august, september, october 2014 · 2016. 7. 30. · pcr-restriction fragment length polymorphism...

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O Foundation Scholarships 1 www.scabb.org August, September, October 2014 Tell us a little bit about your facility and current position. FN: Blood Systems is one of the nation’s oldest and largest non- profit community blood service providers. We operate community blood cen- ters serving nearly 600 hospitals in 18 states, three high-vol- ume donor testing lab- oratories, biological products distribution services, a quality consult- ing group and a world-renowned transfusion medicine research institute. I am the Vice President of Clinical Services at Blood Systems. In this role, I advocate for donors and patients in establishing our medical policy, procedures, processes and clinical based programs. I also work with our Blood Systems Laboratories – IRL, HLA and Cell Therapy labs – as well as the physicians at our United Blood Services blood centers across the country. What do you enjoy most about what you do? FN: I really enjoy interacting with our hospital customers. By listening and engaging with them, I can help solve their transfusion-related prob- lems, sometimes even providing solutions for which they did not even realize Blood Systems could provide. Another gratifying part of my job is the opportunity to constantly learn from other disciplines and specialties that being part of a large organization provides. This includes things such as project/product management, market- ing, operations, and the like. What is an accomplishment that you are most proud? FN: We have a superb clinical team that I have helped assemble during my 6 years at Blood Systems. We provide comprehensive transfusion medicine through the most remarkable team of technologists, technicians, physicians and many other personnel. I’ve been able to have a signifi- cant impact on Blood Systems Laboratories by leading operational, testing and compliance improvements to our HLA, cellular therapy and immunohematology reference laboratories. It is amazing what people can do when they work toward a common goal and it’s been so reward- ing to be a part of the effort! What is unique about the service that your facility provides? FN: Our team is working to create and imple- ment a wide variety of programs. As part of our work with Blood Systems’ Blood Centers Division, we are working to broaden clinical and consultative patient-focused services. This includes the creation of a blood center-based blood management program, transfusion safety officer training program and laboratory efficien- cy programs. What do you see as the most important change to the industry in the next 5 years? FN: We will certainly see the anticipated decrease in blood utilization and competition that will precipitate substantial and difficult changes internal to our organizations and indus- try. However, hospitals will eventually move away from a focus on blood cost and begin to concen- trate more on patient outcome. That’s why I see our clinical team as so important both at the present time and as we move into the future. It is imperative that our industry keep an external focus on the hospitals and patients we serve even during the difficult time ahead. What is a typical day like for you? FN: A typical day is predictably unpredictable. I love the variety that my position affords – the days generally include a mix of clinical service work, strategic planning, and checking in with my teams to make sure they are on track and to see what they need from me. Living in Scottsdale, Arizona allows me to enjoy the out- doors year round. I like to get up early so that I have a chance to drink my coffee outside and enjoy the morning air before it gets really hot. What are some events that helped to shape your life/career? FN: I was able to go through strong residency/fellowship training at the University of Texas Southwestern, which helped to put me on the path that I am on now. I also had many diverse experiences and responsibilities early in career during my nine years at Carter BloodCare, prior to coming to Blood Systems in 2008. In addition to my training and career experiences, I have had excellent mentors over the years, such as Laurie Sutor, MD and Peter Tomasulo MD. These mentors have demonstrated passion for the work that we do and imparted knowledge that has allowed me to better serve our hospital customers and, ultimately, the patients we serve. I have also learned that you grow and gain wis- dom from a variety of sources. Although I have had a lot of excellent professional influences, many of my most formative ones are outside of the industry. I learned my work ethic from my parents, especially my mom. How she managed to keep my three brothers and me in one piece and presentable while educating herself and building her own career, I’ll never know! I’ve had other personal challenges, including cancer, that remind me each day how important our mission can be, to live in the present and really seize the moment. Finally, I owe so much to the support of my wonderful spouse and our 4 dogs and 2 cats. It doesn’t matter how tough a day has been when your dog is rolling around wanting belly rubs. (read more) O Dr. Frank Nizzi, Trendsetter President’s Message . . . . . . . . . . . . 2 AIMS Column . . . . . . . . . . . . . . . . . . 2 Protégé Mentor Profiles . . . . . . . . . 3 Sol Haberman Paper . . . . . . . . . . . . 5 Member News . . . . . . . . . . . . . . . . . 6 Journal Club . . . . . . . . . . . . . . . . . . . 7 IN THIS ISSUE SCABB Foundation Awards Institutional Scholarships Each year the Foundation awards four Institutional Member Scholarships to the Annual Meeting. The Scholarship, in the amount of $700.00 can be used for any expense associated with the Annual Meeting by the receiving Institutional member. For the 2014 Annual Meeting & Exhibit Show, the following Institutions have been awarded scholarships: - Corpus Christ Medical Center - Rio Grande Regional Hospital – Blood Bank - Texoma Regional Blood Center - Coffee Memorial Blood Center For more on the SCABB Foundation or to make a donation, visit w w w .scabb . or g > About SCABB .

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Page 1: August, September, October 2014 · 2016. 7. 30. · PCR-restriction fragment length polymorphism (RFLP) analysis was performed as an alternative genotype method to interrogate cJK

O Foundation Scholarships

1 www.scabb.org

August, September, October 2014

Tell us a little bitabout your facility

and current position.

FN: Blood Systems isone of the nation’soldest and largest non-profit communityblood serviceproviders. We operatecommunity blood cen-ters serving nearly600 hospitals in 18states, three high-vol-ume donor testing lab-oratories, biological

products distribution services, a quality consult-ing group and a world-renowned transfusionmedicine research institute.

