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Gammon RR, Reik RA, Stern M, Vassallo RR, Waxman DA, Young PP, Benjamin RJ. Acquired platelet storage container leaks and contamination with environmental bacteria: A preventable cause of bacterial sepsis. Transfusion 2021; 62:641-650. [PMID: 34927291 PMCID: PMC9299677 DOI: 10.1111/trf.16776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
Background Apheresis platelets (AP) may be contaminated by environmental bacteria via container defects acquired during processing, transport, storage, or transfusion, as highlighted by a recent series of septic reactions related to Acinetobacter spp. and other bacterial strains. Study design and methods The frequency and nature of acquired container defect reports to one manufacturer were evaluated from January 2019 to July 2020. The published incidence of contamination and sepsis due to environmental bacteria with culture screened AP in the United States was reviewed for the period of 2010–2019. Results Review of a manufacturers' records showed 23 US reports of leaks involving 24 containers attributed to postmanufacturing damage, at a rate of 44 per million distributed storage containers. Analysis of returned containers showed evidence of scratches, impressions, and/or piercings. Literature review of US hemovigilance data revealed that environmental bacteria comprised 7% of confirmed positive primary bacterial culture screens, were responsible for 14%–16% of reported septic, and 8 of 28 (29%) fatal reactions with bacterial‐culture screened AP. Sepsis cases have been reported with culture screened, point‐of‐issue (POI) tested, or pathogen‐reduced AP. Discussion Environmental contamination of AP is rare but can cause sepsis. Container damage provides a pathway for contamination after culture screening, POI bacteria testing, or pathogen reduction. Blood collectors and transfusion services should have procedures to ensure proper inspection, handling, storage, and transport of AP to avoid damage and should enhance efforts to detect defects prior to release and to eliminate bacteria from all contacting surfaces to minimize the risk of contamination.
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Affiliation(s)
- Richard R Gammon
- Scientific, Medical, Technical Division, OneBlood, Orlando, Florida, USA
| | - Rita A Reik
- Scientific, Medical, Technical Division, OneBlood, Orlando, Florida, USA
| | - Marc Stern
- Product Management, Cerus Corporation, Concord, California, USA
| | | | - Dan A Waxman
- Transfusion Medicine Blood Services, Versiti, Indianapolis, Indiana, USA
| | - Pampee P Young
- Biomedical Services, American Red Cross, Washington, DC, USA
| | - Richard J Benjamin
- Clinical Research and Medical Affairs, Cerus Corporation, Concord, California, USA
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Senefeld JW, Johnson PW, Kunze KL, Bloch EM, van Helmond N, Golafshar MA, Klassen SA, Klompas AM, Sexton MA, Diaz Soto JC, Grossman BJ, Tobian AAR, Goel R, Wiggins CC, Bruno KA, van Buskirk CM, Stubbs JR, Winters JL, Casadevall A, Paneth NS, Shaz BH, Petersen MM, Sachais BS, Buras MR, Wieczorek MA, Russoniello B, Dumont LJ, Baker SE, Vassallo RR, Shepherd JRA, Young PP, Verdun NC, Marks P, Haley NR, Rea RF, Katz L, Herasevich V, Waxman DA, Whelan ER, Bergman A, Clayburn AJ, Grabowski MK, Larson KF, Ripoll JG, Andersen KJ, Vogt MNP, Dennis JJ, Regimbal RJ, Bauer PR, Blair JE, Buchholtz ZA, Pletsch MC, Wright K, Greenshields JT, Joyner MJ, Wright RS, Carter RE, Fairweather D. Access to and safety of COVID-19 convalescent plasma in the United States Expanded Access Program: A national registry study. PLoS Med 2021; 18:e1003872. [PMID: 34928960 PMCID: PMC8730442 DOI: 10.1371/journal.pmed.1003872] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 01/05/2022] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The United States (US) Expanded Access Program (EAP) to coronavirus disease 2019 (COVID-19) convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents. The objective of this study is to report on the demographic, geographical, and chronological characteristics of patients in the EAP, and key safety metrics following transfusion of COVID-19 convalescent plasma. METHODS AND FINDINGS Mayo Clinic served as the central institutional review board for all participating facilities, and any US physician could participate as a local physician-principal investigator. Eligible patients were hospitalized, were aged 18 years or older, and had-or were at risk of progression to-severe or life-threatening COVID-19; eligible patients were enrolled through the EAP central website. Blood collection facilities rapidly implemented programs to collect convalescent plasma for hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal patterns in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate at the state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions, as well as assessing enrollment in metropolitan areas and less populated areas that did not have access to COVID-19 clinical trials. From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. The majority of patients were 60 years of age or older (57.8%), were male (58.4%), and had overweight or obesity (83.8%). There was substantial inclusion of minorities and underserved populations: 46.4% of patients were of a race other than white, and 37.2% of patients were of Hispanic ethnicity. Chronologically and geographically, increases in the number of both enrollments and transfusions in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled and transfused patients in the EAP, including both in metropolitan and in less populated areas. The incidence of serious adverse events was objectively low (<1%), and the overall crude 30-day mortality rate was 25.2% (95% CI, 25.0% to 25.5%). This registry study was limited by the observational and pragmatic study design that did not include a control or comparator group; thus, the data should not be used to infer definitive treatment effects. CONCLUSIONS These results suggest that the EAP provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The study design of the EAP may serve as a model for future efforts when broad access to a treatment is needed in response to an emerging infectious disease. TRIAL REGISTRATION ClinicalTrials.gov NCT#: NCT04338360.
