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Introduction
Publications
Publications (274)
Background
Pathogen reduction (PR) may be used as an alternative to gamma or x‐ray irradiation (I) to prevent transfusion associated graft versus host disease (TA‐GVHD) if the pathogen reduction technology has been shown to inactivate residual lymphocytes. However, as I is considered the gold standard for reducing the risk of TA‐GVHD, some centers...
Adequacy and safety are the twin prerogatives of the blood transfusion service which in turn is an indispensable component of public health delivery; however, many Caribbean countries have inadequate blood supply for the current and projected demands of their health care systems. Understanding blood donor motivators and barriers is crucial to impro...
Background
In December 2021, the U.S. Food and Drug Administration published a letter to clinical laboratory staff and healthcare providers detailing a risk of false Rapid Plasma Reagin (RPR) when using the Bio‐Rad Laboratories BioPlex 2200 Syphilis Total & RPR kit in people who had received COVID‐19 vaccination; Treponema pallidum particle aggluti...
Background
The U.S. Centers for Disease Control and Prevention (CDC) has reported increasing rates of alpha‐gal syndrome, an allergic response after meat ingestion (AGS). AGS has been associated with prior exposure to tick bites or other biologics characterized by a life‐threatening immunoglobulin E (IgE)–mediated hypersensitivity to galactose‐alph...
Patients with severe aplastic anemia (SAA) are at high risk for morbidity and mortality due to severe infections. We aimed to characterize the role of granulocyte transfusion (GT) in SAA. Primary outcomes were survival from first GT, including overall survival (OS) at last follow up, survival to discharge, and receipt of HSCT. Secondary outcomes in...
Knowing dose calculations for factor concentrates is paramount for the care of hemophilia patients. Nevertheless, challenges can arise when these patients fail to respond to appropriate dose infusions. Solve it!
In some hospital facilities, therapeutic plasma exchange procedures are performed by the renal service. it is important to understand the differences in procedures performed by a renal service versus those performed by a clinical therapeutic apheresis service. Solve it!
Compatibility testing (i.e., crossmatching) is an important step to ensure safe transfusion of red blood cells. One of several types of crossmatches may be performed, depending on the blood bank testing history and immunohematology findings of the patient. Solve it!
Neonatal thrombocytopenia can be problematic. Determining the cause is important to managing the newborn’s condition. Solve it!
The presence of an antibody may be confounded or hidden by another antibody. Antibody panel testing at different phases may be useful in order to elucidate the immunohematology findings. Solve it!
At times, critical blood supply shortages may affect transfusion decision making. Solve it!
Management of the anemic patient who will not accept a transfusion of blood products can be quite challenging. Knowledge of treatment strategies and alternative treatments is key to providing effective care for such patients. Solve it!
Participation in proficiency testing is a regulatory requirement and a cornerstone of laboratory quality assurance. Solve it!
Light transmission aggregometry is a highly specialized test used to measure platelet function. When selectively used, because of the skill and time needed to run the test, it can be an essential assay in detecting underlying inherited platelet disorders. Solve it!
In rare instances, a red blood cell phenotype is found in association with a clinical syndrome. Solve it!
Spurious laboratory results can lead to untoward consequences. Solve it!
Autoadsorption is an important technique in immunohematology testing to remove or reduce autoantibody reactions and uncover the presence of alloantibodies. Solve it!
Antibodies with characteristic “high titer/low avidity” reactivity can be problematic when working up paients who may need transfusions. Solve it!
Cases of fetal-maternal hemorrhage and hemolytic disease of the fetus/newborn can present challenges in transfusion medicine. In addition, knowing special neonatal requirements for blood products is important. Solve it!
Knowing the nuances for hematopoietic stem cell transplantation, including ABO mismatches and complications that may arise, is important for the successful management of the transplant patient. Solve it!
Thrombocytopenia can be associated with bleeding or thrombotic conditions. Determining the underlying cause is essential to management of the patient. Solve it!
Unusual alloantibodies can occasionally cause transfusion complications. Solve it!
The Kleihauer-Betke acid elution test is commonly used to assess fetal-maternal hemorrhage in pregnant women through the detection of fetal hemoglobin. Yet, conditions other than fetal-maternal hemorrhage may affect fetal hemoglobin levels. Solve it!
Investigation of a transfusion reaction may require a thorough review of events that occurred at the patient’s bedside in order to elucidate the underlying cause of the complication. Solve it!
Knowledge of the appropriate indications for Rh immune globulin is essential for the management of Rh-negative pregnant women. Solve it!
Antiplatelet medications are commonly used among patients. Knowledge of the various platelet function assays that are available to measure the effects of these agents is essential. Solve it!