I am the Vice President of Clinical Services atBlood Systems. In this role, I advocate fordonors and patients in establishing our medicalpolicy, procedures, processes and clinical basedprograms. I also work with our Blood SystemsLaboratories – IRL, HLA and Cell Therapy labs –as well as the physicians at our United BloodServices blood centers across the country.

What do you enjoy most about what you do?

FN: I really enjoy interacting with our hospitalcustomers. By listening and engaging with them,I can help solve their transfusion-related prob-lems, sometimes even providing solutions forwhich they did not even realize Blood Systemscould provide. Another gratifying part of my jobis the opportunity to constantly learn from otherdisciplines and specialties that being part of alarge organization provides. This includes thingssuch as project/product management, market-ing, operations, and the like.

What is an accomplishment that you aremost proud?

FN: We have a superb clinical team that I havehelped assemble during my 6 years at BloodSystems. We provide comprehensive transfusionmedicine through the most remarkable team oftechnologists, technicians, physicians and manyother personnel. I’ve been able to have a signifi-cant impact on Blood Systems Laboratories byleading operational, testing and complianceimprovements to our HLA, cellular therapy andimmunohematology reference laboratories. It isamazing what people can do when they worktoward a common goal and it’s been so reward-ing to be a part of the effort!

What is unique about the service that yourfacility provides?

FN: Our team is working to create and imple-ment a wide variety of programs. As part of our work with Blood Systems’ Blood Centers

Division, we are working to broaden clinical andconsultative patient-focused services. Thisincludes the creation of a blood center-basedblood management program, transfusion safetyofficer training program and laboratory efficien-cy programs.

What do you see as the most importantchange to the industry in the next 5 years?

FN: We will certainly see the anticipateddecrease in blood utilization and competitionthat will precipitate substantial and difficultchanges internal to our organizations and indus-try. However, hospitals will eventually move awayfrom a focus on blood cost and begin to concen-trate more on patient outcome. That’s why I seeour clinical team as so important both at thepresent time and as we move into the future. It isimperative that our industry keep an externalfocus on the hospitals and patients we serveeven during the difficult time ahead.

What is a typical day like for you?

FN: A typical day is predictably unpredictable. Ilove the variety that my position affords – thedays generally include a mix of clinical servicework, strategic planning, and checking in withmy teams to make sure they are on track and tosee what they need from me. Living inScottsdale, Arizona allows me to enjoy the out-doors year round. I like to get up early so that Ihave a chance to drink my coffee outside andenjoy the morning air before it gets really hot.

What are some events that helped to shapeyour life/career?

FN: I was able to go through strongresidency/fellowship training at the University ofTexas Southwestern, which helped to put me onthe path that I am on now. I also had manydiverse experiences and responsibilities early incareer during my nine years at Carter BloodCare,prior to coming to Blood Systems in 2008. Inaddition to my training and career experiences, Ihave had excellent mentors over the years, suchas Laurie Sutor, MD and Peter Tomasulo MD.These mentors have demonstrated passion forthe work that we do and imparted knowledgethat has allowed me to better serve our hospitalcustomers and, ultimately, the patients we serve.I have also learned that you grow and gain wis-dom from a variety of sources. Although I havehad a lot of excellent professional influences,many of my most formative ones are outside ofthe industry. I learned my work ethic from myparents, especially my mom. How she managedto keep my three brothers and me in one pieceand presentable while educating herself andbuilding her own career, I’ll never know! I’ve hadother personal challenges, including cancer, thatremind me each day how important our missioncan be, to live in the present and really seize themoment. Finally, I owe so much to the support ofmy wonderful spouse and our 4 dogs and 2 cats.It doesn’t matter how tough a day has beenwhen your dog is rolling around wanting bellyrubs.

(read more)

O Dr. Frank Nizzi, Trendsetter

President’s Message . . . . . . . . . . . . 2AIMS Column . . . . . . . . . . . . . . . . . . 2 Protégé Mentor Profiles . . . . . . . . . 3Sol Haberman Paper . . . . . . . . . . . . 5Member News . . . . . . . . . . . . . . . . . 6Journal Club . . . . . . . . . . . . . . . . . . . 7

IN THIS ISSUE

SCABB Foundation AwardsInstitutional Scholarships

Each year the Foundation awards fourInstitutional Member Scholarships to theAnnual Meeting. The Scholarship, in theamount of $700.00 can be used for anyexpense associated with the Annual Meetingby the receiving Institutional member. For the 2014 Annual Meeting & Exhibit Show, the following Institutions have been awardedscholarships:

- Corpus Christ Medical Center- Rio Grande Regional Hospital – Blood Bank- Texoma Regional Blood Center- Coffee Memorial Blood Center

For more on the SCABB Foundation or tomake a donation, visit www.scabb.org >About SCABB.

