• Home
  • EMCrit-RACC
  • PulmCrit
  • IBCC
  • EMNerd
  • Tox & Hound
  • iSepsis
  • About
    • About EMCrit
    • About PulmCrit
    • EMCrit FAQ
    • Subscription Options
  • Contact Us

EMCrit RACC

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

  • Airway
  • Archives
You are here: Home / EMCrit-RACC / EMCrit 202 – Blood Bank Essentials with Joe Chaffin

EMCrit 202 – Blood Bank Essentials with Joe Chaffin

June 25, 2017 by Scott Weingart 15 Comments


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

  • When to Transfuse Plasma
  • Intro to Apheresis
  • Treatment of TTP

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…

http://media.blubrry.com/emcrit/p/traffic.libsyn.com/emcrit/EMCrit-Podcast-20170626-202-Blood-Bank-Essentials.mp3

Podcast: Play in new window | Download (28.5MB) | Embed

Subscribe: Apple Podcasts | Android | Google Podcasts | RSS | More

  • About
  • Latest Posts

Scott Weingart

An ED Intensivist from NY.

Latest posts by Scott Weingart (see all)

  • EMCrit Podcast 241 – Sepsis Update 2019 - February 21, 2019
  • EMCrit Podcast 240 – Renal Compartment Syndrome & It's all about the Venous Side and We've Been Fracking it up for Years - February 10, 2019
  • EMCrit 239 – Vent Alarms = Code Blue - January 26, 2019

Share this:

  • Facebook
  • Twitter
  • Reddit
  • Pinterest
  • Email
  • Print

Filed Under: EMCrit-RACC Tagged With: podcasts

Cite this post as:

Scott Weingart. EMCrit 202 – Blood Bank Essentials with Joe Chaffin. EMCrit Blog. Published on June 25, 2017. Accessed on February 22nd 2019. Available at [https://emcrit.org/emcrit/blood-bank-essentials/ ].

Financial Disclosures

Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.

You finished the 'cast,
Now get CME credit

Already an EMCrit CME Subscriber?
Click Here to Get CME Credit for the Episode


Not a subcriber yet? Why the heck not?
By subscribing, you can...

  • Get CME hours
  • Support the show
  • Write it off on your taxes or get reimbursed by your department

Sign Up Today!


.

Subscribe Now

If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the Resuscitation and Critical Care goodness.

This Post was by the EMCrit Crew, published 2 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.

15
Comment Here

avatar
Role
8 Comment threads
7 Thread replies
7 Followers
 
Most reacted comment
Hottest comment thread
9 Comment authors
Scott WeingartKavitaEric SiegalDavid M BeckmannJem O Recent comment authors
avatar
Role
newest oldest most voted
LandOfTheLongWhiteCoat
Guest
LandOfTheLongWhiteCoat

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

Vote Up2Vote Down  Reply
1 year ago
Joe Chaffin
Guest
Joe Chaffin

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

Vote Up1Vote Down  Reply
1 year ago
Austin Schrader
Guest
Austin Schrader

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?

Vote Up0Vote Down  Reply
1 year ago
Joe Chaffin
Guest
Joe Chaffin

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).

Vote Up0Vote Down  Reply
1 year ago
Michael Jasumback
Guest
Michael Jasumback

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.

Vote Up0Vote Down  Reply
1 year ago
Michael Jasumback
Guest
Michael Jasumback

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?

Vote Up0Vote Down  Reply
1 year ago
Scott Weingart
Author
Scott Weingart

yep!!!!

Vote Up0Vote Down  Reply
1 year ago
Jem O
Guest
Jem O

Love this. Thanks. I am curious about the future of Prothrombin complex concentrates and ffp. Wonder what the newest studies say.

Vote Up0Vote Down  Reply
1 year ago
David M Beckmann
Guest
David M Beckmann

I would love to here Joe.s take on use of whole blood!

Vote Up0Vote Down  Reply
1 year ago
Joe Chaffin
Guest
Joe Chaffin

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.

Vote Up0Vote Down  Reply
1 year ago
Eric Siegal
Guest
Eric Siegal

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

Vote Up0Vote Down  Reply
1 year ago
Joe Chaffin
Guest
Joe Chaffin

Eric, I’m sorry that I didn’t see this before now, but actually, it’s not the worst thing in the world, because of an article of which I just became aware (more in a sec). You are correct that there is not a ton of data on the use of viscoelastic hemostatic assays like TEG and ROTEM in trauma. There’s more in the cardiac surgery literature (and for the record, I’m a fan). The article I just mentioned is in the Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine (April 2017), lead author Fahrendorff (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390346/pdf/13049_2017_Article_378.pdf). It is a review and meta-analysis of TEG and ROTEM in acutely bleeding patients. As expected, it leans cardiac-heavy, but there’s a little bit on trauma, and the short answer is, “we don’t know yet.” I can’t speak for Scott, but my personal experience with TEG-ROTEM is also very cardiac surgery-heavy. I’ve seen it used in trauma, and I’ve heard people swear by it, but as you experienced, I’ve also heard people swear AT it!! From the cardiac experience I’ve had, though, I’d say that if you are going to use it, you have to “buy in.” What I mean is, I don’t think that picking… Read more »

Vote Up0Vote Down  Reply
1 year ago
Eric Siegal
Guest
Eric Siegal

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.

Vote Up0Vote Down  Reply
1 year ago
Kavita
Guest
Kavita

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.

Vote Up0Vote Down  Reply
1 year ago
Scott Weingart
Author
Scott Weingart

that will be part II

Vote Up0Vote Down  Reply
1 year ago

Follow EMCrit Everywhere

Click for More Subscribe Options


Other Stuff

  • Have a great idea for the next podcast? Share it here!
  • Tough Questions. Maybe you have an answer!
  • When you're done listening to the podcast,
    check out these great sites.

Who We Are

We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM.

Like Us on Facebook

Like Us on Facebook

Subscribe by Email

EMCrit is a trademark of Metasin LLC. Copyright 2009-. This site represents our opinions only. See our full disclaimer, our privacy policy, and here for credits and attribution.

wpDiscuz
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.