Numerous clinical situations require emergent
|
|
- Norah Taylor
- 5 years ago
- Views:
Transcription
1 TRANSFUSION BRIEF REPORT PRACTICE A case for stocking O D+ red blood cells in emergency room trauma bays Erin Meyer and Lynne Uhl BACKGROUND: AABB Standard 5.27 requires transfusion services to have a process for urgent release of blood before completion of compatibility testing. Our institution endorses a policy for the emergency release of group O, D+ red blood cells (RBC; O+ RBC) to males and females at least 50 years of age. Our emergency department (ED) stocks 4 O RBC units. To determine if O+ RBCs can replace ED O RBCs, we performed a retrospective review. STUDY DESIGN AND METHODS: Patients admitted to the ED between January 2001 and August 2011 and transfused emergency-release O RBCs were identified. Data were collected on sex, age, length of stay, clinical status, ABO/Rh, RBC transfusions, and RBC antibody screen results. RESULTS: A total of 498 ED O RBC units were transfused to 268 patients (168 male, 100 female). A total of 322 units were transfused to males and 114 to females at least 50 years of age. Thirty-nine (14%) were D with 18 receiving O+ RBCs. A total of 109 had follow-up antibody screens; one D patient developed alloanti-d. CONCLUSIONS: The findings support the placement of O+ RBCs in the ED. The majority of ED O RBCs (88%) went to patients who qualified for O+ RBCs; a minority (1.5%) of patients were D females less than 50 years of age. The rate of alloimmunization was low. ABBREVIATIONS: BIDMC = Beth Israel Deaconess Medical Center; ED = emergency department. From the Joint Fellowship Program in Transfusion Medicine & Department of Pathology, Beth Israel Deaconess Medical Center; and Harvard Medical School, Boston, Massachusetts. Address reprint requests to: Erin K. Meyer, DO, MPH, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Suite 7105-A, Atlanta, GA 30322; emeyer5@emory.edu. Received for publication June 5, 2014; revision received September 16, 2014, and accepted September 16, doi: /trf AABB TRANSFUSION 2015;55: **;**:**-**. Numerous clinical situations require emergent blood transfusions. According to the 29th edition of Standards for Blood Banks and Transfusion Services, Standard 5.27 requires transfusion services to have a process in place allowing for the urgent release of red blood cells (RBCs) before completion of compatibility testing. 1 Traditionally as the universal donor group O, D RBC units have been used for emergent un cross-matched transfusions. The D antigen s immunogenicity is well documented. Yet the rate of anti-d formation is variable and appears to be dependent on the population transfused. Pollack and colleagues 2 transfused 500 ml of D+ blood to 22 D healthy volunteers and found the rate of alloimmunization to be 81.8% (18 of 22). Cook and Rush 3 in 1974 found in 20 D patients transfused an average of 19.4 D+ units per patient an alloimmunization rate of 95% (19/20). Yazer and Triulzi 4 retrospectively reviewed the transfusion records of 15 hospitals and found 98 D patients received 445 D+ RBC units. The rate of alloimmunization in this study population was approximately 22% (22/98). 4 Gonzalez-Porras and colleagues 5 prospectively evaluated the use of D+ blood in massively transfused patients including women of non child-bearing years and adult men. In 351 D patients who received 1032 D+ units, the incidence of anti-d alloimmunization was 21.4%. 5 Yet in bone marrow transplant patients, patients with solid tumors, and patients with AIDS, the rate of D alloimmunization in D patients after transfusion with D+ blood was less than 10%. 6-9 These rates certainly suggest that increasing immunologic compromise affects the incidence of D alloimmunization. 4,5 Anti-D, however, remains significant for females of child-bearing potential: 20% of pregnancies where maternal anti-d is detectable will have severe hemolytic disease of the newborn. 10 In the United States donor population, group O, D donors only account for approximately 9% of all donors. 11 Due to the limited availability of group O, D RBC units (O RBC), Beth Israel Deaconess Medical Center (BIDMC) endorses a policy for the emergent release of group O, D+ un cross-matched RBCs (O+ RBCs) to all males, regardless of age, and to all females at least 50 years old. Yet BIDMC currently stocks 4 O RBC units in a monitored refrigerator in the emergency department (ED). To Volume 55, Volume April 2015 **, ** ** TRANSFUSION 7911
2 MEYER AND UHL determine if O+ RBCs can reasonably replace the O RBCs stocked in the ED, we performed a retrospective medical record review of all the patients who received blood from the ED refrigerator during a 10-year period examining the use of O RBCs in patients who qualified for O+ RBCs based on our policy. MATERIALS AND METHODS Study population selection and review After institutional review board approval was obtained, patients who were admitted through the ED and transfused with emergency-released RBC units from a monitored ED refrigerator were identified through a computerized query of the Center for Clinical Computing (Boston, MA) blood bank computer database from January 2001 through August Patients current blood type and antibody screen, historic blood type and antibody screen (if available), and number and type of subsequent RBC units, apheresis platelet products, plasma units, and cryoprecipitate units were recorded. Additional data collected included dates and results of any posttransfusion RBC antibody history. In addition, each patient s electronic medical record was reviewed for data on sex, age, length of hospitalization, and clinical status. Patients were evaluated for subsequent anti-d formation if they had at least one antibody screen performed at least 7 days after admission. Serologic investigation RBC typing (forward and reverse typing) as well as D typing were performed by either manual tube or automated technology (Immucor, Inc., Norcross, GA). 