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2 www.scabb.org

O Discrepancies Between Phenotypes

DiscrepanciesBetween Genotype-PredictedPhenotype andSerologicPhenotype in theKidd System

Margaret A. Keller, PhD

([email protected])

National Molecular Laboratory, AmericanRed Cross, Philadelphia, PA

RBC genotyping is becoming a routinetool used in many blood centers and largehospitals to predict the blood groupantigen status in donors and patients.Commercially-available array basedgenotyping products interrogate a limitednumber of single nucleotide polymorphisms(SNPs) in one or more blood groupsystems. SNP genotyping can incorrectlypredict the phenotype of a sample forseveral reasons. First, if the blood groupgene carries an additional variant that isnot interrogated by the array, it may impactantigen expression. Often times, variantantigens are those with one or more aminoacid substitutions that can show differentialreactivity with some antisera and in somecases may put the individual at risk ofalloimmunization. Second, in many bloodgroup systems, many SNPs that result innull alleles have been identified; however,many of these null variants are notrepresented on that array, thus potentiallyresulting in a false positive phenotypeprediction. Third, if a sample carries oneor more other variants that inhibit the poly-merase chain reaction (PCR) amplificationor primer annealing, this can result in failureof that allele to be interrogated, a phenom-enon referred to as “allele drop-out”. Thislimitation is due to the fact that all PCR-based genotyping methods requireoligonucleotide primer annealing andsome genotyping methods require probehybridization. Genetic variation in thearea of the primer or probe can inhibitannealing and hybridization. This canresult in a false negative result.

Examples of discrepancies between geno-type-predicted phenotype and serologicphenotype can be seen in the Kidd bloodgroup system. The JK gene encodes theKidd blood group system antigens with aSNP at JK c.838G>A determining the anti-thetical antigen pair Jka and Jkb. Severalvariant and null alleles have been identifiedand assigned allele names2. If genotyping isperformed that only interrogates the JKc.838G>A SNP, the phenotype predictionwill not take into account null alleles andvariant antigens.

Case 1 involves a 63 year old Black femalewith an ischemic bowel. Testing by HEA

BeadChip1 (Immucor BioArray Solutions)predicted the phenotype to be Jk(a+b+).However, serologic typing indicated thepatient typed Jk(a-b+) with anti-Jka in eluate.SSP-PCR was performed and showed thesample to be heterozygous for JK c.130G/A.The c.130G>A change is associated withweakened expression of the Jka antigen.The Jk(a+weak) antigen status may bemissed with some reagents or techniques.In addition, we have seen this variant withanti-Jka. Based on this additional testing,the patient’s probable allele assignmentsare JK*01W.01 and JK*02 and the revisedpredicted phenotype is Jk(a+weak b+).

Case 2 involves a 78 year old Caucasianfemale with post-operative bleeding.Testing by HEA BeadChip™ predictedJk(a+b+). Serology indicated donor typedJk(a+b-) with anti-Jkb in serum and the eluate.JK cDNA was amplified and DNA sequenceanalysis was performed. The resultingsequence was aligned with the JK referencesequence and identified JK c.194G>A(p.65Gly>Asp). This is a known null allele.Based on this additional testing, we canconclude that the HEA BeadChip resultwas a false positive. The patient’s probableallele assignments are JK*01 and JK*02N.10and the revised predicted phenotypeis Jk(a+b-).

Case 3 involves a 35 year old pregnantfemale, race not provided with anti-Jka .HEA BeadChip™ testing predicted a pheno-type of Jk(a-b+) while serologic typing of thered cells indicated the patient was Jk(a-b-).After ruling out the JK c.130G/A SNP thatcan weaken the Jka typing, cDNA analysiswas performed that identified a JKA tran-script missing exon 6. Genomic DNAsequence analysis of JK exon 6 and the sur-rounding intronic regions identified theIVS5 -1g>a splice site mutation, associatedwith a null phenotype. Based on this addi-tional testing, we can conclude that theHEA BeadChip result was a false positive.The patient’s probable allele assignmentsare JK*02N.01 and JK*02N.01 and therevised predicted phenotype is Jk(a-b-).

Case 4 involves a Hispanic female RBCDonor. HEA BeadChip™ testing predictedRBCs to type Jk(a-b+). However, serologictesting indicated the red blood cells typedJk(a+b+). PCR-restriction fragment lengthpolymorphism (RFLP) analysis wasperformed as an alternative genotypemethod to interrogate JK c.838 and foundthe donor to be heterozygous. To investi-gate the discordant results between HEABeadChip and PCR-RFLP, genomic DNAsequence analysis was performed andidentified an additional SNP at c.814C>T.This novel SNP is predicted to be near thesite of the PCR primer for JK amplificationin the HEA BeadChip™ assay.

(continued on page 4)

Tom ChoiBlood Systems Inc.

Dear SCABB colleagues,In the last issue of the PULSE I promised to provide updateson the working status of the 3major priorities that I wanted tofocus on as this year’s Presidentof SCABB. They were the budg-eting process, affiliations and/orcollaborations and succession

and development planning for our committee members.

Obviously the budget for this fiscal year has already beensubmitted and approved by the Board. It was not a “budg-et as usual” process this year though. In the face of suc-cessive negative net margins the Board had to make somevery tough choices and have some very delicate conversa-tions around both revenue and expense line items. In theend the budget was not ideal, nor was it a game changer.It was (or is), however, REAL. In a perfect world there wasenough time to really dig deep into each area and comeup with an overarching approach that would immediately“stop the bleeding” and result in an epic plan that wouldaddress all of our industries (and thus our Associations)challenges in “one fell swoop”. Alas, real life does not workthat way and what was created is a long term approachcomprised of incremental steps that will need to be continuously worked on in the coming years to get theAssociations finances back in sync with the realities of the current business and professional environment.

