12 July 2021 (Monday) - Getting The Red Light

I seem to do a BTLP-TACT exercise every morning before a night shift, so here we go…
I was presented with two patients:

57372 – an eighty year old chap from the vascular clinic requiring group and save
He typed as A Rh(D) Positive with a negative antibody screen

30703 – a nineteen year old chap from the haematology clinic requiring eight units of blood as soon as possible. His blood group was indeterminate but Rh(D) Negative. There was something odd in the A cells - is he A2B with anti A1?
And to complicate matters he had a positive antibody screen with cells 2 and three reacting. I requested antibody panels and the IAT panel was positive in cells 1, 3, 4, 6 and 7… And that was when the power went off as the nice man from EDF was changing the electricity meter.
Two hours later the power went back on and I saw from what I had copied and saved elsewhere that this corresponded with anti-Jk(a). The enzyme panel was the same.
So… bearing in mind the blood group I wanted eight units of O Neg Jk(a) Negative blood.

I found two…

I got the red light…  because I didn’t supply enough blood. There were only two Jk(a) Negative units available. What was I supposed to do?

9 July 2021 (Friday) -ASH Update

The nice people from the American Society of Hematology sent their update today. Perhaps a tad more clinical than I would prefer, but it was all useful reading:

Post-Transplant MRD Monitoring With Non-DTA Mutations Predicts Outcomes in AML In next-generation sequencing-based MRD monitoring, the use of non-DNMT3A, TET2, or ASXL1 mutations may predict relapse and survival following allogeneic hematopoietic cell transplantation for patients with AML.

Are Physician Perceptions of Transfusions a Barrier to Hospice Enrollment for Patients With AML? The tendency of patients with AML and their caregivers to defer end-of-life transfusion decisions to clinicians without participating in shared decision-making may delay hospice admission in patients who would benefit from this care the most.

Survival Outcomes After HLA-Haploidentical Relative Versus Matched Unrelated Donor Transplant in Acute Leukemias and MDS In patients with acute leukemias, those who underwent haploidentical relative hematopoietic cell transplantation had higher rates of grade 3-4 graft-versus-host disease and mortality compared with those who underwent transplant with a matched unrelated donor.

8 July 2021 (Thursday) - Transfusion News Update

 The Transfusion News update appeared in my in-box this morning. All good stuff…

Gunshot Wounds Cause Significant Mortality, Blood Utilization, and Health Care Costs in the U.S.

July 6, 2021 Half of the world’s civilian firearms are owned by individuals in the United States. The U.S. also leads all high-income countries for gunshot wound (GSW)-related deaths, yet little is known about the blood utilization patterns in GSW victims. Researchers analyzed data from the 2016-2017 National Inpatient Sample and National Emergency Department Sample, which included 58,815 weighted inpatient hospitalizations from GSWs and 168,315 weighted emergency department visits due to GSWs. [Read More]

Reducing Red Cell Use for Patients with Sickle Cell Disease during a Pandemic

June 30, 2021 Since March 2020, the COVID-19 pandemic has strained blood inventories, so researchers at one Philadelphia hospital implemented new measures to reduce blood use in patients with sickle cell disease (SCD). Fifty patients (mean age, 23.5 years [range: 9 to 44 years]) with SCD requiring chronic red cell exchanges every 3 to 5 weeks were followed for 6 months from March 2020 to September 2020 to determine if two new measures reduced blood usage. [Read More]

Tracking HIV Drug Resistance and Subtypes in Blood Donors

June 22, 2021 The risk of HIV transmission from blood transfusion is low (0.16 to 0.49 per million transfusions) but is still possible due to the viral window period during which newly acquired infections are not detected by diagnostic screening methods. In Poland, the frequency of HIV-positive blood donors and donations per 100,000 was 6.6 and 3.3, respectively. Therefore, constant hemovigilance is needed to identify pre-seroconversion infections, but samples can also be used to study HIV genetic diversity and drug resistance patterns. [Read More]