Continuing education episode! Those who oversee blood collection organizations wrestle constantly with two questions: “How can I keep my blood donors safe?” and “How can I keep the recipients of the blood we are collecting safe?” These twin responsibilities shape decisions and policies in blood donor centers worldwide. Dr. Mindy Goldman, Medical Director at Canadian Blood Services (CBS), is deeply involved in the evaluation of those core questions. As a result, I wanted her to describe...

With the FDA's 2019 publication of their Final Guidance on how to prevent patients from receiving platelet products contaminated with bacteria, it finally feels like pathogen reduction technology is about to "get real" (finally) in the United States! There was a time, though, that modern versions of pathogen reduction existed only in the minds of some really, really smart people. One of those brilliant minds is my guest, and his name is Dr. Ray Goodrich. Ray shares the backstory of how modern...

Continuing education episode! Far too many platelet transfusion decisions are made by evaluating a single laboratory value (the platelet count). Dr. Joe Sweeney believes we need more information to make better choices. Platelet transfusion decisions can be complex, and there is wide practice variability both within institutions and among different subspecialty services. In this interview, Dr. Sweeney describes current platelet transfusion guidelines and a more thorough approach to caring for...

Continuing education episode! On September 30, 2019, the United States Food and Drug Administration released the long awaited final guidance on bacterial risk control in platelets (see episode 076 for more details). One way that transfusion services can fulfill the recommendations in the guidance is to implement pathogen reduction technology. Dr. Pat Kopko and her team at the University of California-San Diego are well ahead of the curve, as they implemented PR-platelets in their hospital WAY...

Over the past several years, the United States Food and Drug Administration has considered many proposals for how to decrease the risk that a vulnerable patient would receive a platelet transfusion containing bacteria. On September 30, 2019, FDA released their "Final Guidance" with multiple recommendations that can appear confusing at first glance. This interview with Dr. Pat Kopko from UC-San Diego is designed to be a "first impression" tour through the options in the guidance. NOTE: Every...

Continuing education episode! Are we ignoring the most important coag factor when transfusing bleeding patients? Melissa Cushing thinks the contribution of replacing critically low fibrinogen levels to survival of bleeding patients may be under-recognized. She describes the current evidence for early fibrinogen replacement in the bleeding patient, logistical challenges transfusion services face, studies providing insights to desired fibrinogen target levels, and future options to provide...

Continuing education episode! Transfusion-associated Graft-versus-Host Disease (TA-GVHD) is a notoriously deadly but thankfully rare transfusion complication. Blood banks have used irradiation of cellular blood products for decades to prevent TA-GVHD, but clinicians and laboratorians still sometimes misunderstand what irradiation does and does not do. Dr. Chris Tormey, co-author of a 2018 article in Archives of Pathology and Laboratory Medicine on this topic, is my guest on today's...

More and more trauma surgeons are asking their hospitals when they can get low-titer, cold-stored, group O whole blood ("trauma whole blood"). This product, discussed in depth in episode 040CE, is one that comes with lots of choices, and Drs. David Oh and Mike Goodman from Hoxworth Blood Center and the University of Cincinnati led their hospital through those decisions. They join me to share their insights, lessons learned, and practical tips. Please note: This is not intended to be a...

Continuing education episode! For decades, neonates (especially in the United States) have been given platelet transfusions at considerably higher platelet counts than thresholds used in adults. New data suggests, however, that "less may be more" when it comes to transfusing platelets to these tiny and vulnerable patients! Dr. Martha Sola-Visner, a neonatologist from Boston, joins me to discuss the results of a recent large study that challenges our assumptions about neonatal platelet...

This month, the American Society for Apheresis (ASFA) released a new version of their epic document called “Guidelines on the Use of Therapeutic Apheresis in Clinical Practice” in the Journal of Clinical Apheresis. It is, in many ways, the standard document that professionals in this field refer to when faced with a patient who may need treatment. One of the co-editors of the “Special Issue” (as it is also called), Dr. Nancy Dunbar, joins me to explain why you need to get your hands on the...

Continuing education episode! Alloimmunization after red blood cell (RBC) transfusion is a huge challenge in the treatment of sickle cell disease (SCD). Even when donors and patients are matched using traditional serologic strategies, and even that matching includes blood from minority donors, anti-Rh antibodies in patients with sickle cell disease are formed way often than we would like or expect. Further, Dr. Stella Chou has shown that nearly a third of patients with those new antibodies...

Continuing education episode! Over the past 15 years, Transfusion-related Acute Lung Injury (TRALI) has caused in more deaths than any other complication. Since many cases are caused by antibodies in blood donors, blood collection establishments around the world have taken numerous steps in an effort to prevent TRALI (also known as TRALI "mitigation"). Dr. Beth Shaz and a group of distinguished researchers decided to investigate and see if they could quantify the impact of the interventions....