On the affiliation and collaboration front several meetings and presentations have occurred with theCalifornia Blood Banking Society (CBBS) and the FloridaAssociation of Blood Banks (FABB) going back to April.At their annual meeting in April we were able to convincethe CBBS Board to agree to a 3 year joint meeting rotation as opposed to the current 4 year rotation and in June a SCABB contingent led by our current VicePresident, Christie Loe-Malone met with the FABB Boardto talk about Florida becoming an at large member stateof SCABB. Discussions are still ongoing on both fronts and I am very encouraged with the progress being madethus far.

Both scenarios are designed to help us address the costconcerns of the vendors that support our Associations.Like all of us that are looking for ways to stretch our dollars our vendor partners are hoping for fewer annualmeetings that they have to financially invest in. The morethey can save by attending fewer meetings the more they can afford to invest on those that remain. It is a true “win-win” for all involved and one that looks more promising as each meeting and discussion occurs.

Finally on the succession and development planning sidethe Board has decided to make some fairly unprecedentedchanges to some of our committees to help strengthenthem. Work on the development of committee membersstill needs to be fleshed out but for now we have assignedBoard liaisons and leads to a couple of our committees tohelp build momentum on some of the initiatives while alsohelping to mentor the committee chairs. We’ve also strategically placed Executive Board members and ourDistrict Directors into committees for the same reasons.In the past volunteer members were allowed to pick thecommittees that they wanted to work in. That is still thecase but given the current environment and the nature ofthe challenges we face we need to be a little more proac-tive in placing individuals that bring certain skill sets and experience to the Association that can be leveraged forthe betterment of our members and South Central. As anAssociation we are only as strong as our committees andthe successful completion of their charges. It only makessense to invest in finding ways to help them be successfulin meeting those charges.

As always, we are constantly looking for ways to improveour educational and networking offerings to our members.Whether it’s a SCABBinar, a joint symposium or our interactive members only access to our website we hopethat you can see that we are working hard to improve thevalue of your membership.

Until the next issue peace and prosperity to you all.

O President’s Message

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3

By: Cheri Jennings

According to Webster’s Dictionary, a mentor is atrusted counselor or guide; tutor, coach. Wehave all been lucky enough to have mentors inour lifetime – our parents, relatives, a belovedteacher, co-worker or supervisor. I know that ifit wasn’t for several of my former supervisors, Iwould not have had the courage to go to myfirst SCABB or AABB meeting and I most cer-tainly would never have been a committee mem-ber or chairperson!

The Protégé Mentor Program is a great way to“pay it forward” and help other blood bankersbecome more involved in their profession. Thisyear’s protégé/mentor pairs are: Komal Arora,MD and mentor Kevin Land, MD; StephanieBates, MD and her mentor Laurie Sutor, MD;

Jacqueline Ensley BS, MT, SBB and mentor GaryHaman; Daniel Held BS, MT, SBB and mentorKirk Kitchen MT(ASCP)SBB; Beth Johnson,BS,MT, SBB and mentor Marilyn MouldsMT(ASCP)SBB; and Vernita Moore BS,MT(ASCP) and mentor Larry Franzoi.

This is a diverse group of protégés, with a vari-ety of reasons for joining the program – themost common being career development, super-visory training and networking opportunities.Supporting the pairs are this year’s committeemembers: Kathie Carlson, MT(ASCP)SBB; DustinConover (co-chair), Courtney Fiess, MT; LauroGuerra Jr, BS, MT(ASCP)SBB; and DianeLechuga, MT,BB(ASCP). I think you’ll recognizea few SCABB past-presidents and past and pres-ent board member names among the group aswell as several former protégés!

One of the best things about the Protégé/Mentor Program is that it can be tailored tomeet each protégé’s interests. Mentors arerecruited based upon the protégé’s interests andthe mentors’ expertise and experience. Howlucky is Beth Johnson to be working withMarilyn Moulds and Daniel Held with KirkKitchen?!!

Please join the committee in supporting the2014-2015 Protégés and encourage some of yourstaff/co-workers to apply to be a protégé ormentor next year. For more information aboutthe Protégé/Mentor Program or for future con-sideration by the committee to be involved,please visit the Protégé/Mentor Program pageat www.scabb.org or contact Dustin Conover,[email protected] or Cheri Jennings, [email protected].

O Protégé/Mentor Program

Vernita MooreSenior Marketing AnalystBeckman Coulter Inc.

I was so excited when I received the notification that I had been selected as a protégé in the 2014 SCABB mentor/protégé program. My mentor is Larry Franzoi,Executive Account Manager from Qualtex Laboratories. We had a chance tohave a face-to-face encounter at the 2014 SCABB this year. It was an awesomemeeting and I look forward to working with him, gleaming all that I can.

I received my BS degree in Biology from the University of Texas at Arlington. Iimmediately attended the Medical Technology program affiliation through TarletonState University and acquired my ASCP certification. My blood bank career beganat Carter Blood Center, now Carter BloodCare. I worked there for 4.5 years andthen tried my hand as a Generalist. It was not satisfying at all. I didn’t feel as challenged. I joined John Peter Smith Hospital as a part-time weekender in the Blood Bank department. I became full-time in one month, then SeniorTechnologist 2 years later. I earned the supervisor position three years later and remained in that position until 2005.

I am currently working as a Senior Marketing Analyst with Beckman Coulter Inc.Now my approach to Blood Banking is from a different angle. Whereas before, I served the patient directly through the hospital venue, I now serve patients indirectly by interacting with those that serve them directly. It has been a chal-lenging ride, with a few bumps here and there, but I have enjoyed every moment;bumps will cause you to rise to the next level when examined as an opportunityfor improvements.

