Blood Bank Guy http://www.bbguy.org Teaching basic transfusion medicine to all Wed, 22 Mar 2017 19:19:24 +0000 en-US hourly 1 https://wordpress.org/?v=4.7.3 029: Molecular Testing with Meghan Delaney http://www.bbguy.org/2017/03/20/029/ http://www.bbguy.org/2017/03/20/029/#comments Mon, 20 Mar 2017 08:30:17 +0000 http://www.bbguy.org/?p=27429 The post 029: Molecular Testing with Meghan Delaney appeared first on Blood Bank Guy.

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Molecular (genetic) testing is everywhere in medicine today, and the blood bank is no exception! You don’t have to be a geneticist to see how it all fits, however. I’m happy to have Dr. Meghan Delaney here to present:

7 practical uses for molecular testing in transfusion medicine.

Dr. Meghan Delaney

Dr. Meghan Delaney

You can hardly turn around in health care today without hearing someone talking about genetic testing (just to confuse people, such testing is more formally known as “molecular diagnostics” or “molecular testing”). In the blood bank, molecular testing is available right now, and it can really impact our day-to-day practice.

Fortunately for us, Meghan Delaney works right on the cutting edge of molecular testing. Her unique experience (she oversees both a hospital transfusion service and an AABB-accredited immunohematology reference lab) allows her a great perspective on who should be using this testing and how it all fits together. This is a really enlightening discussion that may just open your eyes to some new possibilities!

Speaker Bio:

Meghan Delaney is an Associate Professor in the Department of Laboratory Medicine and Pediatrics at the University of Washington, Medical Director for the Immunohematology & Red Cell Genomics Reference Laboratory at Bloodworks Northwest, and Medical Director of the transfusion service at Seattle Children’s Hospital. She also focuses on transfusion improvement and medical education and sustainable technology development in developing nations. Dr. Delaney chairs or serves on multiple committees for AABB, ASFA, and CAP. She is an Associate Editor for the journal Transfusion Medicine, and is on the editorial board of Transfusion. She is an Associate Scientific Member of the BEST Collaborative and the Associate Program Director for the Pathology Residency Program at University of Washington.

Use the player above to listen to Episode 029 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Delaney nor I have any relevant financial disclosures.

The images below are generously provided by Dr. Delaney.

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028: Who DAT? with Sue Johnson http://www.bbguy.org/2017/02/27/028/ http://www.bbguy.org/2017/02/27/028/#comments Mon, 27 Feb 2017 11:38:45 +0000 http://www.bbguy.org/?p=27312 For what is really a simple test, the Direct Antiglobulin Test (DAT) can be surprisingly confusing and complex. Sue Johnson is here to guide us to clarity!

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The Direct Antiglobulin Test (also known as the “DAT” or “Direct Coombs” test) seems super-simple, but there’s more to it than meets the eye! Sue Johnson from BloodCenter of Wisconsin, Marquette University, and the Indian Immunohematology Initiative joins Dr. Chaffin to discuss.

Sue Johnson

Susan Johnson, MTSM, MT(ASCP)SBB

The DAT is really, in practice, a particularly basic and easy test to do. For such a simple test, however, most blood bank students struggle with the concepts, as do many clinicians! The DAT leads to discussions of autoantibodies, adsorptions, and elutions, oh my! Never fear, though, Sue Johnson is a master teacher who has taught thousands of students the essentials of the DAT! She is my guest on this episode to guide us to great clarity on this most excellent immunohematology test.

Brief Speaker Bio: Sue Johnson is the Director of Clinical Education at BloodCenter of Wisconsin, as well as the director of BCW’s Specialist in Blood Banking Program. She is also the Director of the Transfusion Medicine Program at Marquette University and Associate Director of the Indian Immunohematology Program. She has extensive experience as a teacher, author, and international lecturer; in short, she knows what she is talking about!

This is a fun episode! Whether you are a pure beginner or an experienced blood banker, you will come away with a much better understanding of why the DAT is so important!

