1
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Jacobs JW, Stephens LD, Chooljian DM, Sharma D, Adkins BD, Booth GS. Crizanlizumab and sickle cell disease: When should medications have their approval status revoked? Am J Hematol 2024; 99:1016-1018. [PMID: 38409818 DOI: 10.1002/ajh.27275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - David M Chooljian
- Ethics Consultation Service & Pulmonary & Critical Care Medicine Section, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Deva Sharma
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Garrett S Booth
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Tanhehco YC, Alsammak M, Chhibber V, Ibeh N, Li Y, Stephens LD, Noland DK, Wu DW, Zantek ND, DeChristopher PJ, Martin MCS, Lu W, Wehrli G. Apheresis practice variation during the COVID-19 pandemic: Results of a survey. J Clin Apher 2024; 39:e22109. [PMID: 38634419 DOI: 10.1002/jca.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare delivery across all specialties including apheresis. To describe the changes in apheresis service practices that occurred during the pandemic, the American Society for Apheresis (ASFA) Apheresis Medicine Attending Physician Subcommittee conducted a survey study. STUDY DESIGN AND METHODS A 32-question survey was designed and distributed to 400 ASFA physician members on September 7, 2022. Attending physicians responded to questions about whether and how apheresis service practices changed during the COVID-19 pandemic compared with the time period prior to the pandemic in terms of: (1) procedure types and volumes, (2) patient consultation workflow, and (3) the use of telemedicine. Descriptive analyses were reported as number and frequency of responses. RESULTS The survey response rate was 13.8% (55/400). Of these respondents, 96.4% (53/55) were attending physicians. The majority of respondents (42/53, 79.2%) indicated that the types of procedures performed during COVID-19 compared to pre-pandemic did not change. Most frequently for apheresis procedure volume, respondents reported: no change in their monthly inpatient volume (21/47, 44.7%) and a decrease in their monthly outpatient volume (28/46, 60.9%). Prior to COVID-19, 75.0% (30/40) of respondents performed consultations at bedside for inpatients and 67.4% (29/43) performed consultations at bedside for outpatients. Bedside consultations decreased in both settings during the pandemic but were still most frequently performed by attending physicians. At the same time, the use of telemedicine increased for 15.4% of survey respondents during COVID-19. CONCLUSION Some, but not all, respondents observed or made changes to their apheresis service during the COVID-19 pandemic. A subset of changes, such as increased utilization of telemedicine, may persist.
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Affiliation(s)
- Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mohamed Alsammak
- Blood Bank/Transfusion Medicine, Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Vishesh Chhibber
- Department of Pathology and Laboratory Medicine, Northwell Health, Manhasset, New York, USA
| | - Nnaemeka Ibeh
- Department of Pathology and Laboratory Medicine, University of Texas Health Houston, Houston, Texas, USA
| | - Yanhua Li
- Transfusion Medicine, UMass Memorial Health and Departments of Medicine and Pathology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Daniel K Noland
- Department of Pathology, University of Texas Southwestern and Children's Health Dallas, Dallas, Texas, USA
| | - Ding Wen Wu
- Department of Pathology and Laboratories, New York University Langone Health, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Phillip J DeChristopher
- Loyola University Health System, Department of Pathology and Laboratory Medicine, Maywood, Illinois, USA
| | | | - Wen Lu
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Rochester, Minnesota, USA
| | - Gay Wehrli
- University Hospitals Samaritan Medical Center and Case Western Reserve University, Ashland, Ohio, USA
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3
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Jacobs JW, Booth GS, Stephens LD, Adkins BD, Martin AA, Lundberg GD, Glover RT, Khan SS, Silver JK, Woo JS. Industry Payments to American Society of Hematology Clinical Practice Guideline Authors. Blood Adv 2024:bloodadvances.2023012527. [PMID: 38569136 DOI: 10.1182/bloodadvances.2023012527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
| | - Garrett S Booth
- Vanderbilt University Medical Center, 1301 Medical Center Dr, Tennessee, United States
| | - Laura D Stephens
- University of California San Diego, La Jolla, California, United States
| | - Brian D Adkins
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Amarilis A Martin
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | | | | | - Shazia S Khan
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Julie K Silver
- Harvard Medical School, Charlestown MA, Massachusetts, United States
| | - Jennifer S Woo
- City of Hope National Medical Center, Duarte, California, United States
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4
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Jacobs JW, Adkins BD, Bibb LA, Stephens LD, Woo JS, Bloch EM, Booth GS. New threats from an old foe: Evaluating the risk to the blood supply due to increasing incidence and endemicity of leprosy in the United States. Transfus Apher Sci 2024; 63:103877. [PMID: 38242725 DOI: 10.1016/j.transci.2024.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
Leprosy (i.e., Hansen's disease) is a chronic disease secondary to infection with either Mycobacterium leprae or M. lepromatosis. While the incidence of this disease is decreasing across the world, there is mounting evidence that it might be increasing, and becoming endemic, in the United States. Leprosy was once considered a potential threat to the blood supply, and while this threat has not borne out, it is worth revisiting the available data to assess whether it may pose a threat in the future. Herein, we discuss the evidence for and against the potential for transfusion-transmission of leprosy, and highlight future areas of research to further elucidate this possibility.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern, Dallas, TX USA3, USA
| | - Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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5
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Abels E, Adkins BD, Cedeno K, Booth GS, Allen ES, Stephens LD, Woo JS, Tormey CA, Jacobs JW. Assessing Recommendations for Determining Fetal Risk in Alloimmunized Pregnancies in the United States: Is It Time to Update a Decades-Old Practice? Transfus Med Rev 2024; 38:150810. [PMID: 38194730 DOI: 10.1016/j.tmrv.2023.150810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
The current recommended testing algorithm for assessing the alloimmunized pregnancy utilized by many obstetricians in the United States (US) fails to consider the most recent evidence, placing fetuses, and mothers at unnecessary risk of poor outcome or death. This narrative review of the current landscape of fetal red blood cell (RBC) antigen testing evaluates the history of hemolytic disease of the fetus and newborn (HDFN) and how its discovery has continued to influence practices in the US today. We compare current US-based HDFN practice guidelines with those in Europe. We also provide transfusion medicine and hematology perspectives and recommendations addressing the limitations of US practice, particularly regarding paternal RBC antigen testing, and discuss the most valuable alternatives based on decades of data and evidence-based recommendations from Europe.
