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Chapter 20 - Transfusion Practices
- from Section VII - Neonatal Transfusion Medicine
- Edited by Pedro A. de Alarcón, Eric J. Werner, Robert D. Christensen, University of Utah, Martha C. Sola-Visner, Harvard University, Massachusetts
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- Book:
- Neonatal Hematology
- Published online:
- 30 January 2021
- Print publication:
- 18 February 2021, pp 329-366
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Summary
Neonatal transfusion therapy requires an understanding of the dynamic interactions of the fetomaternal unit, the physiologic changes that accompany the transition from fetus to neonate to infant, and the underlying pathophysiology of different hematologic disorders. Guidelines for neonatal transfusions remain controversial, since most have been extrapolated from evidence in adults or based on small studies in neonates with marginal statistical validity. Compared to older children and adults, neonates have small total blood volumes but high blood volume per body weight. Because of the limited capacity to expand their blood volume to compensate for their rapid growth, many sick and/or premature infants require significant blood component support, especially within the first weeks of life. Immaturity of many organ systems predisposes them to metabolic derangements from blood products and their additive solutions, and to the infectious and immunomodulatory hazards of transfusion, such as transfusion-acquired CMV (TA-CMV) infection and transfusion-associated graft versus host disease (TA-GVHD). Therefore, component modifications are often required to compensate for the infant’s small blood volume, immunologic immaturity, and/or compromised organ function, and constitute the uniqueness of neonatal transfusion therapy.
2502 The need for an evidence-based CTS specific IDP for early career training and for a long-term and sustainable career in clinical translational sciences
- Camille A. Martina, Janice L. Gabrilove, Naomi Luban, Cecilia M. P. Sutton
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, pp. 61-62
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- Article
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OBJECTIVES/SPECIFIC AIMS: To establish a conceptual framework to develop a CTS-IDP with data analytics, and an e-Learning Faculty Development Guide on best practices and use of the IDP over the CTS academic life-course. METHODS/STUDY POPULATION: To accomplish our goal, we propose the following methods: (1) an online survey, using a convenience sample of the 24 KL2 CTSA IDP Collaborative members (conducted in 2017), to assess perceived needs for a universal CTS-IDP, current IDP practices, barriers to IDP use, and to discern and align each CTSA Hub’s interests, expertise and commitment to specific areas of the study; (2) A scoping narrative literature review, utilizing the Arksey and O’Malley framework covering the time period corresponding to the initiation of funding (1999) of the original K30 Clinical Research Curriculum Awards through to the present CTSA funding period, incorporating Medical Subject Heading (MeSH) keywords (career development; career development plan; employee plan; mentoring plans; compacts; research contracts; career planning; mentor guide), initially delineated by USC reference librarian and to be expanded by reference librarian services from the Icahn School of Medicine at Mount Sinai and University of Rochester, and performed on NIH searchable databases including NCBI PubMed, Central and Medline & Worldwide Science; Web of Science, ProQuest, ProQuest Abi/Inform, Google Scholar, Cochrane, Ovid MEDLINE databases, as well as Google for published papers in English and Spanish. For this portion of the work, we will describe and characterize (1) research career development or progression constructs, domains, and milestones; (2) establish the presence or absence of defined and/or pre-specified timed milestone objectives and inclusion of SWOT analytics (strengths, weaknesses, opportunities, and threats) and/or Gantt chart approaches; (3) delineate IDPs structure, toolkits and their key features (competencies, skills acquisition and processes utilized); (4) and identify specific gaps to best address the need for personalized career development education. Based on this review, we will synthesize CTS milestones, develop a time frame for meeting RCD expectations, and establish RCD benchmarks for achieving these milestones, all in consensus with the IDP Collaborative Workgroup. RESULTS/ANTICIPATED RESULTS: Seventy-seven percent of the IDP CTSA’s responded to the online survey, led by University of Rochester, and the results can be summarized as follows: (1) 100% agreed that the IDP process is important and should be considerably improved to optimize effectiveness; (2) a range of diverse IDP formats are utilized, making comparisons across programs difficult; (3) 50% of CTSA hubs report only fair to good compliance with the IDP process; (4) a major barrier to the IDP process is lack of instruction regarding how best to utilize; (5) poor alignment of currently available IDPs designed for basic science PhDs with CTS investigators; (6) an absence of a CTS specific IDP to best foster RCD for this specific career trajectory. When asked: What are the barriers to writing a detailed and thoughtful IDP, responses in order of agreement from greatest to least were: No verification of acquired competencies, beyond self-report (56%), Static platform (38%), Not constructed for clinical and translational researcher (31%), No analytical or documentation on use (31%), No instruction given to scholars on how to use it effectively and efficiently (31%), The IDP we are using is more constructed for PhD students and postdoctoral fellows (25%), No instruction given to the scholars on why it is important as adult learners (19%), and Not constructed for early career physicians/scientist (13%). Additional progress has been made on our Scoping review: An initial ABI/Inform and PubMed USC research librarian conducted search using Author names yielded 72 articles, of which only 2 were relevant to the topic at hand. A ProQuest™ search yielded 19 potentially relevant articles, 11 of which were of relevance to the topic of IDPs; and a Google Scholar search yielded 18 and 25 on career development and self-management, respectively. This has enabled us to put forth an initial model of factors that impact the purpose and design of IDPs that includes? DISCUSSION/SIGNIFICANCE OF IMPACT: Discussion: Our initial data suggests that many CTSA institutions see the need to further enhance the mentoring process with a more informed and personalized IDP template and process. Furthermore, our initial scoping review suggests a framework upon which to build specific components of a more ideal and useful IDP to best guide mentored research career development of CTS trainees. Significance: Developing and evaluating collaborative evidence-based CTS IDP and corresponding e-Learning Guide could potentially prevent or reduce important delays in RCD, a common roadblock for the translation of clinical interventions. Ultimately, the CTS-IDP serves not only to support and frame a scholar’s RCD “habits of mind” during training and early career development but to also to achieve a sustainable long-term career at a CTS researcher equipped to meet the ever challenging and dynamic research landscape.
