As analyzers evolve, so does transfusion medicine

As analyzers evolve, so does transfusion medicine

By: Fernando Chaves   

September 21, 2017

Today, labs face growing pressure to do more with less and produce the most accurate results for the best patient outcomes. These issues are even more severe in blood banking because it is a specialty with one of the highest overall vacancy rates in the United States.1 In part as a response to these pressures, transfusion medicine is experiencing a breakthrough in blood bank solutions.

Immunohematology is the science of blood compatibility, whose application is to ensure that each patient receiving a blood transfusion is matched correctly to the transfusion that he or she receives. Tests to identify antigens and antibodies in both the blood of the donor and the recipient have historically been performed by manual tube techniques, which are time consuming and prone to human subjective interpretation. Due to this limitation, blood banking has focused primarily on identifying those blood type incompatibilities most relevant to patients, because they can cause immediate and potentially fatal transfusion reactions. That’s why the blood types most commonly known are A, B, AB or O, and Rh, whether positive or negative.

Blood analyzers in transfusion medicine

Traditionally, immunohematology testing was done manually. The cells of the donor and the serum of the recipient are mixed together in a single tube, and the blood banker makes a visual assessment to determine the results. Compatibility is determined primarily by whether the cells are clumping together. This approach presents challenges in that the results are subject to human interpretation and error and testing is labor-intensive.

Analyzers were available for testing in other areas of medicine long before they were developed for transfusion medicine about 20 years ago. The technology offered a way to remove human error from testing and improve lab efficiency. The fundamental advantages of blood analyzers are the decrease in labor required and the increase in the consistency and efficiency of results. They may also use computer algorithms to determine results, providing a standardization of measurement.

More recently, analyzers have helped labs optimize their blood bank capabilities, going beyond types and screens to offer a full range of testing, including serial dilutions for titration studies and selected cell panels. They combine secure monitoring technology and dynamic workflow management to enhance accuracy and efficiency. They also provide responsive safety checks and balances to give blood bankers the ability to monitor and record every step of the automated process. There are several different kinds of analyzers for transfusion medicine. Some are designed to respond to challenges unique to each lab with customization features and the adaptability to accommodate unpredictable workflows while reducing the need for batch testing.

Because automation in transfusion medicine has made labs more efficient, it also has helped ease the effect that a lack of specialized technicians has had on the industry. In the past few years, there has been a trend for laboratorians to be generalized. Blood banking, which is critical to the basic function of any hospital, has suffered a particularly serious need for highly trained personnel.

As a result, analyzers have been widely adopted by blood banks in the U.S.; however, this has not been the case in every country around the world. One challenge to incorporating analyzers is the need for a sufficient volume of testing to justify the investment in the instrument. For labs whose volumes do not justify fully automated solutions, semi-automated systems have been created to manually perform the test and use an analyzer to read results. This saves on labor and provides the desired consistency and accuracy even for mid- to low-volume laboratories.

Anticipated breakthroughs

To date, analyzers in immunohematology have primarily addressed efficiency needs such as throughput, cost, and turnaround time. The time has come for the focus to be on improvements that can clinically impact blood recipients. Beyond the ABO and Rh blood typing systems, there are many other antibodies and antigens which can impact patients. It is easy to forget them simply because we don’t routinely test for them all of the time; it would be economically and logistically prohibitive to do so with currently available technology.

Therefore, the next challenge for technology in immunohematology is the offering of clinical improvements for patients, through improved blood matching for as many antigen-antibody combinations as possible.

Such comprehensive immunohematology testing is more critical for some patients than others. There are hundreds of weaker antigens that can cause the development of antibodies that a person may have in their blood. They might not cause a reaction in a patient with a first transfusion; however, that patient’s immune system could build a resistance against any particular antigen. With subsequent transfusions, if the donated blood contains the same antigen, the patient’s reaction could become strong and more serious. Over time, the immune system builds up so much resistance to certain antigens that it becomes very difficult to find blood that will not cause a reaction.