12 Antibody screens were performed using polyethylene glycol indirect antiglobulin test (Gamma Biologicals, Inc., Houston, TX) and a three-cell screen (R 1R 1, R 2R 2, rr; Immucor, Inc.) according to institutional standard operating procedure with agglutination reactions read macrosopically in tube and graded from 0 to 4+ for patients evaluated between 2001 and In January 2008, solid-phase technology (Capture-R, Immucor, Inc.) using a two-cell screen (R 1R 1,R 2R 2) was introduced for antibody screens. In all instances, positive screening tests were followed by serologic investigation using a panel of 14 phenotypically defined RBCs (Immucor, Inc.) selected to identify antibody specificity. The results of each patient s admission antibody screen and antibody specificity, if observed, were recorded. Only D patients who received D+ units and had subsequent antibody screen(s) performed at least 7 days after transfusion of emergently released ED units were included for serologic follow-up. Statistical analysis All descriptive statistical calculations were performed with computer software (Excel 2010, Microsoft Corp., Redmond, WA). RESULTS Demographics of study population During the study period, 498 O emergency-released RBC units stored in the ED inventory were transfused to 268 patients (168 [63%] male and 100 [37%] female) during January 2001 through August 2011 (see Table 1). Males were transfused 322 O RBC units. Females 50 years and older were transfused 114 O RBC units and female patients less than 50 years of age were transfused 62 O RBC units (Table 1). D patients Thirty-nine of the 268 (14%) patients who received emergency-released blood from the ED refrigerator were D. Eighteen of these D patients required transfusion with D+ RBC units (mean, 9.6 units; median, 4.5 units; range, 1-32 units) during the course of their admission. Seven patients required massive transfusions (>10 units of RBCs transfused within 24 hr). Of the D patients who received D+ RBC, five did not survive beyond 6 days of admission and three did not have a follow-up type and antibody screen. These patients were not included in TABLE 1. Characteristics of patients transfused emergently released ED RBCs Recipient characteristics Total (n = 268) Male (n = 168, 63%) Female (n = 100, 37%) Age (years)* 54.5, 55 (16-97) 53, 52 (16-92) 58, 59 (17-97) D status D+: 86% D+: 86% D+: 82% D : 14% D : 14% D : 18% Number ED O RBC units transfused 498 (100) 322 of 498 (65) 50 years old: 114 of 498 (23) <50 years old: 62 of 498 (12) ED O RBC units transfused per patient* 1.9, 2 (1-4) 1.9, 2 (1-4) 1.8, 2 (1-4) Number receiving additional RBC units/additional 227 (85)/16, 6 (1-166) 146 (85)/12, 6 (1-166) 80 (79)/7, 4 (1-44) RBC units transfused per patient during admission* Length of stay (days)* 12, 6 (0-202) 12, 6 (0-202) 12, 7 (0-146) Mortality (within 7 days of admission) 119 (44) 85 (50) 34 (34) Number with any posttransfusion antibody screen 109 (41) 64 (38) 45 (45) * Data are expressed as mean, median (range) or number (%) TRANSFUSION Volume **, 55, ** ** April 2015
3 O D+ RBCs RBCS IN EMERGENCY ROOMS serologic follow-up. Eight D patients survived 7 days past admission and had at least one follow-up antibody screen after this point (see Serologic follow-up ). These patients received an average of 12.3 D+ RBC units (median, 10 units; range, 1-27 units; Table 2). Serologic follow-up Eighty-six patients died within 7 days of admission from the injuries for which they were admitted and urgently transfused. Of the 182 patients who survived past 7 days (45 females), 179 had negative RBC antibody screens on admission. Six patients had positive antibody screens on admission and were switched to the appropriate antigennegative RBC units after identification. Only four of these patients were alive 7 days after admission. One was an D+ female age 65 with anti-jk(a) and anti-kell, and one was a 62-year-old female with partial D with anti-d and anti-e. The third was a D male (age 50) with anti-d, and the fourth an 89-year-old D female with anti-d. Overall 73 patients did not have a repeat antibody screen at BIDMC during the 10-year study period. A total of 109 patients had at least one repeat antibody screen at BIDMC performed on average 283 days after the emergent transfusion episode (median, 19 days; range, days). Of this group, two patients had a newly positive antibody screen (see Table 2): one 38-year-old group O, D male developed a warm autoantibody, anti-d, anti-c, and anti-e, and one 90-year-old group B, D female developed an anti-e. The male had been transfused 20 units of D+ RBCs during a 24-hour period and the female 6 units of D+ RBCs. The rate of anti-d formation in D patients who received D+ blood and had an antibody screen performed at least 7 days after emergent transfusion was 12.5% (one of eight) in this patient population. DISCUSSION Blood is an altruistic resource that can pose significant risk to patients and needs to be transfused judiciously. In some situations, emergent transfusion of RBCs is necessary and can be lifesaving, particularly in patients admitted through the ED. In an effort to be good stewards of the blood supply, BIDMC has a policy in place to safeguard O RBCs for the population most at risk from anti-d formation: D females of child-bearing potential (<50 years of age). The policy allows for the use of O+ RBCs for all men and women of at least 50 years of age. However, O RBCs are currently stocked in the monitored ED refrigerator, which can be used for any patient admitted to the ED who is in urgent need of blood transfusion. We sought to determine with this retrospective review whether or not the ED refrigerator could be stocked with group O, D+ RBCs by examining the characteristics of all patients transfused from this inventory over a 10-year period. TABLE 2. Characteristics of D recipients who received O+ RBCs and survived past 7 days and had at least one follow-up antibody screen Mortality (during study period)/died from injuries suffered on admission Length of stay (days) Antibody screen result on follow-up Length of serologic follow-up (days) Antibody screen on admission Number of O+ RBC units transfused outside ED Number of ED-released O RBC units transfused in ED Admission service ABO type Age (years) Sex 38 Male O Trauma 2 20 Negative 164 Positive (WAA, anti-d, C, E) 202 Alive/NA 47 Male B Trauma 2 27 Negative 26 Negative 29 Died/yes 90 Female B Gastrointestinal 2 6 Negative 10 Positive (anti-e) 14 Alive/NA 31 Male O Trauma 4 1 Negative 2003 Negative 24 Alive/NA 54 Female A Trauma 2 25 Negative 142 Negative 146 Died/no 74 Male O Vascular surgery 2 3 Negative 65 Negative 14 Alive/NA 50 Male A Gastrointestinal 1 2 Positive (anti-d) 280 Positive (anti-d) 36 Alive/NA 63 Male O Vascular surgery 1 14 Negative 16 Negative 40 Alive/NA Volume 55, Volume April 2015 **, ** ** TRANSFUSION 7933
