survey of current practice. Transfusion 2017;57;463–477. * 2020 Vox Sanguinis Paper: Does Matching Help?: Delaney M et al. Red‐blood‐cell alloimmunization and prophylactic antigen matching for transfusion in patients with warm autoantibodies. Vox Sanguinis 2020;115;515–524.
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 088: Warm Autoantibody Best Practices with Alyssa Ziman and Meghan Delaney appeared first on Blood Bank Guy.
Continuing Education Episode!
Continuing Education!
Blood banks have numerous tools to keep blood safe from transfusion-transmitted infection. Suchi Pandey helps us understand them all!
Dr. Suchi Pandey
Blood transfusion is less likely to transmit infections today than ever. Through a combination of screening questions, donor testing, and direct treatment of blood products, the vast majority of opportunities for transfusion-transmitted infections are eliminated. But it’s all so complex! Dr. Suchi Pandey provides medical oversight for a busy blood donor center, and she simplifies testing strategies and methods in a way that learners will understand. In this interview, she “tells the story” of how the blood industry has implemented safety measures over the decades to arrive at the current state of extraordinary safety from infection for blood recipients.
Dr. Suchi Pandey
Blood transfusion is less likely to transmit infections today than ever. Through a combination of screening questions, donor testing, and direct treatment of blood products, the vast majority of opportunities for transfusion-transmitted infections are eliminated. But it’s all so complex! Dr. Suchi Pandey provides medical oversight for a busy blood donor center, and she simplifies testing strategies and methods in a way that learners will understand. In this interview, she “tells the story” of how the blood industry has implemented safety measures over the decades to arrive at the current state of extraordinary safety from infection for blood recipients.
Download the Transcript for This Episode
About My Guest: Dr. Suchi Pandey is currently Chief Medical Officer for the Stanford Blood Center and she is a Clinical Associate Professor in the Department of Pathology at Stanford. She is a graduate of Drexel University College of Medicine in Philadelphia, the University of California-San Diego Pathology residency, and the University of California-San Francisco/Blood Centers of the Pacific Transfusion Medicine Fellowship. Suchi’s interests include donor health, Transfusion Medicine education, and immunohematology. She is on the board of the California Blood Bank Society, and she is co-chair of the Blood Center of California’s Medical Advisory Committee.
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. Pandey nor I have any relevant financial disclosures.
Further Reading: * Standards for Blood Banks and Transfusion Services, 32nd edition, AABB 2020 * Dodd RY, Crowder LA, Haynes JM, et al. Screening Blood Donors for HIV, HCV, and HBV at the American Red Cross: 10-Year Trends in Prevalence, Incidence, and Residual Risk, 2007 to 2016. Transfusion Medicine Reviews 2020 * Busch MP, Bloch EM, Kleinman S. Prevention of transfusion-transmitted infections. Blood 2019;133: 1854-64 * FDA Babesia Guidance
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 087CE: Transfusion-transmitted Infections with Suchi Pandey 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!
Your patient needs blood, but EVERYTHING is incompatible! Jill Storry says, “Take it easy. Here’s what to do next.”
Dr. Jill Storry
For many blood bankers, figuring out what to do when a patient has an antibody (or antibodies) that is incompatible with EVERY cell in an identification panel is their worst nightmare! These antibodies, commonly called “panagglutinins,” can lead to significant delays in blood availability. Even worse, patients could be harmed if we make poor choices in interpreting the reactions. What’s the Plan? In this interview, Dr. Jill Storry, an internationally recognized expert in immunohematology, outlines her structure for evaluating panagglutinins. She describes how to use the pattern of reactivity, as well as the autocontrol and direct antiglobulin test (DAT) to make rapid evaluations. Her aim is for you to distinguish between the three main possibilities for panagglutinins (autoantibodies, antibodies against high-frequency antigens, and multiple alloantibodies) as quickly as possible.
You Want Practical? You’re in the Right Place! This interview is full of practical tips and advice. We want to help you avoid panic and have a good idea of what to do when everything is incompatible. That’s why it is one of my very favorite episodes of Blood Bank Guy Essentials!
Dr. Jill Storry
For many blood bankers, figuring out what to do when a patient has an antibody (or antibodies) that is incompatible with EVERY cell in an identification panel is their worst nightmare! These antibodies, commonly called “panagglutinins,” can lead to significant delays in blood availability. Even worse, patients could be harmed if we make poor choices in interpreting the reactions. What’s the Plan? In this interview, Dr. Jill Storry, an internationally recognized expert in immunohematology, outlines her structure for evaluating panagglutinins. She describes how to use the pattern of reactivity, as well as the autocontrol and direct antiglobulin test (DAT) to make rapid evaluations. Her aim is for you to distinguish between the three main possibilities for panagglutinins (autoantibodies, antibodies against high-frequency antigens, and multiple alloantibodies) as quickly as possible.
You Want Practical? You’re in the Right Place! This interview is full of practical tips and advice. We want to help you avoid panic and have a good idea of what to do when everything is incompatible. That’s why it is one of my very favorite episodes of Blood Bank Guy Essentials!
Download the Transcript for This Episode
About My Guest: Jill Storry, PhD is an Associate Professor at the Division of Haematology & Transfusion Medicine, Lund University, Sweden, and responsible for the Immunohematology laboratories within the Department of Clinical Immunology and Transfusion Medicine, Laboratory Medicine, Lund.
Her primary areas of interest are the study of human blood group systems, both from a clinical perspective in the provision of providing blood to alloimmunized patients and from the perspective of human polymorphism. She has authored over 80 original papers, reviews and text books related to blood groups, and given over 100 talks at international and national conferences and courses.
