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Background and Objectives Maximal surgical blood order schedules (MSBOS) are prepared to assist surgeons and anaesthesiologists with pretransfusion test orders. The literature on the prevalence and usefulness of MSBOS in international settings is lacking. We developed a survey to understand the prevalence of MSBOS in hospitals and to analyse compliance with MSBOS recommendations. Method and Materials A survey tool was developed by the Biomedical Excellence for Safer Transfusions (BEST) collaborative. The survey link was distributed to BEST members who were encouraged to forward the link to colleagues. Survey respondents were asked to contribute data regarding their hospital’s MSBOS and MSBOS compliance. Results There were 174 completed surveys. Greater than half of respondents did not have an MSBOS. The total number of beds was significantly different (P = 0.04) in hospitals with (N = 81) or without (N = 93) an MSBOS. Less than a quarter of respondents felt that their MSBOS was being followed despite widespread access to the MSBOS. Over 60% of type and screen orders were MSBOS compliant; however, just 42% of cross-match orders were compliant. There was a significant difference between the number of red-blood-cell units returned to the blood bank when comparing MSBOS compliant and MSBOS non-compliant cross-match orders (227 versus 788 units, respectively, P = 0.0026). Conclusions An MSBOS could be a useful tool to help with pretransfusion test orders; however, the majority of respondents lacked a MSBOS. In hospitals with a MSBOS, it was reported to be under-utilized, which might contribute to the low compliance rates seen for cross-match orders. [ABSTRACT FROM AUTHOR]

Current management of heparin‐induced thrombocytopenia (HIT) involves prompt discontinuation of all heparin products and concomitant initiation of a direct thrombin or anti‐Xa inhibitor for anticoagulation. In the setting of HIT complicated by an urgent need for cardiopulmonary bypass (CPB), the safety and the efficacy of short‐term heparin‐based anticoagulation after therapeutic plasma exchange (TPE) have been previously demonstrated. Patients with HIT requiring TPE are frequently on extracorporeal circuits (either CPB, extracorporeal membrane oxygenation [ECMO] or external ventricular assist devices [VADs]). Performing TPE in parallel with these circuits involves additional consideration for circuit size, anticoagulant/citrate management, as well as flow rates, and risk of air embolus. We report a case of a patient with HIT on external biventricular assist device (BiVAD) requiring urgent CPB who experienced thrombotic and hemolytic complications related to anticoagulation management around apheresis line placement for TPE. We also present results from a national survey of academic apheresis services regarding specific practices in managing patients with HIT on extracorporeal circuits who require TPE. In addition, we demonstrate the utility of TPE in patients with HIT on extracorporeal circuits and the risks of this procedure and the need to develop practice guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Congenital factor XI (FXI) deficiency is associated with a variable bleeding phenotype. Recent reports have documented the use of therapeutic plasma exchange to rapidly and isovolumetrically increase FXI levels before invasive procedures in patients with congenital FXI deficiency. We report a case of acquired FXI deficiency in a pregnant woman with lupus. We proved that the inhibitor was an IgG, therefore potentially capable of crossing the placenta. While immune suppression eliminated detectable circulating inhibitor, the woman's FXI remained quite low. A multi‐disciplinary team was formed and therapeutic plasma exchange with 100% plasma replacement was performed when the patient went into labor, to acutely raise her FXI level and remove any potential non‐neutralizing inhibitor. The mother had a controllable level of bleeding during post‐TPE cesarean section; the baby had no bleeding and the baby's FXI levels were not overtly abnormal. Therapeutic plasma exchange in acquired FXI deficiency (or other acquired hemophilias) can both acutely isovolumetrically raise factor levels and remove any circulating inhibitor. [ABSTRACT FROM AUTHOR]

We surveyed multiple apheresis centers represented by the authors for their clinical approach to the management of anticoagulation issues during therapeutic plasma exchange (TPE). We present the results of their practices and a review of the pertinent literature. As plasma is removed during TPE, replacement with all or partial non‐plasma‐containing fluids (eg, 5% albumin) may lead to significant changes in hemostasis. These changes are amplified in patients who are receiving anticoagulation. We discuss various anticoagulants as well as the monitoring and adjustment of anticoagulation before, during, and after TPE. No single guideline can be applied, but rather, patients must be monitored individually, taking into account their often complex clinical conditions and medication profiles. [ABSTRACT FROM AUTHOR]