4 MEYER AND UHL This 10-year retrospective review supports the placement of group O, D+ RBCs in the ED inventory. The majority of D RBCs stocked in the ED (436, 88%) were transfused to patients who qualified for group O, D+ RBCs per institutional policy: men and women at least 50 years of age. The patient population most at risk for the deleterious effects of anti-d alloimmunization (i.e., females of child-bearing potential [women < 50 years of age per institutional policy]) received only 12% of the group O, D ED units (62 units). Furthermore consistent with national demographics, 86% of the overall study population were D+ and were transfused 413 of the group O, D RBC (83%). 11 Similar to a recent study by Zalpuri and colleagues, 13 serologic follow-up in this study was limited to at least 7 days. Previously alloimmunized patients would most likely present with a positive antibody screen (even with a negative screen on admission) less than 7 days after reexposure due to amnestic response while a period of 7 days allows for a primary immune response. 13 Only two patients who survived past 7 days and had at least one additional follow-up antibody screen at our institution developed alloantibodies. Both patients were D patients and received D+ RBCs. One was a 38-year-old male who received 20 units of D+ RBCs within a 24-hour period and developed a warm autoantibody, anti-d, anti-c, and anti-e. The other was a 90-year-old female transfused 6 units of D+ RBCs within a 24-hour period who developed an anti-e. Thus overall the incidence of anti-d alloimmunization in the D patients who received D+ RBC was low (12.5%, one of eight) in our study population. The rate of D alloimmunization observed in this study (12.5%) is lower than that observed in other studies. Frohn and coworkers 14 studied the rate of anti-d alloimmunization in hospitalized D recipients of D+ RBCs and used statistical modeling to account for those patients who would have formed an alloantibody on follow-up but did not during the study period (November 1987-June 2002). Frohn and coworkers 14 cite stressinduced immune suppression as a potential reason for their study s low alloimmunization rate. This could also have played a role in our study population as many of our patients suffered traumatic injury which has been previously described as a major factor in stress-related immune suppression The derived alloimmunization rate of Frohn and colleagues 14 was 30.4%. However, Yazer and colleagues calculated the actual alloimmunization rate of Frohn and colleagues to be 21%, which is consistent with Yazer and Triulzi s observation in their multicenter retrospective review of an anti-d seroconversion rate of 22%. 4,14 The lower anti-d alloimmunization rate observed here may be related to the study s limitations. The data were collected retrospectively, and serologic follow-up was limited to only our institution. A prospective study would allow for a more complete follow-up on patients who receive their care at other institutions. Also complete transfusion, alloimmunization, and pregnancy histories were not available for all patients. In addition, our study had a relatively small number of subjects (268 patients) of which only 18 D were transfused D+ RBCs during their hospitalization. The results of this review suggest that the placement of group O, D+ RBC in the ED inventory should be considered. The majority of the units transfused (88%) from this inventory were given to patients who qualified for group O, D+ RBCs per institutional policy. In addition, only a minority of patients (4, 1.5%) were D females of childbearing potential (<50 years of age), 25% (one) of whom did not survive the injuries for which she was admitted and transfused. CONFLICT OF INTEREST The authors have disclosed no conflicts of interest. REFERENCES 1. American Association of Blood Banks. Standards for blood banks and transfusion services. 29th ed. Bethesda (MD): American Association of Blood Banks; Pollack W, Ascari WQ, Crispen JF, et al. Studies on Rh prophylaxis II. Rh immune prophylaxis after transfusion with Rh-positive blood. Transfusion 1971;11: Cook K, Rush B. Rh(D) immunization after massive transfusion of Rh(D)-positive blood. Med J Aust 1974;1: Yazer MH, Triulzi DJ. Detection of anti-d in D recipients transfused with D+ red blood cells. Transfusion 2007;47: Gonzalez-Porras JR, Graciani IF, Perez-Simon JA, et al. Prospective evaluation of a transfused policy of D+ red blood cells into D patients. Transfusion 2008;48: Schonewille H, Haak HL, van Zijl AM. Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion 1999;39: Baldwin ML, Ness PM, Scott D, et al. Alloimmunization to D antigen and HLA in D- immunosuppressed oncology patients. Transfusion 1988;28: Holohan TV, Terasaki PI, Deisseroth AB. Suppression of transfusion-related alloimmunization in intensively treated cancer patients. Blood 1981;58: Asfour M, Narvios A, Lichtiger B. Transfusion of RhD incompatible blood components in RhD-negative blood marrow transplant recipients. MedGenMed 2004;6: Eder AF, Manno CS. Alloimmune hemolytic disease of the fetus and newborn. In: Means R, Foerester J, Greer JP, et al., editors. Wintrobe s clinical hematology. 12th ed. Philadelphia (PA): Lippincott, Williams and Wilkins; p TRANSFUSION Volume **, 55, ** ** April 2015