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Affiliation(s)
- Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Koraima Cedeno
- Department of Obstetrics and Gynecology, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | | | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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6
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Fung MK, AuBuchon JP, Stephens LD. Classification of posttransfusion adverse events using a publicly available artificial intelligence system. Transfusion 2024; 64:590-596. [PMID: 38400777 DOI: 10.1111/trf.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Correct classification of transfusion reactions is important not only for effective patient care and donor management but also for accurate tracking of events in hemovigilance systems. We compared the ability of a generative artificial intelligence (AI) system to correctly diagnose hypothetical clinical situations as transfusion reactions in comparison to previous studies reporting the accuracy of transfusion medicine (TM) specialists in assessing these cases. METHODS An AI system was requested to assess 36 case scenarios to provide a diagnosis, severity, and imputability of the transfusion reactions using the CDC National Healthcare Safety Network (NHSN) criteria. Responses were compared to an expert panel's classifications and to the published responses of a panel of TM specialists. Additionally, the AI's responses were compared to the TM specialists' prior attempts to use the TrDDx web-based algorithm for the five most challenging cases. RESULTS The AI's classification accuracy varied widely depending on the NHSN category. The AI accurately classified all transfusion-associated circulatory overload and transfusion-related acute lung injury cases, exceeding TM specialists' assessments. Conversely, it did not correctly identify any cases in select NHSN categories such as DSTR. Overall accuracy among all diagnostic categories was 48.7% for AI responses versus 72.1% for prior TM specialist responses (p = 0.005). AI-generated responses included non-standard terminology, limited severity assessments, and no imputability determinations. DISCUSSION A generative AI system may have a role in helping healthcare providers to consider transfusion reaction categories that might be missed, but caution is advised in applying the AI's output to transfusion reaction classification at present.
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Affiliation(s)
- Mark K Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - James P AuBuchon
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, San Diego, California, USA
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7
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Jacobs JW, Sharma D, Stephens LD, Figueroa Villalba CA, Rinder HM, Woo JS, Wheeler AP, Gerberi D, Goel R, Tormey CA, Booth GS, Bloch EM, Adkins BD. Thrombosis risk with haemoglobin C trait and haemoglobin C disease: A systematic review. Br J Haematol 2024; 204:1500-1506. [PMID: 38291731 DOI: 10.1111/bjh.19313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
The thrombotic risk with haemoglobin C trait (HbAC) or haemoglobin C disease (HbCC) is unclear. However, individuals with HbCC have demonstrated chronic haemolysis, higher blood viscosity and altered rheology when compared to individuals with wild-type haemoglobin (HbAA). These physiological alterations may theoretically translate to increased risk of thrombosis; therefore, a systematic literature review was performed to investigate the possible association between HbAC and/or HbCC and thrombosis. Twenty-two studies met inclusion criteria representing 782 individuals with HbAC (n = 694) or HbCC (n = 88). Fifteen studies described the presence/absence of venous thromboembolism (VTE) in patients with HbAC (n = 685) or HbCC (n = 79), while seven studies described patients with HbAC (n = 9) or HbCC (n = 9) and arterial thrombosis. Most (n = 20) studies were case reports or case series; however, two studies suggested a potential increased VTE risk with HbAC compared to HbAA in (i) all patients (OR 2.2, 95% CI: 0.9-5.5) and in (ii) pregnant individuals (RR 3.7, 95% CI 0.9-16). This review is the largest assessment of patients with HbC trait or disease and thrombosis to date; despite its limitations, the findings suggest HbC may be a predisposing risk factor to thrombosis. Prospective cohort studies are warranted to definitively elucidate the risk of thrombosis in this population.
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Affiliation(s)
- Jeremy W Jacobs
- Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Deva Sharma
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | | | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Allison P Wheeler
- Division of Coagulation Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruchika Goel
- Department of Internal Medicine, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Vitalant, Corporate Medical Affairs, Scottsdale, Arizona, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Garrett S Booth
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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8
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Bibb LA, Adkins BD, Stephens LD, Booth GS, Jacobs JW. Biologic immunomodulatory medications and autoimmune cytopenias: A cross-sectional analysis of a national surveillance database. J Am Acad Dermatol 2024:S0190-9622(24)00506-1. [PMID: 38513833 DOI: 10.1016/j.jaad.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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9
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Wang DK, Clark LM, Stephens LD, Adkins BD, Khan SS, Booth GS, Jacobs JW. Analysis of editor in chief gender and associated journal variables among 126 pathology journals. Am J Clin Pathol 2024:aqae018. [PMID: 38437878 DOI: 10.1093/ajcp/aqae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/01/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Gender equity studies have shown that women are underrepresented in journal editor in chief positions, which confer major professional opportunities and influence. We sought to systematically investigate editor in chief gender and journal attributes within pathology. METHODS We constructed a journal data set using the Scimago Journal & Country Rank and Clarivate Journal Citation Reports databases. We also included official journals of the major medical societies for the 12 pathology subspecialties recognized by the Association of American Medical Colleges. The final data set included 126 journals. We obtained editor in chief gender, impact factor, publication model (ie, hybrid access vs open access), year of founding, and geographic location for all included pathology journals. RESULTS Women made up only 18% of the 141 total editor in chief positions. This inequity was present irrespective of all pathology journal variables studied. Among 10 journals with 2 editor in chief positions, 5 had only men and 5 had 1 man and 1 woman. All 3 journals with 3 editor in chief positions had 2 men and 1 woman. CONCLUSIONS Women are significantly underrepresented among editor in chiefs across pathology journals. Journals and affiliated members should advocate for diversity among these influential positions, given their impact on research, science, and medicine.