Use the player above to listen to Episode 028 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Ms. Johnson nor I have any relevant financial disclosures.

The images below are generously provided by Sue Johnson. The featured image seen in the podcast episode list and on Facebook and Twitter was illustrated by Jenny O’Connor, MLS(ASCP)SBBCM.

Don’t miss these videos for a visual look at what Sue described:

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027: NAIT with Brian Curtis http://www.bbguy.org/2017/02/13/027/ http://www.bbguy.org/2017/02/13/027/#respond Mon, 13 Feb 2017 09:46:04 +0000 http://www.bbguy.org/?p=27166 Neonatal alloimmune thrombocytopenia is like HDFN, but with platelets, but not quite! Dr. Brian Curtis shows us how to not hate NAIT!

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Dr. Curtis

Dr. Brian Curtis

Dr. Brian Curtis from BloodCenter of Wisconsin joins Dr. Chaffin to discuss Neonatal Alloimmune Thrombocytopenia (NAIT).

Neonatal alloimmune thrombocytopenia (NAIT), the disease with many names, continues to confound blood bankers everywhere! The conversation goes like this: “This baby has a low platelet count…is it NAIT?” Answer: “Ummmm….” I’m not meaning to offend anyone in transfusion service-world, because obviously, there are experts on this topic out there! Fortunately for us, I happen to have interviewed one of those experts for this podcast episode! Dr. Brian Curtis oversees one of the the world’s foremost labs for platelet antigen/antibody testing, and he explains how to take the right steps to find the answer, both in the real world and the exam world.

Use the player above to listen to Episode 027 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Curtis wants you to know that he has done research for Prophylix, the Norwegian company mentioned in the episode that is attempting to bring a medication to market to prevent NAIT. I (Dr. Chaffin) have no relevant disclosures.

The images below are generously provided by Dr. Curtis.

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026: TTP Treatment with Jeff Winters http://www.bbguy.org/2017/01/23/026/ http://www.bbguy.org/2017/01/23/026/#respond Mon, 23 Jan 2017 08:14:06 +0000 http://www.bbguy.org/?p=27211 Continuing the discussion from BBGE 025, Jeff Winters explains a true emergency: Thrombotic Thrombocytopenic Purpura (TTP).

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Jeff Winters

Dr. Jeff Winters

Dr. Jeff Winters from Mayo Clinic, Rochester, MN returns to discuss a true, honest-to-goodness blood bank treatment emergency, Thrombotic Thrombocytopenic Purpura (TTP).

Most people listening to this podcast are involved in blood banking in one way or another. In general, blood bankers like to do things in an organized, “take-your-time” fashion (it’s just our nature!). However, we can’t sit around and wait and think when we have a patient with TTP; we must act quickly! Since we must be prompt, we could really use a guide to get us to a decision point.

Jeff Winters practices therapeutic apheresis all day long, and he gave us a terrific overview in BBGuy Essentials 025. Today’s episode addresses how to use those principles to treat TTP. This terrifying disease, caused in adults primarily by a deficiency of an enzyme with a funny name, “ADAMTS13“, can be rapidly fatal if not promptly diagnosed and treated. In modern practice, treatment is primarily done using Therapeutic Plasma Exchange (TPE), with replacement of the “bad” plasma with “good.” Dr. Winters helps us understand the pathophysiology of this nasty disease, as well as when we should pull the trigger on treating patients suspected of having TTP. He will also discuss the use of the poorly understood blood product, “cryo-poor plasma,” as a replacement fluid option. Trainees and practitioners in pathology, hematology, and laboratory sciences will benefit from this discussion.

Use the player above to listen to Episode 026 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Winters nor I have any relevant financial disclosures.

The images below are generously provided by Dr. Winters.