5 O D+ RBCs RBCS IN EMERGENCY ROOMS 11. American Association of Blood Banks. Frequently asked questions. Updated August 6, [cited 2014 May 21]. Available from: aspx#a8 12. Roback JD, Grossman BJ, Harris T, et al., editors. Technical manual. 17th ed. Bethesda (MD): American Association of Blood Banks; Zalpuri S, Middelburg RA, Schonewille H, et al. Intensive red blood cell transfusions and risk of alloimmunization. Transfusion 2014;54: Frohn C, Dümbgen L, Brand JM, et al. Probability of anti-d development in D patients receiving D+ RBCs. Transfusion 2003;43: Hotchkiss RS, Tinsley KW, Swanson PE, et al. Sepsis inducted apoptosis causes progressive profound depletion of B and CD4+ T lymphocytes in humans. J Immunol 2001; 166: Puyana JC, Pellegrini JD, De AK, et al. Both T-helper-1 and T-helper-2-type lymphokines are depressed in posttrauma anergy. J Trauma 1998;44: Hensler T, Hecker H, Heeg K, et al. Distinct mechanisms of immunosuppression as a consequence of major surgery. Infect Immun 1997;65: Volume 55, Volume April 2015 **, ** ** TRANSFUSION 7955
Blood Component Testing and Labeling
Blood Component Testing and Labeling Each donor unite must be tested and properly labeled before its release for transfusion. Required Tests: In most blood banks, pretransfusion testing involves determining
More informationA30-year-old G2P1 female is 12 weeks pregnant
HOW DO I...? How do I manage Rh typing in obstetric patients? Richard L. Haspel 1 and Connie M. Westhoff 2 A30-year-old G2P1 female is 12 weeks pregnant and her red blood cells (RBCs) type as A1 with a
More informationEssentials of Blood Group Antigens and Antibodies
Essentials of Blood Group Antigens and Antibodies Non-Medical Authorisation of blood Components Nov 2017 East Midlands Regional Transfusion Committee Transfusion Terminology Antigens and Antibodies Antibodies
More informationBLOOD COMPONENT SUPPORT OF RhD NEGATIVE INDIVIDUALS
REASON FOR ISSUE: Review of section 4 along with changes in requirement to inform TMS in respect of authorisation process (in Appendix A) DCR16969. 1. INTRODUCTION of RhD positive blood components to an
More informationTransfusion Practices and Creation of a Registry for Patients with Sickle Cell Disease within the Atlanta Sickle Cell Consortium
Transfusion Practices and Creation of a Registry for Patients with Sickle Cell Disease within the Atlanta Sickle Cell Consortium Annie Winkler MD Assistant Professor, Emory University Department of Pathology
More information8/28/2018. Disclosures. Objectives. None. Automation to PreciseType and Everything in Between
Automation to PreciseType and Everything in Between Jessie Singer MT(ASCP) Transfusion Medicine Children s Hospital Los Angeles None Disclosures Objectives Describe the application of molecular testing
More informationAutomation to PreciseType and Everything in Between. Jessie Singer MT(ASCP) Transfusion Medicine Children s Hospital Los Angeles
Automation to PreciseType and Everything in Between Jessie Singer MT(ASCP) Transfusion Medicine Children s Hospital Los Angeles None Disclosures Objectives Describe the application of molecular testing
More informationTransfusion Guidelines in AIHA; Indications, Compatibility Testing and Administration.
Transfusion Guidelines in AIHA; Indications, Compatibility Testing and Administration. Lawrence D. Petz, M.D. Emeritus Professor University of California Los Angeles, California, U.S.A.; Medical Director
More informationWebinar: Association of Hgb A Clearance & RBC Antibodies
Webinar: Association of Hgb A Clearance & RBC Antibodies Second Webinar Session A second session of this webinar will be hosted Wednesday, July 12 2:00 PM EST (1800 GMT) Register at the link below: https://attendee.gotowebinar.com/rt/9012031991808089089
More informationTransfusion Awareness
Transfusion Awareness Learning Outcomes By the end of this you should be able to: Explain sample validity and the importance of the group check sample (2 sample rule) Discuss the significance of the ABO
More informationPILOT STUDY OF ANTIGEN MATCHING FOR AUTOIMMUNE HEMOLYTIC ANEMIA
PILOT STUDY OF ANTIGEN MATCHING FOR AUTOIMMUNE HEMOLYTIC ANEMIA Sharon Rice & Fred Plapp Saint Luke s Hospital Kansas City, MO CENTRALIZED TRANSFUSION SERVICE Antibody identification Antibody titer Antigen
More informationSpecific Requirements
Specific Requirements AIMS Specific requirements your patients have for transfusion and how this is managed Classify which patients require: Irradiated components CMV negative components Washed components
More informationBlood Components & Indications for Transfusion. Neda Kalhor
Blood Components & Indications for Transfusion Neda Kalhor Blood products Cellular Components: Red blood cells - Leukocyte-reduced RBCs - Washed RBCs - Irradiated RBCs Platelets - Random-donor platelets
More informationCASE STUDIES IN CLINICAL APPLICATIONS OF THERAPEUTIC PLASMA EXCHANGE
CASE STUDIES IN CLINICAL APPLICATIONS OF THERAPEUTIC PLASMA EXCHANGE Eric Rosa, MLS (ASCP) CM Medical Laboratory Scientist Transfusion Service April 18, 2018 Objectives Explain the process of a therapeutic
More informationLifetime risk and characterization of red blood cell alloimmunization in chronically transfused patients with sickle cell disease
Woldie et al. 1 ORIGINAL ARTICL PR RVIWD OPN ACCSS Lifetime risk and characterization of red blood cell alloimmunization in chronically transfused patients with sickle cell disease Woldie I., Swerdlow
More informationALL Blood Transfusion samples must be hand-written in accordance with the Trust's Blood Administration Protocol
Blood Transfusion Routine Investigations ALL Blood Transfusion samples must be hand-written in accordance with the Trust's Blood Administration Protocol Full Group & Screen 2ml EDTA Can be stored at 2-8C
