Infants and children are NOT just “little adults!” Dr. Cassandra Josephson shares 5 principles you must know about pediatric transfusion.
About My Guest:
Dr. Cassandra Josephson is one of only a few physicians in the United States trained and board-certified in Pediatrics, Pediatric Hematology/Oncology, and Blood Banking/Transfusion Medicine. She is a Professor in the Departments of Pathology and Lab Medicine and Pediatrics at Emory University in Atlanta, GA. She is the medical director of the blood/tissue banks, and apheresis services at Children’s Healthcare of Atlanta and Director of Clinical Research in the Emory Center for Transfusion and Cellular Therapies. She is also the co-author of the “Neonatal and Pediatric Transfusion” chapter in the 18th edition of the AABB Technical Manual, among many other publications.
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. Josephson serves as a consultant to the following companies: Immucor, Octapharma, and Biomet Zimmer.
- 02:00: Intro to Dr. Josephson
- 09:45: Top Five Things #1: “The Volumes Vary”
- 19:10: Out of group plasma risk discussion
- 20:25: Top Five Things #2: “Predicting Platelet Effect in Neonates, Pediatric Oncology, and Stem Cell Patients”
- 22:30: Description of new paper showing no benefit of platelet transfusions in preventing neonatal intraventricular hemorrhage!
- 25:05: PLADO subanalysis showing platelet count does not predict bleeding in children
- 32:40: Top Five Things #3: “Cleaning House; Irradiation and “CMV-safe” products”
- 35:55: Neonates at risk for TA-GVHD
- 39:28: CMV-safe blood products and neonatal CMV transmission
- 45:37: Optimal CMV prevention strategy
- 49:30: Top Five Things #4: “An Ounce of Prevention Makes RBC Transfusion Possible and Lifesaving”
- 53:45: Matching RBC transfusions in sickle cell disease
- 60:00: Future danger of allowing pediatric sickle cell patients to make alloantibodies
- 65:20: Top Five Things #5: “A Look at Hemolytic Disease of the Fetus and Newborn”
- 67:35: ABO Hemolytic Disease of the Newborn
Further Reading (in order mentioned):
- Hendrickson JE et al. Coagulopathy is Prevalent and Associated with Adverse Outcomes in Transfused Pediatric Trauma Patients. J Peds 2012;160(2):204-9
- Sparger KA et al. Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants. JAMA Pediatrics 2016 (early view online May 23, 2016).
- Slichter SJ et al. Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage. N Engl J Med 2010;362:600-13.
- Josephson CD et al. Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypo proliferative thrombocytopenia. Blood 2012:120(4):748-60.
- Josephson CD et al. Blood Transfusion and Breast Milk Transmission of Cytomegalovirus in Very Low Birth Weight Infants. JAMA Pediatrics 2014;168(11):1054-62.
- Delaney M et al. Postnatal cytomegalovirus infection: a pilot comparative effectiveness study of transfusion safety using leukoreduced-only transfusion strategy. Transfusion 2016 (early view online April 15, 2016).
- Vichinsky EP et al. Prospective RBC phenotype matching in a stroke-prevention trial in sickle cell anemia: a multicenter transfusion trial. Transfusion 2001;41:1086-92.
- Chou ST et al. High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood 2013;122(6):1062-71.
- Nickel RS et al. Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series. Transfusion 2016;56(1):107-14.
- McLaughlin JF and Ballas SK. High mortality among children with sickle cell anemia and overt stroke who discontinue blood transfusion after transition to an adult program. Transfusion 2016;56(5):1014-21.
Dr. Josephson’s talk was SUPERB. This should be required listening for all incoming Heme/Onc Fellows as well as Transfusion Medicine Fellows. Her clear and concise review of the 5 topics listed above will give you evidence-based answers for your toughest pediatric blood bank questions. Thanks Dr. Chaffin for providing quality podcasts!!
Thanks for the comment! Dr. Josephson is indeed incredible, and I’m very glad you enjoyed the podcast!
Dear Dr. Chaffin,I’m from Qingdao,a beautiful city in China.I work in blood transfusion department.I pay attention to your web site for a long time.The web site you create is so great.I want to translate your blogs and podcast into Chinese.I want to introduce you to China for doctors who work in blood transfusion department or blood bank. Can you authorize me to translate your articles into Chinese? Thank you for your website，I got a way to learn about transfusion in America. In China the APP “WeChat” is very popular .We use WeChat chat.We use WeChat share articles.Also We use WeChat reservation.I have created a WeChat public number called “Blood transfusion information”.I share some video from your website blood bank guy on WeChat public number. My English is not well,there may be some mistakes in grammar. Hope have more communication with you！I I will study hard to improve my oral English.
Thanks for writing! Your English is fine! Please contact me directly through the “Ask BBGuy” link (bbguy.org/ask) for further discussion about your ideas, ok?
Excellent joe. Outstanding
Thanks very much!
Absolutely superb! Yes please do bring Dr. Josephson back to discuss more neonatal and pediatric TM topics. I really enjoyed her podcast.
Thanks, Canadian BB’er! She really is terrific, and I love her enthusiasm and passion for what she does. I will definitely have her back in 2017 (if she is willing).
Hello Dr. Joe! Jad here from Saudi Arabia.
First of all, your website is soooo cool!!! So educational and easy to understand. I have never ever seen BB-website better than this! Your a guardian angel for BBankers!!!:D All the podcasts are noteworthy:)
I’d like to request if you can have a topic about Quality Management in BB, accreditation and regulation, difference between hospital-based and Blood Center or any related to this. I know its too much. But thank you in advance 🙂
Way to go doc!
Thank you for focusing on Paediatric and Neonatal Transfusion Practice which are so often overlooked. This is an excellent podcast and I look forward to more.
Transfusion Safety Clare
Transfusion Safety Nurse Clincian from Canada
I had problem playing podcast 012 pediatric transfusion. Nothing happens after I clicked ‘play’ arrow. Any suggestion?
No problem with the other ones I heard.
Thanks for letting me know! Try it again; it should be working now (reload your page if it doesn’t work the first time).