G Whiz!

This post has been updated and revised, and the new version is on the Blood Bank Guy website. Please check it out (and the rest of the newly updated site!)

-Joe Chaffin, MD

So Long, Walter Reed!

I have been following the news of the impending closure of Walter Reed Army Medical Center in Washington, DC, from afar for several years. I have very mixed feelings right now about the whole thing.

I spent the majority of my time in the military, from 1991 to 1999, at Walter Reed, first as a pathology resident, and later as a staff pathologist and medical director of blood services. While I and everyone who has ever worked there would tell you that it was FAR from a perfect place, I can say with certainly that the medical and nursing staff that I dealt with were incredible! There was so much skill, so much caring, and so much passion for giving soldiers and dependents the best possible medical care that you couldn't help but go home every day full of pride. At the same time, the frustrations regarding cuts in support staff, facilities that were aging badly, and the results of seemingly millions of previous poor administrative decisions on everything from computers to lab equipment became exhausting.

Despite all of the frustrating parts of being at "Walter Wonderful," I can honestly say that my time there was among the most important and beneficial of my career. I was forced (sometimes against my will) to make leadership and medical decisions that I wasn't sure I was ready to make, and the resulting experiences have stayed with me and guide things that I do today. The Army was great to me, and my memories of Walter Reed are mostly very good.

If you read the article I linked above, you will see that the comment section contains thoughts about Walter Reed that are decidedly mixed. That is understandable. Anyone who spent any time there knows that the place had flaws, sometimes big glaring flaws. I would bet, however, that most of us would also say that we are better healthcare providers as a result of the experience we gained at Wally World. I will miss the place, and cherish the memories of the people that I knew there.

Total Eclipse of the...Virus

Terminology can get a bit confusing when discussing different stages or "periods" of viral infections in relationship to transfusion-transmitted infections. I've tried to simplify some things in this post, to help you understand the differences between "windows" and "eclipses!

Perils of Poly(agglutination)

OK, here's one for all you immunohematology geeks out there (I say that with all admiration and respect, by the way)!

Not long ago, the immunohematology reference lab at the blood center where I work received a sample for a lectin workup from a patient suspected to have polyagglutination. The patient was a child, and had recently been diagnosed with sepsis secondary to Streptococcus pneumoniae. This situation led me to think about polyagglutination and summarize it for you.

Feeling Positive?

Is a donor "reactive" for a particular infectious disease marker or is he "positive"? What does "repeat reactive" mean? Can you have a reactive test on a particular sample and still be categorized as "non-reactive"? When studying transfusion-transmitted diseases (podcast on this topic coming soon), you will read terminology that can sometimes be confusing to non-virologists of the world (I proudly include myself in that category!). This blog entry will discuss several confusing terms related to viral marker testing results.

XMRV-An Emerging Infection Case Study

In the early 1980’s, physicians in San Francisco and New York were puzzled by a growing number of aggressive cases of a rare malignancy known as Kaposi’s sarcoma, as well as a rare lung infection, Pneumocystis carinii (now "jirovecii") pneumonia. These illnesses were discovered initially in homosexual men, but were later seen in a growing number of patients suffering from hemophilia.

Hepatitis C Testing

I recently received a question from a friend at a hospital-based donor center regarding re-entry testing for a donor that had a previous reactive test for Hepatitis C virus (HCV). The rules have recently changed regarding how to re-enter people in this situation, so it seemed like a good opportunity to write about the overall HCV testing strategy in U.S. donors, with an emphasis on those recent changes.

CMV, Serologic Testing, and Leukoreduction

For years, blood bankers and physicians have debated the relative merits of preventing CMV infection through the exclusive use of blood from donors who do not have demonstrable anti-CMV antibodies vs. blood that is leukocyte reduced. The data is mixed, and the two methods seem to be nearly equivalent (and imperfect). Why both fail at roughly the same low rate (about 1-4%) has never been particularly clear to me, until recently.

Volunteer?

When is a "volunteer" really a volunteer? For blood donor centers, this is a hugely important question to ask, since keeping an all-volunteer blood supply has been considered a mainstay of transfusion medicine for at least the last 25 years. I attended an interesting lecture today given by an incredibly knowledgable person (Gina Ramirez, manager of regulatory affairs) at the blood center where I work, and thought I would share some information from her lecture and my thoughts with you here.

Fluid Choice for Plasma Exchange

Situation: A blood center receives requests for large volumes of group B plasma from two separate hospitals for plasma exchange. The center supplies plasma in three main forms: 1) Plasma frozen within 24 hours (FP24) from male donors and never-pregnant female donors, 2) FP24 from female previously pregnant donors, and 3) As cryo-reduced plasma, made exclusively from male and never-pregnant female donors.

Welcome to My Blog!

Hi, and welcome to the Blood Bank Guy blog! It is now 2011, and following the lead of my friend Keith Kaplan, MD (www.tissuepathology.com), I've decided to dive deeper into the mainstream of the digital world!

I started the Blood Bank Guy website way back in 1998, initially as a way of connecting with the large numbers of people that attended the Osler pathology review course and heard me speak. At the time, what I was doing was pretty "cutting edge" (despite how silly it looks to me when I look back now!).