More informationRed-blood-cell alloimmunization and number of red-blood-cell transfusions
ORIGINAL PAPER ª 2011 The Author(s) Vox Sanguinis ª 2011 International Society of Blood Transfusion DOI: 10.1111/j.1423-0410.2011.01517.x Red-blood-cell alloimmunization and number of red-blood-cell transfusions
More informationTransfusion Reactions. Directed by M-azad March 2012
Transfusion Reactions Directed by M-azad March 2012 Transfusion Reactions are Adverse reactions associated with the transfusion of blood and its components Transfusion reactions Non-threatening to fatal
More informationIt s not just allo-antibodies that a red cell transfusion can stimulate
It s not just allo-antibodies that a red cell transfusion can stimulate Associate Professor Ralph Green Laboratory Medicine RMIT University Melbourne, Australia Transfusion practice Minimise risk of transmitting
More informationAntibody identification. Antibody specificity
Red blood cell (RBC) transfusions are frequently used in sickle-cell anaemia (SCA) patients to treat and prevent the complications of their disease. Acute simple transfusions are usually used to treat
More informationASFA 2015 Consensus Conference: RBC Exchange in Sickle Cell Disease
ASFA 2015 Consensus Conference: RBC Exchange in Sickle Cell Disease Session 5B: SELECTION OF RED CELLS Araba Afenyi-Annan, MD, MPH Adjunct Assistant Professor Department of Pathology & Laboratory Medicine,
More informationResearch Article Prevalence and Specificity of RBC Alloantibodies in Indian Patients Attending a Tertiary Care Hospital
Advances in Hematology, Article ID 749218, 5 pages http://dx.doi.org/10.1155/2014/749218 Research Article Prevalence and Specificity of RBC Alloantibodies in Indian Patients Attending a Tertiary Care Hospital
More informationNLBCP-017 INDIRECT ANTIGLOBULIN CROSSMATCH TUBE METHOD. Issuing Authority
Government of Newfoundland and Labrador Department of Health and Community Services Provincial Blood Coordinating Program INDIRECT ANTIGLOBULIN CROSSMATCH TUBE METHOD Office of Administrative Responsibility
More informationImmunohematology (Introduction)
Modified from Serotonin version Immunohematology (Introduction) References: -Blood Groups and Red Cell Antigens (Laura Dean) -Cellular and molecular immunology, 8 th edition Introduction to replace blood
More informationCase-Control Study: ABO-Incompatible Plasma Causing Hepatic Veno-Occlusive Disease in HSCT
Case-Control Study: ABO-Incompatible Plasma Causing Hepatic Veno-Occlusive Disease in HSCT Erin Meyer, DO, MPH Assistant Medical Director of Blood, Tissue, and Apheresis Services Children s Healthcare
More informationDIAGNOSTIC SERVICES MANITOBA
DIAGNOSTIC SERVICES MANITOBA YEAR IN REVIEW JANUARY DECEMBER 2012 CANADIAN BLOOD SERVICES MANITOBA DIAGNOSTIC SERVICES SENIOR STAFF AND CONTACT INFORMATION MEDICAL DIRECTOR Debra Lane MD, FRCPC 204.789.1079
More informationSupporting solid organ transplants: Challenges for Blood Transfusion Labs
Supporting solid organ transplants: Challenges for Blood Transfusion Labs Dora Foukaneli Consultant in Haematology and Transfusion Medicine NHSBT Cambridge and Addenbrooke s Hospital Addenbrooke s Blood
More informationAll you wanted to know about transfusion support for transplants
All you wanted to know about transfusion support for transplants Dr Dora Foukaneli NHSBT and Addenbrooke s Hospital Cambridge When / why / why not? What ABO group? Do other groups matter? Transplantation
More informationINVESTIGATION OF ADVERSE TRANSFUSION REACTIONS NLBCP-006. Issuing Authority
Government of Newfoundland and Labrador Department of Health and Community Services Provincial Blood Coordinating Program INVESTIGATION OF ADVERSE TRANSFUSION REACTIONS Office of Administrative Responsibility
More informationCURRENT COURSE OFFERINGS
The American Red Cross offers regular educational opportunities as a convenient way for healthcare providers to receive relevant blood banking and transfusion medicine information. The bi-monthly sessions,
More informationImmunohematology (Introduction) References: -Blood Groups and Red Cell Antigens (Laura Dean) -Cellular and molecular immunology, 8 th edition
Immunohematology (Introduction) References: -Blood Groups and Red Cell Antigens (Laura Dean) -Cellular and molecular immunology, 8 th edition Introduction to replace blood lost by hemorrhage or to correct
More informationINFORMATION ONLY Changes to Requesting HLA/HPA Selected Apheresis Platelets Customer Letter #
INFORMATION ONLY Changes to Requesting HLA/HPA Selected Apheresis Platelets Customer Letter # 2015-21 Head Office / Siège social 2015-08-11 Dear Customer, We are writing to inform you of changes to the
More informationCo-dominance. Dr.Shivani Gupta, Department of Zoology, PGGCG-11, Chandigarh
Co-dominance Dr.Shivani Gupta, Department of Zoology, PGGCG-11, Chandigarh Blood groups and Rhesus factor History of Blood Groups and Blood Transfusions Experiments with blood transfusions have been carried
More informationClinical decision making: Red blood cell alloantibodies
Clinical decision making: Red blood cell alloantibodies Beth H. Shaz, MD Chief Medical Officer, VP New York Blood Center; Clinical Associate Professor Emory University School of Medicine 1 5 non-abo fatal
More informationREFERENCE LABORATORY. Regular Hours - Monday through Friday 8:00 AM to 4:00 PM. On-Call Staff - Evenings, Nights, Weekend and Holidays.
I. REFERENCE LABORATORY HOURS OF OPERATION: Regular Hours - Monday through Friday 8:00 AM to 4:00 PM. On-Call Staff - Evenings, Nights, Weekend and Holidays. All Reference Lab procedures are subject to
More informationGuidelines for Requesting Type and Screen Testing for Elective Surgical Adult Patients within the WRHA Surgery Program
Guidelines for Requesting Type and Screen Testing for Elective Surgical Adult Patients within the WRHA Surgery Program BACKGROUND Request for preoperative blood testing, specifically Type and Screen (T&S)
More informationCrossmatching and Issuing Blood Components; Indications and Effects.