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Affiliation(s)
- Dayle K Wang
- Vanderbilt University School of Medicine, Nashville, TN, US
| | - Landon M Clark
- Vanderbilt University School of Medicine, Nashville, TN, US
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, US
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Shazia S Khan
- Departments of Pathology and Laboratory Medicine, Yale School of Medicine, New Haven, CT, US
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
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Jacobs JW, Booth GS, Woo JS, Adkins BD, Stephens LD. How the United States syphilis epidemic may portend a resurgence of an unusual hematologic condition: The connection between syphilis and paroxysmal cold hemoglobinuria. Am J Hematol 2024; 99:484-485. [PMID: 38151909 DOI: 10.1002/ajh.27190] [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] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
The connection between syphilis and paroxysmal cold hemoglobinuria.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
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11
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Jacobs JW, Martin AA, Stephens LD, Adkins BD, Woo JS, Sharma D, Wheeler AP, Glover RT, Yui JC, Walker SC, Khan SS, Booth GS, Silver JK. Gender composition and geographical representation of American Society of Hematology clinical practice guideline authors. Lancet Haematol 2024; 11:e182-e183. [PMID: 38428444 DOI: 10.1016/s2352-3026(24)00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Amarilis A Martin
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Deva Sharma
- Division of Transfusion Medicine, Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison P Wheeler
- Division of Coagulation Medicine, Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raeshun T Glover
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer C Yui
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon C Walker
- Division of Transfusion Medicine, Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shazia S Khan
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA; Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Garrett S Booth
- Division of Transfusion Medicine, Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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12
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Jacobs JW, Adkins BD, Bibb LA, Woo JS, Allen ES, Stephens LD, Binns TC, Bloch EM, Booth GS. The potential association between extracorporeal photopheresis and thrombosis. Bone Marrow Transplant 2024; 59:270-273. [PMID: 37996561 DOI: 10.1038/s41409-023-02153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rocester, MN, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Thomas C Binns
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Jacobs JW, Booth GS, Woo JS, Stephens LD, Figueroa Villalba CA, Adkins BD. Challenges in recognising paroxysmal cold hemoglobinuria. Transfus Med 2024; 34:71-73. [PMID: 38151804 DOI: 10.1111/tme.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | | | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Adkins BD, Usmani A, Stephens LD, Jacobs JW, Booth GS. The devil's in the details: Exploring historically low board pass rates in Blood Banking/Transfusion Medicine. Am J Clin Pathol 2024; 161:108-110. [PMID: 37793032 DOI: 10.1093/ajcp/aqad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Amena Usmani
- Department of Pathology, University of California, San Diego, San Diego, CA, US
| | - Laura D Stephens
- Department of Pathology, University of California, San Diego, San Diego, CA, US
| | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Garrett S Booth
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
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15
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Allen ES, Perez-Alvarez I, Woo JS, Stephens LD. How do we design a laboratory space for a hospital transfusion medicine service? Transfusion 2024; 64:6-15. [PMID: 37876315 DOI: 10.1111/trf.17577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Transfusion service laboratories (TSL) often need to renovate or design new laboratory space, and their leaders must be involved in the complex and multifaceted design process. STUDY DESIGN AND METHODS This manuscript outlines the design process and considerations for a dedicated TSL space. RESULTS Proactive engagement with key collaborators throughout the design process is essential. Major design considerations include physical features such as location, size, service/equipment needs, and zones within the laboratory; intangible issues such as efficiency, well-being, and disaster planning; and adaptations for suboptimal space and changes over time. CONCLUSION Investing in the design of the laboratory space facilitates high-quality TSL operations, productivity, customer satisfaction, regulatory compliance, staff well-being, and most importantly, patient safety.