The development of new technologies is underway that will make it possible to test for at least dozens of those weaker antigens and antibodies and provide patients with more compatible blood. This may help avoid the sensitization of patients who need multiple transfusions and promote better outcomes. Furthermore, the technology also will be able to accomplish all this testing in the same amount of time it takes to do less testing today. As technologies advance, labs become more efficient and better able to handle the shortage of specialized staff.

Automation has made immunohematology testing more manageable and reliable. Now, leaders in the industry are driven to continue advancing the technology to provide healthier, safe outcomes for all transfusion patients.

 

 

REFERENCE

  1. Garcia, E, Ali AM, Soles RM, Lewis DG. The American Society for Clinical Pathology’s 2014 Vacancy Survey of Medical Laboratories in the United States. American Journal of Clinical Pathology. 2015;144(3);432-443.

Current U.S. Blood Supply Now Adequate to Handle Demands Resulting from Hurricane Harvey

Current U.S. Blood Supply Now Adequate to Handle Demands Resulting from Hurricane Harvey

Blood Centers Continue to Encourage Donations to Ensure that Blood Will Be Available When Needed

ethesda, Md. – The AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism has determined that the current blood supply in the United States is now adequate to meet the needs of patients in areas affected by Hurricane Harvey. Thanks to the support and donations of blood donors nationwide in the aftermath of the disaster, blood supply needs are being met in Southeast Texas and other impacted areas.

“Blood centers across the country rallied to provide blood to Houston in the days following the storm when donor centers there were closed and blood drives couldn't be held,” said Dennis Todd, chair of the Task Force. “However, as always, we encourage eligible individuals to give blood and platelets regularly so that the U.S. blood supply remains sufficient.”

The Task Force applauds those who wish to help and encourages all eligible individuals to schedule regular blood and platelet donation appointments so that blood is available whenever and wherever it is needed. 

Those interested in donating blood may contact the following organizations to find a local blood drive or donation center and to schedule an appointment:

AABB: www.aabb.org; +1.301.907.6977

America’s Blood Centers: www.americasblood.org; +1.202.393.5725

American Red Cross: www.redcrossblood.org; +1.800.RED CROSS (+1.800.733.2767)

Armed Services Blood Program: www.militaryblood.dod.mil; +1.703.681.8024

The Task Force was formed in January 2002 to help make certain that blood collection efforts resulting from domestic disasters and acts of terrorism are managed properly and to deliver clear and consistent messages to the public regarding the status of America’s blood supply. The Task Force is composed of representatives from U.S. blood services, associations and commercial entities, as well as liaisons from governmental agencies, who work together in an effort to ensure that safe and adequate blood product inventories are in place at all times in preparation for disasters. In addition, the task force operates as a mechanism to assess the need for collections and/or transportation of blood should a disaster occur. 

AABB serves as the designated coordinating entity for the Task Force. In addition to AABB, members include AdvaMed, America's Blood Centers, American Association of Tissue Banks, American Hospital Association, American Red Cross, Blood Centers of America, College of American Pathologists, National Marrow Donor Program and the Plasma Protein Therapeutics Association. Liaisons from the following government agencies also participate in task force discussions: Armed Services Blood Program and the U.S. Department of Health and Human Services, which includes the Centers for Disease Control and Prevention, and the Food and Drug Administration.


About AABB

AABB is an international, not-for-profit association representing individuals and institutions involved in the fields of transfusion medicine and cellular therapies. The association is committed to improving health through the development and delivery of standards, accreditation and educational programs that focus on optimizing patient and donor care and safety. AABB membership includes physicians, nurses, scientists, researchers, administrators, medical technologists and other health care providers. AABB members are located in more than 80 countries and AABB accredits institutions in more than 50 countries. For more information, visit www.aabb.org.

We Should All Know These 7 Things About Our Blood Type!

We Should All Know These 7 Things About Our Blood Type!

AUGUST 12, 2017 0 COMMENTS

Humans have four blood type categories, each blood type tells a story of an individual’s ancestry, what foods are best, and even what exercises render the best results for mind, body, and soul.

