Julie Katz Karp

Transfusion medicine in American undergraduate medical education.

BACKGROUND: Blood transfusion is the most common procedure performed in American hospitals, and transfusions are commonly ordered by physicians without formal training in transfusion medicine. Several transfusion medicine curricula have been proposed, including those developed through the Transfusion Medicine Academic Awards (TMAA). To our knowledge, no comprehensive study has assessed how transfusion medicine is incorporated into undergraduate medical education.

Conversion to low transfusion-related acute lung injury (TRALI)-risk plasma significantly reduces TRALI.

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is an uncommon but serious transfusion reaction. Studies have shown that the transfusion of HLA and HNA antibodies in donor plasma can lead to TRALI. Female donors are more likely to have such antibodies due to alloantigen exposure during pregnancy. Many blood suppliers have now implemented various TRALI risk reduction strategies to unknown effect. A retrospective analysis of TRALI reactions in plasma recipients before and after the conversion to low‐TRALI‐risk plasma (all‐male donor plasma, male‐predominant plasma, nulliparous female plasma, and HLA antibody–tested plasma) is reported.

International variation in volunteer whole blood donor eligibility criteria

BACKGROUND: This study assesses international variation in volunteer whole blood donor eligibility criteria.

Lymphangioma of the Palatine Tonsil

Lymphangioma of the palatine tonsil is a rare, benign lesion that presents as a tonsillar outgrowth and causes symptoms related to irritation and airway obstruction. Histologically, the mass has abundant dilated lymphatic channels amid a fibrous stroma with lymphoid and adipose elements. There are several theories regarding the pathogenesis of these lesions, and the appropriate diagnostic classification is controversial. Because a lymphangioma may resemble a true neoplasm of the palatine tonsil clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy. Lymphangioma of the palatine tonsil is treated with surgical excision and has no recurrence once completely resected.

The definition of severe systemic lupus erythematosus needs clarification in the next ASFA guidelines

Dear Editor, Systemic lupus erythematosus (SLE) is a highly heterogeneous chronic disease. In the 2016 ASFA guidelines, the treatment of SLE with therapeutic plasma exchange (TPE) is divided into two categories: severe lupus (category II) and lupus nephritis (category IV). Based on a recent request to initiate a series of TPE on a patient with SLE, we believe that a better definition of “severe SLE” in the next edition of the ASFA guidelines is warranted. Rheumatologists often define the activity and severity of a patient’s SLE based on the SLEDAI (SLE Disease Activity Index) or SLEDAI-2K score (Table 1). These clinical tools give a global picture of the patient’s disease status both at a single time point and over time. The SLEDAI score may also be prognostic of overall survival. While various studies use different cutoff scores, active SLE is typically defined as a SLEDAI score 6, and severe SLE defined as a SLEDAI score 11. The 2016 ASFA guidelines do discuss the SLEDAI score but state only that “SLEDAI score> 5.0 defines active disease”; severe disease is not defined. Instead, the guidelines note that “multiple well-documented [case reports] of beneficial effects of TPE in SLE” support the use of TPE in specific complications of SLE, such as diffuse alveolar hemorrhage, myasthenia gravis, and thrombotic thrombocytopenic purpura. When asked to perform TPE for a patient with “severe SLE” based on the SLEDAI score, but without one of these specific complications, how should apheresis practitioners proceed? Our clinical apheresis service was recently asked to perform TPE on a patient with a SLE flare whose primary manifestation was acute kidney injury requiring dialysis. On hospital admission, renal biopsy demonstrated class IV and V lupus nephritis with necrotizing vasculitis but minimal scarring. Concurrent manifestations of SLE included pancytopenia, hypocomplementemia, fatigue, fever, and headache. We initially declined to initiate TPE because the primary diagnosis was lupus nephritis, a category IV indication with grade 1B evidence. Based on the patient’s overall symptomatology and laboratory findings, the rheumatology service assigned a SLEDAI score of 21, thus putting the patient into the severe SLE category, a category II indication for TPE. After multidisciplinary discussion with the primary service, rheumatology, nephrology, and the hospital ethics committee, we agreed to initiate a series of four TPEs based on the TABLE 1 SLEDAI score calculation.

