Comparison of Polybrene DAT and Conventional DAT in Cases of Suspected DAT Negative Autoimmune Hemolytic Anemia (AIHA)

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S160-S161
Author(s):  
S Sultana ◽  
R Balbuena-Marle ◽  
C Tormey ◽  
J Gollan ◽  
R Skeret
Keyword(s):  
Hemolytic Anemia ◽  
No Value ◽  
Signs And Symptoms ◽  
Blood Bank ◽  
Red Cross ◽  
American Red Cross ◽  
New Haven ◽  
Hexadimethrine Bromide ◽  
Study Sites ◽  
Time Standard

Abstract Introduction/Objective A negative Direct Antiglobulin Test (DAT) is seen in approximately 1-5% of patients presenting with signs and symptoms of immune hemolysis. A well-performed ‘standard’ DAT detects ~100-500 molecules of bound IgG per red cell. A more sensitive polybrene DAT may be helpful in order to confirm a diagnosis of AIHA in patients whose samples have tested negative via standard DAT. However, there has been little reported on utility of the polybrene DAT in evaluating such cases with modern DAT reagents. We hypothesized that the polybrene DAT would not contribute substantially to the analysis of Coombs-negative hemolytic anemia (C-NHA), based primarily on our anecdotal observation. As such, we undertook a study to assess results of polybrene DAT in cases evaluated for possible (C-NHA). Methods/Case Report Two study sites were used for data analysis (Yale-New Haven Hospital, Site A, and VA Connecticut, Site B) over a five year period (2016-2021). During this time, standard DATs were performed at both study sites by the tube method using polyspecific antiglobulin and, if positive, reflex to anti-IgG and -C3. For cases of suspected C-NHA (which are reported to Blood Bank via a consult mechanism), conventioned DAT- samples are referred to our regional immunohematology laboratory (American Red Cross, Farmington, CT) for manual hexadimethrine bromide (Polybrene) DAT. Polybrene DAT is reported as negative with two sources of polyspecific AHG. Subsets of patients also underwent acid elution studies (Gamma ELU-KITII) as part of a C-NHA algorithm developed during the study period. Results of standard DAT, acId elution, and polybrene DAT were extracted from Blood Bank electronic records at both study sites. Results (if a Case Study enter NA) Evaluation for C-NHA was performed in 32 patients/cases over the study period. Amongst these individuals, 96.8% (31/32) underwent polybrene DAT assessment and none (0%; 0/31) demonstrated a positive polybrene DAT result. Notably, acid elution studies were performed in 90.6% (29/32) of traditional DAT negative cases. Of these, 10.3% (3/29) had reactive eluates. Conclusion Performance of the polybrene DAT appeared to be of no value in the assessment of suspected C-NHA. Given that nearly 10% of individuals with a negative conventional DAT had a positive acid elution, this testing step appears to be of greater value in potentially identifying an autoantibody in suspected cases of C-NHA.

Construction of An Outpatient Erythrocytapheresis Program for Pediatric Patients with Sickle Cell Disease

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4067-4067
Author(s):  
Paulette Bryant ◽  
Richard Parmley ◽  
Christine Bolen ◽  
Theresa Sunderland ◽  
Robert Johnson ◽  
...  
Keyword(s):  
Iron Overload ◽  
Sickle Cell ◽  
Nursing Staff ◽  
Pediatric Patients ◽  
Blood Bank ◽  
Red Cross ◽  
American Red Cross ◽  
Double Lumen ◽  
Intravenous Access ◽  
Sickle Hemoglobin

