2017 AABB Annual Meeting On-Demand Select Patient Blood Management & Related Sessions

Transcription

1 2017 AABB Annual Meeting On-Demand Select Patient Blood Management & Related Sessions The following 15 Patient Blood Management (PBM) and topics of interest for PBM professionals are eligible for up to 20.5 CE/CME credits and up to credits for Florida or California Lab Personnel. The number of credits is based on the on-demand recording length of each session. Presentations are available at the discretion of the speakers and subject to change without notice. Sessions include: Mass Casualty Events: Transfusion Service Perspective Program #: 0108-TC-SS-2017 Recording Length (Mins): 90 Blood bank physicians responding to the Boston bombings, the Paris shootings and the Nice truck attack discussed recent mass casualty events, the process of getting blood to patients, lessons learned, and subsequent quality improvements made. Updates to the hospital portion of the AABB handbook were presented, as well as input from the speakers on further ideas for updates. Pre-Hospital Blood Product Resuscitation in Patients with Life Threatening Hemorrhage Program #: 0123-TC-SS-2017 Recording Length (Mins): 161 CME, CN & General Credit: 2.5 CLP & FLP Credit: 2.5 Although much attention has recently been focused on the blood product resuscitation of traumatically injured patients once they arrive at the hospital, their pre-hospital blood product needs have not been as well characterized. Even with a short transportation time between the site of injury and the hospital, much can be done to improve the patient s chances of survival. Recent US Military data reveals that prehospital blood product use is associated with improved survival. While some interventions in this setting are already widely in place, like using tranexamic acid, the use of novel blood components during the pre-hospital period has not been widely adopted. Similarly, it is essential for blood centers and transfusion services to have a plan to deal with large-scale emergencies. The ability to triage blood products and manage inventory shortages is essential when large numbers of bleeding casualties descend on the emergency department and the roads are inaccessible and the hospitals are cut off from their suppliers. This session discussed the magnitude of the problem of bleeding deaths in trauma, introduced some concepts of remote damage control resuscitation, described some novel blood products that might be lifesaving in the pre-hospital setting, and reviewed disaster preparedness models so that civilian blood bankers can learn lessons not only from the military experience but also from hospitals that have implemented various blood product resuscitation strategies in the pre-hospital setting. Don't Play "Hot Potato" with TTP: A 360 Degree Approach to TTP Patient Care (Mobile ARS) Program #: 0212-TC-SS-2017 Recording Length (Mins): 95 Treatment of patients with thrombotic thrombocytopenic purpura (TTP) can be "siloed" into different areas including apheresis, inpatient care, coagulation testing, and outpatient care. However, efficient interactivity of these critical elements can streamline and optimize the care of these patients as well as their treatment transitions. In this session, a model that integrates the different facets of TTP patient care was presented that demonstrates how communication can improve the care that these chronic 2017 AABB Annual Meeting On-Demand: PBM Sessions Page 1

2 patients receive at various points of their treatment of each disease episode as well as of disease surveillance for recurrence. Pediatric Transfusion Practice Program #: 0213-TC-SS-2017 Recording Length (Mins): 91 This session presented data from three large, recent, international, multi-center observational trials designed to analyze transfusion practice and outcomes in three distinct settings: plasma transfusions in the PICU, platelet transfusions in the PICU, and children with life-threatening bleeding. Precision Transfusion Medicine - Master the Bleeding Disaster! (Mobile ARS) Program #: 0226-TC-SS-2017 Recording Length (Mins): 80 As healthcare moves towards connected, data driven, and integrated personalized medicine, the role of transfusion medicine clinicians in managing bleeding patients will evolve. The goals of this session are to describe innovative ways to accomplish precision transfusion medicine in a fun and interactive learning environment. Dr. Cushing will lead participants in patient-specific and personalized transfusion therapies for patients in the intensive care unit. Dr. Haas will follow with a session on consultative use of coagulation factor concentrates, with participants learning