I am Cait, and I am a transgender blood donor

I t would seem to even the most casual observer that transgender issues are now part of daily American discourse. In the entertainment world, both Laverne Cox’s 2014 TIME magazine cover (under the prescient title, “The Transgender Tipping Point: America’s Next Civil Rights Frontier”) and Caitlyn Jenner’s 2015 debut have pushed transgender issues to the fore. Legislatively, North Carolina House Bill 2 was signed into law on March 23, 2016, which, among other things, limits individuals to public restrooms that correspond to the sex on their birth certificate. Social opposition and legal challenges to this law continue, even as this commentary is being written. Transgender issues have been slower to enter into the medical literature and, of particular interest to TRANSFUSION readers, the transfusion medicine literature. Entering the term “transgender” into the search field of the TRANSFUSION journal website yields only four confirmed references. All four references are focused on blood donors who are men who have sex with men (MSM) and, not surprisingly, these references are only from 2014 onward. The first reference, by Liszewski and colleagues, refers to administering a survey at “two public lesbian, gay, bisexual, and transgender (LGBT) festivals to collect data on the percentage of MSMs who have donated blood, whether MSMs would donate blood were the deferral changed, whether MSMs could differentiate the risks that various behaviors might pose to blood donation safety, and whether participants believed that it would be safe to donate blood based on their own health and sexual practices.” Among other requirements, participants “had to be born a biologic male.” There was no further mention of transgender issues. The term “transgender” was used once in May 2015 when the REDS-II study published on the risk factors for retrovirus and hepatitis viral infections. In a table of demographic characteristics, “transgender” is listed under the heading “sex,” with only one donor apparently fitting this description. There was no further mention of transgender issues. A few months later, in December 2015, the REDS-III study published the Blood Donation Rules Opinion Study (Blood DROPS). Again, the term “transgender” is mentioned only under the Materials and Methods, where, as part of a second phase of data collection, “two surveys were conducted, a survey of male blood donors at the REDS-III blood centers, and for comparison, a sample of MSM recruited via lesbian, gay, bisexual, transgender, and queer (LGBTQ) organizations and social networks.” The term “transgender” is also mentioned briefly in the third phase of data collection when “40 qualitative telephone interviews (20 identified through the male donor survey and 20 through the LGBTQ community survey) explored motivations for noncompliance and potential impacts of a modified deferral period.” There was no further mention of transgender issues. Most recently, O’Brien and coworkers used the term “transgender” in the discussion of their study of the impact of the Canadian 5-year MSM blood donor deferral. They write, “Our stakeholder consultations indicate that the lesbian-gay-bisexual-transgender (LGBT) community advocates a behavior-based screening process rather than a time deferral.” There was no further mention of transgender issues. Indeed, the US Food and Drug Administration (FDA) provides little more guidance on transgender issues. In the December 2015 Guidance for Industry on Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products, there is a note that indirectly addresses transgender blood donors. Under the recommendations for donor educational material and donor history questionnaire, the note reads, “In the context of the donor history questionnaire, FDA recommends that male or female gender be taken to be self-identified and self-reported.” No further recommendations are made as to how blood

Cost of Purchased Versus Produced Plasma from Donor Recruitment Through Transfusion

BackgroundPlasma is used to treat acquired coagulopathy or thrombotic thrombocytopenic purpura, or to reverse warfarin effect. Scant data are available, however, about its costs.ObjectiveTo estimate total costs of plasma from production through administration, from the perspective of a US hospital blood donor center (BDC).Study Design and MethodsSix sequential decision analytic models were constructed and informed by primary and secondary data on time, tasks, personnel, and supplies for donation, processing, and administration. Expected values of the models were summed to yield the BDC’s total cost of producing, preparing, and transfusing plasma. Costs (

Transfusion medicine on American television.

US 2015) are reported for a typical patient using three units of plasma. Models assume plasma was obtained from whole blood donation and transfused in an inpatient setting. Univariate sensitivity analyses were performed to test the impact of changing inputs for personnel costs and adverse event (AE) rates and costs.ResultsBDC production cost of plasma was

Critical developments of 2017: a review of the literature from selected topics in transfusion. A committee report from the AABB Clinical Transfusion Medicine Committee

91.24/patient (

Does therapeutic plasma exchange have a role in the treatment of prosthetic hip-associated cobalt toxicity? A case report and literature review.

30.41/unit), a