scholarly journals Prevalence of erythrocyte alloimmunization in polytransfused patients

2011 ◽  
Vol 9 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Roberto de Oliveira Cruz ◽  
Mariza Aparecida Mota ◽  
Fabiana Mendes Conti ◽  
Ricardo Antônio d'Almeida Pereira ◽  
Jose Mauro Kutner ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Blood Cells ◽  
High Probability ◽  
Low Frequency ◽  
Albert Einstein ◽  
Red Cell ◽  
Hemolytic Disease ◽  
High Incidence ◽  
Transfusion Reactions

Objective: To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. Methods: A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The records of all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. Results: During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most common specificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolated or combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. Conclusion: Polytransfused patients have a high probability of developing alloantibodies whether alone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to prevent alloimmunization and hemolytic transfusion reactions.

Correlation of Red Blood Cells and Platelets Parameters.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3764-3764
Author(s):  
Zoi Saouli ◽  
Georgia Kaiafa ◽  
Fotios Girtovitis ◽  
Zisis Kontoninas ◽  
George Ntaios ◽  
...  
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Red Cell ◽  
Blood Cell Count ◽  
Distribution Width ◽  
Mean Values ◽  
Cell Parameters ◽  
The Mean

Abstract INTRODUCTION: Platelet along with red blood cell count is a part of complete blood cell count, one of the most frequent laboratory tests in medicine. Platelet distribution width, plateletcrit and mean platelet volume are three indices provided by hematological analyzers. There are few reports in literature regarding the correlation of these three parameters with red blood cell parameters. AIM: Aim of this study is to investigate the correlation between these platelets parameters and red cell parameters: hematocrit, mean corpuscular volume and red blood cell distribution width. METHODS: Three hundred and three healthy blood donor volunteers (176 men and 127 women, mean age 37,3 years) were included. None of them had any known hematological disease in the past. The parameters mentioned above were measured by the automated hematological analyzer Coulter®LH780. RESULTS: The mean values for platelets were: PCT: 0,25±0,11%, MPV: 8,11±1,94 fL and PDW: 15,89±2,74%. The mean values for their parallel red blood cell parameters were: HCT: 40,55±2,63%), MCV: 91±4,17 fL, RDW: 13,3±1,35% Statistical and regression analysis including the correlation coefficient between platelet and red cell parameters as well as Student’s t-test was carried out. CONCLUSIONS: There seems to be no significant correlation between HCT and PCT. MCV and MPV were not correlated significantly as well, indicating that red blood cell and platelet sizes are independent. But there is a statistically significant correlation between RDW and PDW (r: 0,68, p<0,01) demostrating that anisocytosis of red blood cells and platelets might occur simultaneously. Based on these observations, further more studies should be carried out for the correlation between platelets and red blood cell indices in certain disorders.

scholarly journals The Effects of Concentrated Eluted Anti-Red Blood Cell Antibodies on the in Vivo Survival of Normal Red Blood Cells

Blood ◽  
1960 ◽  
Vol 15 (4) ◽  
pp. 525-533 ◽  
Author(s):  
NEIL W. CULP ◽  
HUGH CHAPLIN
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
Hemolytic Anemia ◽  
Normal Control ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Red Cells ◽  
Significant Alteration ◽  
Red Cell

Abstract 1. A method has been described for the preparation and sterilization of a concentrated eluate from human red cell stroma. 2. Red cells sensitized by such an eluate prepared from normal control red cells showed entirely normal in vivo survival, as did cells sensitized by eluate from anti-H coated cells. 3. Sensitization of red cells by concentrated eluates from a patient with Coombs-negative acquired hemolytic anemia and from a patient with Coombs-positive acquired hemolytic anemia did not cause significant alteration in the in vivo survival of the red cells. 4. Red cells sensitized by the concentrated eluate from anti-D sensitized cells disappeared from the recipient’s circulation very rapidly and were sequestered in the spleen, indicating preservation of the physiologic properties of the antibody throughout the elution, concentration and sterilization procedures.

scholarly journals Safety and Tolerability of Donor Type Red Blood Cell Transfusion before Allogeneic Stem Cell Transplantation in Children with Major ABO Mismatch

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3415-3415
Author(s):  
Andrea Jarisch ◽  
Jan Soerensen ◽  
Emilia Salzmann ◽  
Eva Rettinger ◽  
Andre Manfred Willasch ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Research Funding ◽  
Pure Red Cell Aplasia ◽  
Red Blood Cell Transfusion ◽  
Red Cell ◽  
Donor Type ◽  
Transfusion Reactions ◽  
Rbc Transfusion