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Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Ingrid Perez-Alvarez
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
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16
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Jacobs JW, Stephens LD, Woo JS, Adkins BD, Booth GS. Discrepancies among studies reporting the prevalence of positive direct antiglobulin tests in the COVID-19 patient population. Transfus Med 2023. [PMID: 38151773 DOI: 10.1111/tme.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/28/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Centner, Dallas, Texas, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Jacobs JW, Adkins BD, Sharma D, Wheeler AP, Stephens LD, Woo JS, Khan SS, Booth GS. Assessing authorship of clinical practice guidelines. Lancet Haematol 2023; 10:e950. [PMID: 38030315 DOI: 10.1016/s2352-3026(23)00337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Brian D Adkins
- Department of Pathology, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Deva Sharma
- Department of Pathology, Microbiology and Immunology, Medical Center, Vanderbilt University, Nashville, TN, USA; Department of Medicine, Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Allison P Wheeler
- Department of Pathology, Microbiology and Immunology, Medical Center, Vanderbilt University, Nashville, TN, USA; Department of Pediatrics, Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Shazia S Khan
- Department of Pathology and Department of Laboratory Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Medical Center, Vanderbilt University, Nashville, TN, USA
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18
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Abels E, Adkins BD, Allen ES, Booth GS, DiGuardo MA, Ding JJ, Guarente J, Klein M, Stephens LD, Tormey CA, Woo JS, Jacobs JW. Updates in the care of the alloimmunized pregnant patient: A transfusion medicine and clinical laboratory perspective. Am J Clin Pathol 2023; 160:441-443. [PMID: 37471256 DOI: 10.1093/ajcp/aqad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Affiliation(s)
- Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, US
| | - Brian D Adkins
- Division of Transfusion Medicine and Hemostasis, Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, US
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | | | - Jia Jennifer Ding
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, US
| | - Juliana Guarente
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, US
| | - Monica Klein
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, US
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, US
| | | | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, US
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, US
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19
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Jacobs JW, Stephens LD, Booth GS, Woo JS, Adkins BD. Assessing transfusion-related costs: More than just the price of blood. J Trauma Acute Care Surg 2023; 95:e49-e50. [PMID: 37518902 DOI: 10.1097/ta.0000000000004038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
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20
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Jacobs JW, Booth GS, Stephens LD, Woo JS, Adkins BD. Considering the impact of climate change and viral hemorrhagic fevers on the safety of the blood supply. Transfus Clin Biol 2023; 30:454-455. [PMID: 37392817 DOI: 10.1016/j.tracli.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Garrett S Booth
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Jacobs JW, Binns TC, Chooljian DM, Adkins BD, Woo JS, Stephens LD, Schlafer TD, Savani BN, Booth GS. Blood bans and COVID-19: Government attempts to influence medicine and science threaten us all. Am J Clin Pathol 2023; 160:435-436. [PMID: 37410089 DOI: 10.1093/ajcp/aqad071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
| | | | - David M Chooljian
- Veterans Affairs Loma Linda Healthcare System and Loma Linda University School of Medicine, Loma Linda, CA, US
| | - Brian D Adkins
- University of Texas Southwestern Medical Center, Dallas, TX, US
| | | | | | - T D Schlafer
- Lincoln Memorial University Duncan School of Law, Knoxville, TN, US
| | - Bipin N Savani
- Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, TN, US
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22
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Jacobs JW, Stephens LD, Milner DA, Bloch EM, Goel R, Tobian AAR, Shibemba AL, Eichbaum Q. Survey of blood collection and transfusion practices among institutions in Africa. Transfusion 2023; 63:1849-1858. [PMID: 37646070 DOI: 10.1111/trf.17501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Dramatic improvements in blood transfusion have occurred during the last two decades. Transfusion medicine services and practices in Africa remain underexplored. METHODS A survey of blood bank/transfusion medicine (BBTM) practices, available blood products, blood product source(s), pre-transfusion testing, and blood donor infectious disease testing methodologies across Africa was performed using the American Society for Clinical Pathology (ASCP) listserv. Survey recipients included hospital-based laboratories/blood banks, national transfusion medicine services, and free-standing laboratories (collectively referred to as institutions). RESULTS Responses from a total of 81 institutions across 22 countries were analyzed. All 81 institutions provide at least one type of blood product-whole blood, red blood cells (RBCs), platelets, plasma, and cryoprecipitate, with whole blood (90.1%, 73 of 81) and RBCs (79.0%, 64 of 81) most common, while cryoprecipitate is least common (12.4%, 10 of 81). Only five countries had a responding institution that provides all types of products. Among institutions that collect blood onsite, the most common sources of blood products are patients' family members (94.1%, 48 of 51) and pre-screened on-demand volunteer donors (82.4%, 42 of 51). The most commonly screened infectious agents are HIV and hepatitis B virus (both 81.5%), while 70.4% (57 of 81) test for hepatitis C virus (HCV) and Treponema pallidum. DISCUSSION This study highlights significant variability and restrictions in blood product availability, pre-transfusion testing, and blood donor infectious disease testing across Africa. Further studies are needed to ascertain barriers to improving blood donor availability, blood product safety, and infectious disease testing.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois, USA
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Departments of Internal Medicine and Pediatrics, Simmons Cancer Institute at SIU School of Medicine, Springfield, Illinois, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Lunda Shibemba
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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23
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Stephens LD, Allen ES, Bloch EM, Crowe EP, Campbell-Lee SA, Booth GS, Kopko P. How do we ensure a safe ABO recheck process? Transfusion 2023; 63:1789-1796. [PMID: 37660311 DOI: 10.1111/trf.17530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Collecting a patient's blood in a correctly labeled pretransfusion specimen tube is essential for accurate ABO typing and safe transfusion. Noncompliance with specimen collection procedures can lead to wrong blood in tube (WBIT) incidents with potentially fatal consequences. Recent WBIT events inspired the investigation of how various institutions currently reduce the risk of these errors and ensure accurate ABO typing of patient samples. MATERIALS AND METHODS This article describes the techniques employed at various institutions across the United States to mitigate the risk of misidentified pretransfusion patient specimens. Details and considerations for each of these measures are provided. RESULTS Several institutions require the order for an ABO confirmation specimen, if indicated, to be generated from the transfusion medicine (TM) laboratory. Others issue a dedicated collection tube that is available exclusively from the TM service. Many institutions employ barcoding for electronic positive patient identification. Some use a combination of these strategies, depending on the locations or service lines from which the specimens are collected. CONCLUSION The description of various WBIT mitigation strategies will inform TM services on practices that may be effective at their respective institutions. Irrespective of the method(s) utilized, institutions should continue to monitor and mitigate specimen misidentification errors to promote sustained safe transfusion practices.
