I wanted to do a show on the basics of the blood bank and there was no better guest than Joe Chaffin, MD. He is the CMO of the Lifestream Blood Center and a pathologist with expertise in transfusion medicine. I first came across Dr. Chaffin due to his extraordinary blog and podcast at bbguy.org. He started BBGuy.org in 1998 primarily to teach pathology residents. Today, the site exists to help anyone who wants to learn the essentials of blood banking and transfusion medicine. His teaching includes humor, occasional irreverence, and clear communication to highlight your path to understanding complex topics. I've been an avid listener since its inception, so it was a great honor to get him on the show.
At the same time we recorded this episode, I was interviewed for an episode of Joe's show. If you like what you heard here, check out that one as well:
Ep. 33 of the Blood Bank Guy Essentials Podcast
Topics of Discussion
- What actually is a type + screen
- What are you actually accomplishing with a crossmatch
- What type of FFP is acceptable for massive/emergent transfusion (PMID:28452877)
- Do we need to be type-specific with platelets
- What INR is acceptable for procedures
Episodes to Listen to Immediately on the BBGE Podcast
EMCrit Episodes Mentioned
- Podcast 197 – The Logistics of the Administration of Massive Transfusion
- Podcast 144 – The PROPPR trial with John Holcomb
- Podcast 71 – Critical Questions on Massive Transfusion Protocols with Kenji Inaba
Now on to the Podcast…
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Scott Weingart
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Hi, my name is Scott Weingart.
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15 Comments on "EMCrit 202 – Blood Bank Essentials with Joe Chaffin"
Hey Scott, I run a podcast for med students here in NZ and am 90% through writing an episode that looks literally identical to this! Great content, here in NZ so much blood is wasted through simple misunderstanding of G+S and XM. Thanks – Josh
Thanks for the opportunity, Scott! On the platelet ABO issue, I was also going to mention that there are some who believe that ABO incompatibility for platelets IS a bigger issue than we have thought in the past, but crossing those boundaries is still done hundreds if not thousands of times every day.
-Joe
Great Episode!!! I would love to hear the perspective on pre-hospital blood administration as it has been an up and coming trend for many Helicopter and Critical Care Transport programs throughout the US. Thoughts?
Scott and Dr. Holcomb addressed this previously in EMCrit 144. Pre-hospital component transfusion, to a blood banker, is a little scary from the regulatory perspective, but I have seen it done well (and it has been and is being studied in already published retrospective papers like the UPMC paper [http://www.journalacs.org/article/S1072-7515(15)00036-8/pdf], and in trials like PROHS [https://clinicaltrials.gov/ct2/show/NCT02272465] and PAMPer [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618798/]). As with other issues related to blood banking, my advice before moving down this pathway is to have detailed conversations with your blood bank team to understand just what it is they need and help them understand just what you need. As to whether it is actually EFFECTIVE, that’s a different question for which the above studies may give us a better answer (and I’ll leave to Scott to comment).
Sadly, there is no credible evidence to support any of the prehospital use of blood at this time. RePHILL is recruiting and will help answer this question. That doesn’t mean that it won’t work, physiologically, it should.
Great podcast as usual! Any chance of getting Joe back on to answer questions? Such as…..
When do I use CMV negative product? When should it be irradiated? When should we use cryo?
yep!!!!
Love this. Thanks. I am curious about the future of Prothrombin complex concentrates and ffp. Wonder what the newest studies say.
I would love to here Joe.s take on use of whole blood!
Well, David, I think that whole blood, especially “fresh whole blood” in massive transfusion situations makes sense! However, I think that if you ask any blood banker, we would say, “great idea…REALLLY hard to implement!” We aren’t really opposed, we just think it’s really difficult to do. Blood banks moved away from whole blood decades ago, when we started separating blood into components, and so the entire system is constructed to favor the use of individual parts of the blood. People smarter than me are thinking about this, though, and I hope that we can do something workable in the future, but for now, the 1:1:1-1:1:2 transfusion ratios discussed by Scott elsewhere is the closest approximation we can get in most places.
Scott,
I’d love to hear Joe’s thoughts on TEG and ROTEM as arbiters of the efficacy of coagulation. We rely on TEG in our cirrhotic and cardiac surgery patients, but have incrementally expanded its application to other patient populations as well. As examples, we use TEG to gauge platelet function in bleeding patients who are taking antiplatelet agents, or to reassure skittish proceduralists that the INR of 1.7 isn’t having any material impact on reaction time. Are any of these applications valid? Beats me. Not much literature out there.
As in the case of many tests, TEG helps me when it confirms my biases, and drives me nuts when it conflicts. I recently heparinized a patient for a PE and one of my partners ordered a TEG. The PTT was therapeutic, but the TEG reaction time was entirely normal. Was that patient anticoagulated? Hell if I know. I stuck with the PTT because that’s supported by the overwhelming preponderance of literature, but I fretted about it for quite some time.
Curious what you are doing and what Joe thinks about all of this.
Cheers,
Eric
Thanks for sharing that study. It’s consistent with what we’ve seen; TEG has decreased our use of blood products to correct coagulopathy. Which is presumably good.
Tests of clot kinetics make a lot intuitive sense to me. Deciding a patient’s coagulo-competency (you heard the term here first) based on a platelet count seems like deciding how sturdy a house is by counting the number of bricks.
I have pretty much bought in. Mostly. I think.
Thanks for a very interesting and helpful podcast, Dr W and Dr C. I still have one question I was hoping you would answer: which patients require irradiated products?
Thanks again for sharing your expertise.
that will be part II