Abstract Background Major ABO mismatch in allogeneic bone marrow transplant (BMT) can cause clinical problems like severe transfusion reactions, acute haemolysis, and delay of red blood cell (RBC) engraftment or manifestation of pure red cell aplasia, related to circulating isoagglutinin titers. Even there is no increased incidence of graft failure or slower engraftment of neutrophils and platelets ABO mismatch leads to an increase of transplant related mortality. To reduce circulating isoagglutinin titers pre transplant plasma exchange during conditioning period can be performed. This procedure can be wearing for the patient and rebound effects are observed. RBC depletion can cause a loss of CD34+stem cells in bone marrow. A further strategy to reduce circulating isoagglutinin titers is in vivo immunoadsorption due to donor type RBC transfusion pre transplant. Aim of the study The Aim of the retrospective single center study was to investigate the safety and tolerability of donor-type red blood cell transfusion prior to allogeneic stem cell transplantation in children with major ABO mismatch. Methods From 2007-2015 37 children (median age 7 years, range 0.6-18.4) received an ABO mismatched RBC transfusion (2-3 ml KG BW) pre transplant under antihistaminic and steroid cover. Reaction to donor type RBC and graft transfusion, number of donor type RBC transfusions, haemolysis parameters, and trend of isoagglutinin titers, and engraftment data were observed. Wilcoxon signed-rank test was used to examine the difference between the paired values of titers (Conventional test tube, CTT; titration method using nonspecific anti-IgG antibody; Anti-IgG gel titer) before and after donor type RBC transfusion. Age and time until engraftment were reported using median and ranges. The quantitative values were reported using frequency and percentage. All statistical tests were two-sided with a significance level of 5%. Data analysis was performed using commercial software R.Statistical methods. Results Safety of mismatched RBC transfusions Compared with accidentally transfused RBC no severe complications are observed in our cohort. 34 (92%) children presented no reactions (Grade 0), 1 child had a minimal oxygen demand,1 child showed a mild hypertension (Grade 1) and 1 child a moderate hypertension, requiring treatment. Neither severe reactions nor anaphylactic shock were observed. Efficiency of mismatched RBC transfusion A significant reduction of isoagglutinin titers was defined as a final titer of 1:4 or at least a reduction of 3 titer steps was achieved. 23 of 37 (64%) required 1 donor type RBC transfusion to reduce significant the isoagglutinin titers, 8 patients (22%) needed a second and 5 patients (14%) a third transfusion. Figure 1 showed the significant reduction of isoagglutinin titers in the different patients groups after donor type RBC transfusion. The pairwise analysis of isoagglutinin titers indicates that the initial titer of patients required one donor type transfusion of RBC was significant lower than in the patient group required 2 or 3 transfusions. Engraftment data The median time to WBC and platelet engraftment was 21.5 (range 19-24) and 28 (range 26-60) days respectively. Haemolysis parameter post mismatched RBC transfusion Haemolysis parameter lactat dehydrogenase (LDH) and bilirubin was determined on a daily base. In all patients no significant increase of bilirubin levels was observed. Conclusion Donor type RBC transfusion is a safe, tolerable and effective procedure to reduce the isoagglutinin titers prior to allogeneic ABO mismatched bone marrow transplantation in children. In our cohort no severe transfusion reactions, acute haemolysis, delay of engraftment or manifestation of pure red cell aplasia was observed. Figure Figure. Disclosures Jarisch: Novartis: Consultancy. Bader:Novartis: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Medac: Research Funding; Riemser: Research Funding; Neovii: Research Funding.

scholarly journals Microangiopathic Hemolytic Anemia Associated with Radiation-Induced Hemangiosarcomas

1980 ◽  
Vol 17 (4) ◽  
pp. 443-454 ◽  
Author(s):  
A. H. Rebar ◽  
F. F. Hahn ◽  
W. H. Halliwell ◽  
D. B. DeNicola ◽  
S. A. Benjamin
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
Hemolytic Anemia ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Red Cell ◽  
Microangiopathic Hemolytic Anemia ◽  
Neoplastic Tissue ◽  
Cell Parameters ◽  
Radiation Induced

A retrospective study of red blood cell parameters in 53 dogs with experimental radiation-induced hemangiosarcoma showed 24 had anemia. Morphologic alterations in red blood cells in peripheral blood films from anemic dogs included signs of regeneration (anisocytosis and polychromasia), hypochromasia, red cell fragmentation and acanthocytosis. The degree and type of red cell changes varied from dog to dog and generally correlated with the principal site of tumor involvement. Blood from dogs with tumors principally involving liver had red cell regeneration, fragmentation and acanthocytosis. Blood from dogs with tumors primarily involving the heart had only red cell fragmentation. Blood films from dogs with skeletal and pulmonary hemangiosarcomas were similar to blood films from dogs with hepatic hemangiosarcoma except that red cell alterations generally were less severe. Scanning and transmission electron micrographic evaluation of neoplastic tissue showed large amounts of fibrin within neoplastic vascular sinuses and disruption and distortion of red blood cells traversing these abnormal vascular beds. The red blood cell fragmentation syndrome associated with radiation-induced hemangiosarcomas therefore was considered to be a microangiopathic hemolytic anemia of localized origin.

