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JEMarti

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About JEMarti

  • Birthday 07/23/1965

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    Chicago, IL
  • Occupation
    Associate Director of Marketing for a major blood bank diagnostics company.

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  1. There are differences between the Ortho MTS system and Grifols DG gel system in terms of the amount of LISS found in the RBC reagents and gel cards. Speaking from the Grifols perspective, we have had customers try to validate the use of Ortho RBCs in DG gel cards and frequently these customers observe non-specific agglutination, indicating that there may be some incompatibility between how the reagents and gel cards are formulated.
  2. We had a presentation 3 weeks ago from the manufacturer at a local BB conference. They indicated that the positive Ab Screen can show up within the first day and positive DAT can persist 6 months or more post treatment. They are recommending phenotyping the patients prior to starting DARA therapy and using DTT treated cells for screening and transfusing K negative units to patients who are K neg.
  3. I think the concern here is not regarding gel testing but may be referring to the fact that (as far as I know) all automated analyzers sample their RBCs from the bottom of the specimen tube (for the simple reason that the instrument does not detect where the cell/plasma interface is). Therefore, if the population of RBCs at the bottom of the tube might be skewed toward transfused cells such testing may be erroneous. However, since we do backtypes, unless we have totally diluted out the patient's antibodies we will always be able to catch a discrepancy and resolve it manually.
  4. In Europe Ortho uses glass bead technology. In the US they use gel.
  5. Grifols was the OEM manufacturer for the ProVue and manufactured all of the ProVue instruments for Ortho. Ortho is still allowed to service their ProVue instruments and Grifols has no say as to Ortho's policies regarding the servicing of Instruments sold under the Ortho name. Ortho can continue servicing them until they exhaust their spare parts inventory or until they choose to stop servicing them. Grifols provided spare parts to Ortho until the ending of their contract. The patent situation was that Ortho had license to the patent for gel testing and had blocked both Grifols and Bio-Rad from the US market. When that patent expired in 2012 Ortho lost that protection and now both of these other companies are bringing gel products to the US market. Grifols does have a full line of gel testing instruments which are currently available for sale in the US. Also - Grifols did not make the manual workstation for Ortho. Grifols has their own workstation, which includes an optional automated card reader, and again, they are available in the US already.
  6. The reason that you irradiate HLA matched platelets is because the risk of TAGVHD is greater when you have the likelihood of a close HLA match between donor and recipient. Such a match is unlikely with an RBC from the shelf. As for cytokines, my thinking would be that refrigeration would lead to a greater amount of them being released since WBC's do not fare well in the fridge.
  7. I just arrived here in the Bay Area late last night (my office is here despite my living outside of Chicago). The earthquake was centered in Napa so most of the damage was up there and not really in the Bay Area directly. What I can say is that the good news is that this area is extremely well prepared to deal with this. Building codes mean that most structures are able to withstand the quake and while there are a lot of older buildings that sustain damage and quite a few will have to come down, very few people were seriously injured. When you get to the San Francisco/Oakland area things are pretty much normal. Here is a good local news story: blogs.kqed.org/newsfix/2014/08/24/quake-rolls-through-bay-area
  8. You say that the reference lab screened 9 donors to find 1 compatible. Are you sure that you are talking about HLA antibodies? HLA matched products are not screened on the shelf. You identify a donor and collect them specifically for the recipient. You may luck out and have a product from a matching donor available but you don't go screening units. What you describe sounds like a platelet crossmatch because your patient has platelet antibodies. As for HLA: TAGVHD is caused by having transfused lymphocytes that are a very close HLA match to the recipient mount an immune response against host tissue and the host immune system not being able to successfully recognize the transfused lymphocytes as non-self. Unless you are living in a relatively homogenous community (I recall case reports coming out of Israel and Japan years ago when irradiation was first being employed) this should not be a problem for RBC transfusion with a regular volunteer donor unit. The odds of finding an HLA A,B match in the general US population is far less than 1 in 9. Also WBC's don't fare well in the refrigerator. After about 72 hours at 2-4 degrees they are mostly dead. Most TAGVHD cases from RBC transfusion that you see in the literature are from fresh blood.
