Transfusion Medicine Rotations for Pathology Residents: Structure, Resources, and Milestones.

CONTEXT.­: Transfusion medicine can be a challenging subject to teach to pathology residents while also ensuring that all the Accreditation Council for Graduate Medical Education's (ACGME's) milestones are met. OBJECTIVE.­: To explore how one major academic residency program has structured its transfusion medicine rotation. DESIGN.­: The residents on the pathology rotation have very defined roles for their day-to-day responsibilities. Many new resources have been developed during the past 3 years to improve the residents' educational experience on their transfusion medicine rotation. A daily patient list is used to direct the residents' educational and service responsibilities. They also have numerous resources to help with independent study and reading during their rotation. RESULTS.­: The implementation of several new resources has greatly improved the residents' educational experience and has improved the overall evaluation of the rotation by the residents. Many of the ACGME milestones can be met by the structure of this rotation. CONCLUSIONS.­: With the proper structure and resources, transfusion medicine can be effectively taught to all pathology residents while also meeting the ACGME milestones requirements.

Injured recipients of low-titer group O whole blood have similar clinical outcomes compared to recipients of conventional component therapy: A single-center, retrospective study.

INTRODUCTION: Low-titer group O whole blood (LTOWB) is being increasingly transfused to injured patients. This study evaluated a range of clinical outcomes to determine if receipt of LTOWB predisposed recipients to worse outcomes compared to recipients of conventional component therapy (CCT). METHODS: A retrospective analysis of trauma patients who received at least 3 units of LTOWB (LTOWB group) versus those that received at least 3 units of RBCs, 1 unit of plasma and 1 unit of platelets but no LTOWB (CCT group) during the first 24 h of their admission was performed. Causal treatment effects were explored using propensity score matching (PSM) and coarsened exact matching (CEM). Important clinical outcomes were evaluated. RESULTS: There were 165 CCT and 155 LTOWB recipients eligible for matching. PSM and CEM reduced covariate imbalances between the CCT and LTOWB groups, with the exception that males remained over-represented in the LTOWB group due to the hospital's former resuscitation policy of not administering RhD-positive LTOWB to females <50. In both of the matched analyses, the LTOWB group received a median of 4 LTOWB units. There were no significant differences in 6-, 24-h mortality or 30-day mortality between groups, nor were there differences in the frequency of other clinical outcomes such as acute kidney injury, sepsis, venous/arterial thromboembolism; delta MODS was lower for the LTOWB recipients in the exact match group. CONCLUSION: In both matched analyses, administration of a median of four LTOWB units did not result in a different frequency of major clinical outcomes including mortality.

Hemolytic markers following the transfusion of uncrossmatched, cold-stored, low-titer, group O+ whole blood in civilian trauma patients.

BACKGROUND: Low-titer group O whole blood (LTOWB) is increasingly being used in the civilian trauma setting, although there is a risk of hemolysis. This study evaluated the impact on hemolytic markers following the transfusion of 4 or more units of uncrossmatched LTOWB. METHODS: Civilian adult trauma patients who received four or more units of leukoreduced group O+, low-titer (<50 anti-A and anti-B), platelet-replete uncrossmatched whole blood during their initial resuscitation and who survived for more than 24 hours after the transfusion were included in this retrospective study. Lactate dehydrogenase (LDH), total bilirubin, haptoglobin, potassium, and creatinine were evaluated on the day of LTOWB transfusion (Day 0) and the next 3 days. Blood product administration over the first 24 hours of admission was recorded. RESULTS: There were 54 non-group O and 23 group O recipients of four or more LTOWB units. The median (interquartile range [IQR]) number of transfused LTOWB units was 4 (4-5) and 4 (4-4), respectively, the maximum number in both groups was eight. The non-group O patients received a median (IQR) volume of 1470 mL (1368-2052) of ABO-incompatible plasma. Comparing the non-group O to the group O recipients, there were no significant differences in the haptoglobin, LDH, total bilirubin, potassium, or creatinine concentrations at any of the time points. There were no reported transfusion reactions. CONCLUSION: Receiving at least four LTOWB units was not associated with biochemical or clinical evidence of hemolysis.

Colchicine Toxicity: The Fatal Masquerader.

Colchicine toxicity results in fatal multiorgan failure. We present a case of colchicine toxicity resulting in transient biventricular failure and cardiogenic shock that were successfully treated with packed red blood cell exchange. (Level of Difficulty: Beginner.).