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Article: The enhanced direct antiglobulin test in current practice has a limited impact on management of adult patients.

Thant, Mamie / Cancelas, Jose / Kaplan, Alesia

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis

2023 Volume 62, Issue 5, Page(s) 103768

Abstract: Introduction: The direct antiglobulin test (DAT) identifies immunoglobulin IgG and/or complement onthe red blood cell surface, allowing discrimination between immune and non-immunehemolysis. When the DAT is negative but there is clinical suspicion for ... ...

Abstract	Introduction: The direct antiglobulin test (DAT) identifies immunoglobulin IgG and/or complement onthe red blood cell surface, allowing discrimination between immune and non-immunehemolysis. When the DAT is negative but there is clinical suspicion for immunehemolysis, an enhanced DAT can be sent to an immunohematology referencelaboratory (IRL). Methodology: This retrospective study assessed the volume of enhanced DATs at a large tertiarycare center and evaluated their impact on patient care. Enhanced DATs were sent on21 adult patients (January 2019 - January 2021) at the University of Pittsburgh MedicalCenter and Allegheny Health Network. Laboratory and clinical data were collected andanalyzed. Results: Four out of 21 patients had positive tests (DAT and other serologic tests) at the localIRL. Enhanced DAT testing yielded positive results in an additional 5 patients butnegative or invalid results for 2 patients. High-dose steroid therapy was started in 12patients prior to receipt of enhanced DAT results. Enhanced DAT testing was sent amedian of 5 days after initiation of steroid therapy. For the patients trialed on steroids,the enhanced DAT results impacted medical decision-making in only 3 patients, and inonly one of those patients was the enhanced DAT positive despite a negative DAT at alocal IRL. In the non-steroid treated patients, enhanced DAT results did not contributeto clinical decision-making. Conclusion: Enhanced DATs generally did not impact medical decision-making in adults withhemolytic anemia.
MeSH term(s)	Humans ; Adult ; Anemia, Hemolytic, Autoimmune ; Retrospective Studies ; Coombs Test/methods ; Erythrocytes/metabolism ; Steroids ; Alzheimer Disease
Chemical Substances	Steroids
Language	English
Publishing date	2023-08-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2046795-3
ISSN	1878-1683 ; 1473-0502
ISSN (online)	1878-1683
ISSN	1473-0502
DOI	10.1016/j.transci.2023.103768
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Article ; Online: How do we…consistently provide high-dose granulocyte products for transfusions in neutropenic patients?

Bubar, Robert / Kiss, Joseph E / Triulzi, Darrell J / D'Andrea, Pam / Zilich, Ashley / Kaplan, Alesia

Transfusion

2023 Volume 63, Issue 7, Page(s) 1267–1276

Abstract: Background: The therapeutic use of granulocyte transfusions for the treatment of infections in immunocompromised patients has been a controversial practice. Randomized controlled trials suggest that benefit may be provided when a high-dose product, ... ...

Abstract	Background: The therapeutic use of granulocyte transfusions for the treatment of infections in immunocompromised patients has been a controversial practice. Randomized controlled trials suggest that benefit may be provided when a high-dose product, defined as providing a dose of at least 0.6 × 10 Methods: A retrospective chart review was performed for apheresis granulocyte donations collected between 2018 and 2021 following implementation of combined G-CSF and dexamethasone donor stimulation at our institution. Data collected includes donor demographics, G-CSF administration timeline, pre-collection cell counts, product yields, donor adverse events, and post-transfusion ANC increments. Results: A total of 269 granulocyte units were collected from 184 unique donors. The median neutrophil yield (ANC) following G-CSF implementation was 7.5 × 10 Discussion: In order to properly assess the effectiveness of granulocyte transfusions in patients, it is necessary to ensure that the products being transfused contain an adequate granulocyte dose. This study demonstrates that the combination of G-CSF and dexamethasone donor stimulation, followed by apheresis granulocyte collection, is safe and can reliably yield a high-dose product. Consistent production of high-dose units allows for better assessment of patient outcomes by reducing dosage variability.
MeSH term(s)	Adult ; Humans ; Retrospective Studies ; Granulocytes ; Neutrophils ; Granulocyte Colony-Stimulating Factor/therapeutic use ; Dexamethasone/therapeutic use
Chemical Substances	Granulocyte Colony-Stimulating Factor (143011-72-7) ; Dexamethasone (7S5I7G3JQL)
Language	English
Publishing date	2023-06-26
Publishing country	United States
Document type	Case Reports
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.17461
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Zs.A 284: Show issues

