This case, a portion of the presentation "Cases in Therapeutic Blood Management", describes the perioperative management of a 33-year-old patient with combined Factor V and Factor VIII deficiency requiring repeat mitral valve replacement.  At the time of admission his Factor V and Factor VIII were extremely low and his clinical condition was grave due to severe pulmonary hypertension.  He was successfully made replete with both coagulation factors with little to no bleeding during the procedure and postoperatively. This case highlights TPE as a promising modality for the treatment of patients with similar factor deficiencies.

The talk also involves a case study of a woman with both a lupus anticoagulant and major factor deficiency (Factor II). The patient had a significant bleeding over the past decade in the GI tract. Cerebral hemorrhage occurred during an admission of the fall of 2015.  She was found to have both a lupus anticoagulant and an acquired Prothrombin (Factor II) deficiency. She was treated with Therapeutic Plasma Exchange with an excellent Clinical Response.

Laura Brown graduated from the Faculty of Medicine at the University of Szeged in Hungary, and is currently a first-year pathology resident at the University of Kansas.   

Lowell Tilzer received his medical training; residency in Anatomic and Clinical Pathology, as well as his Ph.D. from the University of Kansas Medical Center. Dr. Tilzer was on the faculty of the Department of Pathology and Laboratory Medicine at the KU School of Medicine since 1978. In 1982, he was promoted to associate professor of pathology, and in 1990, to professor of pathology.

Dr. Tilzer been nationally recognized for his pathology research. He was the first to suggest use of anti-progestins for treatment of inoperable meningiomas, a treatment still used today. He invented and patented novel techniques for extracting DNA and RNA using gel barrier technology, and in 1990, started Isogene Biotechnology, Inc., a biotech company that sold DNA purification systems. Dr. Tilzer is also the co-author of the Laboratory Test Handbook, which was the second largest-selling laboratory medicine book in the country. Dr. Tilzer is nationally known for his expertise in Patient Blood Management.

Dr. Tilzer left KU in 1992 to pursue a career in the Blood Banking in Blood Centers throughout the Midwest and South.  He left his position in 2004 as CEO of the American Red Cross Southwest Region Blood Services to return to KU as Medical Director of the KU Hospital Clinical Laboratory. In 2009, he became Professor and Chairman of the Department of Pathology and Laboratory Medicine. He stepped down as Chair of the department in 2015 while remaining as a Professor in the department. He now also devotes time as one of the Medical Directors of Clinical Reference Laboratory overseeing Quality.

Case Study - It's a Bird, It's a plane, No, it's a...

Objectives:

1. Discuss the clinical manifestations associated with post transfusion purpura.
2. Discuss the testing required to diagnose post transfusion purpura and the common antibodies associated with post transfusion purpura.
3. List the recommended treatment for post transfusion purpura and recommendations for blood products for transfusion.

Julie is the technical supervisor of the Immunohematology Reference Laboratory at Community Blood Center. Julie got her Medical Technology training from Research Medical Center in Kansas City and her Specialist in Blood Bank training at Memorial Blood Center in Minnesota.  She has worked at Community for 25 years.

Discuss and review the literature concerning the use of red cell additive solutions for both large and small volume neonatal transfusion. The discussion will focus on some of the most common concerns associated with the transfusion of additive solutions to neonatal patients.

Lastly discuss and review the results of a survey conducted/published in 2015; the results of the survey address and include the following.

-Red cell additive solutions of choice for neonatal patients in a variety of clinical settings.

-Discuss policies concerning the usage of CMV Seronegative blood products for neonatal patients.

-Discuss policies concerning the usage of irradiated blood products for neonatal patients.

Ryan Pyles graduated from Forest Park Community College in May of 2012 with an Associates in Applied Sciences degree. Shortly after graduation, he started working at Cardinal Glennon Children’s hospital in St. Louis and is still currently employed there today. He is a member of the AABB’s Pediatric Subsection Committee.

Christina is the IRL Director for the Missouri-Illinois and Greater Ozarks-Arkansas Regions, with laboratories in St. Louis, MO, Little Rock, AR, and Lenexa, KS.  She began her IRL career with the American Red Cross in 1988 and also serves as an AABB IRL assessor. 

• Understand physiology of the phases of trauma coagulopathy 
• Understand how massive transfusion protocols work to alleviate the coagulopathy
• Understand logistics of massive transfusion protocol

Dr. Senaldi is board certified in anatomic and clinical pathology, and transfusion medicine.  He has twenty five years of experience in transfusion medicine as medical director for various blood centers in New York and New Jersey.  He now serves as the Medical Director of Community Blood Center of Greater Kansas City and is interim Director of Transfusion Services at St. Luke's Health System, Kansas City, MO. 

Thanks to genetic testing, we know more about chimeras than ever before. Once thought to be rare, we have discovered they are much more common than once believed!

