The Need for Education in Molecular Immunohematology: A Survey of Specialists in Blood Banking.

BACKGROUND: Within transfusion medicine, the education of molecular technologies lacks standardization. OBJECTIVE: To address this problem, we surveyed specialist in blood bank technology (SBBT) programs, immunohematology reference laboratories, and SBBT graduates to define its current state. METHODS: An anonymous online survey (SurveyMonkey) was emailed to the 15 American Association of Blood Banks (AABB) SBBT programs, 59 AABB IRLs, and 82 SBBT graduates. RESULTS: In the didactic portion of the SBBT curriculum, all programs incorporate knowledge base of blood groups, 13 incorporate molecular techniques, and 5 include case studies. Thirteen programs have intentions of expanding the knowledge base in molecular topics. Most IRLs (97%) think SBBT programs should continue to expand molecular knowledge base. Most graduates (94%) believe more molecular topics should be included in the SBBT curriculum; however, only 50% believe they currently apply their molecular knowledge in their post-graduate employment. CONCLUSION: We propose a more descriptive molecular diagnostics curriculum for SBBT programs to help standardize the education of molecular topics.

Noninvasive buccal swab antigen sample and molecular testing provides extended antigen typing for patients with hemoglobinopathies.

OBJECTIVE: To demonstrate the feasibility of performing a noninvasive, molecular-based red blood cell (RBC) antigen test on infants and very young children with sickle cell disease as part of a statewide newborn screening follow-up program. STUDY DESIGN: A prospective pilot project was conducted using a noninvasive buccal swab and test kit to perform DNA-based, extended RBC phenotyping in 92 children participating in a newborn hemoglobinopathy screening follow-up program. Reported data include the extended panel of antigens detected by molecular analysis compared with unaffected population estimates. RESULTS: Molecular-based RBC antigen testing was successful, with extended RBC typing generated for all subjects. Molecular testing detected several rare negative or rare positive phenotypes, demonstrating the utility of obtaining an extended antigen panel. CONCLUSION: This study demonstrates the feasibility of performing antigen testing on buccal swab specimens from children with sickle cell disease as part of a newborn screening follow-up program with the aim of allowing specific unit matching to prevent alloimmunization with RBC transfusions. The general applicability of testing may be limited by a lack of uniform insurance coverage for buccal swab testing, however.

Two case studies and a review of paroxysmal cold hemoglobinuria.

Paroxysmal cold hemoglobinuria (PCH) is an acquired hemolytic anemia caused by immunoglobulin G (IgG) antibodies that sensitize red blood cells (RBCs) at cold temperatures by fixing complement to the RBCs causing intravascular hemolysis on rewarming. PCH usually appears in young children as recurrent high fevers, chills, and passage of red-brown urine. The diagnostic test for PCH is the Donath-Landsteiner test, an in vitro assay for biphasic hemolysis. Herein, we present 2 cases of PCH that occurred within 12 months of each other. We quickly diagnosed the second case and treated the patient successfully, in part due to our recognition of its characteristics based on the first case. PCH is a hemolytic anemia for which there is a specific diagnostic test; the timely recognition of this entity by physicians and laboratory staff will allow prompt, supportive therapy and will raise the odds of quick resolution of hemolysis.