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Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Katie L. Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Noud van Helmond
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Michael A. Golafshar
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Stephen A. Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Allan M. Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew A. Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan C. Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
- ImpactLife, Davenport, Iowa, United States of America
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Camille M. van Buskirk
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James R. Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Beth H. Shaz
- Department of Pathology, Duke University, Durham, North Carolina, United States of America
| | - Molly M. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Bruce S. Sachais
- New York Blood Center Enterprises, New York City, New York, United States of America
| | - Matthew R. Buras
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Mikolaj A. Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Benjamin Russoniello
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Larry J. Dumont
- Vitalant Research Institute, Denver, Colorado, United States of America
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - John R. A. Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Pampee P. Young
- American Red Cross, Washington, District of Columbia, United States of America
| | - Nicole C. Verdun
- Center for Biologics Evaluation and Research, U. S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Peter Marks
- Center for Biologics Evaluation and Research, U. S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - N. Rebecca Haley
- Bloodworks Northwest, Seattle, Washington, United States of America
| | - Robert F. Rea
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Louis Katz
- ImpactLife, Davenport, Iowa, United States of America
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dan A. Waxman
- Versiti, Indianapolis, Indiana, United States of America
| | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Aviv Bergman
- Department of Systems and Computational Biology, Albert Einstein College of Medicine, New York City, New York, United States of America
| | - Andrew J. Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mary Kathryn Grabowski
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kathryn F. Larson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan G. Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kylie J. Andersen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew N. P. Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Joshua J. Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Philippe R. Bauer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Janis E. Blair
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Zachary A. Buchholtz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michaela C. Pletsch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Katherine Wright
- School of Sustainability, Arizona State University, Tempe, Arizona, United States of America
| | - Joel T. Greenshields
- Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - R. Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
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O'Rourke J, Long S, LePage NL, Waxman DA. How do I create a partnership between a blood bank and a milk bank to provide safe, pasteurized human milk to infants? Transfusion 2021; 61:350-355. [PMID: 33459378 DOI: 10.1111/trf.16267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
The now 5-year collaboration between the Indiana Blood Center, now Versiti Blood Center of Indiana, and The Milk Bank has increased the number of human milk donors, improved the collection and processing of donor milk, and improved awareness of this lifesaving resource. The Indiana Blood Center provides greater visibility for The Milk Bank, creating more opportunities to reach potential donors, and can provide the screening blood test for potential donors to become approved human milk donors. The resources of the multiple locations of the Indiana Blood Center permitted the formation of new milk depots in five different cities and quicker transportation of donated milk through their active courier system. This partnership most importantly has improved awareness for both lifesaving missions to the communities they serve.