Crossmatching and Issuing Blood Components; Indications and Effects. Alison Muir Blood Transfusion, Blood Sciences, Newcastle Trust Topics Covered Taking the blood sample ABO Group Antibody Screening Compatibility
More informationBlood group serology. Background. ABO blood group system. Antibodies of the ABO system. Antigens of the ABO system
ORIGINAL PAPER Blood group serology Blackwell Publishing Ltd 1AR-09 ISBT Science Series (2009) 4, 1 5 Journal compilation 2009 International Society of Blood Transfusion H. Goubran Head of Serology Department,
More informationCHAPTER 10 BLOOD GROUPS: ABO AND Rh
CHAPTER 10 BLOOD GROUPS: ABO AND Rh The success of human blood transfusions requires compatibility for the two major blood group antigen systems, namely ABO and Rh. The ABO system is defined by two red
More informationFriday, June 3,2011 Aaron T. Gerds, MD HEMATOLOGY FELLOW S CONFERENCE
Friday, June 3,2011 Aaron T. Gerds, MD HEMATOLOGY FELLOW S CONFERENCE Admit H&P - September 25, 1998 48 year old man with a history of diabetes, hypertension, and chronic anemia who has felt weak since
More informationImmunohematology. Done by : Zaid Al-Ghnaneem
Immunohematology Done by : Zaid Al-Ghnaneem Hello everyone, in this sheet we will talk mainly about immunohematology which is the reactions between our immune system with Antigens found mainly within blood
More informationA sickle in a pickle! by Julie Kirkegaard, MT(ASCP)SBB Community Blood Center, KC, MO and Elizabeth Jones, MT(ASCP)BB Saint Luke s Hospital, KC, MO
A sickle in a pickle! by Julie Kirkegaard, MT(ASCP)SBB Community Blood Center, KC, MO and Elizabeth Jones, MT(ASCP)BB Saint Luke s Hospital, KC, MO A couple of definitions! Sickle Cell Disease- an autosomal
More informationBlood transfusion. Dr. J. Potgieter Dept. of Haematology NHLS - TAD
Blood transfusion Dr. J. Potgieter Dept. of Haematology NHLS - TAD General Blood is collected from volunteer donors >90% is separated into individual components and plasma Donors should be: healthy, have
More informationThe Possible Advantages of Cryoprecipitate Prepared From Fresh Frozen Plasma From Blood Stored for 24 Hours
The Possible Advantages of Cryoprecipitate Prepared From Fresh Frozen Plasma From Blood Stored for 24 Hours Joseph Philip, MD, 1* Samantha Kumarage, MBBS, 1 Tathagata Chatterjee, DM, 1 Sudeep Kumar, MBBS,
More informationDIAGNOSTIC SERVICES MANITOBA YEAR IN REVIEW JANUARY DECEMBER 2015
DIAGNOSTIC SERVICES MANITOBA YEAR IN REVIEW JANUARY DECEMBER 2015 Diagnostic Services Year in Review statistics are based on a January to December calendar year. The calendar year provides better correlation
More informationQUICK REFERENCE Clinical Practice Guide on Red Blood Cell Transfusion
QUICK REFERENCE 2012 Clinical Practice Guide on Red Blood Cell Transfusion Presented by the American Society of Hematology, adapted from Red Blood Cell Transfusion: A Clinical Practice Guideline from the
More informationSelected blood test. Danil Hammoudi.MD
Selected blood test lab Danil Hammoudi.MD Blood typing blood type =blood group is a classification of blood based on the presence or absence of inherited antigenic substances on the surface of red blood
More informationIMMUNOBIOLOGY OF TRANSPLANTATION. Wasim Dar
IMMUNOBIOLOGY OF TRANSPLANTATION Wasim Dar Immunobiology of Transplantation Overview Transplantation: A complex immunologic process Contributions Innate Immunity Adaptive immunity T Cells B Cells HLA Consequences
More informationCarol Cantwell Blood Transfusion Laboratory Manager St Mary s Hospital, ICHNT
Carol Cantwell Blood Transfusion Laboratory Manager St Mary s Hospital, ICHNT History Why is blood transfusion involved? What tests are performed in blood transfusion and why? What does a protocol look
More informationMASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE
MASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE CONTENTS Definition Indications Transfusion trigger Massive transfusion protocol Complications DEFINITION Massive transfusion:
More informationRetrospective analysis of ABO discrepancies among patients and blood donors in a tertiary care hospital
TRANSMEDCON 2016, BHOPAL Retrospective analysis of ABO discrepancies among patients and blood donors in a tertiary care hospital Dr Brinda Kakkar 3 rd year DNB graduate Department of Transfusion Medicine
More informationHuman Blood Groups. ABO Blood Grouping 5/1/12. Dr Badri Paudel Landsteiner s Rule
Human Blood Groups ABO Blood Grouping Dr Badri Paudel www.badripaudel.com RBC membranes have glycoprotein an:gens on their external surfaces These an:gens are: Unique to the individual Recognized as foreign
More informationRHESUS BLOOD GROUP SYSTEM (Author: Alvine Janse van Rensburg; ND Biomedical Technology-Microbiology, Haematology, Chemistry)
RHESUS BLOOD GROUP SYSTEM (Author: Alvine Janse van Rensburg; ND Biomedical Technology-Microbiology, Haematology, Chemistry) Introduction The term Rh refers to a complex blood group system that comprised
More informationASH Draft Recommendations for SCD Related Transfusion Support
ASH Draft Recommendations for SCD Related Transfusion Support INTRODUCTION American Society of Hematology (ASH) guidelines are based on a systematic review of available evidence. Through a structured process,
More informationFIT Board Review Corner March 2016
FIT Board Review Corner March 2016 Welcome to the FIT Board Review Corner, prepared by Sarah Spriet, DO, and Tammy Peng, MD, senior and junior representatives of ACAAI's Fellows-In-Training (FITs) to the
More informationCrackCast Episode 7 Blood and Blood Components
