American Association Of Blood Banks Research Articles

Type-specific whole blood still has a role in the era of low-titer O universal donor transfusion for severe trauma hemorrhage.

Whole blood can be ABO-type specific (type-specific whole blood (TSWB)) or low-titer O universal donor (low-titer O whole blood (LTOWB)). Having previously used LTOWB, the US Armed Forces Blood Program began using TSWB in 1965 as a method of increasing the donor pool. In contrast to military practice, the Association for the Advancement of Blood and Biotherapies formerly the American association of blood banks (AABB), from its first guidelines in 1958 until 2018, permitted only TSWB. Attempting to reduce time to transfusion, the US military reintroduced LTOWB in the deployed environment in 2015; this practice was endorsed by the AABB in 2018 and is progressively being implemented by military and civilian providers worldwide. Low-titer O whole blood is the only practical solution prehospital. However, there are several reasons to retain the option of TSWB in hospitals with a laboratory. These include (1) as-yet ill-defined risks of immunological complications from ABO-incompatible plasma (even when this has low titers of anti-A and -B), (2) risks of high volumes of LTOWB including published historical advice (based on clinical experience) not to transfuse type-specific blood for 2 to 3 weeks following a substantial LTOWB transfusion, (3) uncertainty as to the optimal definition of "low titer," and (4) expanding the potential donor pool by allowing type-specific transfusion. Several large randomized controlled trials currently underway are comparing LTOWB with component therapy, but none address the question of LTOWB versus TSWB. There are sufficient data to suggest that the additional risks of transfusing LTOWB to non-group O recipients should be avoided by using TSWB as soon as possible. Combined with the advantage of maintaining an adequate supply of blood products in times of high demand, this suggests that retaining TSWB within the civilian and military blood supply system is desirable. TSWB should be preferred when patient blood group is confirmed in facilities with a hematology laboratory, with LTOWB reserved for patients whose blood group is unknown.

Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System.

According to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm. To reduce inappropriate duplicate T&S testing across a large, multihospital setting. The largest urban safety net health system in the USA, with 11 acute care hospitals. Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S. The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days. Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05). Our intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.

Biochemical characteristics and functional performance of cold-stored platelets: an in-vitro comparative study

Background: Platelet refrigeration could eliminate bacterial contamination and improve the hemostatic function even better than already-used room-temperature storage. This study aimed to assess the effect of cold storage, with and without agitation, on the apheresis platelets' hemostatic, metabolic, and functional activity. Materials and methods: The study included 10 healthy volunteer donors to collect Apheresis PLT. They were submitted to careful clinical examination and standard laboratory workup. Collected samples were processed in accordance with American Association of Blood Banks (AABB) guidelines. Every aliquot collected from each volunteer was stored for up to 5 days at one of the following storage conditions: 1. In an FDA-approved-PLT incubator with agitation at room temperature (RT + AG as a group; GI), 2. In an FDA-approved-refrigerator at 4 oC with agitation (4 oC + AG as a group; GII), 3. In an FDA-approved- refrigerator at 4 oC without agitation (4 oC – AG as a group; GIII). The following PLT workup was done; PLT count and mean platelet volume (MPV), metabolic variables, PLT aggregation studies, PLT receptors expression, and PLT pro-inflammatory mediator’s release.Results:All samples had a significant PLT count decline compared to baseline data. No changes in MPV were observed in all groups on day 3 and day 5, meaning that single PLT size remained unchanged. In addition, GI showed a mark of significant increase in metabolic activity when compared to baseline PLTs in contrast to GII, and GIII, which were more metabolically stable and less active.Comparison between the studied groups regarding PLT aggregation revealed significantly higher PLT aggregation response to ADP and collagen in GII and GIII compared to GI on the 3rd and 5th days. Moreover, it was shown that GII and GIII samples had significantly higher CD62p expression when compared with GI on the 3rd and 5th days despite being less active and more stable. While it was found that TXB2 levels were significantly higher, nearly 3-fold, in GI as compared to GII and GIII.Conclusions: Apheresis platelets (AP) cold storage provides a clear advantage over standard conditions regarding biochemical balance and hemostatic performance, which could markedly improve AP's clinical and economic value in different scenarios. Keywords: Platelet aggregation, P-selectin, Thromboxane B2.