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Affiliation(s)
- Laura D Stephens
- University of California San Diego Health, La Jolla, California, USA
| | - Elizabeth S Allen
- University of California San Diego Health, La Jolla, California, USA
| | - Evan M Bloch
- Johns Hopkins University School of Medicine Baltimore, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Johns Hopkins University School of Medicine Baltimore, Baltimore, Maryland, USA
| | | | - Garrett S Booth
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia Kopko
- University of California San Diego Health, La Jolla, California, USA
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24
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Jacobs JW, Adkins BD, Allen ES, Parra-Herran C, Stephens LD, Woo JS, Booth GS. An Assessment of Gender Equity and Parity Among "Nontraditional" Pathology Awards. Lab Med 2023; 54:519-522. [PMID: 36857473 DOI: 10.1093/labmed/lmac166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the gender composition of nontraditional pathology recognition award recipients. METHODS Cross-sectional analysis of American Society for Clinical Pathology (ASCP) Top Five 40 Under Forty and The Pathologist Power List award recipients' gender. Gender was independently analyzed by 2 authors using pronouns. Two analyses were performed: difference in gender parity and difference in gender equity for award recipients. RESULTS From 2014 through 2022, 618 total awards were conferred. Significantly more men than women received an award overall (57.1% vs 42.9%; P < .001). Compared with population benchmarks, awards conferred to US-based nontrainee pathology physicians (men 56.2%, women 43.8%; P = .091) and US-based pathology physician trainees (men 60.5%, women 39.5%; P = .15) are equitable. Conversely, gender inequities exist among awards conferred to US-based nonphysician laboratory professionals (men 51.7%, women 48.3%; P < .001). CONCLUSION The Pathologist Power List and Top Five ASCP 40 Under Forty awards have not completely achieved gender parity, and gender inequities remain among subgroups.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern, Dallas, TX, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | | | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Stephens LD, Jacobs JW, Adkins BD, Booth GS. Battle of the (Chat)Bots: Comparing Large Language Models to Practice Guidelines for Transfusion-Associated Graft-Versus-Host Disease Prevention. Transfus Med Rev 2023; 37:150753. [PMID: 37704461 DOI: 10.1016/j.tmrv.2023.150753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Abstract
Published guidelines and clinical practices vary when defining indications for irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease (TA-GVHD). This study assessed irradiation indication lists generated by multiple artificial intelligence (AI) programs, or chatbots, and compared them to 2020 British Society for Haematology (BSH) practice guidelines. Four chatbots (ChatGPT-3.5, ChatGPT-4, Bard, and Bing Chat) were prompted to list the indications for irradiation to prevent TA-GVHD. Responses were graded for concordance with BSH guidelines. Chatbot response length, discrepancies, and omissions were noted. Chatbot responses differed, but all were relevant, short in length, generally more concordant than discordant with BSH guidelines, and roughly complete. They lacked several indications listed in BSH guidelines and notably differed in their irradiation eligibility criteria for fetuses and neonates. The chatbots variably listed erroneous indications for TA-GVHD prevention, such as patients receiving blood from a donor who is of a different race or ethnicity. This study demonstrates the potential use of generative AI for transfusion medicine and hematology topics but underscores the risk of chatbot medical misinformation. Further study of risk factors for TA-GVHD, as well as the applications of chatbots in transfusion medicine and hematology, is warranted.
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Affiliation(s)
- Laura D Stephens
- Department of Pathology, University of California San Diego, San Diego, CA, USA.
| | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Brian D Adkins
- Department of Pathology, Department of Pathology, University of Texas Southwestern Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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26
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Bibb LA, Jacobs JW, Adkins BD, Woo JS, Stephens LD, Booth GS. Appropriate use of sex and gender for diversity, equity, and inclusion in biomedical research. Lancet Haematol 2023; 10:e397-e398. [PMID: 37263714 DOI: 10.1016/s2352-3026(23)00115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Lorin A Bibb
- Department of Dermatology, University of Connecticut Health, Farmington, CT, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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27
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Stephens LD. ChatGPT in transfusion medicine: A new frontier for patients? Transfusion 2023. [PMID: 37186393 DOI: 10.1111/trf.17385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
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Jacobs JW, Diaz M, Arevalo Salazar DE, Tang A, Stephens LD, Booth GS, Lehmann CU, Adkins BD. United States blood pricing: A cross-sectional analysis of charges and reimbursement at 200 US hospitals. Am J Hematol 2023. [PMID: 37096559 DOI: 10.1002/ajh.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
A violin plot demonstrating listed chargemaster charges for RBC transfusion at 200 hospitals based on hospital ownership. A violin plot shows the volume of the samples at each point by width and lines correspond to the 25th percentile, median, and 75th percentile.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marlon Diaz
- Paul L. Foster School of Medicine, El Paso, Texas, USA
| | - Dory E Arevalo Salazar
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Albert Tang
- University of Texas Southwestern School of Medicine, Dallas, Texas, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christoph U Lehmann
- Department of Pediatrics, Population and Data Sciences, and Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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29
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Jacobs JW, Stephens LD, Allen ES, Binns TC, Booth GS, Hendrickson JE, Karafin MS, Tormey CA, Woo JS, Adkins BD. Epidemiological and clinical features, therapeutic strategies and outcomes in patients with hyperhaemolysis: A systematic review. Br J Haematol 2023. [PMID: 37074146 DOI: 10.1111/bjh.18825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023]
Abstract
Hyperhaemolysis syndrome (HHS), a severe form of delayed haemolytic transfusion reaction most commonly described in patients with sickle cell disease (SCD), involves destruction of both donor and recipient red blood cells (RBCs). As the epidemiology and underlying pathophysiology have yet to be definitively elucidated, recognition can be challenging. We systematically reviewed PubMed and EMBASE to identify all cases of post-transfusion hyperhaemolysis and characterized the epidemiological, clinical and immunohaematological characteristics and treatments of HHS. We identified 51 patients (33 females and 18 males), including 31 patients with SCD (HbSS, HbSC and HbS/β-thalassaemia). The median haemoglobin nadir (3.9 g/dL) occurred a median of 10 days post-transfusion. 32.6% and 45.7% of patients had a negative indirect anti-globulin test and a negative direct anti-globulin test, respectively. The most common therapies included corticosteroids and intravenous immune globulin. 66.0% of patients received ≥1 supportive transfusion, which was associated with a longer median hospital stay/time to recovery (23 days vs. 15 days; p = 0.015) compared to no supportive transfusion. These findings illustrate that HHS that often results in marked anaemia 10 days post-transfusion is not restricted to patients with haemoglobinopathies, and additional transfused RBCs may be associated with a longer time-to-recovery.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Thomas C Binns
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew S Karafin
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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30
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Jacobs JW, Stephens LD, Woo JS, Allen ES, Booth GS. Firearms and blood transfusion: an inescapable disentanglement. Lancet 2023; 401:914-915. [PMID: 36933937 DOI: 10.1016/s0140-6736(23)00110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06511, USA.
