In this 288th episode I welcome Dr. Tym Kajstura to the show to do an ABA keyword episode. We discuss considerations for electroconvulsive therapy (ECT) and transfusion reactions.

Big thanks to Dr. Pranav Shah, a cardiac anesthesiologist/intensivist at VCU and one of their physician informaticists. He provided some great detail on how blood preparation works:

Cross-matching isn’t a physical process majority of time, and hasn’t been for about 20 years per our Blood Bank. “Electronic Crossmatch” is the norm.

Details:

*A patient needs “two” samples within a certain time-period.
-time-period is institutional, but commonly (for inpatients) about 3 days.
-one sample is “historical” for ABO/Rh status
-one sample is “current” for ABO/Rh Status “confirmation” (to reduce the likelihood of a single clerical error for leading to harm)

Current specimens are “Type and Screen” where one part is above (ABO/Rh)..

Second part is screening … for a large library of common antibodies. (Kell, Duffy etc.)

*Scenario A (common):
Conditions:
patient has two samples,
antibody screen is negative (current and PAST)
patient isn’t “special” (e.g. sickle cell where special blood rules exist)

In this very common scenario (majority of patients), the cross-match is VIRTUAL.

When you request a unit of pRBC, Blood Bank “says” the patient
“has two samples” + “samples give same ABO / Rh” + “no antibodies ever” + “not quirky Blood Bank subpopulation”…
.. then they run an “Electronic” crossmatch. Fundamentally just hands you a blood off the shelf that meets the criteria. There is no vial mixing.

Therefore, in this scenario, Blood is available VERY quickly!

*Scenario B:
1) patient has two samples
2) patient has antibody screen that is positive.

Now, blood bank doesn’t just do an electronic screen. They do use that to identify a high-probability match unit (in my words). But they need to do a physical cross-match (my understanding).
Depending on the frequency of the antigen that the antibody is to (e.g. say Anti-Starwars antibody. But StarWars antigen is present in 96% of folks in US), the cross-match may take DAYS.

CME: Link

Random Recs:

Elantris

The Lightbringer Books

Formula 1

References:

Anesthesiahub.com

OpenAnesthesia.org

Barash, P. Clinical Anesthesia 8th edition. Walters Kluwer.

In this 280th episode I share the shocking and tragic news that Dr. Gillian Isaac died suddenly and unexpectedly a few weeks ago. She was an incredible human being, teacher, doctor, wife and mother. She will be missed more than I can say by more people than we can possibly count. I know that she would want us to continue with these keyword episodes that she loved doing and so I am going to try. I know they will never be the same, but they will be dedicated to her memory. Today I address the keyword of shock states and discuss the 4 types of shock and how they may be covered on your exams. I miss you, Gillian.

CME: Link

References:

Anesthesiahub.com

OpenAnesthesia.org