Most blood bankers will tell you that cardiac surgery can lead to some of the most intense interactions between a transfusion service and an operating room. Over the decades, we have seen wide variations in how much blood surgeons transfuse, even among those practicing in the same hospital! Those times are changing, however. Dr. Pierre Tibi is a busy cardiac surgeon in Arizona who also happens to be a Patient Blood Management champion! Pierre joins me to pull back the curtain on what is...

CE Episode! It feels like everyone is talking about patient blood management. That's a GOOD thing, but does it really mean what they think it means? Dr. Carolyn Burns joins me to discuss "Five Things Patients and Physicians Should Question" regarding blood management, and what she has to say may show you that you are NOT doing everything you can or should with PBM in your facility.

Here's what we thought we knew: IgA deficiency leads to anaphylactic transfusion reactions. Not so fast! Dr. Gerald Sandler from Georgetown University noticed something when he was in charge of one of the US national reference labs: Hardly anyone with true anaphylactic reactions actually had IgA deficiency and anti-IgA! There's more to the story, and Jerry is here to share it with us (including why it's still ok to look for IgA deficiency in these patients).

Jehovah's Witnesses refuse transfusion based on strong religious beliefs, but the "rules" can be confusing. Transfusion Medicine professionals are often called to help clinicians manage Witnesses' care (despite the fact that these patients will not accept most of what we supply!). In this interview, Jed Gorlin details how to be helpful, respectful, and a great team member in the care of Jehovah's Witnesses who refuse transfusion.

Continuing education episode! Granulocyte concentrate has been around for as long as apheresis platelets, but the product has come into and out of favor repeatedly over the years. While the most recent randomized trials were disappointing, Dr. Ron Strauss believes a closer look at the data from the famous "RING Study" convinces him that if we transfuse a "modern," high-dose granulocyte concentrate, the results can be very positive! Let's look together at the history and future of granulocyte...

Continuing education episode! Ever since the introduction of anti-CD38 (daratumumab, or DARA), blood bankers have been hearing about a new chemotherapy agent, anti-CD47, that would interfere far more in our testing than anti-CD38. Well, anti-CD47 is here (in trials), and it lives up to its reputation! Connie Westhoff and her team report on results from blood bank testing of patients taking the drug, and what you can do to overcome the problems. This episode is eligible for free CME and...

Continuing education episode! For patients who might need blood transfusion, the ideas of donating their own blood (“autologous donation”) and/or choosing their blood donor (“directed donation”) seem VERY appealing! However, Dr. Julie Karp explains the good reasons why both special donation types are getting less and less common, and tells us what role, if any, each has in today's Transfusion Medicine. This episode is eligible for FREE CME and SAMs/CC credit for physicians and P.A.C.E....

Continuing education episode! You know all about AABB Standards, but how do you make them practical? Anne Chenoweth gives great tips to make your next assessment better! This episode is eligible for FREE CME and SAMs/CC credit for physicians and P.A.C.E. contact hours for laboratorians through Transfusion News Continuing Education on Wiley Health Learning.  

Continuing education episode! Nancy Dunbar says a few simple adjustments to "the rules" we learned long ago could reduce shortages of O-neg RBCs, AB plasma, and platelets! This episode is eligible for FREE CME and SAMs/CC credit for physicians and P.A.C.E. contact hours for laboratorians through Transfusion News Continuing Education on Wiley Health Learning.

A 25-year-old, A negative female needs blood. She will receive RhD-negative RBCs, of course, but what about antigen matching for Kell, or for other Rh antigens? Meghan Delaney explains her study, "AMIGO," in which she tried to determine if there is evidence that such matching is important.

Continuing education episode! Venous thromboembolism after surgery is a huge problem, and we may have underestimated one big contributing factor: Red cell transfusion! Ruchika Goel and colleagues put together the first study to primarily address the role of perioperative red blood cell transfusions in developing postoperative venous thromboemboli, and she is here to tell us what they found. This episode is eligible for FREE CME and SAMs/CC credit for physicians and P.A.C.E. contact hours for...

Isolated nonspecific reactions ("antibodies of undetermined specificity") on antibody workups can delay transfusions, but it may be impossible to determine whether or not they matter to the patient. Brenda Grossman explains possible causes and potential solutions when these annoying but common situations arise.

Patients with liver disease often have basic coagulation laboratory values that seem AWFUL, and as a result, they receive almost 1 in every 5 blood products transfused in hospitals! Jeannie Callum thinks that’s too much, and shows us how to improve our practice.