Appropriateness of packed red blood cells transfusions in chronic anemic patients in the emergency department: the TRANSFUS-ED retrospective analysis

Patients suffering from chronic anemia can benefit from scheduled transfusions of packed red blood cells (PRBCs), while urgent transfusions have specific indications. These patients frequently seek medical attention in the emergency department (ED), where they can be inappropriately transfused, but research in this field is limited. This study aimed to assess the appropriateness of PRBCs transfusions in chronic anemic patients in the ED. A retrospective analysis was performed on patients who accessed the ED of the Azienda Ospedaliera di Padova (Padova, Italy) between 2016 and 2019 and received PRBCs transfusions. Patients aged ≥ 18 years old and with chronic anemia were included, while those with acute anemia or admitted to the hospital after the transfusion were excluded. Chronic anemia was defined as satisfying one of the following in the past medical history: diagnosis of chronic anemia; two or more previous blood samplings demonstrating anemia; periodic transfusions. As primary outcome, the appropriateness of transfusions was assessed according to the American Association of Blood Banks (AABB) 2016 criteria, using the recommended threshold of 7 g/dL for hemodynamically stable adults and 8 g/dL for patients with pre-existing cardiovascular disease. Out of 1153 transfusions, 344 transfusions were included in the study. According to our criteria, 139 (40.4%) patients were inappropriately transfused, resulting in a total estimated cost of 54,528.71 € in the study period. This study showed that transfusions in chronic anemic patients are recurrent events in the ED and are frequently inappropriate. A possible explanation could be the lack of a well-structured primary care network granting periodic transfusions in ambulatory centers. In the future, implementing and improving chronic anemic patients’ access to transfusion services through dedicated pathways could reduce the burden on the ED and also decrease costs.

Abstract 1775: Expansion of human T cells using xenogeneic free and gamma irradiated human platelet lysate

Abstract Commercially available human platelet lysate (hPL) is produced using expired human platelets obtained from accredited blood banks in the United States. These platelets were originally intended for use in patient transfusion. The safety of platelets used in transfusion is managed by the U.S. Food &amp; Drug Administration (FDA), as well as the American Association of Blood Banks (AABB). These organizations set standards, including testing for transmissible diseases. The United States record for blood safety is well established, with extremely low rates of disease transmission, making the platelet units used for hPL manufacture low risk. The Covid-19 pandemic has increased awareness of emerging infectious diseases, even though transmission of Covid-19 via blood transfusion has not been documented. For that reason, gamma irradiated hPL offers an additional safety measure in the clinic. Chimeric Antigen Receptor (CAR) expressing T-cells have demonstrated potent clinical efficacy in patients with hematological malignancies. In addition, there are several phase I clinical trials evaluating the use of CAR-T-cells for targeting of solid tumor-associated antigens. Some of the challenging issues found during production of CAR-T cells are the efficiency of T cell transduction to generate CAR-T cells, the expansion of T cells to clinically relevant numbers and the long-term survival in vivo of the therapeutic cells. The use of human platelet lysate has been demonstrated to improve these issues. Our data from experiments performed using human CD3+ from donors demonstrates that human platelet lysates offer an improved performance on T cell expansion versus serum derived products. hPL efficiently promotes T cell expansion, with higher cell yields and lower cell exhaustion rate. Additionally, we efficiently developed a protocol for suspension culture of T cells, which could facilitate the large-scale expansion of allogeneic CAR-T cells. Citation Format: Vanesa Alonso-Camino. Expansion of human T cells using xenogeneic free and gamma irradiated human platelet lysate [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1775.

Application of Modified DTT Methods to Reduce the Interference of Daratumumab on Serological Detection

To modified the classic dithiothreitol (DTT) method for treating red blood cells (RBCs) in Technical Manual of American Association of Blood Banks（AABB） and evaluate its application value in pre-transfusion examination of patients treated with daratumumab. The classic 0.2 mol/L DTT method was improved in terms of PBS, DTT concentration, donor RBCs concentration (suspended/packed) and sample processing time. The modified DTT methods and AABB classic DTT method were applied to the blood matching tests of 12 multiple myeloma patients treated with daratumumab. The effect of treating panel RBCs with modified DTT methods on the detection of other irregular antibodies was evaluated by using antiserum and antibody reagents with known antibody properties. Two modified DTT methods were established (method 1: changed the concentration of DTT to 0.01 mol/L; method 2: changed the concentration of DTT to 0.02 mol/L and replaced the packed RBCs with 3% RBCs suspension). The optimal treatment time was 35 min for the modified DTT methods. At this time, the pan-agglutination caused by daratumumab was eliminated, but the detection of antibodies such as anti-E, anti-JKa, anti-M were not affected, and the titer of anti-K antibodies was only slightly decreased. The modified DTT methods were effective, which can eliminate the interference of daratumumab while retaining the activity of the Kell blood group system, and can replace the current classic DTT method in AABB Technical Manual.