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Jacobs JW, Adkins BD, Woo JS, Stephens LD, Booth GS. Alemtuzumab and autoimmune haemolytic anaemia: Coincidence or causation? Vox Sang 2023; 118:257-259. [PMID: 36683306 DOI: 10.1111/vox.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern, Dallas, Texas, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Jacobs JW, Karafin MS, Allen ES, Abels E, Park YA, Stephens LD, Ward DC, Woo JS, Gehrie EA, Booth GS, Adkins BD. Blood conservation strategies at United States hospitals during the COVID‐19 pandemic: Findings from a multi‐institutional analysis. Transfusion 2022; 62:2271-2281. [PMID: 36093583 PMCID: PMC9538724 DOI: 10.1111/trf.17116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Background Due to the coronavirus disease 2019 (COVID‐19) pandemic, the transfusion medicine community has experienced unprecedented blood supply shortages since March 2020. As such, numerous changes to everyday practice have occurred with a specific emphasis on blood conservation. We sought to determine the strategies used to mitigate blood shortages and promote blood conservation during the pandemic. Methods An anonymous, 37‐question survey was developed using Research Electronic Data Capture and distributed via e‐mail to transfusion medicine specialists across the US obtained via publicly available databases. Results Amongst surveyed [41.1% response rate (51/124 institutions)], 98.0% experienced a product shortage, with the greatest number reporting red blood cell (RBC) shortages (92.0%). This led to 35.3% of institutions altering the composition and/or number of blood product suppliers, including a 100% increase in the number of institutions acquiring blood from organizations that connect hospital transfusion services with blood collection centers (e.g., Blood Buy) compared to before March 2020. Prospective triaging of blood products was the most common blood conservation strategy (68.1%), though 35.4% altered their RBC exchange or transfusion program for patients receiving chronic RBC transfusion/exchange. As a result of these changes, 78.6% of institutions reported that these changes resulted in a reduction in blood product usage, and 38.1% reported a decrease in product wastage. Conclusions Most hospitals experienced the effects of the supply shortage, and many of them implemented blood conserving measures. Conservation strategies were associated with decreased blood utilization and waste, and future studies could evaluate whether these changes persist.
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Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine, Division of Transfusion Medicine Yale School of Medicine New Haven CT USA
| | - Matthew S. Karafin
- Department of Pathology and Laboratory Medicine University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Elizabeth S. Allen
- Department of Pathology University of California San Diego La Jolla CA USA
| | | | - Yara A. Park
- Department of Pathology and Laboratory Medicine University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Laura D. Stephens
- Department of Pathology University of California San Diego La Jolla CA USA
| | - Dawn C. Ward
- Wing‐Kwai and Alice Lee‐Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Jennifer S. Woo
- Department of Pathology City of Hope National Medical Center Duarte CA USA
| | - Eric A. Gehrie
- American Red Cross, National Headquarters Washington DC USA
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center Nashville TN USA
| | - Brian D. Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis University of Texas Southwestern Dallas TX USA
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Jacobs JW, Adkins BD, Stephens LD, Woo JS, Booth GS. Gender inequities in Transfusion Medicine society recognition awards. Transfus Med Rev 2022; 36:82-86. [DOI: 10.1016/j.tmrv.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Booth GS, Jacobs JW, Stephens LD, Chooljian DM, Savani BN, Gehrie EA. When should we tell patients there may be no blood? Evaluating the 'informed' consent process. Br J Haematol 2022; 198:e8-e10. [PMID: 35315509 DOI: 10.1111/bjh.18156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura D Stephens
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - David M Chooljian
- Ethics Consultation Service & Pulmonary Section, Medical Service, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Bipin N Savani
- Department of Medicine, Hematology, Stem Cell Transplantation and Cellular Therapy Section, Division of Hematology/Oncology, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, Tennessee, USA
| | - Eric A Gehrie
- American Red Cross, National Headquarters, Washington DC, USA
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Pagano MB, Treml A, Stephens LD, Joshi S, Li Y, Lopez-Plaza I, Poyyapakkam S, Schwartz J, Tanhehco Y, Zantek ND. Entrustable professional activities for apheresis medicine education. Transfusion 2020; 60:2432-2440. [PMID: 32757215 DOI: 10.1111/trf.15983] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are well-defined, executable, observable, and measurable activities that are performed by a trainee and can be performed independently as training progresses. The purpose of this study is to develop EPAs specific for the practice of apheresis medicine (AM). METHODS Members of the American Society for Apheresis Graduate Medical Education subcommittee developed a list of 28 apheresis medical activities linked to Accreditation Council for Graduate Medical Education milestones and competencies in five areas: (a) consultation, (b) clinical care for therapeutic apheresis, (c) clinical care for donor collections, (d) test optimization, and (e) vascular access. Ten AM experts using a validated tool to measure the quality of the EPAs (QUEPA) evaluated these activities with use of a Likert scale. Per group consensus, an activity was considered acceptable for each domain if it had received an average score greater than 3.7, and it was rated 4 or 5 (agree or strongly agree) by at least 70% of experts. RESULTS Of the 28 activities, 11 did not have acceptable QUEPA scores: 7 activities were rated as unobservable, 4 were rated unfocused, 2 were rated unrealistic and not generalizable, and 2 were rated as not addressing multiple competencies. Four activities had unacceptable scores in more than one domain. Subcommittee members edited these 11 activities over two review cycles to produce a final list of 26 activities. CONCLUSION A set of practical, focused, and observable EPAs in AM were systematically developed. These EPAs can be used to assess and support trainee performance in AM.
