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Neil Blumberg

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About Neil Blumberg

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  1. TP names or alternatives: what function title do you use?

    In the United States, PhD scientists can run, if properly credentialed, infectious disease testing laboratories and histocompatibility laboratories, but cannot, in general, be directors of hospital transfusion services or hematology laboratories. There are exceptions but these are uncommon.
  2. TP names or alternatives: what function title do you use?

    Parallel terminology for other professions would be Transfusion Medicine Nurse (or Apheresis Nurse) or Nurse Co-ordinator (for patient blood management programs) and Transfusion Medicine/Blood Bank Medical Technologist (for medical technical staff, who are often licensed in the USA).
  3. TP names or alternatives: what function title do you use?

    How about "Transfusion Medicine Physician?" In the USA, pathologist and blood banker (for both physicians and medical technologists) are used most often, which tends to (1) mislead the public and other practitioners since what pathologists are thought to do is primarily anatomic pathology (autopsy, surgical pathology, etc.) and (2) blood banker sounds like we should have an ATM, rather than a consultant clinical service :). Many transfusion service physicians (particularly outside the USA) are hematologists (or haematologists) by training. I've often used the expression "laboratory based hematologist focusing on blood transfusion" to describe what I do, but it's a mouthful.
  4. Indeed, while long stored red cells (hard to define) clearly are somewhat more toxic than medium duration stored red cells, shorter storage red cells actually are more dangerous to the extent that they mediate a higher rate of nosocomial infection in recipients. So not only are fresher red cells not better, they appear to be worse in some respects. This is the abstract reference reporting preliminary data confirming this finding, and proposing a mechanism that may contribute, namely, abnormal oxidation/reduction potential in freshly collected red cells: "Fresher blood is associated with higher oxidation reduction potential and increased risk of infection in critically ill adults. Transfusion 57 (Supplement S3): 33A (2017). To be presented by Dr. Schmidt at the AABB in San Diego soon. Blood. 2016 Jan 28;127(4):400-10. doi: 10.1182/blood-2015-09-670950. Epub 2015 Dec 1. Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis. Alexander PE1, Barty R2, Fei Y3, Vandvik PO4, Pai M5, Siemieniuk RA6, Heddle NM7, Blumberg N8, McLeod SL9, Liu J10, Eikelboom JW7, Guyatt GH1. Author information Abstract The impact of transfusing fresher vs older red blood cells (RBCs) on patient-important outcomes remains controversial. Two recently published large trials have provided new evidence. We summarized results of randomized trials evaluating the impact of the age of transfused RBCs. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Database for Systematic Reviews, and Cochrane CENTRAL for randomized controlled trials enrolling patients who were transfused fresher vs older RBCs and reported outcomes of death, adverse events, and infection. Independently and in duplicate, reviewers determined eligibility, risk of bias, and abstracted data. We conducted random effects meta-analyses and rated certainty (quality or confidence) of evidence using the GRADE approach. Of 12 trials that enrolled 5229 participants, 6 compared fresher RBCs with older RBCs and 6 compared fresher RBCs with current standard practice. There was little or no impact of fresher vs older RBCs on mortality (relative risk [RR], 1.04; 95% confidence interval [CI], 0.94-1.14; P = .45; I(2) = 0%, moderate certainty evidence) or on adverse events (RR, 1.02; 95% CI, 0.91-1.14; P = .74; I(2) = 0%, low certainty evidence). Fresher RBCs appeared to increase the risk of nosocomial infection (RR, 1.09; 95% CI, 1.00-1.18; P = .04; I(2) = 0%, risk difference 4.3%, low certainty evidence). Current evidence provides moderate certainty that use of fresher RBCs does not influence mortality, and low certainty that it does not influence adverse events but could possibly increase infection rates. The existing evidence provides no support for changing practices toward fresher RBC transfusion.