Hemostatic properties of cold-stored whole blood leukoreduced using a platelet-sparing versus a non-platelet-sparing filter.

BACKGROUND: Whole blood (WB) is an appealing alternative to component-based transfusion in patients with significant bleeding. Historically, WB was transfused less than 48 hours after collection and was not leukoreduced (LR). However, LR components are now standard in many hospitals and LR WB is desirable. We investigated the effect of the type of LR filter used, as well as storage duration, on coagulation laboratory testing of WB. STUDY DESIGN AND METHODS: Ten units of LR WB-5 units manufactured with a Food and Drug Administration (FDA)-approved platelet (PLT)-sparing filter (WB-PS) and 5 units manufactured with an FDA-approved non-PLT-sparing filter (WB-NPS)-underwent complete blood count, PLT function analyzer (PFA [PFA-100]), thromboelastography (TEG), prothrombin time (PT), partial thromboplastin time (PTT), Factor (F)V activity, chromogenic FVIII, thrombin generation, and microparticle quantification on Storage Days 3, 5, 7, 10, and 14. RESULTS: WB-PS contains more PLTs than WB-NPS (mean, 71 × 109 /L vs. 1 × 109 /L, p < 0.001). WB-PS yielded essentially normal TEG tracings, while TEG tracings of WB-NPS were grossly abnormal (mean reaction time, 7.0 min for WB-PS vs. 9.7 min for WB-NPS, p < 0.001; mean alpha-angle 54.9° vs. 38.1°, p < 0.001; mean maximum amplitude, 54.9 mm vs. 13.9 mm, p < 0.001). PFA-100 closure was more common among units of WB-PS compared to units of WB-NPS (72% vs. 4%, p < 0.001). PT, PTT, and factor activities were not dramatically affected by the LR filter. CONCLUSION: The choice LR filter has a major impact on the hemostatic properties of WB. Although storage of WB is associated with a rapid decline in PLT count, hemostasis as assessed by TEG and PFA-100 is not diminished over a 2-week storage period.

The epidemiology of bacterial culture-positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016.

BACKGROUND: Bacterial contamination and associated septic transfusion reactions (STRs) remain the leading infectious risk to the blood supply. We sought to characterize the risk and clinical presentation of blood culture-positive transfusion reactions (BCPTRs) and STRs at our institution. STUDY DESIGN AND METHODS: A retrospective analysis was conducted of all suspected transfusion reactions reported to the transfusion service at a 1000-bed tertiary academic medical center from January 2009 to September 2016. Routine investigation included review of the clinical presentation, Gram stain, and bacterial culture of residual blood from the transfused product or associated blood bag. BCPTRs were defined by the presence of a positive bacterial culture in the blood product and/or recipient. STRs met definitive Centers for Disease Control and Prevention hemovigilance criteria for transfusion-transmitted infection, with definite imputability and concordant bacterial culture of the blood product and recipient. RESULTS: A total of 688,514 blood products were transfused during the study period, 3170 transfusion reactions were reported, and 18 (0.57%) were BCPTRs of which seven (0.22%) were STRs. Fifteen of 18 (83.3%) BCPTRs and six of seven (85.7%) were associated with transfusion of apheresis platelets. Major symptoms and signs of BCPTRs included chills (67%), fever (61%), and nausea and vomiting (50%). Four of seven (57.1%) STRs were classified as severe or life-threatening. CONCLUSION: BCPTRs are rare yet potentially serious. The signs and symptoms of BCPTRs, and associated STRs, are not specific, posing risk of misclassification. Challenges surrounding reporting and case ascertainment underscore the need for laboratory measures to address residual risk of contamination.

Sulfhydryl treatment of serum or plasma for the reduction of IgM antibodies.

CONCLUSIONS: Dithiothreitol (DTT) and 2-mercaptoethanol (2-ME) are sulfhydryl compounds that can be used to treat serum or plasma to denature IgM antibody reactivity. By using sulfhydryl agents, IgG and IgM antibodies can be separated, the relative amount of IgM and IgG antibodies can be determined, and the risk of hemolytic disease of the fetus and newborn can be assessed.

Medical laboratory scientist motivation to pursue graduate education.