  9. As I am no longer working in the lab (having left to go into industry) I will answer... If memory serves, in the lab I left 3 years ago we were paying $245 for a unit of LRBC's from our local supplier. I think that the key factor is where you are located rather than the size of your institution. If there is competition for your hospital's business then your prices will be lower. If there is not then you are pretty much stuck even if you are a large university hospital. With ever increasing consolidation in the industry the likelihood of your being able to shop around for a supplier is slim. I also think that the ability to shop around is worst at the extremes. The small rural hospital is difficult to serve and their usage is low so there is little incentive for a blood center to negotiate on price. Years ago when the ARC made their big price increase many rural hospitals tried to switch but the cost of servicing them was so high that many independent blood centers declined to pick them up. On the other hand, the largest of the university hospitals are so large that many blood centers cannot handle them on their own (exceptions being large networks such as the ARC and UBS). In that case these hospitals have limited choices as to who can service their needs and they too have a limited ability to negotiate on price. Still, there are deals that can be had on the spot market. If you are large enough and can take a large shipment of blood there are some blood centers who will provide very aggressive pricing (and not demand that you take all short dates). If your local supplier imports you can usually see where they are getting their blood from and it may be possible to contact those centers directly. But I would caution that maintaining a good relationship with your local supplier is important. While the institution I worked for did bring in blood from other blood centers from across the country, we made sure that we honored our commitments. Getting a good deal for even a couple hundred units is not worth jeopardizing the relationship you have with the local blood center.
  10. I think the problem you are going to run into is that there simply isn't any documentation or literature surrounding this issue. You might try to point out the fact that there isn't anything written on this issue and that you cannot find any other institution anywhere that does this. You could compare that to the fact that apheresis manufacturers all specify the resting period after collection for their instruments but are silent on resting after any kind of shipment. (this latter is significant since blood centers have satellite centers collecting apheresis platelets and they will not adhere to any protocol requiring resting after shipping them to the main center. And really, unless you have a position of authority to force the issue you might not be able to do anything even though it is pretty unnecessary.
  11. The issue is that you face two separate problems. 1) Sufficiently describing the effects of repeated freeze/thaw cycles on the product and demonstrating that it maintains the clinical utility that is expected. This would lead to defining an expiration based on cumulative thawed time and number of freeze/thaw cycles. 2) you need to identify a tracking mechanism that can ensure that the defined limit on cumulative thawed time/number of freeze/thaw cycles is not exceeded. Which brings us to the 3rd and biggest obstacle: Who has time for all that and does the investment of resources deliver a payoff that is worth it??
  12. Gel cards might seem expensive but they are cheap compared to the antisera. Considering that a drop from a dropper is ~100ul you can cut your antisera costs by 75% per test by using 25ul in a gel card. WIth some antisera running around $1000 per vial the antisera cost is potentially the biggest component of the test. Also, in a past life I did a cost study on antigen typing and in interviewing bench techs discovered (surprise) that techs often rely upon their training for how they do Ag typing and not the package insert(or their SOP). So while the package insert says to use 1 drop and hold the dropper vertically, they will hold the dropper at an angle and use up to 2 drops (such was the way I was trained back in the 80's). That can triple your cost per test really fast. I found that average technique ran somewhere between the package insert and old school training (in truth almost right down the mddle). Gel testing allows you to control antisera usage in a way that tube testing cannot so not only will you use less but your usage will be more predictable. If you want another eye opener, take a vial of antisera and see how many drops you get out of it and how that varies by your technique. Some manufacturers will give you very different results with a variance in technique others less so but there is always a difference. Holding a dropper at an angle can decrease the number of drops/tests per vial by 30% or more. Full disclosure: My current company is not one that sells antisera or blood typing reagents, although I have worked for one of those companies in the past.
  13. The reason the method is not recommended is because the manufacturer does not have sufficient data to support the use and what they are telling you is essentially an off label use for their product. So legally they cannot make an official recommendation but they can tell you what is technically possible and that you need to validate it or QC it yourself. Even then I would be shocked to see them put this into writing. Undoubtedly, this works fine but manufacturers are constrained by regulations as to what they can recommend as the use for their products.
  14. Blood pressure increases with the infusion of fluid. That is not necessarily an improvement especially in patients with CHF. Infusing cells can also increase blood viscosity which is not always beneficial either. But no, one does not transfuse in order to rescussitate a patient's BP.
  15. Most? I have never seen any article claiming that blood transfusion was linked to autoimmune diseases. And if transfused stem cells were causing those symptoms by definition it is not an "auto" immune disease. This article contains some truth but what is there is put in the most alarmist and misleading way. It seems calculated to gain himself notoriety at the expense of others inluding the medical community and patients as well. Sadly, this is not the first newspaper article slamming the blood industry with falsehoods and misrepresentations, and it is unlikely to be the last.
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