Changes in plasma phospholipids after intravenous phosphatidase A injection in the rabbit

1962 ◽  
Vol 203 (1) ◽  
pp. 114-118 ◽  
Author(s):  
Chaja Klibansky ◽  
Eleanor Condrea ◽  
Andre De Vries
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Cell Shape ◽  
Marked Decrease ◽  
Blood Stream ◽  
Red Cell ◽  
Plasma Phospholipids ◽  
Red Cell Shape

Intravenous injection of snake venom phosphatidase A into rabbits produced rapid and marked changes in the plasma phospholipids. Five to fifteen minutes after injection there was a marked decrease in plasma lecithin and an increase in plasma lysolecithin. At the same time red blood cell sphering had occurred and lysolecithin was found attached to the red blood cells. Within 2 hr after injection the plasma lysolecithin dropped toward normal, whereas plasma lecithin remained low. The decrease in plasma lysolecithin was paralleled by reversion of the spheric red cell shape to normal bidiscoid. Evidence was obtained for disappearance of plasma phospholipids from the blood stream after phosphatidase injection.

Effect of osmolality on red blood cell viscosity and transit through the lung

1977 ◽  
Vol 42 (6) ◽  
pp. 941-945 ◽  
Author(s):  
R. M. Effros ◽  
R. S. Chang ◽  
P. Silverman
Keyword(s):  
Sodium Chloride ◽  
Blood Cell ◽  
Red Blood Cells ◽  
Cell Size ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Relative Rate ◽  
Red Cell ◽  
Transit Times ◽  
The Mean

The mean transit times of labeled red blood cells and albumin were compared in eight isolated rabbit lungs perfused with physiological albumin solutions. The osmolality of these solutions was adjusted by altering the concentration of sodium chloride. The ratios of the mean transit times of injected red blood cells to those of albumin increased as perfusion osmolality increased from hypotonic to isotonic and from isotonic to hypertonic levels. This change occurred despite a decline in pulmonary vascular resistance and red blood cell size as osmolality was increased. Red blood cell viscosity (determined with a cone-plate viscometer) increased with osmolality and it was concluded that this change of viscosity impaired the relative rate of red blood cell transit through the lungs. Passage of red blood cells through rigid homoporous membranes appeared to be related primarily to red cell size rather than vascosity. These observations suggest that both red blood cell viscosity and capillary distensibility play an important role in determining the velocity of red blood cells through the capillaries.

scholarly journals Correlation between Red Cell Distribution Width (RDW) with Kidney Function and Hematologic Parameters in Patients undergo Regular Hemodialysis

2020 ◽  
Vol 2 (4) ◽  
pp. 171-176
Author(s):  
Soraya Mourina Hutasuhut ◽  
Alwi Thamrin Nasution ◽  
M. Feldy Gazaly Nasution
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Red Cell Distribution Width ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Hematological Analysis ◽  
Regular Hemodialysis

Background. Red cell distribution width (RDW) is a coefficient of variation in red blood cells that can decrease erythropoesis or increase the destructiveness of red blood cells. The objectives of research  to determine the relationship of RDW as an inflammatory marker with renal function and hematological parameters in patients undergoing regular hemodialysis Method; Cross sectional research on 20 patients undergoing regular hemodialysis > 3 months in RSUP H Adam Malik Medan. Vital sign, antropometry and venous blood retrieval are performed  shortly  before hemodialysis. RDW measurement comes from the red blood cell distribution curve in hematological analysis and is an indicator of variation in red blood cell size. Result: out  of 20 subjek studies,  there were 13 men (65.0%) and 7 (35.0%) women The majority of subjects had comorbid  diabetes mellitus  14 (70.0%), hypertension 4 (20.0%). The average length of time patients underwent  hemodialysis was 24.45 ± 20.98 months. There is a significant correlation between RBW and creatinine, Hb, and neutropil (r: 0.519, p:0,019*; r:  0.497,  p: 0.026*;r: 0.464,  p: 0.039*, respectively) Conclusion: There is a significant relationship between RBW and creatinine, Hb and neutropphils in patients undergoing regular hemodialysis > 3 months.

