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Neil Blumberg

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  1. Like
    Neil Blumberg got a reaction from John C. Staley in Critical values   
    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.
  2. Like
    Neil Blumberg got a reaction from jnadeau in Infant transfusion units   
    Just for the record, if the blood is leukoreduced, CMV testing is redundant and adds no benefit.  One less thing to complicate life. We haven't used CMV seronegative blood for any patient in 20 years and have yet to have a case of CMV associated with transfusion after >2,000 stem cell transplants and greater than 1,000 transfused premature newborns. Passive reporting, obviously, but this experience is supported by a fair amount of randomized trial and observational data. We also use recently (as in within a few days) irradiated washed red cells <21 days in storage for our newborn intensive care unit.  There is no evidence that red cells any shorter in storage provide any clinical benefit. Indeed, shorter storage red cells are associated with increased nosocomial infection in randomized trials.
  3. Like
    Neil Blumberg got a reaction from jnadeau in Critical values   
    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.
  4. Like
    Neil Blumberg got a reaction from Sherif Abd El Monem in Critical values   
    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.
  5. Like
    Neil Blumberg got a reaction from Nibal Harb in RBC Unit Cell Washer   
    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
  6. Like
    Neil Blumberg got a reaction from John C. Staley in RBC Unit Cell Washer   
    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.
  7. Like
    Neil Blumberg got a reaction from John C. Staley in RBC Unit Cell Washer   
    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
  8. Like
    Neil Blumberg got a reaction from Bet'naSBB in RBC Unit Cell Washer   
    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.
  9. Like
    Neil Blumberg got a reaction from Malcolm Needs in RBC Unit Cell Washer   
    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
  10. Like
    Neil Blumberg got a reaction from John C. Staley in Dr Patricia Tippett.   
    Hail and farewell.  
  11. Like
    Neil Blumberg got a reaction from Malcolm Needs in Dr Patricia Tippett.   
    Hail and farewell.  
  12. Like
    Neil Blumberg got a reaction from jnadeau in Transfusing O positive RBCLR to O negative   
    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.
  13. Like
    Neil Blumberg got a reaction from Baby Banker in Transfusing O positive RBCLR to O negative   
    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.
  14. Like
    Neil Blumberg got a reaction from John C. Staley in Transfusing O positive RBCLR to O negative   
    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.
  15. Like
    Neil Blumberg got a reaction from John C. Staley in What problems in transfusion services that you encountered that is worth doing a study?   
    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.
  16. Like
    Neil Blumberg got a reaction from John C. Staley in Respiratory Syncytial Virus (RSV) Vaccine   
    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).
  17. Like
    Neil Blumberg got a reaction from Malcolm Needs in Respiratory Syncytial Virus (RSV) Vaccine   
    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).
  18. Like
    Neil Blumberg got a reaction from Cliff in Respiratory Syncytial Virus (RSV) Vaccine   
    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).
  19. Like
    Neil Blumberg got a reaction from Judes in CPDA-1 Blood   
    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
  20. Like
    Neil Blumberg got a reaction from simret in Who can order blood products?   
    It's a state law issue. Each state sets its own regulations about who can order what, if I recall correctly.  It sometimes may be an institutional issue.
  21. Like
    Neil Blumberg got a reaction from TreeMoss in CPDA-1 Blood   
    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
  22. Like
    Neil Blumberg got a reaction from Mabel Adams in CPDA-1 Blood   
    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
  23. Like
    Neil Blumberg got a reaction from jnadeau in CPDA-1 Blood   
    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
  24. Like
    Neil Blumberg got a reaction from Jsbneg in CPDA-1 Blood   
    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
  25. Like
    Neil Blumberg got a reaction from Bet'naSBB in CPDA-1 Blood   
    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
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