BACKGROUND: Medical laboratory staffing shortages have persisted, with challenges in maintaining adequate medical laboratory professionals. The career trajectory for medical laboratory scientists beyond entry level is ambiguous, but advancement opportunities are enhanced with specialist certifications and advanced degrees. OBJECTIVE: This study explored the motivation and preferences of medical laboratory scientists in pursuing graduate medical laboratory science education based on the importance of professional development, career advancement, recognition, and employment benefits. METHODS: A quantitative, cross-sectional, and descriptive correlational study surveyed American Society for Clinical Pathology Board of Certification-credentialed medical laboratory scientists using an online questionnaire. RESULTS: The overall response rate was 2.5%, and 1247 complete surveys were analyzed. Educational preferences varied by respondent age and amount of laboratory experience. Professional development, career advancement, recognition, and employment benefits were all important motivators for seeking graduate degrees, but those who were younger and had less experience indicated they were more important. CONCLUSION: This study suggests several areas of improvement for educational programs, health care organizations, and professional organizations to support the motivation of medical laboratory scientists to pursue graduate education.

ABO antibody titers are not predictive of hemolytic reactions due to plasma-incompatible platelet transfusions.

BACKGROUND: The overall risk of hemolytic transfusion reactions (HTRs) from plasma (minor)-incompatible platelet (PLT) transfusions and the role of a critical anti-A or anti-B titer in predicting and preventing these reactions has not been clearly established. STUDY DESIGN AND METHODS: We evaluated all apheresis PLT (AP) transfusions for 3 months. Using the gel titer method, we determined the anti-A and/or the anti-B immunoglobulin (Ig)G titer for all incompatible APs. Reported febrile transfusion reactions and HTRs were recorded; transfusions were not prospectively evaluated by the study team. A posttransfusion direct antiglobulin test (DAT) and eluate were performed after a reported febrile or hemolytic reaction for patients who received plasma-incompatible APs. RESULTS: A total of 647 of 4288 AP transfusions (15.1%) were plasma incompatible. Group O APs (n = 278) had significantly higher anti-A and anti-B titers than group A or B APs (p < 0.0001). No group A or B APs had a titer of more than 128 (0/342). For group O APs, 73 had titers of 256 or greater (26.3%), and 27 had titers of 512 or greater (9.7%). No HTRs were reported to any plasma-incompatible AP transfusion during the study period. Two plasma-incompatible AP transfusions were associated with fever and chills and positive DATs, of which one had a positive eluate. The incidence of a DAT and eluate-positive febrile transfusion reaction in the plasma-incompatible AP population is 0.15% (95% confidence interval, 0.0%-0.86%). CONCLUSION: A critical anti-A or -B titer is not sufficient to predict the risk of hemolysis in patients receiving plasma-incompatible APs, although underreporting of reactions to the blood bank may limit the generalizability of this study.

A Department-Sponsored, Hospital-Based Pathology Education Symposium Is a Cost-Effective Method to Provide Laboratory Staff With Highly Rated Continuing Education Experiences.

CONTEXT.­: Continuing education improves the quality of medical care and is a required part of most health care professions. Although a variety of educational modules are available online or at external conferences, completion of these activities can be expensive and time-consuming. In addition, externally produced modules may have limited applicability to a local practice. OBJECTIVE.­: To assess the ability of an economically efficient, locally produced, department-wide pathology educational seminar to efficiently meet education requirements for a large number of employees in a large health system. DESIGN.­: A multiday continuing education symposium was produced annually from 2013 through 2019 at no cost to participants. Metrics related to attendance, number of educational sessions available for registration, and participant satisfaction were tabulated, trended, and compared with similar metrics tabulated from an external continuing education conference that was offered from 2011 through 2012. RESULTS.­: The production of an internal, hospital-based educational symposium increased employee attendance (mean of 635 attendees per year versus 247 at the external program; P < .001) while reducing mean annual cost per attendee ($51 versus $140, P < .001). The number of sessions produced for the internal symposium was 39 per year on average, compared with 12 per year at the external program. Technical staff, residents, fellows, and faculty all contributed to internal educational programming, helping to build a team culture in the department. Overall employee satisfaction was 96.2%. CONCLUSIONS.­: An internal educational pathology symposium led to cost-efficient distribution of continuing education credits to a large number of technical staff, with a high degree of reported employee satisfaction.