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025: Intro to Therapeutic Apheresis with Jeff Winters http://www.bbguy.org/2017/01/16/025/ http://www.bbguy.org/2017/01/16/025/#comments Mon, 16 Jan 2017 09:33:02 +0000 http://www.bbguy.org/?p=27168 Therapeutic apheresis doesn't have to be scary! Dr. Jeff Winters is an enthusiastic and willing guide, and he gives us the Essentials!

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Jeff Winters

Dr. Jeff Winters

Dr. Jeff Winters from Mayo Clinic, Rochester, MN joins Dr. Chaffin to discuss the Essentials of Therapeutic Apheresis.

It is very common for trainees and practitioners of Transfusion Medicine to have low levels of comfort and experience with therapeutic apheresis procedures. It just “feels” complicated! Fortunately for us, Dr. Jeff Winters, editor of the Journal of Clinical Apheresis, past president of the American Society for Apheresis, and director of the very busy therapeutic apheresis service at Mayo Clinic, is an enthusiastic and willing guide! This episode is the first of two on this topic. In this episode, Dr. Winters takes us on a detailed tour through the basics of this sometimes mysterious-sounding discipline. He covers theoretical and practical aspects, including telling you where you can find a truly AMAZING educational resource that you can and should get your hands on today. I promise, you will end your time with him with a much clearer picture of how to approach these patients, and hopefully, you’ll be ready to dive even deeper into therapeutic apheresis (which you will get the chance to do in episode 026)!

Use the player above to listen to Episode 025 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Winters nor I have any financial disclosures relevant to today’s topic.

The images below are generously provided by Dr. Winters.

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My Five Favorite Interviews of 2016! http://www.bbguy.org/2016/12/28/five-favorites/ http://www.bbguy.org/2016/12/28/five-favorites/#comments Wed, 28 Dec 2016 20:30:58 +0000 http://www.bbguy.org/?p=27098 After 24 episodes of the Blood Bank Guy Essentials Podcast, here are my top 5 favorite interviews (but don't stop here!)

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2016 marked a new beginning for the Blood Bank Guy website. Among other major changes, I debuted the “Blood Bank Guy Essentials Podcast” in April, an interview-style educational audio presentation targeted toward those learning blood banking and transfusion medicine. Since I couldn’t bring myself to create completely new stuff every other week, most of the episodes involved me interviewing an expert on a particular topic. I published 24 episodes of the podcast by the end of the year, and listeners like you downloaded those 24 episodes over 26,000 times!

I had a great time doing every interview, and I recommend all 24 of them to you! Each of the incredible interviewees are amazing in their own way. However, I recently found myself reflecting on which ones I had enjoyed the most, for various reasons. Since 2016 is a few days from ending, and that calls for reflection and list-making, here are my five favorite BBGuy Essentials Interviews of 2016!

I want to make it really clear that this list does not indicate a dislike for any of the other interviewees! Far from it! Many of those not on this list are close friends of mine, and I am honored and grateful for all of them. Please see the main podcast page to listen to any episode, as well as find the list of the five most downloaded episodes.

5. Awesome Presentations! (Dr. Kristine Krafts)

The scoop: Kristine is an Assistant Professor at the University of Minnesota, but she has an international audience! Kristine runs the extremely popular site pathologystudent.com, a “go-to” resource for medical and dental pathology students worldwide. She has deservedly won numerous teaching awards from the students at Minnesota (she wins one pretty much every year, and has done so for quite some time now!). Direct link to show page for this interview.

Why it made my list: My favorite things about Kristine are her passion for teaching and her hilarious writing and speaking style! This episode was based on a series of blog posts where she outlined her thoughts on how to make medical presentations awesome! You will hear five practical tips from a master teacher that will IMMEDIATELY improve your presentation skills. Plus, she and I had a blast, and there’s even a discussion of a rubber chicken! Finally, if you really want to annoy Kristine, send her a message in the Arial font…

4. Plasma Transfusions in Non-obvious Situations (Dr. Jeannie Callum)

The scoop: My goal with the BBGuy Essentials Podcast is to help those who listen understand topics that are sometimes challenging or under-researched. The transfusion of plasma in situations where things have not been well-studied (such as before bedside or minor procedures when the coagulation tests show only mild abnormalities) is definitely one of those situations! Direct link to show page for this interview.