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Article ; Online: Unexpectedly Weak Anti-B in 2 Group O Pediatric Patients on Parenteral Nutrition and Disease Specific Supplemental Enteral Feeds.

Kaplan, Alesia / Gabert, Kimberly A / Yazer, Mark H

Laboratory medicine

2019 Volume 51, Issue 3, Page(s) 296–300

Abstract: Anti-A and anti-B antibodies are naturally occurring and develop from exposure to intestinal bacteria after age 4 to 6 months. In the laboratory, strong agglutination with A1 and B cells, or B cells only and A1 cells only, on reverse typing in a healthy ... ...

Abstract	Anti-A and anti-B antibodies are naturally occurring and develop from exposure to intestinal bacteria after age 4 to 6 months. In the laboratory, strong agglutination with A1 and B cells, or B cells only and A1 cells only, on reverse typing in a healthy person with immunocompetence is expected for patients with ABO types O, A, and B, respectively. However, absent or weak anti-A and anti-B antibodies can be observed in some clinical scenarios, such as patients with immunodeficiencies, newborns, elderly patients, and patients who have recently received bone marrow transplants. In this article, we report the cases of 2 pediatric patients with group O blood type who were receiving total parenteral nutrition (TPN) and disease-specific enteral feeds and who have strong anti-A and absent/weak anti-B.
MeSH term(s)	ABO Blood-Group System/immunology ; Antibodies/blood ; Child ; Child, Preschool ; Enteral Nutrition/methods ; Female ; Gastroschisis/diagnosis ; Gastroschisis/immunology ; Humans ; Infant ; Male ; Parenteral Nutrition/methods ; Urea Cycle Disorders, Inborn/diagnosis ; Urea Cycle Disorders, Inborn/immunology
Chemical Substances	ABO Blood-Group System ; Antibodies
Language	English
Publishing date	2019-09-19
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	391758-7
ISSN	1943-7730 ; 0007-5027
ISSN (online)	1943-7730
ISSN	0007-5027
DOI	10.1093/labmed/lmz057
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Article ; Online: Benchmarking the centralized urgent plasma exchange service for patients admitted with a diagnosis of suspected acquired thrombotic thrombocytopenic purpura at a large healthcare system.

Seheult, Jansen N / Stram, Michelle N / Sevcik, Joan / Kaplan, Alesia / Kiss, Joseph E

Journal of clinical apheresis

2021 Volume 36, Issue 5, Page(s) 678–686

Abstract: Background: Consensus guidelines recommend that therapeutic plasma exchange (TPE) should be started within 4 to 8 hours after the diagnosis of suspected acquired thrombotic thrombocytopenic purpura (aTTP). This study aimed to audit the steps from ... ...