how to use personalized bedside viscoelastic coagulation testing to dose and administer factor concentrates such as prothrombin complex concentrates and fibrinogen concentrate perioperatively, in adults and children. Finally, Dr. Iqbal will demonstrate how precision medicine testing can help transfusion specialists recommend individualized therapies in massive transfusion and describe limitations of precision medicine approaches to treat bleeding patients. Whole Blood Exchange for Severe, Life-Threatening Autoimmune Hemolytic Anemia Program #: 0315-TC-SS-2017 Recording Length (Mins): 67 Autoimmune hemolytic anemia (AIHA) is relatively rare disorder and is commonly treated with high dose steroids, IVIG, more recently rituximab, some other immunosuppressive medications and splenectomy with transfusion support. Although death from warm AIHA (WAIHA) is considered uncommon, severe AIHA can progress to multi-organ failure with a reported mortality rate around 10%. Therapeutic plasma exchange (TPE) has been tried to remove autoantibodies, but the procedure is often not applicable due to patient s low Hct level and hemodynamic instability, and the efficacy of TPE for WAIHA is uncertain due to high volume of distribution of IgG. In recent years, some literatures were published about AIHA cases that were treated by manual or automated re-constituted whole blood exchange with rapid clinical improvement. This innovative treatment is not well known so far. This session reviews common treatment for AIHA, several cases of AIHA treated with re-constituted whole blood exchange, the clinical and scientific rationale for considering whole blood exchange in severe AIHA, as well as different procedure methods and the factors of successful treatment for performing whole blood exchange in adults. How Pathogen Inactivation of Platelet Concentrates Impacts Patient Outcome Program #: 0321-TC-SS-2017 Recording Length (Mins): 60 Pathogen inactivation of platelet concentrates yields safer transfusions but at the cost of lower increments after transfusion. To what extent the poorer transfusion outcomes affect bleeding tendency in patients is only partially known. A number of clinical trials were recently completed, that compared pathogen inactivated versus untreated platelet concentrates. In one trial, daily monitoring of patients 2017 AABB Annual Meeting On-Demand: PBM Sessions Page 2

3 for bleeding symptoms was performed, giving detailed information on site and severity of the bleed. The outcomes of the trial will be discussed, and the applicability of bleeding as primary study endpoint will be discussed. There are no good laboratory measures to predict bleeding in a patient. However, thrombocytopenia induces damage to the blood vessel wall, including those in the kidney, which may result in albuminuria. The usefulness of albuminuria as bleeding predictor will be presented. Between 5 and 10 percent of the patients develop HLA antibodies when undergoing transfusion therapy. These antibodies result in poor platelet increments, putting these patients at risk for increased bleeding. They come to rely on HLA matched concentrates for their platelet support. Animal models have shown that antibody response can be prevented when a pathogen inactivation step is used, and data of two studies in humans will be presented (for two pathogen inactivation techniques) to answer the question whether treatment of platelet concentrates alone is sufficient to prevent antibody formation in a real life clinical setting. The principal aim of pathogen inactivation is lowering the risk of viral and bacterial transmission from donor to recipient. The incidence of transfusion-transmitted diseases is extremely low which makes demonstration of pathogen kill virtually impossible. Therefore, the transmission of anello virus, a genetically polymorph non-pathogenic virus, was studied to demonstrate the efficacy of the pathogen reduction step. Bacterial screening around the time of blood donation ensures increased safety of platelet transfusions, and between 0.5 and 1% is positive in this initial culture. Platelet concentrates in the clinical trial were cultured before and after pathogen inactivation, and the frequency of positive culture results will be compared with that of untreated units. Iron in Transfusion Medicine: Consequences of Too Much or Too Little Program #: 0326-S-SS-2017 Recording Length (Mins): 99 Iron plays a crucial role in multiple metabolic pathways of the body with iron deficiency resulting in growth arrest and anemia. Recent studies have identified iron deficiency as a potentially hazardous consequence of blood donations and iron supplementation protocols have been implemented to