CrackCast Episode 7 Blood and Blood Components Episode Overview: 1) Describe the 3 categories of blood antigens 2) Who is the universal donor and why? 3) Define massive transfusion 4) List 5 physiologic
More informationGUIDANCE DOCUMENT FOR MASSIVE HEMORRHAGE MANAGEMENT IN ADULTS
GUIDANCE DOCUMENT FOR MASSIVE HEMORRHAGE MANAGEMENT IN ADULTS 1.0 Definitions & Acronyms 1.1 Massive Hemorrhage Event (MHE): Transfusion of a volume of blood components equivalent to a patient s estimated
More informationAIHA The Laboratory Perspective on Testing. Tom Bullock Joint UK NEQAS (BTLP) & BBTS BBT SIG Annual Meeting 20 th November 2018
AIHA The Laboratory Perspective on Testing Tom Bullock Joint UK NEQAS (BTLP) & BBTS BBT SIG Annual Meeting 20 th November 2018 Auto Immune Haemolytic Anaemia (AIHA) BSH guideline (Hill et al. 2017): AIHA
More informationTransfusion challenges in transplantation fields
Transfusion challenges in transplantation fields Unité d hématologie transfusionnelle Département des Spécialités de Médecine Dr. S. Waldvogel Abramowski Swisstransfusion 2018 Friday 24 th August 2018
More informationBassett Medical Center The Mary Imogene Bassett Hospital Clinical Laboratory Blood Bank Title: MTP 2016 Revision: 2.00 Created By: Admin, The Last
Bassett Medical Center The Mary Imogene Bassett Hospital Clinical Laboratory Blood Bank Title: MTP 2016 Revision: 2.00 Created By: Admin, The Last Approved Time: 7/22/2016 12:44:54 PM Massive Transfusion
More informationLong Term Storage Effect of 0.2M Dithiothreitol on Red. Cell Antigen Integrity on Stored Reagent Red Blood Cells
Long Term Storage Effect of 0.2M Dithiothreitol on Red Cell Antigen Integrity on Stored Reagent Red Blood Cells 1 ABSTRACT BACKGROUND: Treating reagent red cells with 0.2M dithiothreitol (DTT) removes
More informationBCSH Appropriate Use of O Neg. Dr Megan Rowley Consultant In Transfusion Medicine SNBTS at the Royal Infirmary of Edinburgh
BCSH Appropriate Use of O Neg Dr Megan Rowley Consultant In Transfusion Medicine SNBTS at the Royal Infirmary of Edinburgh http://www.b-sh.org.uk/guidelines/ Good Practice Paper Used to recommend good
More informationBlood Product Modifications: Leukofiltration, Irradiation and Washing
1. Leukocyte Reduction Definitions and Standards: o Process also known as leukoreduction, or leukofiltration o Applicable AABB Standards, 25th ed. Leukocyte-reduced RBCs At least 85% of original RBCs
More informationPassenger Lymphocyte Syndrome (case presentation) Dr. Namal Bandara Kings College Hospital
Passenger Lymphocyte Syndrome (case presentation) Dr. Namal Bandara Kings College Hospital Case history 24year Female Known Patient with Wilsons Disease DBD donor Liver Transplantation done on 15/08/2016
More informationGreat Ormond Street Hospital for Children. Patient Transfer. Penny Eyton-Jones TLM, Great Ormond Street NHS Foundation Trust
Patient Transfer TLM, NHS Foundation Trust Patient Transfer - intro Hospital was founded in 1852 by Charles West as the first hospital dedicated to the treatment of children. The original 10 bed hospital
More informationDirect Antiglobulin Test (DAT)
Exercise 8 Direct Antiglobulin Test (DAT) Objectives 1. State the purpose for performing the DAT. 2. State what a positive DAT indicates. 3. List the reagents which are used for performing the DAT. 4.
More informationTransfusion 2004: Current Practice Standards. Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service
Transfusion 2004: Current Practice Standards Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service Massive Transfusion Protocol (MTP) When should it be activated? Massive bleeding i.e. loss of one blood
More informationAll institutions that transfuse blood components and products should implement national and local policies and written procedures for:
5.0 GENERAL GUIDE TO GOOD TRANSFUSION PRACTICE Blood and the various components prepared or manufactured from it are biologic (in the case of blood cells, living human tissues) products intended for use
More informationAn Audit of Emergency Group O blood use in Royal Devon and Exeter Hospital
An Audit of Emergency Group O blood use in Royal Devon and Exeter Hospital Jack Cunningham Keira Soanes Why are we looking at our use of Emergency Group O RhD negative blood? Following the NHSBT National
More informationLifeBridge Health Transfusion Service Sinai Hospital of Baltimore Northwest Hospital Center BQA Transfusion Criteria Version#2 POLICY NO.
LifeBridge Health Transfusion Service Sinai Hospital of Baltimore Northwest Hospital Center BQA 1011.02 Transfusion Criteria Version#2 Department POLICY NO. PAGE NO. Blood Bank Quality Assurance Manual
More informationAntibody elutions in Thai patients with a positive direct antiglobulin test
ORIGINAL ARTICLE Antibody elutions in Thai patients with a positive direct antiglobulin test Oytip Nathalang 1, Pramote Sriwanitchrak 1, Jintana Tubrod 2, Pawinee Kupatawintu 2 1 Department of Medical
More informationImmunohaematology: a branch of immunology that deals with the immunologic properties of blood.
1 Immunohaematology: a branch of immunology that deals with the immunologic properties of blood. The red blood cells have on their surface hundreds of antigens and according to the antigen on their surface
More informationABO Hemolytic Disease of the Newborn
ABO Hemolytic Disease of the Newborn A Retrospective Analysis of 5 Cases D. ROBERT DUOUR,.D. AND W. PATRICK ONOGHAN, PH.D. Dufour, D. Robert and onaghan, W. Patrick: ABO hemolytic disease of the newborn.
More informationAntibody Information
Antibody Information Rh Blood Group System Anti-D is an IgG antibody directed against the D antigen in the Rh blood group system. Anti-D is Newborn. Patients with Anti-D should receive D- blood (Rh negative).