Unsuccessful Treatment with Lenalidomide in a Diamond-Blackfan Anemia Patient.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4219-4219
Author(s):  
Peter Joosten ◽  
Mels Hoogendoorn ◽  
Huib Storm ◽  
Robby Kibbelaar
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
Ribosomal Protein ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Ribosomal Proteins ◽  
Red Blood Cell Transfusion ◽  
Red Cell ◽  
Diamond Blackfan Anemia ◽  
Red Cell Aplasia

Abstract Abstract 4219 Background Diamond-Blackfan Anemia (DBA) is an autosomal dominant inherited bone marrow failure syndrome due to a defect in the ribosomal protein (RP) synthesis. Diagnostic criteria consist of presentation of anemia before birth with near normal or slightly decreased neutrophil counts, variable platelet counts, reticulocytopenia, macrocytosis, and normal marrow cellularity with a paucity of red cell precursors (Diamond et al 1976). Patient characteristics In 2002 a 34 year old man was presented with a hemoglobin (Hb) level of 2.4 mmol/l, a MCV of 117 fl, no reticulocytes and a normal leukocyte and platelet count. Except shortness of breath he had no other complaints. He did not use any medication. On physical examination there was only a short stature. Marrow cytology showed 20% erythropoesis with some dyserythropoesis. Marrow histology and cytogenetic were normal. A recent parvovirus infection was excluded. His medical history started in 1968 at the age of five weeks. A DBA was diagnosed and treated successfully with corticosteroids. There was a relapse at the age of 3 with again a good response on corticosteroids. In 2002 he was initially treated with 6 units of red blood cells, resulting in a rise of the Hb to 6.4 mmol/l. After five months he had a Hb of 3.8 mmol/l, a normal MCV and 50.109/l reticulocytes. Kidney and adrenal function were normal, there was no hypogonadism and no splenomegaly. Hb electrophoresis showed an elevated HbF of 6.4%. By exclusion of other causes of anemia, it was concluded that the anemia had to be considered as a relapse DBA. Corticosteroids (1 mg/kg) for 6 months did not show any improvement. Cyclosporine 100 mg two times a day raised the Hb above 8 mmol/l from November 2003 till May 2004. While on cyclosporine he relapsed again and became red blood cell transfusion dependent from February 2006. A search for a HLA identical donor at that time was unsuccessful. ATG, cyclosporine and corticosteroids did not diminish the need for red blood cell transfusion. In 2007 the RPS19 (ribosomal protein S19) mutation was demonstrated in this patient, which definitively confirmed the diagnosis made 35 years ago. In 2008, still red blood cell transfusion dependent, treatment with lenalidomide 10 mg/day for 21 days during each 28 days was initiated. Treatment considerations All mutated genes in DBA cause a decreased synthesis of ribosomal proteins. As a consequence erythroid progenitors and precursors are highly sensitive to apoptosis (Perdahl et al 1994). One of the mechanisms is activation of p53 (Danilova et al 2008). Both the 5q- syndrome and DBA show haploinsufficiency for closely related ribosomal proteins RPS-19 and RPS-14. It is assumed that the pathophysiology of the 5q- syndrome and DBA are the same (Ebert et al 2007). Because lenalidomide is effective in patients with the 5q- syndrome, lenalidomide was considered as treatment option in DBA at the Annual DBA International Consensus Conferences in 2008 and 2009. Results Due to severe pancytopenia, lenalidomide was stopped after 5 weeks. During the next 6 months a slow recovery of white blood cells and platelets was observed. Before and 3 months after the start of the lenalidomide treatment marrow cytology, histology and cytogenetics were done. Both times there was a red cell aplasia, no signs of myelodysplasia and no cytogenetic abnormalities. Rechallenge with lenalidomide in a dose of 10 mg each fourth day resulted again in a pancytopenia in 6 weeks time. Each 3 weeks 3 units of red blood cells are necessary ever since. Discussion and Conclusion Treatment of DBA with lenalidomide in this patient was unsuccessful and resulted in a temporarily and severe neutropenia and thrombocytopenia. These adverse effects are also documented in 62% of the 5q- syndrome patients treated with 10 mg Lenalidomide. Moreover, in retrospect, we doubt if lenalidomide can be effective when red cell aplasia is already present as a late complication of DBA. Disclosures: No relevant conflicts of interest to declare.

