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Daniela Hermelin, MD 🇺🇦 Profile picture
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Jun 16 • 9 tweets • 5 min read
Thank you for joining me to today for the @SSMHealthSTL Pediatric Education Webinar Series where we discussed the topic of 🩸👶🏾Pediatric Patient Blood Management.
From our rural hospitals to large academic ones, together let's optimize pediatric & neonatal care.
👇🏽 #Blooducation
Coming out of #WorldBloodDonorDay, it was perfect timing to discuss this topic as we celebrate our incredible blood donors while bringing awareness of the need to collect and transfuse safe blood to our patients, many which are so 🖐️🏽tiny, fitting within the palm of our hand.
💎Blood is a precious resource.
⚖️Blood transfusions have risks.
"Transfusing the right product, in the right dose, to the right patient, at the right time" is the fundamental concept of Patient Blood Management.
How do we apply these concepts within the pediatric setting?
🏃🏽‍♀️To get started, recruit hospital champions on a multidisciplinary level (clinical + administrative) to develop consensus goals.
Develop evidence based guidelines to establish hospital policy.
Monitor adherence.
Audit, audit, audit.
Did you accomplish a successful intervention?
Consider many strategies:
1) Blood conservation (reducing blood draws)
2) Restrictive transfusions (less is more)
3) Personalize transfusion/optimize coagulation
4) Autologous blood therapies (Bloodless medicine)
Need additional resources to develop and implement Patient Blood Management Programs, please check out @bloodmgmt phenomenal online publications:
sabm.org/publications/
Make sure to review these fantastic @aabb Patient Blood Management🧰 toolbox resources 👉🏽🩸aabb.org/news-resources…
Also, I highly recommend this outstanding Transfusion Medicine Reviews article by @ruchika_goel1, @cushing_melissa & @AaronTobian 👉🏽Pediatric Patient Blood Management Programs: Not Just Transfusing Little Adults sciencedirect.com/science/articl…
⁉️ Do you have experience developing Pediatric Patient Blood Management programs at your institution?
What areas have you focused on?
🙏🏽Thanks for you providing your insights below!

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More from @HermelinMD

Daniela Hermelin, MD 🇺🇦 Profile picture
Nov 17, 2021
Thank you for joining me today to learn about how TEG6S can be utilized within #Anesthesiology. Let's recap on some of the topics that we learned such as specimen collection and transportation, test components, interpretations and more.
👇🏽Follow the #tweetorial below.
First, we reviewed concepts of hemostasis.
Imagine that you cut your hand on a sharp piece of glass, ouch😲
After vasoconstriction, endothelial injury leads to PLT adhesion & aggregation --> the PLT plug.
Release of tissue factor activates coagulation cascade -->fibrin clot
Although we learn these pathways as if they happen sequentially, they are really happening simultaneously. 🔄Platelets are activated by thrombin formation, thrombin formation is activated by platelets.
⁉️What are the traditional coag labs?
Read 11 tweets
Daniela Hermelin, MD 🇺🇦 Profile picture
Jun 3, 2021
🅰️🅱️🅾️🆎#Blooducation colleagues: Fantastic new @bloodbankguy 🎧podcast with Dr. Mark Yazer on the topic of Whole Blood in Trauma Resuscitation discussing benefits and safety, and review of many important published trials. Listen now --> BBGuy.org/091.
Dr. Yazer explains some major benefits of #wholeblood. Balanced resuscitation in just 👜ONE bag, making logistics so much easier. There are fewer donor exposures and less additives & anticoagulants. Additionally, cold stored platelets are "primed for coagulation activity"
In 2018, 31rst @AABB Standards indicates that the definition of “low titer” shall be made locally by each transfusion service, and that policy specifies which patients are eligible to receive whole blood, the maximum quantity of how to monitor for adverse events post transfusion.
Read 6 tweets
Daniela Hermelin, MD 🇺🇦 Profile picture
Jun 2, 2021
A 1 day y/o 👶🏽neonate, born at 40 weeks, was transferred to our NICU for anemia & hyperbilirubinemia. He is jaundice but has no signs of encephalopathy.🩸The antibody screen is positive.
👇🏽Check out his peripheral smear below and notice the increased number of nucleated RBCs.
🤔Based on the peripheral smear findings, you begin to investigate the patient’s blood bank history because you are suspecting:
🙌🏽You got it! Based on the history and the peripheral smear findings, you are suspecting hemolytic disease of the fetus and newborn (#HDFN), which is when maternal antibodies are directed against fetal RBC antigens. What is the most common cause of #HDFN?
#Blooducation
Read 7 tweets
Daniela Hermelin, MD 🇺🇦 Profile picture
Oct 20, 2020
Listen now! #Blooducation Graphic Medicine @Pathologists virtual lecture with @KreuterMD
learn.cap.org/lms/activity_o… Image
"My heart beats for patient collaboration and that's why I went in Transfusion Medicine...." Image
Important to know how to approach a #DonorLookBack which is a multistep process a blood establishment must complete as a response to a donor who is newly reactive for an infectious disease test. Check out @bloodbankguy for more information 👆🏼👉🏼 bbguy.org/education/glos… Image
Read 16 tweets
Daniela Hermelin, MD 🇺🇦 Profile picture
Feb 10, 2020
🤩I am constantly marveled by the endless ways in which we #Pathology and #LabMedicine, can use Twitter to engage, share, support & learn from each other. Here is the link to my presentation that celebrates the unlimited opportunities to harness Twitter👉🏽
bit.ly/39kA627 Image
Like the #SolarEclipse that occurred in August 2017, to me, Twitter has been a community wide experience of marveling a visual process that can create a burst of awe at an organic velocity. It's really exciting to be engaged in this global experience. Image
#AcademicTwitter is using Twitter at the University and Research setting to teach. It has wide range benefits and I recommend reading the following article written by @soragnilab and @Aiims1742 published in @nature that describes this phenomenon. doi.org/10.1038/s41568… ImageImage
Read 12 tweets
Daniela Hermelin, MD 🇺🇦 Profile picture
Nov 29, 2019
A 23-year-old woman w/ a history of SLE was admitted to the hospital w/ abdominal pain & headache. Purpura is seen on her chest & thighs. Hb /Hct= 8.3,28.4, PLT= 7,000, LDH = 952, Hapto = <8, Ind Bili = 1.2, Cr = 1.2 PT/INR = 1.3. 👇🏼Take a look at her peripheral smear.
⁉️Based on the initial lab results and the peripheral smear findings above, what is your differential? #PathTweetorial #Blooducation #ApheresisRounds
The findings above (evidence of hemolysis, drop in platelet count & schistocytes on the peripheral smear) point to a thrombotic microangiopathic hemolytic anemia (TMA). The classic diseases that fall under this category are #TTP & #HUS. Let's review how we manage these patients
Read 10 tweets

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