There are four principle types: A which is for Agrarian, B for Bavarian, O for Original hunter, and AB is the most modern blood type and has the best immune system. Still there exists another 400 subcategories for blood types, these all determine an individual’s health profile, it is also important to note that these aspects will refine ones directional compass. Therefore the following is mostly an outline to help you get started in understanding your health in relation to your blood type. 

Foods that benefit your blood type:

  • Blood type A: Vegetarian based diet with fish, chicken, and yogurt. Avoid legumes, spicy foods, dehydration, and coffee. 
  • Blood type B: Dairy, mutton, fish, vegetables, tea and grains suit this blood type best. Avoid alcohol, preservatives, and excessive noise. 
  • Blood type O: Meat, fish, vegetables, and fasting. Avoid dairy, processed foods, and over-eating. 
  • Blood type AB: This is considered the modern blood type, therefore they can digest anything efficiently. Its is recommend to eat organic, fresh live foods, as eating fried (etc) foods take away from your energy.

 

Blood type and personality:

  • Blood type A: compassionate, organized, efficient, leaders
  • Blood type B: meditative, flexible, friendly, action oriented
  • Blood type O: practical, assertive, attentive, empathetic
  • Blood type AB: rational, calm, strong, forward thinking

Blood type and stress:

  • Blood type A: Highly susceptible to high cortisol and takes longer to recover from stress. Drinking water helps to calm down.
  • Blood type B: Mostly calm, but reaches the limit and has an extreme swing to high levels of cortisol. Breathing helps to return to harmony.
  • Blood type O: Susceptible to an outburst of anger, because of their primordial ancestry. Visualizing something peaceful helps to restore peace. 
  • Blood type AB: Handles stress very well, can become frustrated at the worst. Activity like walking helps release built-up tension. 

Blood type and fat:

  • Blood type A: Will accumulate fat from meats and sugars.
  • Blood type B: Is ill affected by fried foods and breads.
  • Blood type O: Gains fat from eating irregularly.
  • Blood type AB: Gains fat from inactivity.

 

Blood type and Mate:

  • RH Factor is the second most important blood group system, after ABO consist of 50 defined blood-group antigens, of which D, C, c, E, e are the five most important. A.K.A. RH Factor, RH Positive, RH Negative which refers to the D antigen only. 
  • RH positive has the D antigen and RH negative does not have the D antigen.

In pregnancy, the RH factor can cause complications such as:

  • Hemolytic Disease- breakdown of red blood cells
  • Erythroblastosis Fetalis- producing immature red blood cells, in the fetus

This occurs when the fetus or the fathers’ blood type is incompatible with that of the mothers (i.e.. typically the mother being RH-negative and the father RH-positive). 

The mother is to receive an injection called RhoGAm or Rho (D) which is a sterile solution (made from human blood plasma) at 28 weeks of gestation and within 72 hours after birth to avoid the development of antibodies from the mother towards the fetus (an allergic reaction could be possible). The injection works like a vaccine, it contains RH-positive blood, the mothers’ body then detects these antibodies and reacts as though the immune system had already taken action against the “foreign” Rh-positive red blood cells. Therefore distracting the mothers’ immune system from attacking the fetus.

Blood types and transfusions:

Blood type compatibilities

  • AB is the universal blood type receiver, but can only donate to AB.
  • A can receive blood type from A or O, and can donate to A or AB.
  • B can receive blood type from B or O, and can donate to B or AB.
  • O can only receive from blood type O, and is the universal blood type donor. 
  • Individuals with type O RH D negative blood type are often called universal donors, and those with type AB RH D positive are called universal recipients.

Plasma compatibility

  • AB can only receive plasma from AB, and is the universal plasma donor to any blood group.
  • A can receive from A and AB, but can only donate to A and O.
  • B can receive from B and AB, but can only donate to B and O.  
  • O  is the universal plasma receiver, but can only donate plasma to O.
  • Type O plasma containing both anti-A and anti-B antibodies can only be given to O recipients. Conversely, AB plasma can be given to patients of any ABO blood group, due to not containing any anti-A or anti-B antibodies. 

Please visit NutritionActivist.com to learn more about your blood type and enhance your health with this technique.

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Source: http://www.online-education.co/know-these-...