The Role of the Distal Erythropoietin Receptor in Iron Deficiency Anemia

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1312-1312
Author(s):  
Grant C. Bullock ◽  
Lorrie L. Delehanty ◽  
Anne-Laure A Talbot ◽  
Chante Richardson ◽  
Adam Goldfarb
Keyword(s):  
Iron Deficiency ◽  
Blood Cell ◽  
Red Blood Cells ◽  
Signaling Pathways ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Deficiency Anemia ◽  
Red Cell ◽  
Iron Restriction

Abstract Abstract 1312 Anemia affects the quality of life and the life expectancy of millions of people in the U.S. Many patients are either intolerant or unresponsive to available treatments, so alternative strategies are needed. Red blood cell production requires the action of erythropoietin (Epo) on red blood cell precursors in the bone marrow. Iron restriction results in loss of Epo-responsiveness and anemia, despite increased serum Epo levels. Iron infusion restores Epo-responsiveness suggesting that iron dominantly regulates Epo-receptor (EpoR) signaling. Understanding how iron restriction regulates EpoR signaling pathways has major clinical significance. Agonists could offer an iron-free approach that enhances the response to Epo in anemia due to iron deficiency or chronic diseases. In addition, antagonists could be used to treat polycythemia vera or other myeloproliferative disorders. We have discovered that the aconitases, multifunctional iron-sulfur cluster proteins that convert citrate into isocitrate are key in connecting iron to Epo-signaling in early erythroid progenitors (GC Bullock, et. al. Blood 2010;116:97). We also discovered that isocitrate, the downstream product of aconitase, can enhance the effectiveness of Epo during iron deficiency in vitro and in vivo in mice with IDA. These observations suggest that isocitrate or derivatives of isocitrate that synergize with erythropoiesis stimulating agents (ESAs) have important therapeutic application in the treatment of anemia. Deletion of EpoR in mice is incompatible with life, however mice and humans that express truncated EpoR show increased production of red blood cells. These observations suggest that the distal cytoplasmic domain of the EpoR inhibits production of red cells and may play a critical role in iron deficiency anemia. EpoR mutant mice lacking the distal half of the cytoplasmic domain of the EpoR (EpoR-H mice) and mice with the same EpoR truncation mutation plus an additional mutation of tyrosine 343 (EpoR-HM mice) show near normal levels of steady state erythropoiesis. To determine the role of the distal domain in erythroid suppression during iron deficiency, EpoR-H, EpoR-HM and EpoR-wildtype mice were fed a low iron diet and compared by weekly CBCs and flow cytometry. EpoR-H mutant mice continue to efficiently produce red blood cells during iron deficiency. And this occurs despite a decrease in hemoglobin. EpoR-HM mice produce fewer rbcs than EpoR-H mice, however rbc production by EpoR-HM mice resists the suppressive effects of iron restriction. Similar experiments also suggest that the distal EpoR is necessary for the isocitrate-mediated enhancement of Epo-driven erythropoiesis. In addition to aconitase/isocitrate and the distal EpoR other candidate key signaling components of this Epo-dependent, iron-responsive pathway have been identified in our recent preliminary experiments. These components include specific protein kinase C (PKC) isozymes, AKT1 and ERK1/2. These findings support a new model of iron sensing by aconitase/isocitrate that alters EpoR signaling to decrease red blood cell production and conserve iron when supplies are low. This model fits better than older “heme-deficiency” models because disorders in heme synthesis block red cell differentiation at a later stage. This model also has potential to explain changes seen in other tissues during chronic iron deficiency. Nutritional iron restriction may have unmasked a new role for the distal EpoR in red cell development and implicated new iron-responsive Epo signaling pathways that can be used to develop new therapeutic agonists and antagonists of Epo. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Case Study in Process Improvement to Minimize Delays from Obtaining Blood for Red Cell Exchange for a Patient with Sickle Cell Disease and Multiple Red Blood Cell Alloantibodies

2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Damodaran Narayanan ◽  
Noreen B. Hogan ◽  
Karen A. Schaser ◽  
Patricia Ruegsegger ◽  
William Nicholas Rose
Keyword(s):  
Sickle Cell Disease ◽  
Blood Cell ◽  
Process Improvement ◽  
Red Blood Cell ◽  
Blood Cells ◽  
Red Cell ◽  
Cell Disease ◽  
Clinically Significant ◽  
E Mail

The process of procuring several units of red blood cells for red cell exchange can sometimes take several hours to days, especially for patients with multiple clinically significant red cell alloantibodies. This can introduce delays, inconveniences, and even health challenges for the patient. For most planned exchanges, these delays are preventable with some foresight and process modifications that are relatively minor yet high leverage. We report a case study of process improvement whereby the apheresis nurse sends an e-mail to the blood bank when the nurse makes the patient’s next red cell exchange appointment as the signal to order blood about 6–8 weeks before the exchange.

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