Ferric Carboxymaltose for Long-Term Correction of Iron Deficiency Anemia in the Emergency Department

Background: Despite the implementation of the Choosing Wisely Campaign of the AABB (formerly the American Association of Blood Banks), red blood cell (RBC) transfusions continue to be a common choice of treatment for iron deficiency anemia (IDA) in hemodynamically stable patients presenting to the emergency department (ED). This occurs despite the considerable risk and high cost of RBC transfusions and the availability of alternative treatments with robust safety profiles such as intravenous (IV) iron. An understanding of the patient clinical factors that affect the decision to transfuse is essential to narrowing the gap between clinical guidelines and current clinical practice, and to ensuring appropriate RBC usage. Aims and methods: To assess the clinical management of severely anemic, hemodynamically stable patients presenting to the ED, we performed an observational, retrospective study at a tertiary care hospital in Milan, Italy, over a five-year period from 2017 through 2021. Only patients with severe anemia (i.e., hemoglobin < 8 g/dL) were included. Patients with conditions for which transfusion is the first-line treatment, including hemoglobinopathies and active onco-hematological disorders, were excluded. Results: 967 patients were included in the study. The population was 63% female with a median age of 77 years (IQR, 61-85). Hematological parameters (Table 1) characterized the study population as microcytic, with high red cell distribution width (RDW) and, when available, low ferritin values, indicative of a significant role of iron deficiency anemia within the population. 72% of patients (n=700) received a transfusion in the ED. 20% (n=189) received both transfusion and IV iron, 11% (n=108) IV iron only, and 16% (n=159) received neither transfusion nor intravenous iron. Half of the subjects presented to the ED with symptoms, largely with asthenia and exertional dyspnea, while severe symptoms (palpitations, syncope, chest pain) were present in less than 4% of patients. Gastrointestinal bleeding (33%, n=319) was the most common known cause of anemia, followed by gynecological bleeding (6%, n=56). For data analysis, patients were divided into two treatment groups (transfused (T) vs. non-transfused (NT)) and two outcome groups (discharged (D) vs. admitted (A)). Patients with documented heavy gynecological bleeding were more represented in the transfused group and the discharged group (T:3.7% vs NT:11.2%; D:0.8% vs A:10.3%; p<.001). Similarly, patients with malabsorptive diagnoses (e.g. celiac disease, inflammatory bowel disease, bariatric surgery) were more prevalent among those discharged (A:1% vs D:3.1% p=.027). Patients with cardiovascular disease were more represented among those transfused (T:42.3% vs NT:24.3%, p<.001) and among those admitted (A:42.4% vs D:32.7%, p=.002). Diabetic patients were likewise more prevalent among those transfused (T:17.8% vs NT:11.2%, p=.012) and those admitted (A:18.8% vs 13.3%, p=.020). Patients on antithrombotic therapies were more represented in the transfused (T:49.7% vs NT:27.7%, p<.001) and admitted (A:48% vs D:39.5%, p=.008) groups. Discharged patients who received IV iron in the ED saw significantly higher increases in hemoglobin levels at an initial (mean 18 days post-discharge) and second (mean 41 days) follow-up (Table 2). Transfused patients spent a mean 12.8 hours longer in the ED than those who were not transfused, demonstrative of a significantly higher utilization of ED resources in the administration of red blood cells. Conclusions: Our study demonstrated a high usage of red blood cell transfusions to treat anemia in the ED. Overall, transfused patients were older, with a higher prevalence of cardiovascular disease and diabetes and anticoagulant or antiaggregant therapy. It seems probable that these characteristics could have influenced the physician in the decision to transfuse. IV iron preparations were demonstrated to not only be effective in managing severe iron deficiency anemia in the ED but also more efficacious in the long-term correction of anemia. Our study overall demonstrated a continued knowledge-to-practice gap in the management of severe anemia in the emergency department. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