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Affiliation(s)
| | - Sarah Long
- The Milk Bank, Indianapolis, Indiana, USA
| | - Nichole L LePage
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dan A Waxman
- Versiti Blood Center of Indiana, Indianapolis, Indiana, USA
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Wehrli G, Rossmann SN, Waxman DA, Katz LM. Evaluation and improvement of blood donor educational materials: results from a multicenter randomized controlled trial. Transfusion 2020; 60:1756-1764. [PMID: 32562440 DOI: 10.1111/trf.15866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blood collection centers are charged with creating donor educational materials (DnEM) that are easily understood across all prospective donor populations, while addressing mandates and recommendations from regulatory agencies and professional standard setting organizations. Donors must have sufficient information to understand the donation process with its risks and benefits, time to consider options before deciding, and opportunity to choose whether to proceed with or decline donating. The goal of this multisite randomized controlled trial was to evaluate knowledge acquired using standardized DnEM. America's Blood Centers' Working Group (WG) for Donor Education and Communication was formed to evaluate and suggest modifications of these documents. Based on pilot work, a randomized clinical trial was designed to test donor knowledge across a variety of populations. The WG identified several shortcomings in the current DnEM and proposed new DnEM. The new DnEM were tested against the same, current DnEM being used at all three sites (Blood Donor Educational Material, 2016 version 2.0, published in conjunction with the AABB uniform donor history questionnaire). METHODS AND MATERIALS One-hundred sixty-five first time and returning donors were randomized in a 2x2 model to review either new DnEM or current DnEM. Every participant completed a pre- and post-quiz that tested their understanding of the DnEM. RESULTS Returning donors had greater baseline knowledge compared to new donors, but new donors improved more versus returning donors. Donors using the new DnEM showed greater improvement in knowledge than those using current DnEM. CONCLUSION Comprehension of DnEM can be improved. With this sample size the results suggest that the findings are independent of demographic characteristics, but a larger study would be necessary to confirm this.
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Affiliation(s)
- Gay Wehrli
- University of Virginia Health, Charlottesville, Virginia, USA
| | | | | | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
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5
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Bowen L, LePage N, Lewandowska M, Waxman DA. Anti-Pr antibody induced cold autoimmune hemolytic anemia following pneumococcal vaccination. Clin Case Rep 2019; 7:1763-1765. [PMID: 31534744 PMCID: PMC6745373 DOI: 10.1002/ccr3.2365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022] Open
Abstract
While rare, vaccination-induced autoantibodies can occur outside of the pediatric population. This diagnosis should be considered after infectious and lymphoproliferative disorders are ruled out. Clinical management will depend on the individual case, but all patients should be monitored closely.
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Affiliation(s)
- Laurel Bowen
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Nichole LePage
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisINUSA
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6
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Stanley J, AuBuchon JP, Erickson Y, Waxman DA, Williamson PC, Bertuzis R, Huynh N, Duncan JR, Dyer N, Pate LL, Galel SA. Evaluation of a new West Nile virus nucleic acid test for screening of blood donations. Transfusion 2018; 59:623-628. [PMID: 30427542 PMCID: PMC7379961 DOI: 10.1111/trf.15022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/07/2018] [Accepted: 09/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND West Nile virus (WNV) is transmitted to humans through mosquito bites and can be further transmitted to humans through transfusion or transplantation. Because most infected individuals are asymptomatic, blood donor screening is important in areas where WNV is endemic. These studies evaluated the performance of a new test for detection of WNV RNA in blood donations. STUDY DESIGN AND METHODS Analytical performance evaluation included sensitivity, specificity, inclusivity, and correlation. A clinical specificity study was conducted at four blood donor testing laboratories in parallel with the cobas TaqScreen WNV Test (Roche Molecular Systems, Inc.). RESULTS The 95% and 50% limit of detection for cobas WNV was 12.9 copies/mL (95% confidence interval [CI], 10.8–16.3) and 2.1 copies/mL (95% CI, 1.9–2.4) for WNV lineage 1, respectively, and 6.2 copies/mL (95% CI, 4.8–8.9) and 1.1 copies/mL (95% CI, 0.8–1.3) for WNV lineage 2, respectively. Clinical specificity was 100% in 10,823 donor samples tested individually (95% CI, 99.966%–100%) and 63,243 tested in pools of 6 (95% CI, 99.994%–100%). Samples of other members of the Japanese encephalitis virus serocomplex, including St Louis encephalitis, Japanese encephalitis, Murray Valley encephalitis, Usutu, and Kunjin viruses were detected by cobas WNV. CONCLUSION The cobas WNV test for use on the cobas 6800/8800 System, a fully automated test system, demonstrated high sensitivity and specificity and is suitable for the detection of WNV in blood donors.
