Susan L. Wilkinson

Donor return after temporary deferral

BACKGROUND: The consequences of temporary predonation deferral are unsatisfactorily understood. Studies have found that deferral negatively impacts future donor return. However, the applicability of these findings across centers has not been established.

Using standardised patients in an objective structured clinical examination as a patient safety tool

Standardised patients (SPs) are a powerful form of simulation that has now become commonplace in training and assessment in medical education throughout the world. Standardised patients are individuals, with or without actual disease, who have been trained to portray a medical case in a consistent manner. They are now the gold standard for measuring the competence of physicians and other health professionals, and the quality of their practice. A common way in which SPs are used in performance assessment has been as part of an objective structured clinical examination (OSCE). The use of an SP based OSCE can be a powerful tool in measuring continued competence in human reliability and skill performance where such skills are a critical attribute to maintaining patient safety. This article will describe how an OSCE could be used as a patient safety tool based on cases derived from actual events related to postdonation information in the blood collection process. The OSCE was developed as a competency examination for health history takers. Postdonation information events in the blood collection process account for the majority of errors reported to the US Food and Drug Administration. SP based assessment is an important patient safety tool that could be applied to a variety of patient safety settings and situations, and should be considered an important weapon in the war on medical error and patient harm.

Risk for malaria in United States donors deferred for travel to malaria-endemic areas

BACKGROUND: Deferral for travel to malaria‐endemic areas excludes many blood donors in the United States. Most transfusion‐transmitted malaria is associated with lengthy residence in malaria‐endemic areas rather than routine travel. This study compares the impact of existing deferral requirements to the risk that a presenting donor with malaria travel history harbors malaria parasites under current and hypothetical alternate regulations.

Demographics of successful, unsuccessful and deferral visits at six blood centers over a 4-year period

BACKGROUND: Descriptions of donor demographics are of value in formulating recruitment and retention strategies. The demographics of successful (SV), unsuccessful (UV; meaning a nonuseable unit), and deferred (DV) donor visits over a 4‐year period were investigated using Retrovirus Epidemiology Donor Study (REDS)‐II databases.

Atypical presentation of acute phase, antibody-induced haemolytic anaemia in an infant

Summary. We describe a case of ‘warm’antibody‐induced haemolytic anaemia (WAIHA) in which marked depression of red cell Rh antigen expression resulted in the patient presenting with severe anaemia but a negative direct antiglobulin test (DAT). The serum contained potent IgG Rh antibodies. Unlike two previously reported cases (Koscielak, 1980; Veer et al, 1981) in which the diagnosis of WAIHA was established before the DAT became negative, this patient presented with negative serological findings during his first episode of anaemia. As a result, the serum antibodies appeared to be allo‐ not autoimmune in nature and to be unrelated to the patients anaemia. Confirmation of the autoimmune nature of the Rh antibodies was not possible until nearly 2 years after the first episode of anaemia.

Donath‐Landsteiner hemolytic anemia due to an anti‐Pr‐like biphasic hemolysin

Anemia, hyperbilirubinemia, and reticulocytosis subsequent to viral infection were present in a 32‐year‐old woman. The direct antiglobulin test was negative, and no unexpected antibodies were detected in pretransfusion tests. Rosettes of red cells (RBCs) around neutrophils were observed in peripheral blood smears, and a Donath‐Landsteiner (D‐L) test was positive. However, the patient did not show the classic features of paroxysmal cold hemoglobinuria (PCH). There was no hemoglobinuria, and in vivo hemolysis was not precipitated by cold. The D‐L antibody was IgG, but classic anti‐P specificity was not apparent. Rather, protease‐ or neuraminidase‐treated RBCs, as well as certain sialic acid deficient RBCs of uncommon MN phenotypes, were not hemolyzed in D‐L tests. Further, D‐L antibody activity could be inhibited by MN sialoglycoprotein. These data support a diagnosis of chronic D‐L hemolytic anemia, caused by an anti‐Pr‐like biphasic hemolysin.

Evaluation of Commercial Antiglobulin Sera Over a Two‐ Year Period. Part I. Anti‐Beta 1A, Anti‐Alpha 2D, and Anti‐Beta IE Levels

Antiglobulin sera from nine different manufacturers have been tested, over a two‐year period, for their ability to detect the complement components beta 1A, alpha 2D, and beta IE. The results demonstrate considerable variation in the abilities of sera from different manufacturers to detect these components and indicate that not all sera on the market are suitable reagents for diagnostic use and compatibility tests. The results also show that there is considerable variation between different lots of serum from some of the manufacturers. In general, the anti‐complement levels of these reagents have increased during the two‐year period of study but not all companies produce suitable reagents for routine use.

Donation return time at fixed and mobile donation sites

BACKGROUND: This study investigated the effect of blood donation environment, fixed or mobile with differing sponsor types, on donation return time.

An objective structured clinical examination to evaluate health historian competencies

BACKGROUND : Post‐donation information events in the blood‐collection process account for the majority of errors reported to the FDA. An eight‐station objective structured clinical examination (OSCE) based on information reported after donation was developed as a competency examination for health historians.

Characteristics of post donation information donors and comparison with appropriately deferred donors

BACKGROUND: Post donation information (PDI) is the most frequently reported biological product deviation (BPD) related to donor suitability and the health history screening process. PDI occurs when a deferrable health history known by the donor is not disclosed, but is subsequently disclosed at a future donation.