Transfusion Medicine and Cellular Therapy

Transfusion Medicine
Robert DeSimone, MD, Director

Medical Director of Education, Regulatory and Quality Affairs
Maria De Los Angeles Muniz, MD

The Transfusion Medicine Laboratory provides blood banking and transfusion testing services at NewYork-Presbyterian/Weill Cornell Medicine. The laboratory provides testing and expertise to identify factors in transfusion recipients that may increase their risk of reactions and complications. The primary goals are ensuring the safe use of blood products and the proper utilization of scarce resources. The laboratory is regulated under the U.S. Food and Drug Administration (FDA) and New York State Department of Health and is accredited by the College of American Pathologists (CAP) and AABB (formerly the American Association of Blood Banks). A quality assurance team within the service assures compliance with regulatory and accrediting agencies.

Test menu:

• ABO/Rh typing on donors/recipients
• Antibody screening
• Antibody identification.
• Direct antiglobulin test
• Indirect antiglobulin test
• Alloantibody titers
• Transfusion reaction work-up
• Fetal RBC screen
• Red cell phenotyping
• ROTEM

Cellular Therapy

The Cellular Therapy Laboratory is part of the blood and marrow transplantation team at NewYork-Presbyterian/Weill Cornell. The laboratory is responsible for processing, testing, storing, and assisting with the infusion of cellular therapy products used for autologous and related and unrelated allogeneic transplantation. The laboratory is regulated under the U.S. Food and Drug Administration (FDA) and New York State Department of Health and accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) and the College of American Pathologists (CAP). All services are performed in compliance with governmental regulations and national standards and guidelines, under the direction of the quality assurance team.

Processing encompasses procedures such as volume reduction, red cell and plasma reduction, washing of cells to remove cryoprotective media, and more complex procedures such as CD34 enrichment. Testing includes quantitative flow cytometry for CD34 and CD3 content, nucleated cell counts, and hematopoietic progenitor cell cultures on cell therapy products, as well as monitoring peripheral blood samples during mobilization to optimize apheresis collections. 

Storage involves addition of cryoprotective media to products, followed by cryopreservation, and placement into the vapor phase in liquid nitrogen freezers. Cellular Therapy delivers cryopreserved or washed products to the recipient’s bedside (both inpatient and outpatient), and is responsible for thawing the cryopreserved specimens at the bedside and assisting with product infusion.

Test menu:

• CD34 enumeration including 7AAD viability
• CD3/19 enumeration
• Pre-harvest CD34
• CD34 midpoint
• HPC
• CBC
• Automated differential
• Endotoxin testing
• CFU assay
• Trypan blue viability

Transfusion Medicine Consultative Services:

• Evaluation and product selection for platelet refractoriness
• Transfusion reaction investigation
• Identification of rare red cell alloantibodies and the corresponding product selection required for this type of patient
• Appropriate product selection for patients with factor deficiencies
• Utilization of Massive Transfusion Protocol
• Treatment strategies for uremic bleeding
• Evaluation for Cold Agglutination Syndrome
• Evaluation for Paroxysmal Cold Hemoglobinuria (Donath Landsteiner test)
• Maximizing hemostasis prior to invasive procedures
• Interpretation of viscoelastic testing (ROTEM) in bleeding patients

Research

Transfusion Medicine and Cellular Therapy Laboratory physicians also participate in research projects. Examples include:

• Novel products for the prevention of transfusion reactions
• Treatment of perioperative bleeding using point of care testing
• Cellular therapy processing improvements to improve outcomes
• Cellular therapy product characterization
• Microparticle analysis
• Patient Blood Management
• Management of Perioperative Bleeding
• Transfusion Outcomes Research
• Investigational cellular therapy product clinical trials
• Pediatric transfusion medicine

Education

In addition, faculty members are involved in educational initiatives, including:

• A fellowship in Transfusion Medicine, in collaboration with the New York Blood Center
  
• Transfusion medicine training for anesthesiology fellows and pediatric and adult hematology fellows
• Education of pathology residents and medical students
• Lectures at Grand Rounds and similar events

Access N.Y.B.C.

Blood Banking / Transfusion Medicine Fellowship