More informationAN EDUCATIONAL RESOURCE PUBLISHED BY AMERICAN RED CROSS BLOOD SERVICES WINTER 2018
PLUS AN EDUCATIONAL RESOURCE PUBLISHED BY AMERICAN RED CROSS BLOOD SERVICES WINTER 2018 Using molecularly and racially matched units to support adult sickle cell disease patients the alloimmunization rate
More informationTRANSFUSION REACTIONS
14 TRANSFUSION REACTIONS 14.1 INTRODUCTION Transfusion of blood and blood products are reported to cause reactions during or after procedure specially in patients who receive multiple transfusions. These
More informationOptimal RBC products for RBC exchange for patients with sickle cell disease
Optimal RBC products for RBC exchange for patients with sickle cell disease Stella T. Chou, MD ASFA Annual Meeting Fort Lauderdale, FL May 6, 2016 I have no conflicts of interest to disclose Outline Apheresis
More informationHLA Selected Platelets
HLA Selected Platelets Dr PhD Clinical Scientist Department of Histocompatibility & Immunogenetics NHS Blood and Transplant Colindale Poor increment (
More informationDIAGNOSTIC SERVICES MANITOBA YEAR IN REVIEW JANUARY DECEMBER 2017
DIAGNOSTIC SERVICES MANITOBA YEAR IN REVIEW JANUARY DECEMBER 2017 Diagnostic Services Year in Review statistics are based on a January to December calendar year. The calendar year provides better correlation
More informationAn Approach to the Patient Refractory to Platelets Transfusion. Harold Alvarez, MD
Harold Alvarez, MD Objectives Explain the etiology of platelet refractoriness Discuss the different types of platelet refractoriness Describe how platelet refractoriness is diagnosed Discuss different
More informationABO and H Blood Groups. Terry Kotrla, MS, MT(ASCP)BB 2010
ABO and H Blood Groups Terry Kotrla, MS, MT(ASCP)BB 2010 History Discovered in 1900 by Karl Landsteiner and remains the most important blood group system Mixed blood of colleagues (serum from one, cells
More informationBLOOD GROUPS. HAP Unit 5th
BLOOD GROUPS HAP Unit 5th 1 Introduction Blood group systems ABO blood group system Rh blood group system 2 A blood group also called a Blood Type Classification of blood is based on the presence or absence
More informationThe Journal of International Medical Research 2011; 39:
The Journal of International Medical Research 2011; 39: 934 943 Comparative Evaluation of the Microcolumn Gel Card Test and the Conventional Tube Test for Measurement of Titres of Immunoglobulin G Antibodies
More informationTransplant Applications of Solid phase Immunoassays Anti HLA antibody testing in solid organ transplantation
AACC Professional Course BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD MEDICAL SCHOOL Transplant Applications of Solid phase Immunoassays Anti HLA antibody testing in solid organ transplantation J. Ryan
More informationFrequency & specificity of RBC alloantibodies in patients due for surgery in Iran
Indian J Med Res 138, August 2013, pp 252-256 Frequency & specificity of RBC alloantibodies in patients due for surgery in Iran Khademi Reyhaneh 1, Gharehbaghian Ahmad 2, Karimi Gharib 1, Vafaiyan Vida
More informationBlood Banking in India: Ten Years Later
Blood Banking in India: Ten Years Later Sue Johnson, MSTM, MT(ASCP)SBB Director, Clinical Education BloodCenter of Wisconsin Milwaukee, WI Objectives Describe the Indian Immunohematology Initiative. Explain
More informationBlood Banking in India: Ten Years Later. Sue Johnson, MSTM, MT(ASCP)SBB Director, Clinical Education BloodCenter of Wisconsin Milwaukee, WI
Blood Banking in India: Ten Years Later Sue Johnson, MSTM, MT(ASCP)SBB Director, Clinical Education BloodCenter of Wisconsin Milwaukee, WI Objectives Describe the Indian Immunohematology Initiative. Explain
More informationAlister Jones Patient Blood Management Practitioner NHS Blood and Transplant. Lab Matters study day Oake Manor, Taunton, 8 th July 2015
Alister Jones Patient Blood Management Practitioner NHS Blood and Transplant Lab Matters study day Oake Manor, Taunton, 8 th July 2015 NPSA Rapid Response Report 2010 Transfusion of blood and blood components
More informationTRANSFUSION REACTION EVALUATION
Lab Dept: Test Name: Transfusion Services TRANSFUSION REACTION EVALUATION General Information Lab Order Codes: Synonyms: CPT Codes: Test Includes: TRXR Transfusion Complication Workup; Hemolytic reaction
More informationImmunohematology Case Studies
Immunohematology Case Studies 2016-2 Nicole Thornton International Blood Group Reference Laboratory (IBGRL) NHS Blood and Transplant Bristol, United Kingdom nicole.thornton@nhsbt.nhs.uk Clinical History
More informationSignificance of Antibodies and appropriate selection of red cells for transfusion Chris Elliott Haematology Service manager
Significance of Antibodies and appropriate selection of red cells for transfusion Chris Elliott Haematology Service manager James Cook University Hospital Friarage Hospital Over the next 30 minutes Bit
More informationImmunity. Acquired immunity differs from innate immunity in specificity & memory from 1 st exposure
Immunity (1) Non specific (innate) immunity (2) Specific (acquired) immunity Characters: (1) Non specific: does not need special recognition of the foreign cell. (2) Innate: does not need previous exposure.
More informationAnalysis of the human blood
Analysis of the human blood Blood liquid connective tissue general functions: - transportation gases, nutrients, hormones, waste products - regulation ph, body temperature, osmotic pressure - protection
More informationGuidelines for the Management of Platelet Transfusion Refractoriness GUIDELINES FOR THE MANAGEMENT OF PLATELET TRANSFUSION REFRACTORINESS
GUIDELINES FOR THE MANAGEMENT OF PLATELET TRANSFUSION REFRACTORINESS Reviewed by Dr Colin Brown (26/03/2008) Author(s): Colin Brown Page 1 of 7 Purposes To define and recommend policies and procedures
More informationShould red cells be matched for transfusions to patients listed for renal transplantation?
Should red cells be matched for transfusions to patients listed for renal transplantation? Dr M.Willicombe Imperial College Renal and Transplant Centre, Hammersmith Hospital Should red cells be matched
More informationApheresis: Transfusion Indications. Sasha Wilson: Transfusion Senior Nurse
Apheresis: Transfusion Indications Sasha Wilson: Transfusion Senior Nurse Apheresis: Transfusion Indications Focus of talk will be blood component transfusion in the context of apheresis procedures: Special
More informationEDUCATIONAL COMMENTARY TRANSFUSION-RELATED ACUTE LUNG INJURY
EDUCATIONAL COMMENTARY TRANSFUSION-RELATED ACUTE LUNG INJURY Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationTransfusion supply of chronically transfusion dependent patients: antigen-, rare blood type and ethnicity-related challenges
Thierry PEYRARD PharmD, PhD, EurClinChem tpeyrard@ints.fr National Institute of Blood Transfusion - Paris French National Immunohematology Reference Laboratory Transfusion supply of chronically transfusion
More information