Krystol Weidner
Apheresis Manager,
Therapeutic Apheresis Department
Hoxworth Blood Center
University of Cincinnati
At the end of a red blood cell exchange (RBCX) procedure for a patient with sickle cell disease (SCD), you expect to see lower hemoglobin S (HbS) values than before the treatment. So, when the therapeutic apheresis team at
Hoxworth Blood Center — a leader in transfusion medicine — discovered that HbS values were the same before and after a patient’s RBCX treatment, they wanted to understand why. To see how their review led to an ASFA poster — and protocol changes to improve their process — we talked with Hoxworth Apheresis Manager Krystol Weidner.
Access Point: Congratulations on having your poster published at ASFA. Can you take us back to the start and tell us more about the initial situation?
Wiedner: The ordering physician was reviewing the pre- and post-RBCX HbS levels and noticed there was no change. She contacted our team to inquire about how the procedure went. Our team launched an investigation and found that the procedure had been scheduled to be performed in single-needle mode. The assigned nurse stated that the Y-connector was connected. But after reviewing the run report on the Spectra Optia™ Apheresis System and the medical chart, as well as discussion with the nurse, we found that single needle was listed as “no” on the run report but marked “yes” on the procedure record.
Access Point: To help our readers understand why this is a problem, we will explain that when the Y-connector is connected, but the operator does not select single-needle access on the Spectra Optia touchscreen, the anticoagulant and donor blood will circulate within the extracorporeal circuit, but the patient will not receive the intended red blood cell exchange. While rare, if this occurs, it can result in a failed procedure with a high potential impact on the patient.
I understand that in your situation, the HbS lab value was an indication that the RBCX procedure was not beneficial. What did you do in response to these findings?
Wiedner: We made updates to our protocol to confirm the appropriate needle selection is chosen during the time-out process.
We updated procedure forms with additional check boxes and visual images, and we now require inspection of initial inlet flow rate to indicate appropriate single-needle selection. We also added a physical tag as a reminder to assess needle status before and during a procedure.
We have assigned our staff to complete required training on the newly implemented procedural safeguards. And we now emphasize timely post-procedural HbS lab review with the clinical team to monitor the success of this quality initiative and ensure we can promptly address any issues.
We follow this same process for both RBCX and therapeutic plasma exchange (TPE).
Access Point: Do you think that implementing these safeguards and other changes has improved your program? Since the updates were implemented, have you experienced any other issues with your single-needle procedures?
Wiedner: We have not observed any other issues from reviewing pre- and post-procedure HbS levels. Ultimately, these changes ensure that our RBCX patients receive the best clinical care. Our open communication with the hematology team remains a strength of our program.
Access Point: Do you have any recommendations that might help other apheresis teams improve their existing single-needle RBCX protocols or advice for other centers considering using single-needle procedures?
Wiedner: Absolutely! Ensure you have one high-quality, functioning point of access. Then have multiple safeguards in place to confirm single-needle access has been selected on the Spectra Optia. This provides a double check that the information was entered and entered correctly. For the red blood cell exchanges, regularly review the pre- and post-RBCX HbS data in a timely fashion.
Access Point: It looks like more than 20% of your RBCX procedures are performed via a single-needle method. What are some of the advantages your patients and staff have seen with using the single-needle option?
Wiedner: The ability for the nurse to complete the procedure if one point of access fails. And improved patient experience, especially for the patients who do not have the vasculature or ability to have two points of access.
Access Point: That wraps up our interview today. Krystol, thank you so much for sharing this experience and your insights with our readers.
About Hoxworth Blood Center
Hoxworth Blood Center is an internationally recognized leader in transfusion medicine, with services including therapeutic apheresis, red blood cell exchange, and photopheresis. A division of the University of Cincinnati and a trusted partner of University of Cincinnati Medical Center and Cincinnati Children’s Hospital Medical Center, it is the oldest operating blood bank in the country. Hoxworth serves more than 30 hospitals and medical centers in Ohio, Kentucky, and Indiana.
Spectra Optia™ is either a registered trademark or trademark of Terumo BCT, Inc. in the United States and/or other countries. See
TerumoBCT.com/trademarks for details.