Anemia in patients undergoing chronic therapeutic plasma exchange.

Therapeutic plasma exchange is known to be an extracorporeal treatment procedure with few adverse effects. Anemia in chronically exchanged patients is not a well-recognized adverse effect. Our aim is to find if adult patients develop anemia while undergoing prolonged TPE treatments and to determine the time of onset of anemia. We retrospectively reviewed all outpatients that have undergone TPE at least once a week from July 2017 to March 2020. Kaplan-Meier time-to-event analysis was employed to calculate the time taken for development of anemia and time to reduction of hemoglobin by 1 g/dL from baseline in uncensored patients. A total of 14 patients met inclusion criteria receiving chronic TPE for neurological disorders including myasthenia gravis (MG). Eleven patients had once a week procedure. Study patients underwent a total of 113 (IQR, 84-227) TPE procedures and the duration of TPE was 4 (IQR, 2-6.5) years. Anemia was prevalent in 29% of this patient cohort before the initiation of TPE with a median hemoglobin of 9.4 (IQR, 8.1-11.0) g/dL. All patients regardless of hemoglobin levels prior to therapy had a decrease of 1 g/dL in hemoglobin in 6 (IQR, 3-8) weeks after initiation of chronic TPE. Anemia occurred in all non-anemic patients who underwent chronic TPE within a short period of ten weeks. Patients who were moderately anemic prior to initiation of TPE progressed to severe anemia within six weeks of TPE. Our results suggest that anemia is a consequence of chronic TPE. Baseline and follow-up laboratory studies are vital for early diagnosis.

How do I create a partnership between a blood bank and a milk bank to provide safe, pasteurized human milk to infants?

The now 5-year collaboration between the Indiana Blood Center, now Versiti Blood Center of Indiana, and The Milk Bank has increased the number of human milk donors, improved the collection and processing of donor milk, and improved awareness of this lifesaving resource. The Indiana Blood Center provides greater visibility for The Milk Bank, creating more opportunities to reach potential donors, and can provide the screening blood test for potential donors to become approved human milk donors. The resources of the multiple locations of the Indiana Blood Center permitted the formation of new milk depots in five different cities and quicker transportation of donated milk through their active courier system. This partnership most importantly has improved awareness for both lifesaving missions to the communities they serve.

Anti-Pr antibody induced cold autoimmune hemolytic anemia following pneumococcal vaccination.

While rare, vaccination-induced autoantibodies can occur outside of the pediatric population. This diagnosis should be considered after infectious and lymphoproliferative disorders are ruled out. Clinical management will depend on the individual case, but all patients should be monitored closely.