Blood Bank Guy Essentials Podcast

Hematopoietic progenitor cell (HPC) transplant continues to be used in more and more situations. In this episode, Dr. Brian Adkins outlines the many issues surrounding transfusion support in HPC transplant patients (yes, including the challenge of ABO-incompatible HPC transplants!).

Dr. Will Flanary is an ophthalmologist and stand-up comic who moonlights as the hilarious “Dr. Glaucomflecken” on social media. The Glaucomflecken videos have earned him an enormous worldwide following, as he has gently parodied physicians of many specialties (including pathology). He and his wife Kristin (aka "Lady Glaucomflecken") join me to share their inspirational story, with NO blood bank learning whatsoever! Even so, you've gotta listen!

Continuing Education episode! Understanding reference lab techniques like adsorption, elution, and enzymes feels like learning a new language! Jan Hamilton is here with an incredible teaching interview to help you learn to speak “reference lab.”

Continuing education episode! Advances in the practice of Transfusion Medicine happen regularly, and it can be difficult for both learners and those with more experience to keep up with the latest information. Further, many learners (and more “seasoned” types!) lack experience to evaluate strengths and weaknesses of the evidence in the medical literature. Dr. Rich Haspel joins me to describe how to evaluate evidence in the medical literature, and to discuss his take on low-titer group O whole blood.

CE episode! To celebrate the 100th episode of Blood Bank Guy Essentials, Dr. Chaffin invites multiple previous guests (plus one brand new one!) to share brief "Pearls of Wisdom" with you. Learners of every level are sure to find Transfusion Medicine tips and tools to help care for patients in better ways. Thanks to all who have listened to this podcast in the past 7 years!

Rh Immune Globulin prevents at-risk moms from making anti-D, but calculating proper dose can be challenging. In fact, numerous reports have suggested that we mess this up a lot! This episode is a teaching session with me and one of the pathology residents at Loma Linda University, Jessica Hudson. In it, I try to simplify the calculations and discuss some of the mechanics and details around the use of this amazingly effective medication.

Continuing education episode! If a research project has been going on for over 30 years, you would think it's probably pretty good, right? Well, that's how long the REDS research project, sponsored by the US National Heart, Lung, and Blood Institute (NHLBI) has been breaking new ground in Transfusion Medicine. The two co-chairs of the fourth phase, REDS-IV-P, are here to explain why the best is yet to come!

Continuing education episode! For decades, medical personnel have been aware of the technique of “Acute Normovolemic Hemodilution (ANH),” the collection of blood immediately before surgery followed by infusion near the end. Dr. Steve Frank and his colleagues in the Bloodless Medicine Program at Johns Hopkins believe ANH is an underutilized strategy. He joins the BBGuy Essentials Podcast to share the details of ANH, and show how other facilities can implement ANH as a part of their overall Patient Blood Management Program.

Continuing education episode! Blood shortages happen, but the one associated with COVID-19 is unique (and severe!). AABB Chief Medical Officer Dr. Claudia Cohn explains why and gives practical survival tips.

Continuing education episode! Plasma product names are confusing, but few are as misunderstood as Liquid Plasma. Dr. Chris Gresens explains why LP might be perfect for your transfusion service.

Continuing education episode! When most United States-based healthcare providers think of a hemoglobinopathy, sickle cell disease is the first to come to mind. That is understandable, given how frequently that disease is present in the US. However, worldwide, the various forms of thalassemia are a MASSIVE problem. Dr. Sujit Sheth takes us through the details around this deadly global disease, and how transfusion professionals can aid in care of thalassemia patients.

Continuing education episode! Usually, red cell alloantibodies are simple (find an antibody, give antigen-negative blood), but occasionally, some of them don't follow the rules! "Antibodies of variable clinical significance" act differently in different patients, sometimes causing hemolysis and sometimes not. They can be very hard to manage, especially because almost all blood donors are incompatible. The Monocyte Monolayer Assay, developed by today's guest, Sandy Nance, and her colleagues at the American Red Cross, helps answer the question, “Do we search the world for rare units of compatible blood, or can we just transfuse ABO-compatible red cells out of our regular inventory?” It's a great story, and this is a rare chance to hear about the MMA from one of the original sources, and to understand how to use it today.