Through the mentor/protégé program I look forward to enhancing my market-ing/public relation skills. I look forward to growth, development, and networkingopportunities in this program. I feel blessed for the chance to expand profession-ally and personally.

Are you interested in becoming a Protégé orMentor? Or are you interested in becoming amember of the Protégé Mentor ProgramCommittee? Applications are currently being accepted through December 31, 2014.Participants will be announced in January 2015.

Call for Protégés and Mentors

Applications and information about theprogram can be found on the SouthCentral Association of Blood Banks website at www.scabb.org. Be a part of shaping and supporting your peers andprofession!

Daniel Held, MHS, MT(ASCP)SBBReference Lab SupervisorThe Blood Center – New Orleans, LA

Confucius once said, “Choose a job you love,and you will never have to work a day in yourlife.” I’m one of the lucky few who knew bloodbanking would be my calling since I shook myfirst tube. My name is Danny Held and I am theReference Lab Supervisor at The Blood Centerin New Orleans, LA. After graduating from

LSUHSC in New Orleans, I worked at the local children’s hospital per-forming blood banking and stem cell processing. It didn’t take longbefore I was back in school training for an SBB and obtaining aMaster in Health Sciences. In my current position, I oversee the opera-tions of an AABB accredited IRL and transfusion service, as well asour new molecular testing laboratory.

I have been lucky to be paired with my mentor and former SCABBpresident, Kirk Kitchen. Since first meeting with Kirk at the SCABBannual meeting, I have been working to start a local journal club andparticipating in SCABB committees. Through the mentor/protégéprogram and Kirk’s experience and expertise, I hope to expand myknowledge of the blood banking field as well as making new con-tacts.

I enjoy spending time with my wife and daughter, gardening, andwine tasting. I always try to find time to experience the abundant cui-sine New Orleans has to offer. I’m looking forward to a challenging,yet rewarding, year in the program and to be an active part of SCABBfor many years to come.

O Protégé Profiles 2014

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4 www.scabb.org

CALL FOR ABSTRACTS NOW OPEN!South Central Association of Blood Banks (SCABB)

2015 Joint Meeting in Las Vegas, Nevada

The Joint Meeting Program Committees wouldlike to extend an invitation to all members as wellas non-members to submit abstracts for the 2015Joint Meeting in Las Vegas, Nevada.

Abstracts may be from any discipline relating tohospitals, donor centers, cellular therapy, tissuetherapy or testing laboratories. Abstracts can bepresented through oral or poster presentations.

ORAL PRESENTATIONS:Authors of abstracts accepted for oral presenta-tions will be limited to a 10-minute presentation,followed by a five minute moderated question andanswer session period.

POSTER PRESENTATIONS:Authors of abstracts accepted for poster presenta-

tions will be limited to a visual display, not toexceed 4’ x 5’ and not less than 8.5” x 11”. Noaudiovisual equipment will be allowed.

The SCABB/CBBS Joint Meeting is a great oppor-tunity to present original investigations. Having anabstract accepted at this meeting is not only anhonor but can serve as a nice entry into a CV.There is no limit to the number of abstracts anindividual may submit and it is a great experienceto present, whether in oral presentation or posterpresentation. All abstracts accepted will be pub-lished in the 2015 Abstract Journal which will bedistributed at the 2015 SCABB/CBBS JointMeeting.

The abstracts must be submitted in electronicform, reflecting original investigation, in the speci-

fied format as designated by Objective, Methods,Results, and Conclusion. See abstract submissionguidelines on scabb.org. All abstract submissionsare peer reviewed by a panel of committee mem-bers to judge the scientific merit of each submis-sion. There is no guarantee of acceptance butthere is a reasonably high acceptance rate ofappropriately structured submissions, if enteredprior to the deadline. Abstracts must be submittedby the deadline of January 30, 2015.

For more information contact the South CentralAssociation of Blood Banks 866-649-6550 Ph 866-649-6590 Fx [email protected] > Annual Meeting > Abstracts

(continued from page 2)

Discrepancies Between Genotype-Predicted Phenotype and SerologicPhenotype in the Kidd System

Thus, it is likely that the presence of this SNPinhibited amplification of this allele, consistentwith drop-out of the JK*A allele and the falsenegative Jk(a-) prediction.

Based on these new findings, the revised predict-ed phenotype is Jk(a+b+). The significance of theamino acid change from leucine to phenylalanineat residue 272 on Jka expression is unknown.

In summary, it is important to know that geno-typing methods have limitations. Though dis-crepancies between genotype-predicted pheno-type and serotype are rare, they do occur. Thecases presented here demonstrate that genotyp-ing can make both false positive and false nega-tive predictions. IRLs and Blood Banks need toinform their molecular immunohematology labo-ratory when a discrepancy between the geno-type-predicted phenotype and the serologicphenotype is identified. The molecular laborato-ry should investigate and, after ruling out testingerrors including sample mix-up, pursue alterna-tive genotyping methodologies. The sample canbe sent to a reference laboratory if these tech-niques are not available at the originating molec-ular immunohematology laboratory.

REFERENCES

1. Hashmi G et al. Transfusion 2007;47:736-747.

2. http://www.isbtweb.org/working-parties/red-cell-immunogenetics-and-blood-group-terminology/blood-group-terminolo-gy/blood-group-allele-terminology/

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5

Author: Yeon Kim,MLS(SBB)SBB

Correlation betweenWarm ReactiveAutoantibodies andthe MonocyteMonolayer Assay

Yeon earned her SBBthrough the University of

Texas Medical Branch SBB program.