Platelets In The 21st Century

The Annual Meeting is now less than three weeks away.  A highlight of the program will be the panel discussion "Platelets in the 21st Century" with Richard Pinkowitz, MD Vice President, Immunetics, Inc., Laurence Corash M.D., Chief Scientific Officer, Cerus and Paul Mintz, MD, Chief Medical Officer, Verax Biomedical.  We anticipate a robust and insightful interchange that should help provide timely information to attendees regarding changes in platelet component production and testing that will directly impact both blood centers and hospitals.

Questions and Answers About Pathogen-Reduced Apheresis Platelet Components

Prepared by the AABB Pathogen Inactivation Technology Review Work Group
The Food and Drug Administration (FDA) has approved pathogen inactivation (PI) technologies that can be employed as an additional safety measure to help maintain a safe blood supply. The FDA has approved the INTERCEPT Blood System (Cerus Corp, Concord, CA) for pathogen reduction of 1) apheresis platelets stored in plasma and platelet additive solution (PAS) and 2) plasma. The FDA has also approved an additional pathogen-reduced plasma product, Octaplas (Octapharma, Vienna, Austria) that uses a solvent/detergent method. This document focuses solely on pathogen-reduced platelets treated using the INTERCEPT Blood System method.

Read the full article here

Board of Directors & Officers 2016-2017

Pascal George, President
Vicki Wille, 1st Vice President
Janet Busse, Secretary

Grace Tenorio, Immediate Past President
Joanne Basket, 2nd Vice President
Susan Kusic, Treasurer

 
Board Members
•    Jerrold Grossman, PhD
•    Greg Francis
•    John Johann
•    David Moolten, MD
•    Pat Kennedy
•    Rob Purvis
•    Brian Sauers
•    Charles Wilson
•    Pilar Brahim
•    Manimala Roy
•    Joanne Toscano-Kluczek, MT (ASCP), SBB
•    Kip Kuttner, DO

Past Presidents & Honorary Members
•    Susan Kusic, MPA, MT (ASCP) BB
•    Gwendolyn Jones, BS, (ASCP) SBB
•    Joy Thomsen, BS, MT (ASCP) SBB
•    Pilar Brahim, MS, MT (ASCP) SBB
•    Rao Andavolu, MD
•    Arpad Szallasi, MD
•    Dae Un Kim, MD
•    Charles Grossenbacher
•    Gerald Kaplan
•    Mercy Kuriyan
•    Tina Llao
•    Sally M. Wells
•    Jeff Miripol
•    Rose Campbell
•    Colleen Hinrichsen
 

Blog Post: Annual Meeting Update

October 12-15, 2013

As a blood bank supervisor, I always appreciate the opportunity that I have to attend the Annual AABB meetings. This year’s meeting was held at the Colorado Convention Center in Denver Colorado and was full of great learning programs; peer to peer learning groups, and CTTEXPO visits and networking opportunities. Since the recent transfusion medicine focus (for me and my colleagues)has been in providing the right blood product to the right patient at the right time, I chose to spend approximately one third of my educational time attending patient blood management sessions and the rest of my time in Colorado attending scientific,technical/clinical, and quality/education programs as well as visiting the vendors in the CTTEXPO.

Membership by Year

Our membership has exploded!

Before the learning sessions began, the annual meeting opened with Aron Ralston, “fearless adventurer” and subject of the film“127 Hours”. I was hesitant about going to the session because I was uncertain how being trapped in Utah for 6 days had anything to do with the blood bank industry. Since I am an optimist, I decided to attend the session and found myself intrigued by his story and very moved by it.  He spoke in detail about his journey while being trapped for 127 hours which included the onerous task of cutting off his arm. There were both mental and physical preparations in order for him to accomplish this, but in the end when he finally figured out how to go about doing so, it saved his life. As he spoke, it became apparent that he was an optimistic person who regained his strength (after failing multiple times) by thinking about the people in his life who were very important to him (family & friends) and the experiences that he still had to live for. Later on that same day while I was reflecting on the contents of Aron’s presentation, I realized that in any career or personal journey it’s the failures that mold us and make us stronger and it’s the individuals in our lives (family, friends, coworkers) that help us to recover from those failures and come out stronger in the end.