Platelets have been used to save the lives of patients with low platelet counts for decades. For the most part, they are considered a safe and effective means to correct the problem of a patient not having enough platelets of their own. Despite that, we have wondered for decades about whether or not platelets should be given to patients with certain diseases where their platelets are being removed from circulation, like ITP, TTP, and HIT. My guest in this episode, Dr. Ruchika Goel, looked at platelet transfusion in those three entities, and she has data to share with us that might change the way you transfuse these patients.

In 2017, Dr. Mark Yazer appeared on this podcast to discuss the burgeoning interest in “Low-titer Group O Whole Blood (LTOWB)” for massive transfusions, particularly in trauma settings. Since then, more data and experience are available to guide the use of whole blood for trauma transfusion. Dr. Yazer updates us on the latest whole blood and incompatible plasma transfusion data, and clears up once and for all the "clear fluids" debate! Plus, there's some hockey trash talk...

Despite guidance in a 2015 publication from international experts in immunohematology and transfusion medicine, many clinicians and laboratorians have yet to integrate RHD genotyping into routine practice when a patient’s RhD serologic typing is weaker than expected. In this interview, international immunohematology expert Sue Johnson shows us how we can do better!

Continuing education episode! Transfusion reactions that involve the heart and/or lungs, especially TACO and TRALI, are responsible for more transfusion deaths than any other entity. In this interview, Dr. Cserti-Gazdewich focuses on these two reactions and gives tips and strategies to identify, manage, and prevent them.

Warm autoantibodies have a well-deserved reputation as tough challenges, creating unfamiliar situations for both clinical and laboratory staff. I interviewed the authors of two recent papers that outlined best practices in this situation to gain some clarity and help!

Continuing education episode! Blood transfusion is less likely to transmit infections today than ever. Through a combination of screening questions, donor testing, and direct treatment of blood products, the vast majority of opportunities for transfusion-transmitted infections are eliminated. In this learner-focused interview, Dr. Suchi Pandey from Stanford outlines current strategies to keep blood safe.

Continuing education episode! Every now and then, the routine practice of Blood Banking/Transfusion Medicine gets intimidating. A difficult patient situation arises here, an impossible choice looms there. What do you do when there are no easy answers? Drs Mark Fung and Jay Hudgins are expert Transfusion Medicine practitioners who have years of experience dealing with these “scary” situations! In this special Halloween 2020 episode, they are here to help learners with ideas on how to approach some seemingly impossible situations.

Continuing education episode! Every now and then, when a transfusion service does a pretransfusion workup, they find that the patient's plasma is incompatible with EVERY other red cell! In other words, NOTHING is compatible! These situations are intimidating, and can lead to delays in transfusion. Dr. Jill Storry is an international immunohematology expert, and she shares practical tips for what to do and how to recognize the three main patterns of panagglutinins.

Special episode! In the midst of the COVID-19 pandemic, does convalescent plasma from recovered patients offer fresh hope for those who are critically ill? The medical leaders of the two largest blood collectors in the US are here to help us work through the challenges and triumphs for COVID-19 convalescent plasma.

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.

Continuing education episode! Ever since the introduction of anti-CD38 (daratumumab, or DARA), blood bankers have been hearing about a new chemotherapy agent, anti-CD47, that would interfere far more in our testing than anti-CD38. Well, anti-CD47 is here (in trials), and it lives up to its reputation! Connie Westhoff and her team report on results from blood bank testing of patients taking the drug, and what you can do to overcome the problems. This episode is eligible for free CME and SAMs/CC credit for physicians and P.A.C.E. contact hours for laboratorians through Transfusion News Continuing Education on Wiley Health Learning.

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

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

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

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

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

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

Continuing education episode! Patients with liver disease often have basic coagulation laboratory values that seem AWFUL, and as a result, they receive almost 1 in every 5 blood products transfused in hospitals! Jeannie Callum thinks that’s too much, and shows us how to improve our practice. This episode is eligible for FREE CME and SAMs/CC credit for physicians and P.A.C.E. contact hours for laboratorians through Transfusion News Continuing Education on Wiley Health Learning.

Continuing education episode! "I never KNEW about that paper!" Most of us have felt that way when we miss some new Transfusion Medicine fact, especially early in our careers. In this interview, two of the editors of a synopsis of 2016-17 BB/TM literature summarize recent developments you should know. 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.

In the 2+ years I've been doing this podcast, more people have asked, "when are you doing ABO discrepancies?" than any other topic. Well, here you go! Let's learn the essentials with Dr. Nicole Draper, who loves ABO discrepancies! See www.BBGuy.org/054 for the visual part.