Blood Bank Guy Essentials Podcast

Continuing education episode! Let’s be honest: Some hospital transfusion committees feel like a waste of time! Sparsely attended sessions and minimal progress on important issues are the norm in many facilities. Others wonder if five minutes of transfusion discussion in a quality or pharmacy committee is really having any impact. However, Dr. Carolyn Burns thinks transfusion committees are not hopeless! In this interview, she outlines her practical steps for building the perfect transfusion committee. She discusses how to recruit members, how to find “champions,” what to discuss and analyze, and shares what she has observed in the most effective transfusion committees. Whether your facility is doing a great job already or you are reading this and thinking, “I’m supposed to be reviewing transfusion stuff?”, Carolyn will help you go beyond just “checking the boxes.”

In this emergency episode, recorded on March 16, 2020, I discuss actions blood collectors and hospitals should be thinking of now to preserve the US blood supply, as well as a look at the global COVID-19 pandemic. We also briefly discuss convalescent plasma and its potential role.

Continuing education episode! The 32nd edition of AABB Standards is effective April 2020. Rich Gammon, Chair of the BBTS Standards Committee, is here with the Top 10 changes you need to know! From blood donors to recipients, these changes will keep you in the know about best practices in Transfusion Medicine, even if you are not AABB-accredited.

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 Canada’s decisions on two big issues: First, whether to impose an upper age limit on blood donors, and second, how long to defer men from blood donation who have had intimate contact with other men. Please note: I encourage respectful comments only at BBGuy.org/080

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" 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 pathogen reduction techniques came to be.

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 thrombocytopenic patients.

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 back in 2017! Along the way, UCSD and their blood supplier (American Red Cross) had to answer many difficult questions and make many decisions (Why can't we just "flip a switch" and go from zero to 100% with PR-platelet supply? If we can't get to 100% right away, which patients get them first? And many more...). Pat joins me to describe lessons learned, with an eye toward where this all fits with the recent guidance.

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 facility should form their own impressions and determine their individual best course. I highly recommend focused conversations between blood suppliers and transfusion services to decide what is best in YOUR setting!

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 early fibrinogen replacement with increased efficiency and safety.

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 interview. Dr. Tormey details the past, present, and future of blood product irradiation in this practical and timely interview.

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 recipe! Every facility must make their own decisions on how to implement trauma whole blood (if they do so at all!). This interview is meant to demonstrate how one facility successfully introduced the product, and what they learned while doing so.

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 transfusion.

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 new guidelines right away!

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 actually have hemolytic transfusion reactions! It's a huge problem. In this interview, Stella Chou, a pediatric hematologist from Philadelphia, shares data she published in 2018 showing that the problem comes in part from widespread genetic RH variations in both African-American blood donors and patients with sickle cell disease. She models a future direction that may help us finally solve this problem once and for all: Genotype matching of donors and patients!

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. They looked at over 10 million transfusions across 9 states in the U.S., and their results may surprise you!

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 really happening in the OR, and offers his thoughts on how we can all care best for our cardiac surgery patients (even those getting a "re-do!").

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 transfusion. 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.