First Massive Transfusion Protocol (MTP) Implementation Proposal in Egypt

Abstract Introduction/Objective Massive transfusion is often defined as transfusion of adults with 10 or more of packed red blood cells units in 24 hours period or transfusion of 4 or more units of packed red blood cells (PRBCs) in one hour when on-going need for more transfusion is foreseeable. Massive transfusion protocol in children is defined as transfusion of &amp;gt;40 mL/kg. Massive transfusion protocol (MTP) is a vital element of damage control resuscitation and provides a coordinated clinical response to hemorrhage in patients requiring massive blood transfusions after hospital admission. Hemorrhage is the most common cause of death within the first hour of arrival to the trauma center. Methods/Case Report This study aims to develop and establish the first massive protocol in Egypt to provide a consistent treatment for blood transfusion for trauma patients that will Reduce delay in ordering and administering blood products and Deliver a reasonable ratio of plasma to red blood cells. The protocol will be first implemented in a military hospital in Egypt. Developing the massive transfusion protocol will allow the practitioners to follow algorithm for rapid replacement of blood products using uncrossmatched packed red blood cells, Plasma, platelets and cryoprecipitate if necessary. Adopting the American Association of Blood Banks (AABB) and the American College of Surgeons (ACS) guidelines are the best practice around the world. The Protocol will be developed by multidisciplinary committee engagement, Blood bank, Diagnostic laboratory and Clinical care areas (OR, ER, ICU, OBS). Results (if a Case Study enter NA) The massive transfusion protocol ratio will be 3:2 (RBC: FFP) and one units of platelets for every 6 units of RBC. according to American College of Surgeons (ACS) guidelines the ratio should be 1:1 to 1:2 (RBC: FFP). The committee established defined criteria for MTP activation and termination. The delivery time of the blood products should be between 5-10 minutes. Administration of tranexamic acid to inhibit plasminogen activation and stabilize the clot. Conclusion The Developing and Implementing MTP in Egypt will provide reduction in mortality for trauma and uncontrolled hemorrhage patients. Once implemented, we will regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes., the MTP will be evaluated to ensure best practice.

Reducing the wastage of fresh frozen plasma in a hospital blood bank through the use of Six Sigma principles.

45 Background: MD Anderson Cancer Center is one of the largest users of blood products in the United States, with approximately 3,600 units of blood (PRBCs) transfused per month, and over 500 units of fresh frozen plasma (FFP) transfused per month. The wastage of blood products has both financial and patient care implications, as well as implications to donors. Decreasing blood product wastage is an institutional priority in terms of both resource utilization and cost savings. Methods: Outside metrics for the waste of blood products published by the American Association of Blood Banks (AABB) were compared to current data on the percentage wastage of blood products for fiscal year 2020. A dedicated project team set an aim to reduce the wastage of FFP by 25% from Q4 2020 to Q3 2021. Using Six Sigma principles, a run chart was developed to track units FFP ordered and transfused from October 2020 – March 2021. Minitab software was used to calculate mean FFP ordered, the upper confidence interval, as well as 2 standard deviations above the mean to determine a new maximum FFP thaw level. Results: The historical FFP “thaw level” was 32 units of FFP thawed per day. From October 2020 – March 2021, the average number of FFP units ordered per day was 8. The upper confidence level was 32, and 2 standard deviations was 24 units. After identifying 3 data points that were “out of control” and unrepresentative of actual usage, these values were adjusted to 7.5 units and 19.5 units, respectively. Based on this data, the daily thaw level was adjusted from 32 units per day to 20 units per day on June 21st 2021. As of Q3 2021, this has resulted in a 40.7% decrease in the wastage of FFP. Conclusions: The application of Six Sigma principles was an effective way to identify variation in the ordering of fresh frozen plasma (FFP), and allowed for a sizeable reduction in the daily thaw level of this blood product. Post-intervention, there has been a dramatic decline in the wastage of FFP, resulting in cost savings for our institution and better stewardship of this scare resource.

Internal quality control of red cell concentrates in a regional blood center.

Objective: To assess the quality of the whole blood-derived red cell concentrates by measuring hematocrit. Study Design: Cross Sectional study. Setting: Regional Transfusion Center in Rawalpindi. Period: February to December 2019. Material &amp; Methods: A total of 390 whole blood-derived red cell concentrates were included using a random sampling technique. These units were evaluated for hematocrit which is a hematological parameter using Sysmex Hematology Analyzer XP 100. The measurement of hematocrit was expressed as the mean range and standard deviation (mean ± SD) using descriptive statistics. Results: A total of 390 whole blood-derived red cell concentrates were subjected to quality analysis by measuring the hematocrit. The mean range of hematocrit was found to be 68.4 ± 4.8 g/dL. The hematocrit of 98.7% units was in compliance with standard criteria according to the American Association of blood banks which suggested it to be less than 80%. Conclusion: The results of this study showed an optimum level of conformity of the quality of whole blood-derived Red Cell Concentrates with International Standards.