prevent iron loss. However, increased iron accumulation is associated with organ damage and opportunistic infections and in certain disorders such as hemochromatosis regular blood donations considered an accepted therapeutic approach to control iron toxicity. Furthermore, some epidemiological studies suggest dietary heme iron intake to be associated with an increased risk of type 2 diabetes. In this session, mechanisms of altered iron metabolism as a result of blood loss and iron accumulation will be discussed. In addition, the effect of regular blood donation on body iron stores will be reviewed and the pros and cos of iron supplementation discussed. Finally, the effects of posttransfusion iron overload in patients with sickle cell disease vs thalassemia will be compared and contrasted with emphasis on a discussion of novel iron-based therapeutics including hepcidin- and transferrin-based therapies. Blood Bank Mythbusters Program #: 0327-TC-SS-2017 Recording Length (Mins): 103 Blood Bank Mythbusters aims to uncover the truth behind popular myths and legends in the blood banking world with unbridled curiosity and conversations regarding best practices in transfusion medicine. Hoping to inspire all blood bankers, the panel will interact and challenge us to get involved with proving or disproving popular myths, misconceptions or legends in our specialized world. Panel members Dr. Mary Townsend, Senior Medical Director at Blood Systems, and Dr. Joe Chaffin, aka Blood Bank Guy - Chief Medical Officer for LifeStream, join session leader Dr. Kevin Land, Vice President of Clinical Services at Blood Systems, Inc for this interesting session. Watch these well-known speakers and educators bring enthusiasm and fun to learning as they seek to bust common myths in Blood Banking! They have extensive experience with both hospital and blood center-based transfusion services, so this is sure to be a treat AABB Annual Meeting On-Demand: PBM Sessions Page 3

4 Revelations and Considerations in Red Cell Exchange for Sickle Cell Disease Program #: 0328-TC-SS-2017 Recording Length (Mins): 65 Based on the 2016 NHLBI summary of Scientific Priorities in Pediatric Transfusion Medicine, uncertainty exists as to whether chronic red cell exchange (RCE) is a more effective RBC transfusion modality compared to chronic simple transfusion, assessed by adequate hemoglobin S suppression and ability to mitigate iron overload in patients with SCD. Dr. Jon Detterich will discuss blood rheology in sickle cell disease, considering the trade-off between suppression of HbS and increased viscosity and rheological considerations. Dr. Kim will critically analyze the available evidence regarding reduced iron overload and increased red cell alloimmunizationin RCE and elucidate the merits of combined depletion-rce versus traditional RCE and case by case considerations. Finally, Dr. Ballas will review evidence for expansion of RCE use beyond current widely accepted indications for RCE, such as its use in priapism, pregnancy management, and a severe vaso-occlusive complications. and address the theoretical question of whether red cell aging is still an issue in sickle cell patients and the potential utility of using washed red cells. The Virtual Blood Bank: The Use of Simulation and Decision Analysis to Study Transfusion Processes Program #: 0329-QE-SS-2017 Recording Length (Mins): 50 CME, CN & General Credit: 0.75 CLP & FLP Credit: 0 Clinical research in patient blood management, including inventory management and allocation of resources, can be difficult and costly to study, as transfusion decision making affects and is affected by many variables spanning the entire healthcare enterprise. Benefits, costs, risks, and ethical considerations must be balanced by observing the interaction of many clinical workflows in the donor center, the laboratory, the operating room, and medical treatment areas. One solution to this complex task is to analyze clinical workflows by the use of simulation and modeling. Processes and patient behavior can be sampled thousands of times in just a few minutes, and at little cost. In this session, we will introduce the concept of the "virtual blood bank," a set of tools to apply simulation to study important questions of patient blood management and optimal transfusion practice. We will discuss the key methods of simulation studies and discuss how they may be applied to transfusion medicine using tools such as decision analysis and cost-effectiveness. We will then describe examples of how computer modeling has been used to address controversial issues in blood banking and transfusion practice, such as the use of red blood cell antigen genotyping to maintain an