The AABB annual meeting is always an exciting and busy time of year. We know that many people interested in transfusion medicine weren’t able to attend, and even those who attended couldn’t make it to every talk, it is impossible to fit it all in. We would like to share our top four lessons learned from this year’s AABB conference. Do you agree with our picks? Please leave your feedback at the end of the blog.
This AABB conference started out with leaving AABB President, Mary Beth Bassett, calling for the Re-imagineers of Transfusion medicine to come forward to bring change to the AABB and transfusion medicine as a whole. This plea was followed up by numerous talks on innovative and controversial topics ranging from the usage of cold stored platelets to the inflammatory side of blood products. However, the first key lesson for us was all about dollars and cents.
How Much Does a Transfusion Cost?
The session titled “Do We Really Know What a Transfusion Costs?” opened eyes and raised some important questions that are in need of answering. Dr. Aryeh Shander said that when they first asked this question, nobody really knew the answer “all the way up to the NIH!” Since then, some additional data has come in. When taking into account product cost, processing, and overhead, a fresh frozen plasma transfusion ends up costing a hospital roughly 3 times the cost of the product. Red blood cells are even more extreme, with the total cost ranging from 5 to 10 times the cost of the product. Dr. Shander didn’t share any data on platelets, as the research is still ongoing, however, if it falls in line with plasma and red cells then a platelet unit that is purchased for $500 could carry a total transfusion cost of anywhere between $1,500-$5,000.
Cold Stored Platelets
This development has been of particular interest to all of us working on ThromboLUX since License to Chill first graced the cover of Transfusion nearly 3 years ago. This year, Colonel Andrew Cap continued to advocate for separate platelet storage conditions for prophylactic and therapeutic uses. One incredible take-away was that even on day 14 cold stored platelets still had an improved aggregation response.
Iron Management Among Blood Donors
This hot topic has come up routinely at AABB conferences in the past. The overall recommendation of the Risk-Based Decision Making Report on Iron Management Among Blood Donors is to address the risk of iron deficiency in repeat donors, however, there were shortcomings in the recommendation. It was concluded that many of the recommendations would reduce the donor base, and were in conflict with the licenses of blood collection facilities (e.g. dispensing iron requires a pharmacy license). Importantly, Dr. Steven Sloan pointed out that there is a “legal risk with the status quo.” It is clear that this topic will need to be revisited with the Re-imagineer mindset in the future.
Looking at the Inflammatory Side
Another session the ThromboLUX staff found very important was “Blood Products: Time to Consider the Inflammatory Side”. Dr. Fabrice Cognasse, first speaker of the session, talked about the inflammatory role that platelets play. As Dr. Cognasse explained, platelets perform a very important role in the innate immune system and the immune interactions of platelets can lead to severe thrombocytopenic states. An example Dr. Cognasse gave was sepsis, wherein pathogens can bind to platelets and cause the platelets to be sequestered and destroyed. The data support that the microparticles produced under a variety of stress conditions that cause platelet activation also have an important immune and inflammatory function, as these microparticles can carry a multitude of cargo to inflammation sites and other cells.
Dr. Eldad Hod then talked about the controversy surrounding the age of red blood cells. He discussed the fact that recent randomized controlled trials did not find outcome differences when comparing fresh red cell transfusions to aged red cell transfusions. He hypothesized that the inflammatory components of the red cells were not accounted for in these studies, and because these inflammatory components can affect patients with compromised immune systems, the RCT results may have been skewed.
Dr. Cognasse ended his talk in the Re-imagineer spirit by concluding that transfusion medicine might be one of the first specialties where personalized medicine comes into effect. Based on our work with ThromboLUX, we couldn’t agree more. One could argue blood typing is personalized medicine par excellence, and matching platelet activation status to patient needs is another level of personalizing platelet transfusions.
How Was Your AABB?
We just summarized our four top lessons learned at AABB 2018. Do you agree with our picks? What did you find interesting at AABB? We would love to hear your feedback.