Dan A. Waxman

Pulmonary pathology of rapidly fatal transfusion-related acute lung injury reveals minimal evidence of diffuse alveolar damage or alveolar granulocyte infiltration.

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is the leading cause of transfusion‐associated death in the United States. Its diagnosis is based on clinical and radiographic changes that are indistinguishable from acute lung injury/acute respiratory distress syndrome (ALI/ARDS). TRALI is presumed to be a form of ALI/ARDS; however, it differs in its triggering events and associated mortality. Two cases of rapidly fatal TRALI in which the postmortem pathology differed from that classically associated with ALI/ARDS are reported.

CRASH-2 Study of Tranexamic Acid to Treat Bleeding in Trauma Patients: A Controversy Fueled by Science and Social Media.

This paper reviews the application of tranexamic acid, an antifibrinolytic, to trauma. CRASH-2, a large randomized controlled trial, was the first to show a reduction in mortality and recommend tranexamic acid use in bleeding trauma patients. However, this paper was not without controversy. Its patient recruitment, methodology, and conductance in moderate-to-low income countries cast doubt on its ability to be applied to trauma protocols in countries with mature trauma networks. In addition to traditional vetting in scientific, peer-reviewed journals, CRASH-2 came about at a time when advances in communication technology allowed debate and influence to be leveraged in new forms, specifically through the use of multimedia campaigns, social media, and Internet blogs. This paper presents a comprehensive view of tranexamic acid utilization in trauma from peer-reviewed evidence to novel multimedia influences.

Transfusion-related acute lung injury: A thrombotic thrombocytopenic purpura treatment-associated case report and concise review

Blood products are frequently required immediately prior to, during, or just after an apheresis procedure. Transfusion‐related acute lung injury (TRALI) is now the leading cause of transfusion‐related mortality, surpassing ABO‐incompatible hemolytic reactions. The reported incidence of TRALI varies but is estimated at 1 in 5,000 transfusions. The true incidence could be higher because of under‐reporting and under‐diagnosis. Plasma is the most frequently implicated blood product. While the pathogenesis of TRALI appears multifactorial, one contributing factor seems to be donor antibodies to cognate recipient neutrophil antigens. Biologically active neutrophil‐priming substances may also play a role. New diagnostic criteria have recently been proposed to aid in the diagnosis of TRALI. We report a thrombotic thrombocytopenic purpura (TTP) treatment‐associated case of TRALI and review the history, pathogenesis, diagnosis and management of this syndrome. Current risk reduction strategies are also discussed. J. Clin. Apheresis, 2008.

Multicomponent donor apheresis in the Americas.

Abstract:  Multicomponent donor apheresis utilizes apheresis technology to collect combinations of red blood cells, platelets and plasma units. The United States has embraced this technology to the greatest extent of the countries in the Americas. As whole blood and apheresis collection have increased, so have the donor deferrals based on potential exposure to infectious agents. However, hemoglobin/hematocrit deferrals still remain the largest upfront deferral for volunteer donors. As the technology is refined in future years, multicomponent donor apheresis may become the predominant method of collecting blood products from donors.

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.

How do we design, implement, and manage an ongoing program to provide iron supplements to women blood donors?

Here we describe the design and management of Indiana Blood Centers 10‐year Iron For Women program, an ongoing community blood center–based program with continual program and donor management providing iron supplements to healthy women blood donors. Donor iron supplementation has typically been limited to research study protocols, for a defined period, with the associated resources and funding. The results of studies have supported the utility of iron supplementation: iron supplementation will enhance dietary iron for increased gastrointestinal absorption triggered as a normal homeostatic response to blood loss, thereby providing a suitable dietary iron source in the event the donors usual diet lacks sufficient iron. Despite proven results, blood centers have been reluctant to adopt the practice due to barriers such as donor selection, ensuring the appropriateness of iron supplementation relative to the health of the donor, supplement costs, provision logistics, and program management costs. We present here how we designed our program and why it is in the Blood Centers interest to help willing women participate in volunteer blood donation by attempting to mitigate associated iron loss.

Sensitivity and specificity of a new automated system for the detection of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus nucleic acid in blood and plasma donations: NEW DONOR SCREEN FOR HBV, HCV, AND HIV

Use of nucleic acid testing (NAT) in donor infectious disease screening improves transfusion safety. Advances in NAT technology include improvements in assay sensitivity and system automation, and real‐time viral target discrimination in multiplex assays. This article describes the sensitivity and specificity of cobas MPX, a multiplex assay for detection of human immunodeficiency virus (HIV)‐1 Group M, HIV‐2 and HIV‐1 Group O RNA, HCV RNA, and HBV DNA, for use on the cobas 6800/8800 Systems.