Thursday, May 13th, 2010

As the Pump Turns: Blood Conservation Techniques in the CVOR
Peter Woods CCP, Saint Luke's Hospital, Kansas City, MO

    Mr Woods presented an overview of blood conservation techniques utilized in the operating rooms in

    cardiovascular surgery.  The basics of perfusion, the heart/lung bypass circuit, and how the perfusion

    console (pump) complicates blood management in the OR were discussed.  Different perfusion techniques

    for decreasing banked blood usage were explained, including cell saving, hemoconcentration, and RAPping

    methods.

Case Study - Passenger Lymphocyte Syndrome
David Baker, St Louis Children's Hospital, St Louis, MO

    Discussed a case of passenger lymphocyte syndrome affecting a patient at SLCH.  Reviewed the frequency

    and typical outcomes of the syndrome.  Passenger Lymphocyte Syndrome refers to the clinical phenomenon

    of alloimmune hemolysis resulting from the adoptive transfer of viable lymphocytes from the donor during

    solid organ and hematopoietic stem cell transplants.  Donor's antibodies can be of ABO or non-ABO origin. 

    Management strategies include immunosuppression, immune-modulation (IVIG), B-Cell targeting (Rituximab)

    and/or exchange transfusion.

DNA Analysis as a Tool in the Resolution of Complex Antibody Investigations
Christine Lomas-Frances, New York Blood Center, Long Island City, NY

    Presentation demonstrated the power of combining hemoagglutination with DNA- based assays in

    investigations that are difficult to resolve with standard methods and available resources.  DNA-based assays

    have become a valuable tool in our arsenal of procedures when resolving complex serological

    investigations.  Case studies were presented involving antibodies to antigens in the MNS, Rh, Dombrock, and

    Cromer blood group systems.

Case Study - Are You My Mother?  In Vitro Fertility Challenges in the Blood Bank
Faith Nilhas, Lawrence Memorial Hospital, Lawrence, KS

    Investigation of ABORh discrepancies between cord bloods of newborns and their mothers is important to

    rule out possible mislabeling of specimens and to assure testing is correct to prevent possible D

    alloiommunization of Rh Negative women.  This case study discussed the discovery that in vitro fertilization

    methods may have been used to achieve pregnancy and that sensitive privacy issues can arise as a result of

    the Blood Bank needing to resolve ABO discrepancies.

Molecular Techniques in the Blood Bank:  Present and Future
Dr. Douglas Lublin, Barnes-Jewish Hospital, St Louis, MO

Acquired Inhibitors
Linda Swanson, NovoNordisk, Rosemount, MN

"Local Boyd Makes Good"; William Clouser Boyd, Blood Groups and Anthropology

Steve Pierce, Retired, Kansas City, MO

    Following Ludwig Hirszfeld's report in 1919 that ABO prevalence varied in different populations, blood

    groups became widely used in physical anthropology.  William Clouser Boyd, from Missouri, was one of the

    leading Americans to use blood groups in anthropological investigations.  He was the first to type Egyptian

    mummies and introduced the use of lectins to Type red blood cells.  This historical presentation examined

    seroanthropology and Boyd's contributions to blood group serology.

Friday, May 14th, 2010

Blood Management...The AABB Advocate
Dr. Gary A. Thompson, Saint Luke's Hospital, Kansas City, MO

    Most transfusion decisions are made without understanding the risks and alternatives.  Many are

    unnecessary.  The science of transfusion medicine is evolving.  Only a small number of hospitals have an

    organized approach to prevent or limit anemia.  Most hospitals utilize few or no procedures to impact

    practicing physicians in transfusion practices (except after the fact).  Dr. Thompson discussed the risks in

    transfusion including infections and increased mortality.   Discussed the development of the Blood

    Management program at Saint Luke's and steps involved.  In summary:  Phlebotomy should be reduced and

    every drop collected should be utilized effectively.  Restrictive transfusion strategy based on evidence-based

    criteria should be applied.  Blood bankers and blood management are aligned in their objectives.  Blood

    management uses a multi-modality approach requiring planning and teamwork.

The Transfusion Exclusion:  Female Platelet Donor Relevance in TRALI Cases - The 2010 HAABB Student Scholarship Winner
Presented by Melody Boudreaux, North Kansas City School of Clinical Laboratory Science, NKC, MO

    Miss Boudreaux's paper has been listed here in its entirety:   The Transfusion Exclusion

Phenotype Matching and Red Cell Alloimmunization in Sickle Cell Disease
Dr. Ram V Kalpatthi, Children's Mercy Hospital, Kansas City, MO
 

Case Study - Investigation of Hemolytic Anemia in a Post Transplant Patient
Charles McDonald, University of Kansas Hospital, Kansas City, MO

    Presented the medical indications and serological findings in determining hemolytic anemia and the use of

    "incompatible blood".  Also discussed supportive therapies in treating anemia.