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Affiliation(s)
- Monica B Pagano
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Treml
- Department of Pathology, Versiti WI, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura D Stephens
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sarita Joshi
- Department of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Yanhua Li
- Department of Pathology and Laboratory Medicine, New York University School of Medicine, New York, New York, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Joseph Schwartz
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yvette Tanhehco
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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Smith BJ, Leyva MJ, Stephens LD, Aston CE, Hermann J, Payton M, Baker MZ. Relationship of American Indian blood quantum with osteoporosis risk: a cross-sectional study of American Indian women in Oklahoma. Osteoporos Int 2018; 29:2251-2260. [PMID: 29943190 PMCID: PMC9134873 DOI: 10.1007/s00198-018-4594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/29/2018] [Indexed: 11/27/2022]
Abstract
UNLABELLED Information regarding the prevalence and risk of osteoporosis among American Indian (AI) women is limited. This study showed that with increasing AI blood quantum, the prevalence of osteoporosis at the hip based on BMD T-scores decreased and this appeared to be independent of other risk factors. INTRODUCTION This study was designed to investigate the effects of AI blood quantum (BQ) on osteoporosis prevalence and risk in a cohort of AI women in Oklahoma. METHODS Women (n = 301), aged 50 years and older, were recruited to participate in the Oklahoma American Indian Women's Osteoporosis Study. Baseline bone density, fracture history, bone biochemical markers, and potential risk factors were assessed. Participants were stratified by AI BQ into BQ1 ≤ 25%, BQ2 = 25-49%, BQ3 = 50-74%, and BQ4 = 75-100%. The effects of BQ on the prevalence and risk of osteoporosis were evaluated. RESULTS Based on T-scores, one in approximately eight women in the study was osteoporotic at one or more sites. The prevalence of osteoporosis decreased (p < 0.05) with increasing BQ, especially at the hip, trochanteric, and intertrochanter regions. No differences in bone-specific alkaline phosphatase and C-telopeptide were observed across BQ that could account for the differences in bone density. 25-OH vitamin D decreased with increasing BQ, but mean for each BQ1-4 was > 40 ng/mL. Fracture history did not differ across BQ, and though 52% of the population consumed less than the RDA for calcium, no effect of BQ was observed. CONCLUSIONS In this cohort of women who identified as AI, greater Indian BQ was associated with a decrease in the prevalence of osteoporosis.
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Affiliation(s)
- B J Smith
- Department of Nutritional Sciences, Oklahoma State University, 420 Human Sciences, Stillwater, OK, 74078, USA.
| | - M J Leyva
- Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L D Stephens
- Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - C E Aston
- Department of Pediatrics CMRI Metabolic Research Program, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - J Hermann
- Department of Nutritional Sciences, Oklahoma State University, 420 Human Sciences, Stillwater, OK, 74078, USA
| | - M Payton
- Department of Statistics, College of Arts and Sciences, Oklahoma State University, Stillwater, OK, USA
| | - M Z Baker
- Section of Endocrinology and Diabetes, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Kim S, Stephens LD, Fitzgerald RL. How much is too much? Two contrasting cases of excessive vitamin D supplementation. Clin Chim Acta 2017; 473:35-38. [PMID: 28801091 DOI: 10.1016/j.cca.2017.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/16/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this report, we describe 2 contrasting cases of hypervitaminosis D. CASE PRESENTATION Patient 1 was a 75-y old man who developed symptomatic hypercalcemia (peak serum calcium concentration of 15.3mg/dl; reference range: 8.5-10.6mg/dl), cardiac injury, and a high total serum vitamin D concentration of 243ng/ml (30-80ng/ml) as a result of daily consumption of prescribed 50,000IU ergocalciferol (vitamin D2) and 500mg calcium-citrate for 1y. Patient 2 was a 60-y old woman who consumed 40,000IU of cholecalciferol (vitamin D3) daily for >10months with a peak total serum vitamin D concentration of 479ng/ml (30-80ng/ml), but did not present with symptoms related to vitamin D toxicity. CONCLUSION These cases demonstrate that individual responses to supraphysiologic concentrations of vitamin D for extended periods of time vary widely, and that defining a toxic concentration of this vitamin is difficult. The different outcomes in these two patients, despite months of high-dose vitamin D therapy, demonstrates that individual patient pharmacodynamics determine clinical sequelae.
