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Biomedical subjects

S H Butch

Publications and source records attributed to S H Butch.

At least 19 recordsLinked to original sources

ISBT 128 blood labeling: introduction and reference laboratory applications.

ISBT 128 will be implemented in the United States during the next two years. In addition to improving unit traceability and lookback tracking, this information technology standard has the power to detect and prevent errors in data entry by using data identifiers and check characters. Additionally, its ability to encode special testing results such as CMV and RBC phenotype on a label provides laboratories a computerized mechanism to verify the accuracy of such labels.

Blood Preservation↗

Practical use of computerized hospital information systems to improve blood transfusion.

Data collection can be enhanced with the use of computers. Care must be taken, however, to ensure that the data collected have a purpose and meet either the quality assessment needs or business functions of the transfusion service. Required data elements are frequently in several data repositories and must be merged to obtain needed information. Effective data collection may be hindered by several factors, including a lack of data elements in the computer systems, data retention limitations, and changes in the computer system or collection needs. Personal computers with commonly available spreadsheet and database management software are useful in preparing summarized reports. An ideal report is legibly printed on one side of a sheet of paper and includes graphs and charts that enhance data presentation and facilitate trend analysis.

Blood Transfusion↗

Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapy.

BACKGROUND: The impact of extracorporeal membrane oxygenation (ECMO), performed on adult patients, on the blood transfusion service of a tertiary-care hospital was assessed. The quantity and pattern of blood component utilization by these patients were compared to those in a previous evaluation of neonatal patients receiving similar treatment. STUDY DESIGN AND METHODS: The records of blood component transfusion to 74 adult patients, treated with ECMO within a 6-year period, were reviewed. This information was correlated with the clinical indication for ECMO and duration of ECMO treatment. In addition, daily use of components for these patients was studied to ascertain whether the blood requirements were predictable and uniform. RESULTS: Over 15,000 units of blood components, with platelet concentrates making up the largest portion, were transfused to these patients while they were undergoing ECMO. The duration of ECMO varied from less than 1 day to 53 days. However, the length of treatment could not uniformly be correlated with blood utilization or with survival. Daily blood transfusion needs often could not be anticipated, which meant that the transfusion service frequently had to respond to urgent requests for transfusion support. The provision of platelet concentrates proved to be the most difficult part of the maintenance of this program. CONCLUSION: Whereas ECMO treatment of neonatal patients has a relatively minor impact on a transfusion service, the same is not true for a program that uses this form of treatment for adults as well.

Adult↗

Electronic verification of donor-recipient compatibility: the computer crossmatch.

BACKGROUND: This article describes standard operating procedures (SOPs) for a computer crossmatch to replace the immediate-spin crossmatch for ABO incompatibility between patient blood samples submitted for pretransfusion testing and the blood component selected for transfusion. These SOPs were developed following recent changes to the Standards for Blood Banks and Transfusion Services of the American Association of Blood Banks (AABB). STUDY DESIGN AND METHODS: SOPs were developed, utilizing currently available software, for pretransfusion testing. The SOP for donor unit processing entails bar code entry of the unit number, component name, and ABO/Rh type; computer entry and interpretation of serologic reactions; warning of discrepancies between bar code-entered blood type and result interpretation; and quarantine of the donor unit in such instances. The SOP for patient sample testing requires bar code entry of specimen accession number, which accesses patient demographics; computer entry and interpretation of ABO/Rh tests; repeat blood typing at the time of crossmatch if only one patient blood type is on record; and warning if there are nonconcordant current and historical blood types. The computer crossmatch SOP requires bar code entry of specimen accession and donor unit numbers; release of group O red cells pending resolution of discrepancies; and immediate-spin crossmatch during computer downtime. Tables validated on-site prompt warning messages and prevent both computer crossmatch and release if blood components of the wrong ABO type are selected. RESULTS: These SOPs meet the requirements of the 15th edition of the AABB Standards. Projected annual time savings at this institution are > 100,000 workload recording units. Further benefits include reduced patient sample volume requirements, less handling of biohazardous material, and elimination of unwanted positive or negative reactions associated with the immediate-spin crossmatch. Release of incompatible blood components when the wrong patient blood type is on record is addressed by requiring the use of group O red cells in the absence of two concordant blood types, one of which must be from a current sample. CONCLUSION: A combination of existing computer programs and carefully developed SOPs can provide a safe and efficient means of detecting donor-recipient incompatibility without performance of serologic crossmatch.

ABO Blood-Group System↗

When is a unit of blood transfused relative to its date of expiration?

Analysis of computer-generated data from 42,902 transfusions of red cells or whole blood reveales that 30 percent of Rh-positive and 46.5 percent of Rh-negative units of blood will be lost from inventory if the permissible storage time for blood is immediately reduced to 25 days. These data indicate that, should such a reduction be adopted as a means of preventing transfusion-transmitted Yersinia infection, the blood banking industry will have serious difficulties in maintaining an adequate blood supply.