Knowing the indications for irradiation of cellular blood products, as well as alternatives, is important for the provision of safe transfusion practices. Solve it!
Although cryoprecipitate and fresh frozen plasma are both plasma products, they have different indications for use and are not interchangeable. Solve it!
Thrombotic microangiopathies (also referred to as microangiopathic hemolytic anemias) are a heterogeneous group of disorders which include thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome, among others. Although therapeutic plasma exchange is often requested for the treatment of these disorders, not all are responsive. Sol...
Molecular genotyping is a powerful tool to aid in resolving complex immunohematology problems, particularly when there are limitations to the use of serologic testing because of recent transfusions. Solve it!
Use of specialized immunohematology testing methods is sometimes necessary in order to elucidate the clinical significance of an identified antibody. Solve it!
Inappropriate and unnecessary transfusions of blood products are problematic. Blood conservation strategies have been developed to minimize the need for blood transfusions. Solve it!
Enzyme-treated panels can be very useful tools when resolving complex antibody problems. Solve it!
Sickle cell anemia patients present challenges and complexities in resolving immunohematology testing which can lead to severe transfusion complications. Solve it!
Monitoring anticoagulation when patients are receiving unfractionated heparin is essential for appropriate care to avoid bleeding or thrombotic complications. Solve it!
Granulocyte transfusions, though very rarely used, may have clinical benefit in very selective circumstances. Solve it!
Men who have sex with men have long been considered high-risk blood donors dating back to the human immunodeficiency virus epidemic of the 1980s. Recommendations for donor deferral have changed in light of modern sensitive transmissible disease testing methods, yet newer highly active antiretroviral prophylactic and therapeutic agents must be consi...
Performing therapeutic apheresis in a small pediatric patient presents significant challenges, given the patient’s total blood volume compared to the extracorporeal volume of the apheresis device circuit. Solve it!
The presence of antiphospholipid antibodies may be suspected in patients with thrombotic conditions. Laboratory detection of these heterogeneous antibodies can be challenging. Solve it!
Platelet mapping is an important feature of thromboelastography that can aid in elucidating the underlying cause of bleeding in a patient and guide therapy. Solve it!
Knowing a patient’s transfusion history can be vital to guiding immunohematology testing and resolving an antibody problem. Solve it!
Massive transfusion protocols have become a cornerstone in trauma resuscitation. Solve it!
Validation and quality control are important concepts under the Clinical Laboratory Improvement Amendments of 1988. Solve it!
Although patients may have differing perceptions in regard to blood transfusions, and in spite of the fact that transfusions are associated with infectious and noninfectious risks, transfusion consent remains inconsistently performed. Consent is often obtained hastily as a part of the overall treatment consent process without adequate understanding...
Some therapeutic agents used for cancer treatment may significantly interefere with immunohematology testing. Solve it!
Prion disease transmission through blood transfusion is a known risk, and measures have been taken to protect the blood supply. Solve it!
ABO typing, while usually straightforward and uncomplicated, may show discrepant results on forward and reverse typing. In such instances, additional testing is necessary to resolve the patient’s true ABO group. Solve it!
Viscoelastic testing offers global coagulation assessment using whole blood compared with conventional plasma-based coagulation testing. Solve it!
Managing blood donor product recall and lookback notifications is a key responsibility of a transfusion service medical director. Solve it!
Paying attention to the phase of reactivity, whether cold- or warm-reacting, is important when considering the clinical significance of an antibody. Solve it!
Careful attention to coagulation status and fluid replacement is key to preventing complications in patients undergoing therapeutic plasma exchange. Solve it!
Careful attention to the patient’s medical history can be paramount in resolving antibody immunohematology findings. Solve it!
Patients who repeatedly fail to get an appropriate response to platelet transfusions are said to be refractory. Such patients can be highly difficult to manage, particularly when there is an immune cause to the refractoriness. Solve it!
Coagulation analyzers can provide data beyond the standard prothrombin and activated partial thromboplastin times through generated clot waveform analysis curves. Solve it!
The workup of patients who present with venous thromboembolic events involves testing for acquired and genetic causes of thrombophilia. Solve it!
Although blood donation is considered to be safe, donor reactions may occur. Most reactions to blood donation are minor, though rare severe complications have been reported. Solve it!
Pulmonary edema associated with transfusion of blood products is a rather unfortunate but relatively common occurrence. Determining the underlying mechanism of the pulmonary edema is important for appropriate management of the patient and, depending on the cause, may have implications for the blood donor. Solve it!
Convalescent plasma has been used throughout history to manage pandemic outbreaks. Most recently, it has been used in the pandemic caused by the coronavirus disease 2019. Solve it!
Necrotizing enterocolitis is a multifactorial disorder that is relatively common in premature very low birth weight neonates. A proportion of such cases has been linked to red blood cell transfusion, though the exact mechanism is unclear. Solve it!