The first learning session that I attended after Aron Ralston’s eye opening presentation was a technical program entitled: “CSI –Who DAT?”. The program was presented by 3 BB specialists (SBBs) using case studies that compared warm autoimmune hemolyticanemia due to delayed transfusion reactions to drug induced hemolytic anemias (which can sometimes mimic a delayed transfusion reaction). The presenters spoke knowledgeably about the cases and reminded the audience that serologic testing is not always clear cut and in order to provide additional data and provide blood for future transfusions, genotyping is often necessary.

A short time later that same day, I attended a patient blood management class entitled:  “How We set up a Preoperative Anemia Management Program”. It was presented by Aryeh Shander, MD, Thomas Vetter, MD, MPH, and Andy Patterson, RN, MSHA. The  three presenters were excellent speakers and shared their own experiences from both an Anesthesiologists’ point of view and from an RN/Hospital Administrator’s point of view. The two MD presenters highlighted studies and shared data that supports the fact that post-operative outcomes are better in the non-transfused population (both cardiac and Orthopedic). They also discussed that patients who are followed and treated pre-operatively for their anemia require less transfusion and their post-operative infection rates and mortality rates are much lower as compared to their transfused counterparts. The third presenter started out his career as an RN and is now a Hospital Administrator at the University of Alabama at Birmingham (UAB).  He spoke about his experiences as a transfusing RN and then discussed the importance of hospital administration’s “buy-in” for the support of a pre-operative anemia management program. While highlighting the successes of the UAB program he shared the acronym “PACT”(Preoperative Assessment Consultation and Treatment Clinic) which is used at UAB to describe their program. He also indicated that it takes a network of individuals for pre-operative anemia management to work as designed and that ongoing educational initiatives for the physicians and transfusionists is necessary for safe patient transfusing practices.

New to the AABB annual meeting this year were Peer to Peer learning and round table discussions. The sessions were informal and were held in the CTTXPO hall. They were facilitated by AABB staff/assessors. The topics included Management/Staffing Issues,Navigating Your Career Path, Adapting to Industry Changes and Staying Informed. I attended the Management/Staffing Issues round table discussion with 3 other individuals and we discussed staffing shortages, competencies, and the effects of the aging population of technologists on the future of laboratory medicine. Overall I felt that it was an hour of worthwhile discussion/conversation that was also an opportunity for networking with other individuals who experience similar issues in the blood bank industry.

Another learning session that I found interesting was a program entitled: “A Bridge to Somewhere: Making Connections Between Your Transfusion Service and the Rest of the Hospital”. The presenters were Karen Dallas, MD from Saskatchewan, Canada

and Justin Kreuter, MD from the Mayo Clinic. The focus of this session was on identifying key stakeholders outside the laboratory(Nursing, IT, Risk Management, Emergency Dept., Operating room) that the blood bank staff could interact with and influence for the purpose of aligning goals, behaviors and processes. Dr. Dallas spoke about the eight steps towards leading change. Those steps include establishing a sense of urgency, forming a powerful & guiding coalition, creating a vision and communicating that vision,empowering others to act & believe in the vision, planning for and celebrating short term wins, consolidating improvements and producing more change, and finally institutionalizing new approaches. Dr. Kreuter discussed the importance of medical education and the utilization of electronic options for ongoing education within the medical community.

As in past meetings, I attended the CTTEXPO on two occasions during the weekend in order to visit with vendors and network with other blood bankers. There appeared to be fewer vendors set up this year but the interest in the vendors was still apparent as was in past meetings.

In my three and a half days in Denver, I attended the opening session, 8 educational sessions, the CTTEXPO, and one peer to peer round table discussion. Overall my take away from the Annual AABB meeting was returning to New Jersey prepared to tackle additional Blood Management initiatives as well as to improve my department’s communication and interactions with those outside the laboratory in the hopes of having a positive impact on patient safety.

I’m already looking forward to attending the 2014 AABB meeting in Philadelphia.