Why it made my list: I feel so fortunate to have had the great (and I mean GREAT) Dr. Jeannie Callum from Toronto with me for this episode. Jeannie has done so much terrific writing and speaking on this issue, and she covers all the hot topics: Bedside procedures, warfarin correction, plasma use in liver failure and sepsis/DIC, and what role plasma plays in bleeding patients taking novel oral anticoagulants. She’s brilliant and quick and funny!

3. Destroying Misunderstandings about Whole Blood-derived Platelets (Dr. Mark Yazer)

The scoop: Dr. Mark Yazer works at the Institute for Transfusion Medicine in Pittsburgh, PA, and he was kind enough to join me as my first victim…er, interviewee on my new podcast! I heard Mark talk about the use of whole blood derived platelets at the AABB Annual Meeting in Anaheim, CA, in 2015. He was so comfortable, at ease, and hilarious that the session really stuck with me. When I decided to start my podcast, I reached out to Mark right away to be my first guest. Direct link to show page for this interview.

Why it made my list: Because it was my first interview! Honestly, I didn’t have a clue what I was doing, and figuring out how to converse with someone while making sure I knew what question to ask next was almost overwhelming. However, Mark could not have been more gracious, and I loved talking to him (two big hockey fans talking about platelets; how great is that?!). Mark takes us through seven comparisons between whole blood-derived and apheresis-derived platelets, and his thoughts might surprise you!

2. Pediatric Transfusion (Dr. Cassandra Josephson)

The scoop: Cassandra Josephson is a force of nature! Seriously, you will see her name all over the pediatric transfusion literature, and she has been and continues to be involved in many of the important studies in that field. I admit that pediatric transfusion is not an area of focus for me, but I couldn’t think of anyone I would rather learn it from than Cassandra, so I asked her to chat with me about a variety of topics. Direct link to show page for this interview.

Why it made my list: Cassandra is passionate, funny, and incredibly knowledgable, and that comes through loud and clear in this episode! I’m certain that this episode sets the record for most words spoken (as both she and I have a tendency to talkreallyreallyfast when we get excited), but you’ll hear great info on things like pediatric platelet transfusion, CMV, sickle cell disease, and HDFN.

1. What About the Age of Blood? (Prof. Nancy Heddle)

The scoop: It just dawned on me while writing this that three out my five favorite BBGuy Essentials episodes involve interviews with Canadians! Well, since I was born and raised in the only major U.S. city where you can go due south and get to Canada (Geography quiz! Do you know it? The answer is below…), I suppose that is reasonable! Nancy Heddle, Professor Emeritus at McMaster University in Hamilton, Ontario, is truly a master teacher and researcher! I reached out to her when the landmark “INFORM” study debunking most of the controversy regarding potential adverse effects of “old” RBCs was published in the New England Journal of Medicine late in 2016, and to my surprise, she was excited to participate! Direct link to show page for this interview.

Why it made my list: This is my favorite episode of the year primarily because Nancy is simply wonderful to interview! She is so smart, so kind, and so interesting that the interview just flew by for me (I can’t speak for her; it may have been like a visit to the dentist on her side!). She patiently laid out the case for the INFORM study and why it appears that the age of blood at the time of transfusion doesn’t really matter, and shared useful and practical information throughout. I think that you will love this one!

ANSWER TO GEOGRAPHY QUESTION ABOVE: I am from fabulous Detroit, Michigan! Don’t believe me about the “going due south into Canada” thing? See the image below, straight from Google Maps!

Detroit and Canada

Honorable Mentions:

These episodes were outstanding, and I just couldn’t resist recommending them to you in addition to the five favorites above:

Shape next year’s shows!

I hope you’ve enjoyed the podcast this year, and my five favorite episodes (plus two)! I’m looking forward to more great topics and discussions in 2017, and I can’t wait to share them with you.