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Affiliation(s)
- Jean Stanley
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
| | | | | | | | | | - Rasa Bertuzis
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
| | - Nancy Huynh
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
| | - John R Duncan
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
| | - Nicole Dyer
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
| | - Lisa L Pate
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
| | - Susan A Galel
- Medical and Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, California
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7
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Galel SA, Simon TL, Williamson PC, AuBuchon JP, Waxman DA, Erickson Y, Bertuzis R, Duncan JR, Malhotra K, Vaks J, Huynh N, Pate LL. Sensitivity and specificity of a new automated system for the detection of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus nucleic acid in blood and plasma donations. Transfusion 2017; 58:649-659. [PMID: 29250788 DOI: 10.1111/trf.14457] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Use of nucleic acid testing (NAT) in donor infectious disease screening improves transfusion safety. Advances in NAT technology include improvements in assay sensitivity and system automation, and real-time viral target discrimination in multiplex assays. This article describes the sensitivity and specificity of cobas MPX, a multiplex assay for detection of human immunodeficiency virus (HIV)-1 Group M, HIV-2 and HIV-1 Group O RNA, HCV RNA, and HBV DNA, for use on the cobas 6800/8800 Systems. STUDY DESIGN AND METHODS The specificity of cobas MPX was evaluated in samples from donors of blood and source plasma in the United States. Analytic sensitivity was determined with reference standards. Infectious window periods (WPs) before NAT detectability were calculated for current donor screening assays. RESULTS The specificity of cobas MPX was 99.946% (99.883%-99.980%) in 11,203 blood donor samples tested individually (IDT), 100% (99.994%-100%) in 63,012 donor samples tested in pools of 6, and 99.994% (99.988%-99.998%) in 108,306 source plasma donations tested in pools of 96. Seven HCV NAT-yield donations and one seronegative occult HBV infection were detected. Ninety-five percent and 50% detection limits in plasma (IU/mL) were 25.7 and 3.8 for HIV-1M, 7.0 and 1.3 for HCV, and 1.4 and 0.3 for HBV. The HBV WP was 1 to 4 days shorter than other donor screening assays by IDT. CONCLUSION cobas MPX demonstrated high specificity in blood and source plasma donations tested individually and in pools. High sensitivity, in particular for HBV, shortens the WP and may enhance detection of occult HBV.
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Affiliation(s)
- Susan A Galel
- Roche Molecular Systems, Inc., Pleasanton, California
| | | | | | - James P AuBuchon
- Bloodworks Northwest.,Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, Washington
| | | | - Yasuko Erickson
- Mississippi Valley Regional Blood Center, Davenport, Iowa.,Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Rasa Bertuzis
- Roche Molecular Systems, Inc., Pleasanton, California
| | - John R Duncan
- Roche Molecular Systems, Inc., Pleasanton, California
| | | | - Jeffrey Vaks
- Roche Molecular Systems, Inc., Pleasanton, California
| | - Nancy Huynh
- Roche Molecular Systems, Inc., Pleasanton, California
| | - Lisa Lee Pate
- Roche Molecular Systems, Inc., Pleasanton, California
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8
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Kinney SN, Slayten J, Waxman DA. The Need for Education in Molecular Immunohematology: A Survey of Specialists in Blood Banking. Lab Med 2016; 47:330-337. [DOI: 10.1093/labmed/lmw042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Paroxysmal cold hemoglobinuria (PCH) is an acquired hemolytic anemia caused by immunoglobulin G (IgG) antibodies that sensitize red blood cells (RBCs) at cold temperatures by fixing complement to the RBCs causing intravascular hemolysis on rewarming. PCH usually appears in young children as recurrent high fevers, chills, and passage of red-brown urine. The diagnostic test for PCH is the Donath-Landsteiner test, an in vitro assay for biphasic hemolysis. Herein, we present 2 cases of PCH that occurred within 12 months of each other. We quickly diagnosed the second case and treated the patient successfully, in part due to our recognition of its characteristics based on the first case. PCH is a hemolytic anemia for which there is a specific diagnostic test; the timely recognition of this entity by physicians and laboratory staff will allow prompt, supportive therapy and will raise the odds of quick resolution of hemolysis.
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Affiliation(s)
- Stephanie N Slemp
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Douglas A Cipkala
- Department of Pediatric Hematology/Oncology, Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana
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10
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White LK, Harris VJ, Cruz JL, Waxman DA. How do we design, implement, and manage an ongoing program to provide iron supplements to women blood donors? Transfusion 2014; 54:2795-801. [PMID: 25100312 DOI: 10.1111/trf.12803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 11/28/2022]
Abstract
Here we describe the design and management of Indiana Blood Center's 10-year Iron For Women program, an ongoing community blood center-based program with continual program and donor management providing iron supplements to healthy women blood donors. Donor iron supplementation has typically been limited to research study protocols, for a defined period, with the associated resources and funding. The results of studies have supported the utility of iron supplementation: iron supplementation will enhance dietary iron for increased gastrointestinal absorption triggered as a normal homeostatic response to blood loss, thereby providing a suitable dietary iron source in the event the donor's usual diet lacks sufficient iron. Despite proven results, blood centers have been reluctant to adopt the practice due to barriers such as donor selection, ensuring the appropriateness of iron supplementation relative to the health of the donor, supplement costs, provision logistics, and program management costs. We present here how we designed our program and why it is in the Blood Center's interest to help willing women participate in volunteer blood donation by attempting to mitigate associated iron loss.