Blood Banks↗

Blood use during extracorporeal membrane oxygenation.

An analysis of the transfusion records of 91 neonatal patients subjected to extracorporeal membrane oxygenation (ECMO) is reported. Mean daily blood usage was 250 mL of red cells (RBCs), 80 mL of fresh-frozen plasma, and 2 units of platelets. Average time on ECMO was 4.6 days. Group O or ABO type-specific RBCs and group AB or ABO type-specific plasma products and platelets were transfused. RBCs were not washed, and neither RBCs nor other components were tested for anticytomegalovirus (CMV) or irradiated. No cases of posttransfusion CMV infection or graft-versus-host disease were observed. Hemolysis in eight patients was traced to occlusions in the ECMO circuit. All but three patients survived ECMO. Contrary to a previous report, an active ECMO program for neonatal patients imposes a minimal burden on the hospital transfusion service.

Bilirubin↗

Is a room-temperature crossmatch necessary for the detection of ABO errors?

The detection of anti-A and anti-B isohemagglutinins by low-ionic-strength saline tests at 37 degrees C and by the indirect antiglobulin technique, without an "immediate'spin" or room-temperature phase, has been studied. Using such a procedure, all but one of 2746 patient blood samples reacted in accordance with ABO type when tested against A2 and B red cells. However, the discrepant sample also was nonreactive when tested by "immediate-spin" technique against saline-suspended A2 red cells. Our findings indicate that compatibility tests performed at 37 degrees C in low-ionic-strength saline are as sensitive as "immediate-spin" tests with saline-suspended red cells for the detection of ABO errors. Performing serologic tests for unexpected alloantibodies and donor-recipient compatibility without an "immediate-spin" or room-temperature phase abbreviates pretransfusion testing and reduces the detection of clinically insignificant alloantibodies solely reactive at room temperature.

ABO Blood-Group System↗

The evaluation of a positive direct antiglobulin test (autocontrol) in pretransfusion testing revisited.

Direct antiglobulin tests (DATs) using anti-IgG were performed on 65,049 blood samples from prospective transfusion recipients; 3570 tests (5.49%) were positive. Using criteria published previously (primarily excluding patients not transfused within the preceding 14 days), 778 samples from other than neonatal patients were selected for further evaluation. Eluates that did not react were obtained on 518 (66.6%) of these samples. Warm-reactive autoantibodies were apparent in 192 eluates, while 16 contained drug-related antibodies, anti-A or anti-B from prior transfusion with ABO mismatched blood components, or anti-D passively acquired from immune serum globulin. Fifty-two eluates contained alloantibodies; however, in only six of these cases did the corresponding serum lack unexpected alloantibodies, as determined by routine pretransfusion studies. Three additional weakly reactive clinically significant alloantibodies were detected solely through additional serum tests performed on DAT-positive samples. On the basis of these findings, the DAT had a low predictive value when used to detect the early manifestations of an immune response to recently transfused red cells. Elimination of the autocontrol from routine pretransfusion testing, therefore, carries minimal risk to patients yet will undoubtedly contribute to the containment of health care costs. Moreover, the risk is lower than that associated with the elimination of the antiglobulin crossmatch.

Antibody Specificity↗

Blood component therapy during the neonatal period: a national survey of red cell transfusion practice, 1985.

A questionnaire to determine patterns of neonatal red cell transfusion practice during 1985 was mailed to 2200 blood banks of American Association of Blood Banks (AABB) institutional members and children's hospitals. There were 915 responses (41.6%); 785 responses (86%) contained sufficient data for analysis. The majority (70.6%) of 785 responding hospitals were community/urban institutions. However, more highly specialized, pediatric hospitals were also represented by 92 university/tertiary-care hospitals (11.7% of respondents) and 29 children's hospitals (3.7% of respondents). Two-thirds of hospitals performed a major antiglobulin crossmatch (rather than an abbreviated one) before all neonatal red cell transfusions. The red cell preparation most frequently selected for small-volume transfusions was ABO and Rh group-specific red cell concentrates. When performing only large-volume exchange transfusions, 19.2 percent of hospitals used whole blood; all others prepared reconstituted units of red cells plus fresh-frozen plasma, a practice that frequently causes exposure to two donors per unit. Another practice likely leading to multiple donor exposure is the use of fresh-frozen plasma to adjust the hematocrit of red cell preparations to a predetermined value prior to a small-volume transfusion. Over one-half of hospitals adjusting hematocrits used plasma, presumably from one donor, to dilute packed red cells from another donor, a practice that has no apparent medical benefit. Most hospitals (63.4%) provided red cells with a reduced risk of transmitting cytomegalovirus; blood from seronegative donors was selected by 65 percent of hospitals. The majority of hospitals, including most of the community/urban hospitals, did not irradiate blood products before transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion↗