Be sure to do two things: First, sign up for the e-mail list below! That will get you early notice of new BBGuy Podcast episodes and blog posts, and occasional special e-mail list only goodies!  Second, use the comment field below to tell me what topics you struggle with that I might address in a BBGuy Essentials Podcast interview. “Help me help you!”

Happy New Year!

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024: Allergic Reactions with Will Savage http://www.bbguy.org/2016/12/19/024/ http://www.bbguy.org/2016/12/19/024/#respond Mon, 19 Dec 2016 10:01:31 +0000 http://www.bbguy.org/?p=27075 Think allergic reactions are benign and boring? Will Savage is here to explain why they are actually a big deal!

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Will Savage

Dr. Will Savage

Dr. Will Savage from Harvard University joins Dr. Chaffin to discuss Allergic Transfusion Reactions (ATRs).

Allergic reactions have become pretty widely known as “nuisance reactions” to blood bankers and clinical staff (“Dang it! Another patient with hives!”), and it’s easy to think that we fully understand them. However, Dr. Savage and his colleagues (primarily from his previous position at Johns Hopkins University) have spent the last few years studying allergic reactions in-depth, and they have shown in numerous recent publications that we don’t yet fully “get it” with ATRs. In fact, what he has to say may surprise you! Dr. Chaffin says, “Speaking personally, the work that Will has been involved in (much of which is referenced in the links at the bottom of this page) has completely changed the way I look at these reactions! Yes, they are a nuisance, but they are a nuisance that really impacts patients to a much greater degree than I understood in the past.”

Use the player above to listen to Episode 024 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Savage nor I have any financial disclosures relevant to this presentation.

The images below are generously provided by Dr. Savage.

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023: RBC Transfusion Guidelines with Jeff Carson http://www.bbguy.org/2016/12/12/023/ http://www.bbguy.org/2016/12/12/023/#respond Mon, 12 Dec 2016 08:49:00 +0000 http://www.bbguy.org/?p=27027 I can't think of anyone better than lead author Jeff Carson to discuss the 2016 AABB RBC transfusion threshold recommendations!

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To transfuse red cells, or not to transfuse? The discussion has changed substantially in recent years. Jeff Carson is lead author of the recently published 2016 AABB RBC Transfusion Threshold Guidelines, and he has terrific insights into how we should be making those decisions.

Jeff Carson

Dr. Jeff Carson

Dr. Jeff Carson from Rutgers Robert Wood Johnson Medical School led the development and publication of the recent article, “Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage” published in JAMA online in October 2016. This project updated the 2012 AABB RBC Transfusion Guidelines (Dr. Carson was also lead author of the previous guidelines). The new guidelines have produced much discussion at national meetings and in the medical press, and Dr. Carson is here to help us understand the background of the guideline development (including the assumptions and values the committee used to work through the many new, prospective articles published since the previous guidelines were released). He also discusses the value of randomized, prospective studies of RBC transfusion thresholds vs. the many observational, retrospective studies that have been published (hint: He and the committee like one type MUCH more than the other!). Finally, Dr. Carson takes us through the RBC guidelines specifically, including why the committee elected to recommend a threshold of 7 g/dL in most cases, but 8 g/dL in a few others.

NOTE: The article also discussed the AABB Committee’s recommendations regarding the “age of blood” discussion, and whether selecting freshest available blood makes a clinical difference in recipients. Please see BBGuy Essentials Episode 022 with Professor Nancy Heddle for further discussion on that issue.

Use the player above to listen to Episode 023 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Carson wishes all listeners to be aware that during the guideline development, he had a pending grant application for a study he mentions in this interview, the “MINT Trial.” Further, he now has a grant from the NHLBI funding that trial. Dr. Chaffin has no disclosures related to this episode.

The images below are generously provided by Dr. Carson.