inventory of antigen-negative units; reducing the risk of alloimmunization in sickle cell disease patients; and using ABO-identical platelet transfusions to minimize the risks of hemolytic transfusion reactions and poor platelet recovery. New Insights into the Neonatal Inflammatory Response: Implications for Transfusion Medicine Program #: 0407-S-SS-2017 Recording Length (Mins): 91 Thrombocytopenia is frequent among critically ill neonates admitted to Neonatal Intensive Care Units. Thrombocytopenic neonates are typically transfused at higher platelet counts than older children or adults, particularly in the U.S. The majority of platelet transfusions in this population are given to neonates with sepsis or necrotizing enterocolitis, a disease unique to premature infants associated with intestinal injury, systemic inflammation and high mortality. Over the last decade, the importance of platelets in inflammation and host defense has been increasingly recognized, but the potential risks and benefits of platelet transfusions in the context of the unique neonatal physiopathology are poorly understood. In this session, we will discuss the recent discovery of a placenta-derived neonatal NET inhibitory factor, and novel pathways implicated in the high mortality associated with neonatal sepsis. We will then review platelet transfusion practices in the U.S. and worldwide, the developmental differences that exist between neonatal and adult platelets, and the potential implications of these differences to neonatal transfusion medicine AABB Annual Meeting On-Demand: PBM Sessions Page 4

5 Iron Supplementation in Blood Donors: Who, What, Why, and How? Program #: 0409-TC-SS-2017 Recording Length (Mins): 88 The high prevalence of iron depletion in blood donors, and the important causal role played by repeated donation, has drawn considerable attention in recent years. One potential policy response with an empirical basis for improving iron levels in donors is extending the minimum inter-donation interval, but available data suggest that blood availability would be compromised were intervals lengthened sufficiently to allow for recovery by most blood donors. In contrast, consumption of supplemental iron accelerates donor recovery of both iron stores and hemoglobin following donation, protecting against iron depletion and benefiting the blood center through reduced low hemoglobin deferrals. Most blood centers encourage use of supplemental iron by at least those who are designated frequent donors, but only one large blood center actually distributes iron pills directly to its donors. This session will present data from a large, systematic survey of blood donors to understand which donors take iron and why they take it, and how responsive donors are to blood center messages to take iron. Also, we will hear detailed results from the only large blood center in the US that directly provides iron to a subset of its donor population, and the key decisions that went into development of its program, and ongoing evaluations thereof. Finally, we will review the medical considerations that come into play from more active engagement by the blood center in promoting iron supplementation in its donors. Same as It Ever Was: Clinical Equipoise in Graft-Versus-Host-Disease Treatments Program #: 0410-TC-SS-2017 Recording Length (Mins): 86 Graft-versus-Host-Disease (GvHD) is a complication that often occurs after allogeneic stem cell transplanatation where newly transplanted cells attack the recipients's tissues. However, there is clinical heterogeneity in the treatment protocols for pharmacotherapy and extracorporeal photopheresis. The goal of this session will be to communicate current and emerging therapies/protocols for GvHD, as well as methodologies for monitoring disease activity and response to treatments. Patient Centred Outcomes in Transfusion Medicine Program #: 0417-TC-SS-2017 Recording Length (Mins): 95 Patient centred outcomes (PCO) are measurable findings that relate to concerns specific to a patient experiencing the condition of interest. PCOs may be collected by research staff or through patientreported outcome measures (PROM), reported directly by the patient. Few, if any, transfusion trials have included such outcomes and it is not possible to estimate the impact of this void. This workshop aims to introduce the concept of patient-centred outcomes and their relevance in transfusion medicine. First person narratives will illustrate how gaps in understanding in the current transfusion literature impact patients. Content experts will identify the role PCOs can have in furthering our understanding of transfusion knowledge AABB Annual Meeting On-Demand: PBM Sessions Page 5