Abstract	Background: Consensus guidelines recommend that therapeutic plasma exchange (TPE) should be started within 4 to 8 hours after the diagnosis of suspected acquired thrombotic thrombocytopenic purpura (aTTP). This study aimed to audit the steps from diagnosis to initiation of plasma exchange at a centralized apheresis service. Methods: A retrospective review of the electronic medical record and laboratory information systems from January 1, 2014 to August 31, 2017 was conducted to identify all patients with suspected aTTP undergoing TPE. Demographics, comorbidities, pertinent laboratory tests, and temporal TPE procedural data were collected. Results: The median (5th-95th percentile) time from request to initiation of TPE was 5.4 (3.2-10.6) hours. TPE was initiated within 8 hours in 94 of the 108 patients (87.0%). The median (5th-95th percentile) time from request to central venous access was 2.5 (0.5-6.9) hours and from request to plasma product issuance from the blood bank was 3.4 (1.6-8.1) hours. aTTP patients in whom TPE was initiated greater than 6 hours from request did not have worse outcomes compared to those with TPE initiation within 6 hours: in-hospital mortality (2/14 [14.3%] vs 2/21 [9.5%], P = 0.66), median length of stay (9.0 [4.7-44.1] vs 8.3 [3.9-27.0] days, P = 0.76), and median number of days to durable platelet count recovery (4.5 [2.0-9.0] vs 4.0 [2.0-18.0] days, P = 0.66). Conclusions: The 4 to 8-hour target window from TPE request to initiation appears feasible for a centralized apheresis program servicing a large healthcare system.
MeSH term(s)	Adult ; Aged ; Benchmarking ; Delivery of Health Care ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Plasma Exchange/methods ; Purpura, Thrombotic Thrombocytopenic/therapy ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2021-06-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	604912-6
ISSN	1098-1101 ; 0733-2459
ISSN (online)	1098-1101
ISSN	0733-2459
DOI	10.1002/jca.21916
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Zs.A 1831: Show issues

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Article ; Online: An unusual case of anti-D detection in two consecutive D+ patient samples: Antibody carryover on an automated gel platform.

Gabert, Kimberly / Seheult, Jansen N / Meyer, Michael P / Triulzi, Darrell J / Kaplan, Alesia

Transfusion

2021 Volume 61, Issue 9, Page(s) 2545–2548

Abstract: Background: Laboratory results can be affected by sample to sample carryover. Carryover of different analytes occurring in automated clinical chemistry, immunology, hematology, and molecular laboratories is well described. However, carryover in a ... ...

Abstract	Background: Laboratory results can be affected by sample to sample carryover. Carryover of different analytes occurring in automated clinical chemistry, immunology, hematology, and molecular laboratories is well described. However, carryover in a transfusion service laboratory is not reported in medical literature. Materials and methods: Immunohematology testing results, demographic data, and clinical data were reviewed on three patients retrospectively from 2015 to 2019. Results: Type and screen samples tested on automated gel platform from two D+ patients were affected by anti-D carryover from a patient sample with a very high-titer anti-D. Additional immunohematology and molecular testing confirmed that anti-D in samples of two D+ patients was due to carryover. Conclusion: A case of anti-D carryover caused false detection of anti-D in two D+ patients. Carryover can have implications for patient management. Transfusion laboratory staff need to be aware of it and investigate any unexpected results further.
MeSH term(s)	Female ; Hematologic Tests ; Humans ; Immunologic Tests ; Laboratories ; Male ; Middle Aged ; Pregnancy ; Quality Control ; Retrospective Studies ; Rh-Hr Blood-Group System/blood ; Rho(D) Immune Globulin/blood
Chemical Substances	RHO(D) antibody ; Rh-Hr Blood-Group System ; Rho(D) Immune Globulin
Language	English
Publishing date	2021-07-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.16578
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Zs.A 284: Show issues

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Article ; Online: Low titer A plasma in three AB patients for therapeutic plasma exchange.

Kaplan, Alesia / Sevcik, Joan / Kiss, Joseph E

Journal of clinical apheresis

2018 Volume 34, Issue 1, Page(s) 7–12

Abstract: Background: Currently, low titer A plasma is used on a routine basis in bleeding trauma patients of unknown AB type. Three AB non-bleeding apheresis patients are presented here who safely received a combination of AB and low titer A plasma during ... ...