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022: Age of Blood with Nancy Heddle http://www.bbguy.org/2016/11/28/e022/ http://www.bbguy.org/2016/11/28/e022/#comments Mon, 28 Nov 2016 10:44:49 +0000 http://www.bbguy.org/?p=26986 The post 022: Age of Blood with Nancy Heddle appeared first on Blood Bank Guy.

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Nancy Heddle

Nancy Heddle

Professor Nancy Heddle from McMaster University in Hamilton, ON joins me for a fascinating discussion on her recently published prospective, randomized, pragmatic, and HUGE study on the association of the age of transfused RBCs with in-hospital mortality. The study is called “INFORM,” and Nancy is the lead author. This is one of my favorite interviews!

If you go into a grocery store to buy milk, you will notice that the grocers have placed the “oldest” milk at the front of the shelf, and the “freshest” milk at the back! Grocers are simply practicing a philosophy called “first in, first out” (FIFO) that minimizes the number of products that expire. Blood banks follow pretty much the same strategy with blood for transfusion (with some exceptions).

A number of years ago, scientists noticed that the appearance and other features of blood at the end of its allowable storage period (“shelf life”) was decidedly NOT the same as at the beginning! Structural, biochemical, and various immunologic changes were described, and quite frankly, it all sounded really scary! In response, a few randomized trials and many more observational, retrospective studies were published. The randomized trials failed to show much of an association between older blood and bad stuff happening, but were underpowered. The observational studies, on the other hand, definitely made blood bankers and clinicians alike worry that something bad was happening (but came with the usual warnings about making too many conclusions based on retrospective studies). The jury was out, and we needed help to resolve the differences!

INFORM, like several other recently published randomized studies such as RECESS and ABLE (see references below), was designed to look prospectively at the issue and determine whether there was evidence that blood bankers needed to change practices. INFORM is the largest and most inclusive randomized study on this issue published, and Professor Heddle takes us through the philosophy, structure, and results of the study! I’ll give you a hint: Blood banks’ current philosophy works! There are still some questions to be answered, but this study goes a long way toward ending the “age of blood” controversy! Check it out!

Use the player above to listen to Episode 022 of the BBGuy Essentials Podcast!


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DISCLAIMER and DISCLOSURES: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Professor Heddle wants you to know that INFORM was funded by the Canadian Institutes of Health Research (CIHR), and her research group receives funding from Canadian Blood Services and Health Canada. I (Dr. Chaffin) have no relevant disclosures for this episode.

The images below are generously provided by Professor Nancy Heddle.

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021: TACO with Garrett Booth http://www.bbguy.org/2016/11/14/021/ http://www.bbguy.org/2016/11/14/021/#respond Mon, 14 Nov 2016 10:59:15 +0000 http://www.bbguy.org/?p=26957 The post 021: TACO with Garrett Booth appeared first on Blood Bank Guy.

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Dr. Garrett Booth

Dr. Garrett Booth

Dr. Garrett Booth from Vanderbilt University joins Dr. Chaffin to discuss Transfusion-Associated Circulatory Overload (TACO).

Despite having possibly the silliest acronym in the history of medicine (note: This is Dr. Chaffin’s personal opinion, not necessarily shared by Dr. Booth!), TACO is a very serious disease. TACO is responsible for the second-most number of deaths from transfusion every year in the United States (and is actually #1 in countries with active hemovigilance programs such as the United Kingdom). It’s not something to mess around with, but far too many clinicians and blood bankers fail to give it the respect it deserves.

Dr. Garrett Booth is a passionate educator who feels strongly about educating us all on the ins and outs of TACO (pun intended), and he shares “Five Essential Tips about TACO” in Episode 021 of the Blood Bank Guy Essentials Podcast! This is an energetic and fast-moving discussion, and you will come away with a much better understanding of why TACO is so important.

Use the player above to listen to Episode 021 of the BBGuy Essentials Podcast!


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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Booth nor I have any relevant financial disclosures.

The images below are generously provided by Dr. Booth and transfusionnews.com.

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