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Neil Blumberg

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Neil Blumberg last won the day on October 26

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    Hematologist/Transfusion Medicine Physician

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  1. Sounds like total rubbish from both a clinical and scientific viewpoint. Another instance how the administrative/legal model of reality is undermining civilization :).
  2. I should have added that I recognize that some cardiac surgeons transfuse platelets routinely post-bypass in the hope of reducing bleeding. I suggest this is a traditional practice without the slightest shred of evidence for benefit. Purely guesswork and expert opinion, for which there is now evidence of harm. So whether you give cold or room temp platelets probably doesn't matter as (1) there is likely no benefit to either approach, and (2) there is likely equivalent harm either way. So my short answer is it doesn't matter, but that platelet transfusion to non-bleeding surgical patients likely doesn't help, and may increase the risk of thrombosis, inflammation and reduced host defenses against post-operative infection.
  3. Why are we transfusing platelets to patients who aren’t bleeding? More likely to harm them than help them in my view.
  4. I agree with the procedures above. But these are basic urgent communications required of any clinical service, and I wouldn't characterize them as critical values, which are emergencies. Perhaps it's just semantics :).
  5. We have no critical values in the Blood Bank and we have a cancer center that sees thousands of patients per month. And it is my recommendation that critical values be restricted to truly life threatening conditions that require treatment within minutes to hours (e.g., very high or low potassium). I would most definitely NOT have critical values for things like creatinine/BUN, liver function tests, MCV, white count, etc. Provides no clinically actionable information acutely, and wastes a lot of time in the lab and amongst practitioners.
  6. I'd also add that none of the cell washers are FDA approved for washing platelets. We've been washing platelets on the 2991 for about 40 years :). I believe there may be a paper on using the ACP-215 to wash platelets but as yet we do not have any hands on experience. We have developed a manual method of platelet washing using a Sorvall centrifuge. If your volume isn't too high, you might consider a manual wash method. It takes a bit longer, but actually has higher recoveries (>90% vs. about 80-85% with the 2991). Folks will tell you that washed platelets don't work clinically and the count increment is Washed Tx Leukemia.pdfWashed Tx Leukemia.pdflower. The increment is indeed lower, but if you employ platelets that aren't ABO incompatible with the recipient and remove the supernatant, the clinical results are actually better than the clueless advice to give ABO major incompatible platelets routinely (e.g., group A to group O recipients). The PLADO study had a bleeding rate using this abominable practice of about 70%. Our bleeding rate avoiding infusion of ABO incompatible antigen or antibody is 5%, with or without washing. A fourteen fold difference. So by all means give washed platelets to patients with severe or recurrent reactions, or avoid infusion of ABO incompatible plasma, and, if you believe our randomized trial data, to improve the survival of younger patients with acute myeloid leukemia. References attached if anyone is interestedWashing AML Greener_et_al-2017-American_Journal_of_Hematology.pdf. Washing Review IJCTM-101401-the-clinical-benefit-of-washing-red-blood-cells-before-transfusion.pdf Washing AML Greener Am J Hemat AML Washing Supplementary Figures and Tables.pdf Jill's washing paper.pdf Plt Washing Vo.pdf
  7. There is no regulatory nor clinical reason not to wash AS-3 units on the Haemonetics device. Just validate it for red cell recovery and hemolysis, comparing AS-3 with five AS-1, CPD-A1 or other units you can obtain from another blood center, if this makes you feel more secure. We wouldn't and won't bother to do so. The results will likely be identical. There is no material difference in red cell preservation issues with the various additive solutions and certainly no evidence of difference in clinical outcomes.
  8. This is why all transfusion services need experienced/trained physicians. It's a clinical decision weighing the risks of not transfusing urgently vs. the risks of alloimmunization. And the risks of not having Rh negative red cells for patients where such products provide important safety (girls and women <40-50; patients with anti-D). Obviously the issues in alloimmunizing a male patient, particularly an older patient, are very different from a woman or girl with the potential for future pregnancy. If not terrifically urgent, requires a discussion between the practitioner responsible for the patient and the transfusion service physician. I've certainly made decisions independently and only informed the patient's physician after the fact, when the maintenance of Rh negative red cell supply has been a priority. Hard to write a procedure that covers all possibilities, so one would have to be broadly written, and probably kept it short on details, since these are so variable.
  9. I would like to see studies as to why transfusion services continue to provide ABO non-identical transfusions when they have ABO identical components in stock. ABO mismatched red cells (so-called universal donor group O red cells), platelets and plasma (so-called universal donor AB plasma) have all been associated in randomized trials (platelets) and observational studies (red cells and plasma) with increased mortality, bleeding and other dire complications. Why has an entire specialty failed to take notice of data that contradict long standing dogma? What can be done to improve this performance and reduce suffering, morbidity and mortality amongst our patients? This is particularly important because ABO non-identical platelets may actually make hemostasis worse, and thus no transfusion is likely better than an ABO non-identical platelet transfusion, as one example.
  10. Not in a blood collection center, so no policy. But scientifically there is no rationale for donor deferment. The vaccines are not live/attenuated but rather just protein with no potentially infectious material of concern to recipients. The virus, in any case, should only infect respiratory mucosa and thus would represent minimal to no risk to recipients even if present in donor blood (similar to coronavirus and influenza).
  11. Our Red Cross just informed us that it will discontinue providing CPDA-1 rbc. We primarily used it to provide volume reduced red cells to pediatric patients under 3 years of age. We will volume reduce AS-1 or AS-3 by centrifugation or washing (Terumo 2991) instead. Probably unnecessary for most patients, but this is a long standing practice here, and it doesn't seem worthwhile trying to adjust pediatric practice in this regard. Most patients do not need the additional volume provided by the anticoagulant-preservative in AS-1, etc., and avoiding unnecessary volume is a reasonable goal in many patients. There is no inherent virtue to CPDA-1 vs. AS-1 and similar solutions, and rbc preservation is slightly better in AS-1/AS-3 by in vitro metrics. There is absolutely no factual basis for using CPD-A1 in preference to AS-1, etc. in pediatrics. Purely expert opinion and probably unduly conservative. I've attached a nice presentation by Dr. Saifee at the University of Washington, who createdAdditive solution AS-1 in Children Univ. Washington presentation Dec 2021.pptx it to educate her colleagues about using AS-1 instead of CPDA-1. Additive solution AS-1 in Children Univ. Washington presentation Dec 2021.pptx Pediatric RBC White Paper - November 2021.pdf
  12. Peter was always helpful, gracious and supportive of everyone in the field. He made great contributions, not least of which was his definitive book Applied Blood Group Serology, which was recently reprinted. A fabulous reference for the ages. Doubt it will ever be replaced or exceeded. Hail and farewell.
  13. While it is infrequently referenced, universal leukoreduction is one strategy for minimizing pulmonary and cardiovascular adverse responses to transfusion (see attached). When we instituted it in 2000 our rate of TRALI decreased by 80+ % and TACO decreased by 50%. Probably mechanism is that white cells, DNA, histones and neutrophil extracellular traps (NETs) cause acute lung injury and inflammation when infused (good animal model data exist). Thus the failure to implement universal leukoreduction in the USA during the last 23-25 years was a terrible and tragic mistake, and this fatal error persists to this day. ULR TRALI TACO PMC version.pdf
  14. Larry Petz died about a year ago. He had completed a transition to working on cellular therapies in his later old age. Here's his obituary. He had a long and very productive life. https://obituaries.neptunesociety.com/obituaries/sherman-oaks-ca/lawrence-petz-10780477
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