The patient was a premature infant, six weeks old and just 2.5 kilograms, already on ECMO for primary cardiopulmonary failure. Sepsis developed secondarily, and the critical-care team requested plasmapheresis for a presumed cytokine storm — a Category III indication  under the current ASFA guidelines. On paper, the rationale made sense. But when I calculated the total blood volume — only 250 mL  (≈ 100 mL/kg for a premature infant) — it was immediately clear this baby was too

The antibody screen looked straightforward at first glance — an O positive patient with apparent anti-D reactivity in plasma. But the autocontrol was positive, and the eluate was a panagglutinin. Those two results change the entire story. Working the Differential When a D-positive patient’s plasma reacts like anti-D, the immediate differentials are familiar: Partial D variant (missing epitope exposure) Passive anti-D (recent RhIg or IVIG) Autoantibody with apparent Rh specifi

1 | Finding the rhythm of replacement When people talk about plasma exchange, they usually focus on what  to replace. Less often...

1 | A brief historical arc In the early years of therapeutic plasma exchange (TPE), replacement was simple: plasma when coagulation...

The Overlooked Half of the Exchange When we talk about plasma exchange, most of the conversation centers on what we’re removing —...

This morning on the apheresis service, I saw a familiar face — one of our regular outpatients. He’s four weeks out from a total knee...

The other day, I asked an AI model about the Diego blood group system. It gave me a slick, confident answer — beautifully formatted,...

I’ve been out of training just long enough to start thinking about the long term. Over the years, I’ve sat through countless wellness...

In Part Two, we followed the fork in the road: cellular and tissue-based products that meet all four criteria in 21 CFR 1271.10(a) can...

In Part One, we mapped out how laws and regulations interact, how the FDA is structured, and why blood is both a drug and a biologic. Now...

When I first dipped my toes into cellular therapy regulations, it felt like drowning in alphabet soup: PHS Act, FD&C Act, Title 21 CFR,...

Most of the time, our red cells are polite. They keep their surface antigens tucked away, only showing the parts of themselves that...

Most days in the blood bank, we’re juggling the usual suspects — ABO, Rh, Kell, Duffy, Kidd, MNS. But every now and then, an antibody...

One of the challenges in transfusion medicine is that the most important areas of knowledge are not always the most glamorous. Beyond the...

When I first wrote my Fresh Frozen Facts  series, I focused on the workhorses. But plasma isn’t a single product: it’s a whole family,...

Mahesar A, et al. Platelet refractoriness during bone marrow transplantation: Comparison in aplastic anemia and beta thalassemia major...

I’ve been taught a lot about resilience. It’s a buzzword now — built into wellness curricula, baked into institutional language, handed...

This week, I graduate from my transfusion medicine fellowship at the NIH. It’s the culmination of a year that was equal parts challenging...

We’ve spent the last three posts talking about plasma as a transfusion product — thawed, typed, delivered in a blood bag, and used (too...

This is the third installment in my four-part series on plasma. In Part I, we broke down the different types of plasma products — from...