Dr. Storry is a Section Editor for Vox Sanguinis and a member of the Editorial Boards of Transfusion Medicine Reviews, Transfusion, and Immunohematology. She is also a member of the ISBT Working Parties on Red Cell Immunogenetics and Red Cell Nomenclature, and Rare Donors.
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. Storry nor I have any relevant financial disclosures.
Further Reading: * BEST Collaborative article mentioned describing best practices: Ziman A et al. Warm-reactive (Immunoglobulin G) autoantibodies and laboratory testing best practices: Review of the literature and survey of current practice. Transfusion 2017;57:463-477 * Landmark article on the usefulness of the monocyte monolayer assay (MMA): Arndt PA and Garratty G. A retrospective analysis of the value of monocyte monolayer assay results for predicting the clinical significance of blood group alloantibodies. Transfusion 2004;44:1273-1281 * Description of serologic evaluation of patients on anti-CD38 (daratumumab): Chapuy CI et al. Resolving the daratumumab interference with blood compatibility testing. Transfusion 2015;55;1545–1554
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 085CE: What to do When Everything is Incompatible with Jill Storry appeared first on Blood Bank Guy.
In the midst of the COVID-19 pandemic, does convalescent plasma from recovered patients offer fresh hope for those who are critically ill?
Drs. Pampee Young and Ralph Vassallo
In the last few months, a new coronavirus called “SARS-CoV-2” has infected millions around the world. While the majority of those who develop “COVID-19” recover, some do not, despite our best efforts. As a result, healthcare providers have been desperately searching for something to help them treat critically ill patients. Is Convalescent Plasma an Answer? Convalescent plasma is collected from those who have recovered from an illness (in this case COVID-19) and transfused to those currently ill. Passive antibody therapy is an old idea, but how much will it help in the current pandemic? Much current research seeks to answer that question.
My guests, Drs Pampee Young and Ralph Vassallo, are the medical leaders of the two largest blood collectors in the United States, the American Red Cross and Vitalant, respectively. They recorded separate interviews with me on April 30, 2020, to discuss what their organizations are doing to make COVID-19 convalescent plasma available for research use. We will also discuss the current pathways US hospitals must follow to transfuse this product.
PLEASE NOTE: Things are moving quickly! One day after I recorded these interviews, the FDA updated their donor criteria. Please stick around until the end of the episode for an update.
Drs. Pampee Young and Ralph Vassallo
In the last few months, a new coronavirus called “SARS-CoV-2” has infected millions around the world. While the majority of those who develop “COVID-19” recover, some do not, despite our best efforts. As a result, healthcare providers have been desperately searching for something to help them treat critically ill patients. Is Convalescent Plasma an Answer? Convalescent plasma is collected from those who have recovered from an illness (in this case COVID-19) and transfused to those currently ill. Passive antibody therapy is an old idea, but how much will it help in the current pandemic? Much current research seeks to answer that question.
My guests, Drs Pampee Young and Ralph Vassallo, are the medical leaders of the two largest blood collectors in the United States, the American Red Cross and Vitalant, respectively. They recorded separate interviews with me on April 30, 2020, to discuss what their organizations are doing to make COVID-19 convalescent plasma available for research use. We will also discuss the current pathways US hospitals must follow to transfuse this product.
PLEASE NOTE: Things are moving quickly! One day after I recorded these interviews, the FDA updated their donor criteria. Please stick around until the end of the episode for an update.
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About My Guests: Pampee Young, MD Dr. Pampee Young is the Chief Medical Officer of the American Red Cross. Prior to taking this position in 2018, she was Professor of Pathology at Vanderbilt University Medical Center where served as the Medical Director of the Section of Transfusion Medicine. She has over 80 peer reviewed publications. Her research interests while at Vanderbilt were in the field of regenerative medicine, using both stem cell based cell therapy and small molecular therapeutics. Currently, she is focused on research in blood center innovation, blood product availability, and safety.
Ralph Vassallo, MD Dr. Ralph Vassallo is the Chief Medical and Scientific Officer of Vitalant, based in Scottsdale, Arizona. Prior to joining Vitalant in 2014, he was the Chief Medical Officer of the American Red Cross Blood Services, Eastern Division, based at the Penn-Jersey region in Philadelphia. In addition to his transfusion medicine expertise, Dr. Vassallo completed a hematology-oncology fellowship at the University of Pennsylvania. Dr. Vassallo is a past chair of the AABB Circular of Information Task Force and Donor Health and Safety Committee. He’s authored book chapters in Williams Hematology, Rossi’s Principles of Transfusion Medicine, McLeod’s Apheresis: Principles and Practice, and more than 70 other articles and reviews.
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. Young, Dr. Vassallo, nor I have any relevant financial disclosures related to this discussion.
Further Reading: * COVID-91 Convalescent Plasma White Paper; Used by permission from America’s Blood Centers. * FDA Guidance for COVID19 convalescent plasma (updated 01 May 2020) * Article on deployment of CCP mentioned several times in episode (free access as of 03 May 2020): Bloch EM et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J. Clin Invest 2020 (Early View 07 Apr 2020) * Editorial on CCP and randomized trials by Dr. Sunny Dzik (free access as of 03 May 2020): Dzik S. COVID-19 Convalescent Plasma: Now Is the Time for Better Science. Transf Med Rev 2020 (Early View April 2020) * Article describing history of passive antibody therapy in previous coronavirus epidemics and in other settings (free access as of 03 May 2020): Sullivan HC and Roback JD. Convalescent Plasma: Therapeutic Hope or Hopeless Strategy in the SARS-CoV-2 Pandemic. Transf Med Rev 2020 (Early view April 2020).
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.
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