Development and Evaluation of a Library of TikToks to Support Recruitment of Committed Hematopoietic Stem Cell Donors from Needed Demographic Groups

IntroductionTikTok is a rapidly growing social media platform that allows users to develop and share short videos. We hypothesized that a library of videos developed through TikTok (TikToks) would support the recruitment of committed hematopoietic stem cell donors from needed demographic groups (i.e. young, male, from diverse ancestries).MethodsMembers of the community of practice (CoP) in stem cell donor recruitment in Canada (facebook.com/groups/stemcellclub) were activated to develop TikToks. Training was provided during e-meetings of the CoP (8/2020, 1/2021, 5/2021) and in a video published online (stemcellclub.ca/training), highlighting the principles of effective TikTok design. These principles included the use of engaging hooks, music, and calls to action; short duration (< 30s); high educational value; and appeal to diverse donors. The training also outlined how to: record content, adjust clip lengths, apply audiovisual effects, and share across social media platforms. A CoP TikTok committee was formed to develop and review TikToks prior to publication.Following launch, we evaluated stakeholder perspective on these TikToks and the impact 1) across social and traditional media and 2) on eligible donors' knowledge and attitudes towards donation.ResultsBetween 9/2020-7/2021, a network of TikTok channels was launched by CoP members, including a national donor recruitment TikTok library (tiktok.com/@stemcellclub). A total of 217 TikToks were produced across these channels (median length 17s, range 4-52s), covering a range of educational topics, designed for use in specific recruitment campaigns, and featuring unique video effects (Fig. A).The TikToks accumulated over 234,000 Views, 42,000 Likes, 3,000 Comments, and 14,200 Shares on TikTok, were republished by Canadian media outlets (e.g. CBC [twitter.com/cbcnewsbc/status/1361511367426080773], CTV News [ctvnews.ca/health/meet-the-women-hoping-to-recruit-more-stem-cells-donors-from-black-communities-1.5314038, ctvnews.ca/health/pride-month-tiktok-drive-encourages-stem-cell-donations-from-gay-bi-men-1.5475113], Victoria News [vicnews.com/news/most-black-canadians-wont-find-a-stem-cell-donor-in-time-this-group-is-working-to-change-that]) and were highlighted by major medical organizations (e.g. Canadian Blood Services [blood.ca/en/stories/meet-stem-cell-club, blood.ca/en/stories/stem-cell-club-volunteers-aim-save-lives-pride-month-campaign], American Association of Blood Banks [aabb.org/news-resources/news/article/2021/02/01/twitter-tiktok-aabb-virtual-journal-club-assesses-use-of-multimedia-resources-for-donor-recruitment]).33 CoP members from 6 provinces across Canada, with a median of 2 years of recruitment experience, completed a post-launch survey. The majority felt that TikToks promote donation in an attention-grabbing way (94%), engage younger donors (100%), and teach key points in a short time period (94%). The majority were confident in their ability to make TikToks (63%), but felt they would benefit from additional training (63%).46 eligible stem cell donors (from 12 different non-Caucasian ancestral groups; living in 5 provinces across Canada) completed surveys evaluating the impact of TikToks on their knowledge and attitudes towards donation. No participants were registered as donors and only four had a personal connection to an individual who needed a stem cell transplant. After being shown a series of TikToks, mean scores on a 6-question stem cell donation knowledge test improved from 59% to 73% (p=0.0012) (Fig. B); mean scores on a modified Simmons Ambivalence Scale decreased from 52% to 30% (p<0.0001) (Fig. C); and participants were more willing to register as donors (70% vs. 39%, p=0.0011). Participants reported that viewing TikToks positively impacted on their decision to register (87%), helped them understand stem cell donation (89%), and would help them talk about stem cell donation with friends/family (78%).ConclusionsWe report the first published experience using TikToks in a donor recruitment context. Our TikToks achieved significant social and traditional impact in a short period of time, and supported recruitment of committed stem cell donors from needed demographic groups. Our work is relevant to recruitment organizations worldwide seeking to modernize their recruitment approaches. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

THOR-AABB Working Party Recommendations for a Prehospital Blood Product Transfusion Program