Although cold-reacting antibodies are not generally considered to be clinically significant, on occasion, they can be problematic. Solve it!
Patients with sickle cell anemia often present with challenges in finding compatible blood because of their propensity to making red blood cell antibodies. Solve it!
Plant protein extracts known as lectins can occasionally be useful for resolving blood bank testing issues. Solve it!
Von Willebrand disease is a relatively common inherited bleeding disorder. Knowledge of the various types of von Willebrand disease is important for understanding modalities necessary to diagnose and manage the disorder. Solve it!
Fever in association with transfusion may be a sign that a reaction has occurred. Additional workup and review of the case is necessary to determine whether or not transfusion is the underlying cause. Solve it!
Sometimes, an antibody just isn’t what it appears to be. Paying close attention to the clinical history and all of the panel testing results, including patient cell testing, is important. Solve it!
Although healthy volunteers are encouraged to donate blood regularly, frequent blood donation may lead to adverse consequences. Solve it!
Antibodies to red blood cell antigens are commonly detected and identified during pregnancy. It is important to determine the nature and source of the antibodies in order to assess the risk of harm to the baby. Solve it!
Knowing treatment modalities to reverse novel anticoagulants can be key to saving the life of an individual who develops a bleeding complication. Solve it!
Challenges can arise in the management of chronically-transfused patients. Solve it!
Patients undergoing solid organ transplantation may have complicated serologic findings on immunohematology testing which require additional consideration for the management of their transfusion needs. Solve it!
Efficient operation of a blood donor center is critical to managing blood supply shortages. Paid donor models may be one solution to meet donor collection goals but bring about concerns. Solve it!
On occasion, the specificity of an antibody may not be very clear based on initial testing results. Additional testing may resolve the identity of the antibody. Solve it!
In addition to the patient’s clinical history, an unusual characteristic may provide a clue as to the nature of an antibody. Solve it!
Though no longer widely used in the United States, there is some continued interest in autologous and directed donor blood donations. Solve it!
The presence of warm-reactive autoantibodies can present significant challenges in patients who need red blood cell transfusions. Nevertheless, patient history can be key in determining the risk of transfusion under such circumstances. Solve it!
Treatment of patients using hematologic growth factors, particularly erythropoietin-stimulating agents, has expanded and now includes use of thrombopoietin receptor agonists. it is important to understand the indications for these agents and their risks. Solve it!
Healthcare institutions in the United States must have a quality assessment and improvement program that includes monitoring of transfusion practices and adverse outcomes. Solve it!
Sometimes, immunohematology findings are entirely unexpected and not easily explainable by the patient’s circumstances. Solve it!
Sickle cell anemia patients have a propensity to making alloantibodies. Special care is often taken to prevent sensitization in this patient population. Yet, alloantibodies may arise unexpectedly. Solve it!
At times, finding compatible blood for a patient may be very difficult or nearly impossible. Solve it!
Autoadsorption is a useful technique to uncover the presence of underlying alloantibodies in patients with warm-reacting autoantibodies but has limitations. In such situations, specialized immunohematology reference laboratories can perform complex differential alloadsorption testing. Solve it!
Drug-induced antibodies are a rare cause of hemolyic anemia for which the immunohematology workup is complicated. Solve it!
The presence of autoantibodies can be particularly vexing when it comes to pretransfusion testing. Specialized, though even relatively simple, immunohematology techniques, such as prewarm testing, can be very useful in resolving the red blood cell antibody reactions in some cases. Solve it!
Leukocytapheresis, though uncommonly performed, can be very useful in select patients with extreme leukocytosis. Solve it!
Resolving Rh antibodies during pregnancy can be vital to guiding Rh immune globulin prophylaxis in Rh-negative women. Solve it!
While there are many underlying causes of thrombocytopenia to consider, some causes are rare and easily overlooked. Solve it!
ABO/Rh typing and antibody identification are basic immunohematology skills from which the learner will build upon to develop knowledge and reasoning skills to work through cases that are more complex. Solve it!
Chimeric antigen receptor T-cell therapy is a form of adoptive immunotherapy that is promising for the treatment of hematologic malignancies. Solve it!
A patient’s blood type can dictate availability of blood products necessary for treatment. Solve it!
Complications arising from platelet transfusions may require specialized testing in order to determine the nature of the reaction. Solve it!
Sickle cell anemia patients often present transfusion challenges because of their high rate of alloimunization as well as other complications that may arise. Solve it!
Collection of hematopoietic stem cells from the peripheral blood via donor apheresis has advantages over bone marrow harvesting, though one must understand the nuances involved, including stem cell mobilization strategies. Solve it!
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