ABSTRACT BACKGROUND: The monocyte monolayer assay(MMA) measures the adherence and phagocytosisof sensitized red cells with peripheral monocytes.The result of MMA may reflect the in vivo destruc-tion of sensitized red blood cells (RBCs). STUDYDESIGN AND METHODS: Blood samples from 20patients with warm reactive autoantibodies wereinvestigated using the MMA. The Monocyte Index(MI) values > 5% were considered positive while MIvalues 5% were considered negative. RESULTS:Of the 20 patients, only one patient had a positiveMMA result with an MI of 30%. All other 19patients demonstrated a negative MI value (<5%).There was no correlation between serologicallydetectable warm reactive autoantibodies and theMMA or DAT. CONCLUSION: The final conclusiondemands more comparative studies between theclinical and serologic features of patients withwarm autoantibodies and the MMA tests. Thereare many variables that exist within the MMAwhich may have an effect on the outcome.

INTRODUCTION Warm reactive autoantibodies are red blood cell(RBC) directed immune responses maximally reac-tive at 37°C. These are often associated with thedestruction of red blood cells in vivo, causinghemolytic anemia in patients.1 These autoantibod-ies present a complex serological problem with apositive direct antiglobulin test (DAT) and cross-match incompatibility with all RBC units tested. Invitro serological tests are routinely used to detectand characterize autoantibodies. However, sero-logical studies performed in patients with warmreactive autoantibodies do not always show strictcorrelation with in vivo occurring phenomena.2 Theclinical significance of autoantibodies may varybetween patients. Further investigation of warmautoantibody interaction in vivo in relation to invitro activity may add value in distinguishingwhether or not the autoantibodies are harmful.

It is well known a positive DAT indicates antibod-ies are present on circulating RBCs in vivo.Nevertheless, individuals with a positive DAT donot always demonstrate obvious signs of RBCdestruction while some patients demonstrateovert hemolysis with a weak or negative DAT.3

This is unexpected since damage in vivo is notonly dependent on direct contact between theerythrocyte and autoantibody but on several otherfactors. These factors include: antibody subclass-es, interaction between Fc receptors and cells ofthe mononuclear phagocytic system, ability toactivate complement, concentration of antibodywith corresponding antigen molecules on the RBCsurface, and chemical and physical characteristicsof the antigens on the red cell membrane.4 Among

all of these the mostimportant factor influ-encing the destructionof red cells is the inter-action between the sen-sitized RBCs and cells ofthe mononuclear phago-cytic system. As aresult, many attemptshave been made byinvestigators to evaluatein vivo red blood celldestruction using cellularassays.

The premise of all invitro cellular assays is tomimic in the laboratorywhat occurs in vivo. Themonocyte monolayerassay (MMA) acts as anin vitro cellular assaythat represents themechanism of red celldestruction viamacrophages in thespleen9. It is performedby incubating sensitizederythrocytes withperipheral monocytesbearing Fc-receptorsand assessing differentstages of the interaction,such as phagocytosisand adherence.9 Manyvariables are involved inthe MMA procedure.Those include: thesource from which themonocytes arecollected,2,9-10 the RBC

sensitization procedure (including whether or notfresh normal serum, as a source of complement isadded),9,11 the culture conditions (a CO2 atmos-phere versus ambient air),9,12 and how the resultsare expressed. Although such variables exist, theMMA is as close to conditions in vivo as is possibleto establish in vitro and provides insight into thepotential clinical significance of autoantibodies.9

The MMA has been used successfully in manystudies to determine the clinical significance of redcell alloantibodies directed towards high frequen-cy antigens.10,13-17 The procedure has also been suc-cessful in investigating the survival of transfusedRBCs.14,17 However, assessing the clinical impor-tance of warm autoantibodies using the MMA hasnot been evaluated thoroughly. When patientspossess warm reactive autoantibodies, presumedserological and clinical laboratory data may notalways correlate with in vivo activity of autoanti-body.16 Evaluation of the functional activity ofwarm reactive autoantibodies using the MMA willcontribute additional value in confirming the sig-nificance of warm autoantibodies. The aim of thisstudy was to evaluate the correlation of warmreactive autoantibodies between the MMA resultand the clinical data. This study also comparedthe DAT reaction strength and Hemoglobin (Hb)level of each patient with the MMA results to see ifa correlation exists.

MATERIALS AND METHODSPatients study samples were selected from bloodsamples referred to a immunohematology labora-tory due to difficulties in resolving serologicalproblems caused by autoantibodies when group-ing or crossmatching compatible RBC donor units.The Hb and Hematocrit (Hct) level with eachpatient’s transfusion history was obtained uponadmission.

RBCs TestedRBCs used in the in vitro sensitization phase of theMMA were selected based on the patient’s RBCphenotype and the specificity of the antibody(ies)each patient possessed in addition to the autoanti-body. Phenotypically matched antigen negativeRBCs were from two different sources; screeningcells from commercial reagents (Panocells,Immucor Gamma; Data-Cyte Plus, MedionDiagnostics AG) and segments from donor RBCunits.