The evidence for the lifesaving benefits of prehospital transfusions is increasing. As such, emergency medical services (EMS) might increasingly become interested in providing this important intervention. While a few EMS and air medical agencies have been providing exclusively red blood cell (RBC) transfusions to their patients for many years, transfusing plasma in addition to the RBCs, or simply using low titer group O whole blood (LTOWB) in place of two separate components, will be a novel experience for many services. The recommendations presented in this document were created by the Trauma, Hemostasis and Oxygenation Research (THOR)-AABB (formerly known as the American Association of Blood Banks) Working Party, and they are intended to provide a framework for implementing prehospital blood transfusion programs in line with the best available evidence. These recommendations cover all aspects of such a program including storing, transporting, and transfusing blood products in the prehospital phase of hemorrhagic resuscitation.

Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey.

There are limited standards guiding the selection and processing of blood components specific for neonatal and pediatric transfusions. Therefore, blood banks (BBs) and transfusion services must create their own policies and procedures. The American Association of Blood Banks (AABB) Pediatric Transfusion Medicine Subsection Committee developed a 74-question survey to capture neonatal and pediatric BB practices in the United States. Thirty-five centers completed the survey: a response rate 15.8%. Responses indicated that most carry a mixed inventory of red blood cells (RBCs); 94.2% allow more than one type of RBC product for small-volume (SV) and large-volume (LV) transfusions to neonatal and pediatric patients. Many had storage age thresholds for RBCs transfused to neonates (SV=60%, LV=67.7%) but not older pediatric patients. The use of Group O for nonurgent RBC transfusion in neonates was common (74.2%). Responses related to special processing of RBCs and platelets indicated that 100% RBC and platelets are leukocyte-reduced (LR) for neonates and 97% for non-neonates. Irradiation of RBCs and platelets was commonly performed for neonatal transfusion (88.6%). Providing cytomegalovirus (CMV) seronegative products, volume reduction, and washing were variable. All centers transfused single-donor apheresis platelets; 20% allowed pathogen reduction (PR). The majority of centers have strategies limiting the amount of incompatible plasma transfused; however, few titrate ABO isoagglutinins in plasma-containing products (20% for platelets and 9.1% for plasma). Variability exists in BB practice for neonatal and pediatric transfusion. Future studies are needed to understand and define best BB practices in these patient populations.

Raw and starting materials

<div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://cdn.insights.bio/uploads/Read photo11.jpg" data-image="1"></div><div class="author-det"> Elizabeth Read, MD is an independent consultant focusing on CMC development and CMC regulatory issues for cell- and tissue-based therapies. Dr. Read received her M.D. from the State University of New York (Buffalo, NY). After clinical training in Internal Medicine, Hematology, Oncology, and Blood Banking/Transfusion Medicine, Dr. Read worked at the National Cancer Institute and later in the Clinical Center’s Department of Transfusion Medicine at the National Institutes of Health (NIH; Bethesda, MD), where she served as Section Chief and Medical Director of the Cell Therapy Core Facility from 1995-2006. Initially engaged with novel cellular therapies in the context of hematopoietic transplantation, she later worked on more complex cell, tissue, and gene therapies for a range of clinical indications. From 2007-2010, she headed the Cell Therapy Program at Blood Systems Research Institute (San Francisco, CA), collaborating with UCSF investigators on grant-funded stem cell projects. She previously served as Medical Director at the American Red Cross Blood &amp; Tissue Services (Los Angeles, CA). Over the past 10 years, she held leadership positions at small biotech companies, including Fate Therapeutics (San Diego, CA), StemCyte (Baldwin Park, CA), Medeor Therapeutics (San Mateo, CA), and Adicet Bio (Menlo Park, CA). Dr. Read has authored over 100 scientific publications, and has served as a faculty lecturer at UCSF and for the American Course on Drug Development and Regulatory Science. She has served on advisory committees focused on quality, safety, and efficacy of blood products and cell, tissue, and gene therapies, including the American Association of Blood Banks, the US DHHS/HRSA Advisory Council for Blood Stem Cell Transplantation, and the US Pharmacopeia. She currently serves as an advisor on clinical-stage cell therapy projects funded by the California Institute of Regenerative Medicine. </div></div></div>

Transfusions in patients with iron deficiency anemia following release of Choosing Wisely Guidelines.