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Affiliation(s)
- Sollip Kim
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Laura D Stephens
- Department of Pathology, UC San Diego Health, San Diego, CA, United States
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Stephens LD, Withy KM, Racsa CP. Migration analysis of physicians practicing in Hawai'i from 2009-2011. Hawaii J Med Public Health 2012; 71:26-30. [PMID: 22737639 PMCID: PMC3347732] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Hawai'i suffers a 20% shortage of physicians. Examining physician migration patterns into and out of Hawai'i may better inform physician recruitment and retention techniques. METHODS 2009-2011 practice location data on all non-military, practicing physicians in Hawai'i were compiled in a database maintained by the University of Hawai'i John A Burns School of Medicine, Area Health Education Center (AHEC). Medical school attended was extracted from an AMA Masterfile list. Physicians were contacted or searched online to ascertain practice location as of September 2011. RESULTS Currently 3,187 physicians actively practice in Hawai'i; 2,707 (84.9%) trained at a total of 136 US medical schools. Nearly half of all US-trained physicians attended medical school in Hawai'i, California, New York, Illinois, or Pennsylvania. International medical graduates represented 191 medical schools from 67 distinct countries, primarily in the Philippines (23.1%). From 2009-2011, 238 physicians retired from clinical activity, and 329 physicians left Hawai'i to practice in other locations. California received the largest portion of Hawai'i's former physicians (26.4%). Only 15.5% of physicians returned to the state where they attended medical school. DISCUSSION Medical schools with some of the most alumni practicing in Hawai'i (eg, Creighton, UCLA, Georgetown) all have active Hawai'i student clubs, suggesting a target for recruitment efforts. Physician emigration cannot be fully explained by geography of a physician's medical school alma mater. Analysis of physician residency locations and exit surveys of physicians leaving Hawai'i are recommended for future study.
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Affiliation(s)
- Laura D Stephens
- University of Chicago Pritzker School of Medicine, Chicago, Il, USA
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Stephens LD, Thomas RH, Kelly LS. A measurement of the average energy required to create an ion pair in nitrogen by 250 MeV/amu C6+ ions. Phys Med Biol 2002. [DOI: 10.1088/0031-9155/21/6/516] [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: 11/11/2022]
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Abstract
Current techniques for the detection and measurement of diacetylmorphine (heroin), morphine and their principal metabolite morphine-3-glucuronide (M3G) are based mainly on chromatography or immunoassay. No enzymatic method for the detection of these compounds has yet been reported. Two novel microbial enzymes have been isolated and characterized in this laboratory: an acetylmorphine carboxyesterase (heroin esterase) and a morphine dehydrogenase (MDH). These highly specific enzymes have been incorporated in an amperometric assay for heroin and morphine using phenazine methosulphate as a mediator. The assay gives a rapid and sensitive response to heroin and morphine, with a detection limit for morphine of 6.8 micrograms ml-1 (23.7 microM).
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Affiliation(s)
- P J Holt
- Institute of Biotechnology, University of Cambridge, UK
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Bruce NC, Wilmot CJ, Jordan KN, Stephens LD, Lowe CR. Microbial degradation of the morphine alkaloids. Purification and characterization of morphine dehydrogenase from Pseudomonas putida M10. Biochem J 1991; 274 ( Pt 3):875-80. [PMID: 2012614 PMCID: PMC1149991 DOI: 10.1042/bj2740875] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [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: 12/29/2022]
Abstract
The NADP(+)-dependent morphine dehydrogenase that catalyses the oxidation of morphine to morphinone was detected in glucose-grown cells of Pseudomonas putida M10. A rapid and reliable purification procedure involving two consecutive affinity chromatography steps on immobilized dyes was developed for purifying the enzyme 1216-fold to electrophoretic homogeneity from P. putida M10. Morphine dehydrogenase was found to be a monomer of Mr 32,000 and highly specific with regard to substrates, oxidizing only the C-6 hydroxy group of morphine and codeine. The pH optimum of morphine dehydrogenase was 9.5, and at pH 6.5 in the presence of NADPH the enzyme catalyses the reduction of codeinone to codeine. The Km values for morphine and codeine were 0.46 mM and 0.044 mM respectively. The enzyme was inhibited by thiol-blocking reagents and the metal-complexing reagents 1,10-phenanthroline and 2,2'-dipyridyl, suggesting that a metal centre may be necessary for activity of the enzyme.
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Affiliation(s)
- N C Bruce
- Institute of Biotechnology, University of Cambridge, U.K
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Abstract
This review introduces biosensors as analytical devices that respond selectively to analytes in appropriate samples and convert their concentrations into electrical signals via a combination of a biological recognition system and a suitable transducer. The last decade has seen dramatic advances in the design of sensor configurations, the marriage of biological systems with modern monolithic silicon and optical technologies, the development of effective electron-exchange systems and the introduction of direct immunosensors.
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Affiliation(s)
- C R Lowe
- Institute of Biotechnology, University of Cambridge, U.K
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Stephens LD. A Quest for Preeminence:
The Launching of Modern American Science, 1846-1876
. Robert V. Bruce. Knopf, New York, 1987. x, 446 pp. + plates. $30. The Impact of the Civil War. Science 1987; 237:1515-6. [PMID: 17816793 DOI: 10.1126/science.237.4821.1515] [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: 11/02/2022]
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McCaslin JB, Stephens LD, Thomas RH. Ground scattering contribution in neutron calibrations. Health Phys 1983; 44:437-439. [PMID: 6841110] [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: 05/21/2023]
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Stephens LD. Joseph Leconte's evolutional idealism: a Lamarckian view of cultural history. J Hist Ideas 1978; 39:465-480. [PMID: 11610404] [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: 05/23/2023]
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Stephens LD, Thomas RH, Kelly LS. A measurement of the average energy required to create an ion pair in nitrogen by 250 MeV/amu C6+ ions. Phys Med Biol 1976; 21:570-6. [PMID: 972922 DOI: 10.1088/0031-9155/21/4/008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Patrick JW, Stephens LD, Thomas RH, Kelly LS. The design of an experiment to study leukemogenesis in mice irradiated by energetic heavy ions. Radiat Res 1975; 64:492-508. [PMID: 1197656] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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