Abstract An Erythrocytapheresis program was started at our institution in October 2006 for pediatric patients with sickle cell anemia who suffered from stroke(n=4) or chronic pain syndromes(n=3) with iron overload (n=6). Singer et al. (1999) along with others demonstrated that erythrocytapheresis is useful in preventing iron overload, and decreasing blood viscosity. In spite of the benefits there are many barriers to starting such a program, including repeated intravenous access, cost, location and complications of central venous devices. Five patients received double lumen Titanium 9.6 gauge Vortex pheresis port. Temporary double lumen, femoral pheresis catheters were placed and removed for each procedure in 2 patients exclusively and in a third patient who initially had a port. Non-coring Pheresis 16 gauge high flow needles were used to access ports manufactured initially by Arrow and now BAXA. Immediately after accessing, heparin (1000units/ml) was removed and Altepase (2 mg/ml) was placed in each lumen for 30 minutes. The Carolinas Region American Red Cross performed the pheresis procedure by Cobe Spectra following manufacturer guidelines. Once the procedure was completed each lumen of the port-a-cath was flushed with 1000 units/ml of heparin to fill the volume of the lumens. Ionized calcium levels were monitored and calcium gluconate was given as needed for each procedure. The goal was to keep the patient hemoglobin at 10 g/dl and %sickle hemoglobin less than 30% except for 2 patients in which we set a target percentage of sickle hemoglobin less than 20%. One patient had progressive stenosis and one had a repeat stroke on chronic erythrocytapheresis. These were the only two patients that had progressive disease and these were the only patients who had episodes of % sickle hemoglobin between 31% and 46% (two occasions for each patient). Average time of pheresis was 1 hour and 40 minutes. Initial pheresis procedures were performed in the pediatric intensive care unit (90 procedures) and those with ports were performed in an outpatient setting without increase in complications (20 procedures). All Patients were typed and crossed 2 days before procedure for phenotypically matched blood. The initiation of the pheresis program required cooperation from the American Red Cross, inpatient and outpatient nursing, PICU, radiology, blood bank, laboratory and the practice business managers. The providers and nursing staff developed a standard policy for pheresis port management and an order set for the scheduled monthly procedures. Secure emails between the hematology providers, the Red Cross, hospital blood bank, and nursing staff would confirm scheduled dates, times and the amount of blood needed for each procedure. North Carolina Medicaid usually reimbursed 25% of the pheresis procedure charges which did not include blood products, supplies and physician fees. Two patients with ports have had significant complications: SVC syndrome and Infection associated with surgical placement resulting in port removal. One patient using the femoral pheresis catheter developed atrial flutter during the procedure. Serum ferritin for all patients decreased. None of the patients developed red cell allo-antibodies. All patients’ using femoral pheresis catheters did not have any clinical signs or radiographic abnormalities suggestive of thrombus or scarring. Vortex ports proved reliable in outpatient erythrocytapheresis and required no patient maintenance, admission to the ICU or repeated sedation as needed for femoral catheter placement. Important factors in starting a chronic pheresis program for these complex patients include the following: communication between all involved departments, well equipped location to support cardiac or neurologic complications reliable intravenous access, staff familiar with the Vortex port and pheresis catheters, supportive apheresis team from the American Red Cross, disclosure of possible cost to the institution and standardized policies and procedures for all locations.

Measuring Intent to Aid of Lay Responders: Survey Development and Validation

2017 ◽  
Vol 45 (5) ◽  
pp. 730-740 ◽  
Author(s):  
Brian Miller ◽  
Jeffrey L. Pellegrino
Keyword(s):  
Sudden Cardiac Arrest ◽  
Affective Domain ◽  
Red Cross ◽  
American Red Cross ◽  
Statistical Validation ◽  
Expert Review ◽  
The Social ◽  
Two Samples ◽  
Intent To Use ◽  
Development And Validation

Background. Increasing lay responder cardiopulmonary resuscitation and automated external defibrillator use during sudden cardiac arrest depends on an individual’s choice. Investigators designed and piloted an instrument to measure the affective domain of helping behaviors by applying the theory of planned behavior (TPB) to better understand lay responders’ intent to use lifesaving skills. Method. Questionnaire items were compiled into 10 behavioral domains informed by the TPB constructs followed by refinement via piloting and expert review. Two samples from an American Red Cross–trained lay-responder population ( N = 4,979) provided data for an exploratory (EFA, n = 235) and confirmatory (CFA, n = 198) factor analyses. EFA derived interitem relationships into factors and affective subscales. CFA yielded statistical validation of factors and subscales. Results. The EFA identified four factors, aligned with the TPB constructs of attitudes, norms, confidence, and intention to act to explain 57% of interitem variance. The internal consistency of factor-derived subscales ranged between 0.71 and 0.91. Reduction of instrument items went from 47 to 32 (32%). The CFA yielded good model fit with the switching of the legal ramification item from the social norm to intention construct. Conclusion. The Intent to Aid (I2A) survey derived from this investigation aligned with the constructs of the TPB yielding four subscales. The I2A allows health education researchers to differentiate modalities and content impact on learner intention to act in a first aid (FA) emergency. I2A compliments cognitive and psychomotor measurements of learning outcomes. The experimental instrument aims to allow curricula developers and program evaluators a means of assessing the affective domain of human learning regarding intention-to-act in an FA emergency. In combination of with assessment of functional knowledge and essential skills, this instrument may provide curricula developers and health educators an avenue to better describe intention to act in an FA emergency.

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