Viva Las Blood Bank!  A Trivia Game for Blood Bankers
Elizabeth Jones, Saint Luke's Hospital, Kansas City MO

    The winning team consisted of the Saint Luke's Hospital CLS students (along with David Baker, past HAABB

    secretary):   Danielle Allen, Lauren Finley, Miche Goodrick, Herman Lee, Aaron Salisbury, Kelsey Sothers

    and Hanna Wilson.

Serological Case Studies:  After Further Review...Does the Call Stand?
Susan T. Johnson, Blood Center of Wisconsin, Milwaukee, WI

    Susan Johnson's first case study involved a transfusion reaction after patient received crossmatch compatible

    cells.  Patient had positive antibody screen but tech had prewarmed panel and screen.  There was still a

    couple of very weak reactions but all alloantibodies ruled out with prewarm, so went ahead with

    transfusion.  Sample was sent to reference laboratory for investigation when blood bank found no change in

    workup post-transfusion.  Reference laboratory found an Anti-K, Anti-E and Anti-Jka  using Peg and Saline-

    tube methods.  In conclusion, reactivity of clinically significant antibodies may be decreased or missed in

    PW testing.  Adding ptentiator does not ensure that antibody seen in that method will be detected by PW. 

    Potentiators enhance cold-reactive autoantibodies.  Prewarm should only be used to detect alloantibodies in

    the presence of cold-reactive autoantibody and/or to determine if cold antibody is reactive at 37C.

    The second case study involved an Rh type discrepancy when using gel method.  Patient had previously

    typed as Rh Positive, but was typed Rh Negative by the transfusion service when patient returned for

    prenatal workup.  Patient was tested by transfusion service using gel method and obtained Rh Negative

    result.  After investigation, determined patient had partial D that was detected previously using tube method

    and DU test.  The discrepant Rh type was due to partial DVI.  Discrepanices are dependent on the reagents

    and methods used to detect the Rh antigen.

    Third Case Study:  Patient receiving second unit of red cells when chills and red urine noticed.  Transfusion

    investigation ordered - clerical checks show no errors.  Pre and post-transfusion testing as O Positive.  Pre

    and post-transfusion DAT are 3+ and 4+ positive with Poly, C3 and IgG.  Eluates are negative.  Drug history

    was reviewed.  During a previous admission, patient had received cefepime, tobra, and vancomycin for

    sepsis.  On this admission, patient received ceftriaxone several hours before and cefepime just before the

    rbc transfusions.  Patient serum tested in presence of each drug was negative.  Patient was also receiving

    bactrim 3 times per week per chemotherpy protocol.  Last dose was 12 hours prior to transfusion.  Testing of

    patient serum in presence of drug showed positive reaction and titer of 1:256 in presence of bactrim and

    1:512 in presence of Trimethoprim.  Eluate + Trimethoprim presented 3+ reaction at IAT stage.  Medication

    history and DAT/eluate results are important when diagnosing transfusion reactions.

Immune-Mediated Coagulopathy Following Topical Hemostat Use
Dr. Michael H Creer, St. Louis University School of Medicine, St. Louis, MO

    Topical hemostatic agents are commonly used to control bleeding from the surgical incision site during

    surgery.  Use of these agents can be associated with an immune response resulting in the development of a

    coagulation inhibitor and severe bleeding that is difficult to control.  This presentation reviewed the

    mechanism of coagulation inhibitor production following topical hemostat use and the clinical approach to

    control bleeding in the complicated setting.  In summary, postoperative coagulopathies following topical

    thrombin use can be due to a wide range of acquired etiologies.  Bovine thrombin includes bovine factor V -

    antibodies to bovine factor V are the most "cross-reactive" with human factor V.  Immune-mediate

    coagulopathy (IMC) is uncommon and under-recognized.  IMC should be considered in the differential

    diagnosis of unexplained bleeding.  Management of IMC can be costly.  Recommendations for treatment for

    patients with anti-factor V and active bleeding:  Trial of FFP transfusion, apheresis platelet transfusion (for

    platelet Factor V replacement); Immunosuppression (IVIG, steroids or plasmaperesis).  May consider use of

    factor VIIa (Novoseven).

Click here to see pictures of some of the presenters