Abstract	Background: Currently, low titer A plasma is used on a routine basis in bleeding trauma patients of unknown AB type. Three AB non-bleeding apheresis patients are presented here who safely received a combination of AB and low titer A plasma during therapeutic plasma exchange (TPE). One control AB patient received AB plasma only. Methods: Data was obtained retrospectively on number of procedures, volume replaced, total plasma, and A plasma volumes including hemolysis laboratory data. Average A plasma volume and % of A plasma out of total plasma volume used were calculated. Results: Two female AB patients were treated for thrombotic thrombocytopenic purpura (TTP) with TPE and a third female AB patient was treated for microangiopathic hemolytic anemia. Patient 1 received a total of 12 procedures, 10/12 with AB+A plasma (average 916.3 ±84.6 mL). Patient 2 received a total of 12 procedures, 4/12 with AB+A plasma (average 1210.5 ±27.9 mL). Patient 3 received a total of six procedures, four out of six procedures with AB+A plasma (average 1009.8 ±80.3 mL). Patient 4, control, received AB plasma only. Percent of A plasma volume exchanged ranged between 23.8% and 47.8%. Haptoglobin, LDH, hemoglobin, and total bilirubin were monitored and trends were comparable with the control patient. The patients had a negative follow up direct antiglobulin test, adequate platelet recovery and a favorable clinical outcome with treatments. Conclusions: TPE was effectively performed without evidence of increased hemolysis using up to 47.8% of low titer A plasma. This approach can reduce strains on limited supplies of AB plasma whereas providing a vital treatment alternative for AB patients undergoing TPE with plasma replacement.
MeSH term(s)	ABO Blood-Group System/blood ; ABO Blood-Group System/immunology ; Adult ; Anemia, Hemolytic/therapy ; Female ; Humans ; Materials Testing ; Plasma Exchange/methods ; Plasma Volume ; Purpura, Thrombotic Thrombocytopenic/therapy ; Retrospective Studies
Chemical Substances	ABO Blood-Group System
Language	English
Publishing date	2018-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	604912-6
ISSN	1098-1101 ; 0733-2459
ISSN (online)	1098-1101
ISSN	0733-2459
DOI	10.1002/jca.21656
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Article ; Online: Targeted prospective hepatitis C virus "lookback" program: is it an efficient and effective use of resources?

Seheult, Jansen N / Triulzi, Darrell J / Kaplan, Alesia

Transfusion

2018 Volume 58, Issue 8, Page(s) 2084–2085

MeSH term(s)	Health Resources ; Hepacivirus ; Hepatitis C/drug therapy ; Humans ; Program Evaluation/methods ; Prospective Studies
Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Letter
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.14785
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Article ; Online: Implementation of tranexamic acid reduces red blood cell utilization in orthopedic surgeries.

Kaplan, Alesia / Wisniewski, Mary / Waters, Jonathan H / Yazer, Mark H

Transfusion

2019 Volume 59, Issue 9, Page(s) 2774–2775

MeSH term(s)	Academic Medical Centers ; Antifibrinolytic Agents/therapeutic use ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/statistics & numerical data ; Blood Loss, Surgical/prevention & control ; Blood Loss, Surgical/statistics & numerical data ; Erythrocyte Transfusion/statistics & numerical data ; Humans ; Implementation Science ; Orthopedic Procedures/adverse effects ; Orthopedic Procedures/methods ; Orthopedic Procedures/statistics & numerical data ; Pennsylvania/epidemiology ; Postoperative Hemorrhage/drug therapy ; Postoperative Hemorrhage/epidemiology ; Postoperative Hemorrhage/prevention & control ; Surgeons/statistics & numerical data ; Tranexamic Acid/therapeutic use
Chemical Substances	Antifibrinolytic Agents ; Tranexamic Acid (6T84R30KC1)
Language	English
Publishing date	2019-06-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.15403
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Article ; Online: Optimizing blood bank resources when implementing a low-titer group O+ whole blood program: an in silico study.