Presentation Objectives:

1. Review the history of Chimeras
2. Describe the different types of chimeras and how they are classified
3. Explain current testing methods
4. Examine how modern day medical advancements have increased the incidence of chimeras
5. Discuss fascinating case studies

Brenda and her husband have recently moved back to the Midwest after living in the South for over 22 years. She has always worked as a generalist and enjoys the challenges of working in the core lab. Education is her passion. Previously as the Education Coordinator at Methodist LeBonheur in Germantown, Tennessee, she had the opportunity to supervise students during clinical rotations and oversee the employee competency program. She received her SBB from Indiana Blood Center in 2014. She is currently working at Children’s Mercy Hospital.

Objectives:

• Understand the rationale for granulocyte transfusion
• Understand the controversy around efficacy and role of granulocyte transfusion
• Understand the ethical implications of the therapy

We will present an overview of granulocyte infusion history and the evidence accumulated to support or refute the therapeutic modality.  We will also discuss this clinician’s perspective and practice.

Currently, Dr. Myers is a clinician/scientist in the field of cell based immunotherapy.  Clinically, he serves as Associate Professor of Pediatrics, University of Missouri Kansas City practicing hematopoietic stem cell transplant.  His research interests include immune reconstitution post-transplant and solid tumor immunotherapy.  His focus as Director of Innovation in Cellular Therapy at Children’s Mercy is building research collaborations to further various cell based immunotherapy approaches in cancer, autoimmune disease and solid organ transplantation tolerance.  

Eric is a graduate of the University of Kansas Medical Center in 2014, and has worked since then at The University of Kansas Hospital as a Medical Lab Scientist. The first year of his career was spent as a generalist and he has worked in the Transfusion Service ever since.

This presentation will review the evidence supporting transfusion thresholds in various patient populations and discuss its application to beating heart organ donors.  We will discuss current transfusion practices in the beating heart organ donor population and consider the potential risks of liberal versus restrictive transfusion in this group, including ethical implications.

Dr. Emily Coberly completed medical school and Internal Medicine residency at the University of Missouri Columbia, then practiced inpatient and outpatient Internal Medicine for 5 years.  She then completed a residency in Clinical Pathology at MU, followed by a Transfusion Medicine fellowship at Vanderbilt University.  She is board certified in Internal Medicine, Clinical Pathology, Clinical Informatics, and Transfusion Medicine and is currently the Medical Director of Transfusion Services at MU.

American Red Cross Blood Services, Missouri-Illinois Region, Lenexa, Kansas

Mary Madden received her degree in Clinical Laboratory Science from Saint Louis University. She began her blood bank career in the Johns Hopkins Hospital Blood Bank where she completed the Specialist in Blood Banking Program in 2015. She now works for the American Red Cross at the new Immunohematology Reference Laboratory located in Lenexa, Kansas.

The objectives of the presentation are to:

1. Take the attendees on a tour of the blood center using pictures and video; and
2. Provide a brief overview of the departments within a blood center.

The first 13 years of Jovona's career were spent in Oklahoma; Jovona worked in hospital laboratories performing blood bank, chemistry, hematology, and microbiolgy testing. Later Jovona managed laboratories and laboratory startups for urgent care and physician offices; from 2006 – 2008 Jovona worked for the American Red Cross in Tulsa Oklahoma. Since 2008, Jovona has been with the Community Blood Center of Greater Kansas City overseeing the Component Manufacturing Lab, Product Testing Lab, and most recently is the Director of Laboratories which includes oversight of the Immunohematology Reference Lab.

1. Provide an introduction to our new Heart Disease in Pregnancy Program
2. Discuss physiologic changes affecting the heart during a normal pregnancy, and potential stressors to those with heart disease
3. Review recent cases including labs from our recent patients

Dr Schmidt is a cardiologist at St Luke’s Cardiovascular Consultants.  Originally from Michigan, she attended the University of Michigan and then went to Wayne State University in Detroit for medical school.  She completed residency in Internal Medicine and Pediatrics followed by adult cardiology fellowship with an additional year of training in adult congenital heart disease.  She has 2 year old twin girls and doesn’t have much time currently for outside interests, but enjoys swimming, cooking, reading and spending time with her husband, Joe.

Geri Helms is 33 years old, happily married with two beautiful little boys, 5 and 3 years old. She was diagnosed with Post-partum Cardiomyopathy in April 2013, 4 months after she had her second baby, she went through a series of medication and surgeries to try and slow down or stop the heart failure, but to no avail. She was listed on the St. Luke’s heart transplant list on July 3, 2014 and received her heart on September 28, 2014! She feels really blessed and grateful to all the cardiologists and nurses and surgeons that took great care of me at St. Luke’s Heart Institute.