In 2016, based on recommendations of the American Association of Blood Banks (AABB), Choosing Wisely Canada released transfusion guidelines for patients with Iron Deficiency Anemia. The goal of the present study was to examine the number of transfusions given in Calgary emergency departments (EDs) before and after the release of these guidelines. We analyzed 11,786 anemia encounters from January 2014 to December 2019. A transfusion was considered potentially avoidable if the patient's hemoglobin was > 70g/L and if the patient was hemodynamically stable. We used time-series analyses to examine change in rate of total and potentially avoidable transfusions quarterly over the total and pre and post intervention periods. In total, 1409/11,786 (12.0%) of the encounters received transfusions; 80.0% (1127/1409) were indicated while 19.9% (281/1409) were potentially avoidable. In the pre-intervention period, the rate of potentially avoidable transfusions was 21.5% (133/618) and in the post-intervention period, the rate of potentially avoidable transfusions was 18.7% (148/791). The rate of potentially avoidable transfusions decreased quarterly at a rate of 0.3% which did not reach statistical significance (p = 0.06). Our data suggest that the number of potentially avoidable transfusions has not decreased since the release of Choosing Wisely Canada guidelines and local educational initiatives. This may be due to the fact that there is a pre-existing down trend in the number of transfusions provided.

Analysis of red blood cell irradiation practices from South India.

INTRODUCTION:Age of red blood cell (RBC) units at the time of irradiation is important and prolonged storage of preirradiated units is detrimental. The objectives were to determine RBC age at irradiation, days from expiry (DFE), and percentage of late transfusions of irradiated RBC. To estimate the concordance on expiry of irradiated RBC units with present American Association of Blood Banks (AABB)/Directorate General of Health Services (DGHS), New Delhi over British Committee for Standards in Hematology (BCSH) and Council of Europe (CE) guidelines.METHODS:All the RBC units irradiated for a 1 year period were included. Retrieved data included date of collection, irradiation, revised expiry, and issue of blood. Late transfusions are units transfused in the last 2 week of RBC's shelf-life and wastage due to expiry was determined. Chi-square and Kruskal–Wallis test were used for comparisons between the guidelines.RESULTS:Out of 1303 RBC units irradiated, the median age for irradiation was 2 (0–36) days and 99.3% units irradiated within day +14. Median DFE for these units transfused was 26 (0–28) days. 2.8% units expired as per local standards. Late transfusions happened in 121 (9.3%) units transfused. AABB/DGHS practice was not concordant with CE standards for 86 (6.6%) units and with BCSH 94 (7.2%) units. Overall discordance between the present practices was CE and BCSH was seen in 130 (10%) events.CONCLUSION:Median RBC irradiation age and DFE was two and 26 days respectively at our center. Only 90% concordance was observed between AABB/DGHS and CE/BCSH guidelines with 9.3% units transfused as late transfusions. Restricting late transfusions of irradiated RBC can act as surrogate to improve the quality of units transfused through an inexpensive strategy.

Refining Blood Products Utilization: Every One (unit) Matters. Post-Intervention Study