Seheult, Jansen N / Tysarczyk, Michele / Kaplan, Alesia / Triulzi, Darrell J / Yazer, Mark H

Transfusion

2020 Volume 60, Issue 8, Page(s) 1793–1803

Abstract: Introduction: Low-titer group O+ whole blood (LTOWB) is becoming commonly used in massive bleeding resuscitation, but the impact on blood center O+ RBCs has not been studied. This in silico model simulated a variety of different LTOWB production and ... ...

Abstract	Introduction: Low-titer group O+ whole blood (LTOWB) is becoming commonly used in massive bleeding resuscitation, but the impact on blood center O+ RBCs has not been studied. This in silico model simulated a variety of different LTOWB production and utilization patterns. Methods: Collections and distributions data from a large blood collector were scaled to vary the total number of O+ red blood cell (RBC) collections, the O+ RBC collection: import ratio, and the O+ RBC apheresis: whole blood (WB) collection ratio. Daily LTOWB demand was determined by the daily number of LTOWB recipients, average number of LTOWB units transfused per patient, maximum number of LTOWB units a single patient can receive, and seasonality of LTOWB use. LTOWB program factors included the high-titer exclusion %, the LTOWB expiry, and whether LTOWB units were reclaimed as O+ RBC units on the date of expiry. Simulations using unique combinations of the above input parameters were performed. Results: For the 1,224,720 unique combinations of input parameters simulated, the average increase in the fraction of additional O+ RBC units required to meet hospital demand was only 0.02%. Higher daily LTOWB demand resulted in more LTOWB shortages. Increasing the minimum LTOWB inventory threshold reduced LTOWB shortages without increasing the number of required additional RBC units. LTOWB wastage was minimal but was lower with longer LTOWB shelf life or manufacture of RBC units from unused LTOWB on Day 14. Conclusion: Implementing an LTOWB program does not have a major impact on the blood collectors' needs for additional RBC units to meet hospital demands.
MeSH term(s)	ABO Blood-Group System ; Blood Banks/organization & administration ; Blood Banks/standards ; Computer Simulation ; Humans
Chemical Substances	ABO Blood-Group System
Language	English
Publishing date	2020-06-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.15826
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Article ; Online: Process mapping of the urgent red cell exchange procedure for patients with severe complications of sickle cell disease at a centralized hemapheresis service.

Smith, Jacob A / Seheult, Jansen N / Sevcik, Joan / Kiss, Joseph E / Kaplan, Alesia

Journal of clinical apheresis

2020 Volume 35, Issue 5, Page(s) 427–434

Abstract: Sickle cell disease (SCD) patients require urgent red cell exchange (RCE) procedures for acute chest syndrome (ACS), demanding a coordinated effort of multiple clinical services. Execution of RCE is a multistep process from the time the procedure is ... ...

Abstract	Sickle cell disease (SCD) patients require urgent red cell exchange (RCE) procedures for acute chest syndrome (ACS), demanding a coordinated effort of multiple clinical services. Execution of RCE is a multistep process from the time the procedure is requested to the time the procedure is initiated. A retrospective review of patients with SCD requiring urgent RCE for ACS and stroke from 2012 to 2017 was performed at a centralized hemapheresis service covering a multihospital healthcare system. A total of 30 urgent RCE procedures performed on 28 patients were evaluated. The time required for red blood cell (RBC) preparation was the longest step in the process (median 3.8 hours). Furthermore, RBC preparation time was longer for sickle cell patients with RBC alloimmunization compared with nonalloimmunized patients (8.6 vs 3.8 hours, P = .03). One mortality event occurred in Ab- group. This study identified potentially modifiable factors, which impact the time to implementation of RCE in one service area. It highlights the importance of a structured and coordinated approach for the efficient and timely delivery of this vital treatment modality.
MeSH term(s)	Acute Chest Syndrome/therapy ; Adolescent ; Adult ; Anemia, Sickle Cell/complications ; Child ; Erythrocyte Transfusion/methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2020-08-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	604912-6
ISSN	1098-1101 ; 0733-2459
ISSN (online)	1098-1101
ISSN	0733-2459
DOI	10.1002/jca.21823
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