The MMAThe MMA was performed using the two-stage sen-sitization method, as previously described byGarratty et al.18 The procedure isolated mononu-clear cells from a healthy volunteer donor using aFicoll-sodium diatrizoate density gradient(Histopaque-1077, Sigma-Aldrich Inc.). The sepa-rated mononuclear cells were then washed withphosphate-buffered saline (PBS, 0.8% NaCl) andsuspended in culture media (RPMI Medium-1640,Sigma-Aldrich) containing 5% fetal bovine serum(Sigma-Aldrich). The mononuclear cell suspensionwas added to an 8-well tissue culture chamberslide (Lab-Tek chamber slide with cover, NalgeNunc Int.) and incubated for one hour at 37°C inatmosphere of 4-5% CO2. Meanwhile, the sensiti-zation of RBCs was prepared using phenotypicallymatched RBCs and patient plasma containingwarm autoantibodies and alloantibodies. Afterone hour of incubation at 37C in saline, RBCs werewashed and the fresh normal serum was added asa source of complement. RBCs were incubated foranother 15 minutes at 37C, washed and re-sus-pended in culture media containing 5% fetalbovine serum. The small aliquot of sensitizedRBCs was tested by indirect antiglobulin test (IAT)with anti-IgG and anti-C3 to determine the degreeof sensitization.

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O 2014 Sol Haberman Scholarship Paper

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The use of group A plasma in trauma patients has gotten a lot ofattention lately. Some are embracing the idea enthusiastically andothers are skeptical about patient safety. This practice is becomingmore and more accepted because of the increasing difficulty in col-lecting AB plasma. New TRALI standards put in to place this year inApril further reduced the donor pool, by eliminating parous femaleplasma from the transfusable product pool. Group AB makes uponly 4-7% of the population depending on the ethnic makeup ofthe donor groups in each area. Of that only about 40% actuallydonate on a regular basis.

Group A on the other hand comprises 24-33% of the donor baseand with 40-50% of them donating, A plasma can be readilyobtained. Even with the decrease in eligible plasma donors usingmale or never pregnant female plasma, the supply can be main-tained much more easily.

What about contraindications? Reactions? The thought processbehind use of A plasma has to do with the low number of poten-tial patients who might react with the Anti-B in A plasma. Group Bmakes up 10% of Caucasian patients, while prevalence goes up withAfrican American and Asian patient populations. During massivetransfusion in trauma situations, ABO incompatible reactions arevery minimal in these situations as evidenced in a 2013 article in theJournal of Trauma and Acute Care Surgery, 2013 APR;74(4): 1182.This study reviewed 254 trauma patients over a three year periodevaluating those who received ABO compatible and ABO incom-patible transfusions. Mortality rate in those who received ABOincompatible emergency release plasma ( group A as opposed toAB) was actually lower due to the immediate availability of prod-uct.

Group A plasma definitely needs to be considered in trauma situa-tions, safety does not seem to be an issued and supply is definitelylarger.

Author: Lara Thedford, BS, MT(ASCP)SBB

O Hot Topic–Plasma in Trauma Patients

6 www.scabb.org

By: Mary Berg, MD, Co-Chair, SCABB Education Committee

The Education Committee hopes that many of you were able totune in for the Free SCABBinar on July 30th where abstracts thatwere from the last Annual Meeting were presented. The abstractspresented were: Technical and Workflow Assessment of the TANGOOptimo System in a Large Transfusion Service (Barb Pumphrey),Donor Screening Capacity and Efficiency (Anna Murphy), and CostEffective Blood Ordering Practices and Deliveries: A Hospital andBlood Center Working Together (Karen Yunker). Another recentpresentation was from Frank Nizzi and Cory Johnson, both fromBlood Systems, Inc., on the benefits of using the National PatientAntibody Database.

Future SCABBinars include:

• October 2, 2014 Cellular Therapeutics: Is there a Role for US Blood Centers?, presented by Frank Nizzi, DO, Kim Nguyen, PhD,Shibani Pati, MD, PhD & Shawn Rossi

• November 12, 2014 The use of Fresh Whole Blood and Pre-hospital use of Plasma, presented by Col. Richard Gonzales, MS, MT(ASCP)SBB

Summer also brought two live educational presentations. First, aSCABB sponsored symposium was held on June 4th in Sarasota,FL in conjunction with the Florida Association of Blood Bank meet-ing. Speakers included Katrina Billingsley, Rebecca Bullock, NancyHaubert, Katherine Beal, and John Judd. On July 18th a regionalsymposium was organized by SCABB and the Association of DonorRelations Professionals (ADRP) in Fort Worth, TX. The symposiumwas sponsored by Haemonetics and covered topics related to thetheme of “Elevating the Donor Experience”.

O Education Committee Report

District at LargeA Mid-Atlantic Regional Symposium isplanned for Friday, April 10, 2015 at theDoordan Health Institute in Annapolis,Maryland. The tentative agenda will includesome of the top speakers in the field ofImmunohematology & Molecular industry. Thespeakers will also present personal case stud-ies and participate in an “Ask the Experts”session. More information, including confirmedspeakers and registration details to be avail-able by the end of the year. If you are interest-ed in sponsoring/exhibiting at this eventplease contact Ashley Combs at 866-649-6550.

District lDistrict I welcomes Star Delivery, Inc. as a newSCABB Associate Corporate Member. StarDelivery provides transport service to theDallas/FortWorth Metroplex and the NorthTexas area. The company takes special careto ensure that each driver maintains a highlevel of professionalism and that specimensare handled according to all regulatory stan-dards.