INTRODUCTION: Transfusion of red blood cells (RBCs) is a balance between providing benefits for patients while avoiding risks of transfusion. Meta-analyses of randomized controlled trials (RCT) comparing restricted versus liberal blood transfusion showed that there was no significant difference in terms of morbidity, mortality, or risk of myocardial infarction. In fact, the restrictive strategy had a significantly lower risk of all-cause mortality in patients with gastrointestinal bleeding. It also resulted in a significantly lower number of transfused units and a lower number of patients needing a transfusion. Examining the extent of adherence to the American Association of Blood Banks (AABB) transfusion guidelines in our VA medical center showed that the average transfused units were 1.4 units per person. The Average pre-transfusion hemoglobin (Hgb) was 7.6. 54% received 2 units, whereas 46% received 1 unit. AIM OF THE WORK: To improve the blood transfusion practice in our VA medical center to better comply with the (AABB) transfusion guidelines and to establish a culture of change to improve patient safety, minimize risks of transfusion reaction and reduce the cost. METHODOLOGY: This is a prospective analysis of transfused patients in the period of November 2019 to April 2020 (n=228) as a continuation of the prior retrospective analysis of randomly selected patients in 2018 (n=162). The data was retrieved from an electronic medical record database, which included patient gender, age, co-morbidities, mean baseline Hgb, pre- and post-transfusion Hgb, hemodynamic status, ordering division, and the number of units transfused. INTERVENTIONS We implemented a two-tier auditing system, based on a low and high priority, which reflects the timeline to address non-compliant transfusion orders. Low priority orders were evaluated during the periodic meeting of the transfusion committee, and high priority orders were addressed within a few hours of the transfusion order. All transfusion orders of Hgb &amp;gt; 7-8 g/dL were flagged with low priority, whereas those with Hgb &amp;gt; 8 g/dL and/or with orders exceeding one unit were flagged with high priority. The appropriate approval was obtained through the institutional review board (IRB), patients' consents for enrollment, and anonymity was maintained all through the study. RESULTS: The total number of transfused PRBC units was 386 units with a mean of 1.6 units per patient compared to 1.7 units in the pre-intervention group (p=0.056). The average Hgb before transfusion was 7.7 mg/dL compared to 7.5 mg/dL in the pre- versus the post-intervention group (p=0.659). Comparing the pre-transfusion Hgb values in both groups per ordering division showed that the average Hgb values were lower after the intervention among all divisions except for the hematology/oncology department. This difference was statistically significant in the Intensive Care Unit (ICU). In terms of the number of transfused units, overall, there was a decrease in the number of transfused units, however, this was not statistically significant.(table 1) The department with the highest number of transfused units was internal medicine. DISCUSSION: Our study showed that the application of an auditing system within the electronic medical system resulted in significant improvement in the transfusion practice in the ICU department. The lack of significant effects among other departments can be attributed to the lower number of cases in the pre- versus post-intervention cohorts, e.g. 22 versus 50 in the Hematology/Oncology department and 6 versus 26 in the Emergency Department. Besides, it was difficult to gauge the reasoning for blood transfusion among the different departments whether it was for objectively significant blood loss despite the stable hemodynamics, or due to symptomatic anemia. The overall acceptance of the new system should be further investigated through a qualitative study e.g. individual interviewing or group discussions to explore reasons for possible resistance to change. CONCLUSION: Changing the transfusion order can help in improving the transfusion practice in healthcare facilities. However, this strategy alone may not be effective, and further investigations into the root causes of the non-significant change in some departments are needed. Enforcing the electronic auditing system along with staff development workshops may result in better outcomes. Disclosures No relevant conflicts of interest to declare.

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

How do I…Incorporate a two-sample blood type verification in a pediatric hospital?

The AABB (American Association of Blood Banks) and the College of American Pathologists (CAP) regulations call on blood banks to address the risk of misidentification of a patient's blood type, which can result in transfusion of a mismatched product. Transfusion of mismatched blood product is potentially fatal due to acute hemolytic transfusion reaction and is considered a preventable event. CAP regulations outline options to reduce risk of mistransfusion by either documenting the ABO group of the intended recipient on a second sample collected at a separate phlebotomy, or utilizing a mechanical barrier system or electronic identification verification system that ensures the patient from whom the pretransfusion specimen was collected is the same patient who is about to be transfused. An electronic or barrier system was not available for implementation at our institution, therefore we developed a protocol for a two-sample verification system. The first determination is performed on a current sample and the second by one of the following methods: (a) comparison with previous laboratory records, (b) testing a second sample collected at a time different from the first sample (i.e., laboratory specimen available with a different timestamp, or a new blood sample). We improved our transfusion process and implemented a policy to require a second sample to confirm a patient's blood type. We also implemented workflows to obtain blood type confirmation from history of a second blood type result from previous laboratory records, including a policy to accept previous blood type records from an outside laboratory. We describe a practice change for two-sample verification for type and screen in a large-scale pediatric hospital. We outline specific workflows for pre-operative and emergency transfusion scenarios, and pediatric-specific challenges.

English

General measures for infection prevention and control should be followed by the health care workers as the world struggles to control Covid-19 spread Medical professionals and researchers continue to fight with the recent global outbreak of Covid-19 and its potential impact on blood transfusion services is real and a cause of concern for transfusion medicine experts The 2002 - 03 SARS outbreak saw 8098 reported cases resulting in 774 deaths, and a 9% mortality rate ((1)) The mortality rates for the same spiked to 50% for individuals over the age of 60 It is accepted that the present Covid-19 outbreak originated in bats As per the American Association of Blood banks (AABB) ((2)) There is no reported or suspected case of transfusion transmitted Covid-19 (3,4,5) Similarly, in India there is no reported case of transfusion transmission Social distancing of blood donors is of paramount importance for blood donors while blood collection Similarly, organizing of blood donation camps by organisers and blood bank staff should ensure the same Facilities for hand washing for blood donors and use of mask should be ensured Blood donation by blood donors with travel history should be deferred for 28 days