18 - Transfusion practices
- from Section VII - Transfusional medicine
- Edited by Pedro de Alarcón, Eric Werner, Robert D. Christensen
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- Book:
- Neonatal Hematology
- Published online:
- 05 February 2013
- Print publication:
- 10 January 2013, pp 303-327
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- Chapter
- Export citation
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Summary
Neonatal transfusion therapy requires an understanding of the dynamic interactions of the fetomaternal unit, the physiologic changes that accompany the transition from fetus to neonate to infant, and the underlying pathophysiology of different hematologic disorders. Guidelines for neonatal transfusions remain controversial, since most have been extrapolated from evidence in adults or based on small studies in neonates with marginal statistical validity. Compared with older children and adult’s, neonates have small total blood volumes but a high blood volume per body weight. Because of the limited capacity to expand their blood volume to compensate for their rapid growth, many sick and/or premature infants require significant blood component support, especially within the first weeks of life. Immaturity of many organ systems predisposes them to metabolic derangements from blood products and their additive solutions, and to the infectious and immunomodulatory hazards of transfusion such as transfusion-acquired cytomegalovirus (TA-CMV) infection and transfusion-associated graft vs. host disease (TA-GVHD). Therefore, component modifications are often required to compensate for the infant’s small blood volume, immunologic immaturity, and/or compromised organ function, and constitute the uniqueness of neonatal transfusion therapy.
Pretransfusion testing
A sample of cord blood is often collected in newborn infants at the time of delivery, but routine testing of cord blood for ABO group and Rh type is not necessary for healthy newborn infants unless the mother is Rh-negative and/or has a positive antibody screen (4). ABO and Rh type should be determined on samples obtained from both mother and baby for sick infants. Cord blood may be used for initial testing, but should be confirmed with an infant’s sample. The infant’s blood group is determined from the red cells alone, since the corresponding isoagglutinins anti-A and anti-B in the serum/plasma are usually weak or absent. Screening for atypical antibodies may be performed on maternal blood if available, or in the neonatal serum/plasma. A conventional cross-match is unnecessary if atypical antibodies are not demonstrable.
14 - Transfusion practices
- Edited by Pedro A. de Alarcón, University of Tennessee, Eric J. Werner
- Foreword by J. Lawrence Naiman, Stanford University School of Medicine, California
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- Book:
- Neonatal Hematology
- Published online:
- 10 August 2009
- Print publication:
- 18 August 2005, pp 349-375
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Summary
Transfusion therapy in the neonatal population requires an understanding of the dynamic interactions of the fetomaternal unit, the physiologic changes that accompany the transition from fetus to neonate and from neonate to infant, and the underlying pathophysiology of different hematologic disorders. Blood products utilized in neonates include packed red blood cells (PRBC), platelet concentrates, granulocyte concentrates, fresh frozen plasma (FFP), and cryoprecipitate, but modifications of the components are often required to compensate for the small blood volume, immunologic immaturity, and compromised organ function of the transfusion recipients, who may be premature and/or sick. Extremely low-birth-weight infants (birth weight <1000 g) invariably receive one or more RBC transfusions, especially in the first few weeks of life [1]. Intensive blood-bank support with PRBCs, platelets, and FFP is vital for neonates undergoing extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass [2, 3].
Although the transfusion of blood products has been an integral part of supportive care of critically ill neonates for decades, guidelines for transfusions remain controversial, since most have been extrapolated from evidence in adults or based on small studies in neonates with marginal statistical validity. The growing awareness of the hazards of blood transfusion, both among medical professionals and in the lay public, has led to a re-evaluation of this hitherto commonly accepted practice, with the development of strategies to minimize risk and improve benefits.
The High Rate of Blood Donor Exposure for Critically III Neonates
- Leigh G. Donowitz, Ronald B. Turner, Mary Ann M. Searcy, Naomi L.C. Luban, J. Owen Hendley
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 10 / Issue 11 / November 1989
- Published online by Cambridge University Press:
- 21 June 2016, pp. 509-510
- Print publication:
- November 1989
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The purpose of this study was to determine the number and volume of red blood cell (RBC) transfusions and the number of donors a newborn is exposed to during his or her newborn intensive care unit (NICU) stay. On one day at the Medical University of South Carolina (MUSC) and two days at the University of Virginia Hospital (UVH) all babies who had or were receiving RBCs comprised the study group. Patient records were reviewed at discharge. Fifty-two (70%) of the 75 NICU babies had or were receiving RBCs and were enrolled. The average number of RBC transfusions was nine (range 1 to 28, median 7) and the average transfusion volume was 16.5 ml (range 5 to 60) for a total volume of 148 ml transfused during a NICU stay. Each baby was exposed to an average of 6.9 donors (range 1 to 25, median 6.5). The practice of splitting RBC packs to share among different infants and of giving multiple small volume transfusions maximizes donor exposure and transfusion-related infectious risks in this population.
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