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11
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Slemp SN, Davisson SM, Slayten J, Cipkala DA, Waxman DA. Two Case Studies and A Review of Paroxysmal Cold Hemoglobinuria. Lab Med 2014. [DOI: 10.1309/lmov11bp1ywnhtjj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Danielson C, Benjamin RJ, Mangano MM, Mills CJ, Waxman DA. Pulmonary pathology of rapidly fatal transfusion-related acute lung injury reveals minimal evidence of diffuse alveolar damage or alveolar granulocyte infiltration. Transfusion 2008; 48:2401-8. [DOI: 10.1111/j.1537-2995.2008.01879.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dlott JS, Waxman DA. David B. Pall, PhD (1914-2004). Transfus Med Rev 2006; 20:84-7. [PMID: 16373192 DOI: 10.1016/j.tmrv.2005.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this edition of the Pioneers and Pathfinders Series, the contributions of David B. Pall, PhD, to transfusion medicine are discussed. With the aid of Dr Pall's unpublished personal history and assistance from family members and the company he founded, we are able to provide perspective to several remarkable scientific advances. For those of us in transfusion medicine, the discovery of the world's first leukoreduction filter prevails as his most significant invention. However, to the rest of the world, Dr Pall pioneered filtration with applications in aerospace, microelectronics, general industry, and most recently, contamination control. The almost 60-year-old Pall Corporation continues to preserve his legacy.
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Abstract
Multicomponent donor apheresis utilizes apheresis technology to collect combinations of red blood cells, platelets and plasma units. The United States has embraced this technology to the greatest extent of the countries in the Americas. As whole blood and apheresis collection have increased, so have the donor deferrals based on potential exposure to infectious agents. However, hemoglobin/hematocrit deferrals still remain the largest upfront deferral for volunteer donors. As the technology is refined in future years, multicomponent donor apheresis may become the predominant method of collecting blood products from donors.
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Affiliation(s)
- Dan A Waxman
- Indiana Blood Center, Indianapolis, IN 46208, USA.
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Abstract
Volunteer donor apheresis has evolved from early plasmapheresis procedures that collected single components into technically advanced multicomponent procedures that can produce combinations of red blood cells, platelets, and plasma units. Blood collection and utilization is increasing annually in the United States. The number of apheresis procedures is also increasing such that single donor platelet transfusions now exceed platelet concentrates from random donors. Donor qualifications for apheresis vary from those of whole blood. Depending on the procedure, the donor weight, donation interval, and platelet count must be taken into consideration. Adverse effects of apheresis are well known and fortunately occur in only a very small percentage of donors. The recruitment of volunteer donors is one of the most challenging aspects of a successful apheresis program. As multicomponent apheresis becomes more commonplace, it is important for collection centers to analyze the best methods to recruit and collect donors.
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Affiliation(s)
- Dan A Waxman
- Indiana Blood Center, Indianapolis, Indiana 46208, USA
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Waxman DA. Cardiac troponins in patients with chest pain. N Engl J Med 1998; 338:1314; author reply 1315. [PMID: 9565495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
BACKGROUND There is little information in the medical literature on t he clinical spectrum of blood donation-related neurologic needle injury and on its frequency in a blood donor population. STUDY DESIGN AND METHODS Sixty-six cases of blood donation-related neurologic needle injury were identified from nursing reports made during a 2-year collection period involving 419,000 whole blood donations. Telephone follow-up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects. RESULTS Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow-up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were <3 days (n = 22), 4 to 29 days (n = 17), 1 to 3 months (n = 13) 3 to 6 months (n = 2), and >6 months (n = 2). Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation-related neurologic needle injury was 1 of every 6300 donations. CONCLUSION While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation-related neurologic needle injury is relatively low.
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Affiliation(s)
- B H Newman
- American Red Cross Blood Services, Southeastern Michigan Region, Detroit, USA
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Waxman DA, Fitzgerald PJ. Exocrine pancreatic cancer at UKSM. J Kans Med Soc 1984; 85:136-40, 152. [PMID: 6330248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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