When asked “How did you learn aboutSCABB?” Rusty Chapman, Vice President ofStar Delivery, said he had heard about SCABBfrom a Carter BloodCare employee. Word ofmouth: the passing of information from per-son to person. What a great marketing tool!Rusty said his company wanted to be aware

of and be an integral part ofchanges in the industry, meet newpeople and to learn how StarDeliver can better serve patientsand the community.

SCABB members: You belong to a wonderfulassociation; start talking it does great things!

District IIIOur Lady of the Lake (OLOL), Baton Rouge,welcomes Sarah Williams to the donor recruit-ment staff. Sarah’s wealth of marketing expe-rience will bolster our donor marketing activi-ties.

OLOL has received an FDA variance whichallows us to manage donors on testosteroneas allogeneic donors if they meet the criteria.The variance also allows us to collect wholeblood more frequently than every 8 weeks.Prior to the variance these donors had to bemanaged as therapeutic phlebotomies. If adonor does not meet allogeneic donor criteria,therapeutic phlebotomy is provided at nocharge. Accelerated RBC production is aknown side effect of testosterone therapy. Thediversion of blood from the therapeutic phle-botomy waste stream to transfusable productshas had a positive effect on donor satisfactionand RBC inventory levels.

OLOL recently consummated the purchase ofBogalusa Community Hospital. The new nameis Our Lady of the Angels. This acquisitionincreased the number of hospitals in theFranciscan Missionaries of Our Lady HealthSystem to seven facilities.

O Member News

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O Welcome New Members

Marla BorenCarter BloodCare815 South Baxter AvenueTyler, TX 75701Office: [email protected] Type: Individual

Francis CampbellTexoma Regional BloodCenter3911 Texoma ParkwaySherman, TX 75090Office: [email protected] Type: Individual

Jessica DrouillardLifeSouth CommunityBlood Centers, Inc.9578 SW 99th PlaceGainesville, FL 32608Office: [email protected] Type: Individual

Liz RosenbaumBlood Systems Inc.3423 Rio Grande Blvd NWAlbuquerque, NM 87107Office: [email protected] Type: Individual

On behalf of the South Central Association of BloodBanks and the SCABB Membership committee, wewould like to extend a warm welcome to our newmembers:

7

O Article Review:Safety of a Liberal Policy for Extended-Date Preadmission Testing Samples.

Le N, Harach ME, Gould JM, and Herman JH.Transfusion 2014; 54:1769-1772.

Review by: Mary Berg, MD

Introduction: Although there are regulationslimiting the use of pre-transfusion specimensfrom patients who have been pregnant ortransfused in the preceding three months,there are no regulatory limits on how long aspecimen may be used if a patient has notbeen recently pregnant or transfused. Forthis reason, practices regarding how longspecimens for pre-transfusion testing are

used vary between institutions. In someplaces, these specimens also outdate in threedays. In others, they may be kept as long asthree months (if kept frozen). The authors ofthis paper evaluated their policy for thesespecimens and changed their practices basedon their findings.

Originally, pre-admission test (PAT) speci-mens at this institution were kept for up to

O Journal Club28 days, as long as the patient had not beenpregnant or transfused within the precedingthree months. In addition, the antibodyscreen on the current specimen had to benegative and the patient must not have had ahistory of red cell antibodies. If the patientdid have a positive antibody screen or historyof antibodies, a new specimen was drawn onthe day of surgery (DOS).

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EXECUTIVECOMMITTEE

President Tom ChoiBlood Systems Inc.4920 South Wendler Dr., Suite 102Tempe, AZ 85282Office: [email protected]

President-ElectSarah Jones, MT(ASCP)SBBSt. Luke's Episcopal Hospital6720 Bertner Avenue, Room C-110Houston, TX 77030Office: [email protected]

Vice PresidentChristie Loe Malone, MT(ASCP)SBBCitra Labs, LLC.55 Messina DriveBraintree, MA 2184Office: [email protected]

Immediate Past PresidentJeannie Gardner, RNOklahoma Blood Institute1001 N. Lincoln Blvd. Oklahoma City, OK 73104 Office: [email protected]

SecretaryStephanie Babin Our Lady of the Lake RMC5000 Hennessy BoulevardBaton Rouge, LA 70808Office: [email protected]

TreasurerGarrick (Rick) Chatelain, BS,MT(ASCP)The Blood Center2609 Canal StreetNew Orleans, LA 70119Office: [email protected]

DISTRICT DIRECTORS

District I – (TX)Roberta Murfin, MBA, MT(AMT),BB(ASCP)Children's Medical Center1935 Medical District DriveDallas, TX 75235Office: [email protected]

Julie Ontiveros Coffee Memorial Blood Center7500 Wallace BoulevardAmarillo, TX 79124Office: [email protected]

District II (AZ, NM, CO, OK)Dustin Conover Oklahoma Blood Institute1001 N. Lincoln BoulevardOklahoma City, OK 73104Office: [email protected]

District III (AR, LA, MS)Katrina Billingsley, MT(ASCP)SBBLifeshare Blood Centers8910 Linwood AvenueShreveport, LA 71106Office: [email protected]

District-at-Large Director Barbara Bryant, MDBlood Center of Wisconsin638 North 18th StreetMilwaukee, WI 53233Office: [email protected]

SCABB Central Office 2901 Richmond Road, Suite 130-176Lexington, KY 40509PH: (866) 649-6550FX: (866) 649-6590

Karla D Stahlman, Executive [email protected]

Ashley Combs, Member [email protected]

Cindy Bleier, Education/[email protected]

Liz Pearce, [email protected]

O 2014-2015 Board of Directors