Abstract Objectives Platelet transfusions are vital for managing thrombocytopenia, but platelets have the shortest shelf life among common blood products due to room-temperature storage and susceptibility to bacterial proliferation, which leads to frequent shortages. Prospective triage protocols optimize platelet use and prevent unnecessary transfusions. This study evaluated the after-hours burden of prospective platelet triage on residents, characterized triage patterns, and examined reasons for denial to identify targets for process improvement. Methods We retrospectively reviewed after-hours platelet triage pages directed to the on-call pathology resident over a 12-month period (July 2025-June 2026) at a large academic medical center. After-hours coverage was defined as weeknights (5:00 pm-8:00 am) and weekends (Friday 5:00 pm-Monday 8:00 am). Data included the number and daily sequence of requests, triage outcomes, and reasons for denial, along with hospital-wide platelet transfusion and outdate totals. Results Of 888 triage pages (mean, 74/mo), 789 (88.9%) were approved, 82 (9.2%) were denied, and 17 (1.9%) were issued as half-units. Most were second-unit requests (624 [70.3%]). Leading reasons for denial were platelet count above threshold (29/82 [35.4%) and absent post-transfusion count (26/82 [31.7%]). Of 9454 platelet units handled, 94.7% were transfused and 5.3% were outdated, while triage denied 82 (0.9%). Conclusions Prospective after-hours platelet triage imposes substantial resident workload but prevents nonindicated transfusions, supporting stewardship, patient safety, and cost savings. Interventions addressing the most common reasons for denial may further optimize resident workload and transfusion practice. However, units saved were far fewer than those outdated, indicating that wastage remains the larger issue.
Abstract Objectives To report a successful kidney transplant from an A1 donor into a genetically confirmed A2 recipient with preformed anti-A1 antibodies identified during pretransplant evaluation. Methods The donor and recipient were typed for ABO blood group, including serologic subgroup testing and molecular genotyping. The recipient was evaluated for ABO and non-ABO antibodies. Human leukocyte antigen typing, T- and B-cell flow cytometry crossmatches, and donor-derived cell-free DNA (AlloSure) testing were performed using standard protocols. Results The recipient was a 73-year-old woman with end-stage kidney disease secondary to AL amyloidosis and a history of several RBC alloantibodies (anti-C, anti-Jk(a), anti-K, and warm autoantibody with anti-e specificity). An ABO discrepancy during transplant evaluation prompted further testing, confirming an A2 blood subgroup (ABO*A2.01/O.01.02) and low-titer anti-A1 antibodies (IgM 1:2; IgG 1:1). Despite the donor being A1, final T- and B-cell flow cytometry crossmatches were negative. The transplant proceeded without desensitization. The patient had immediate graft function, with serum creatinine decreasing from 4.45 mg/dL pretransplant to 1.3 mg/dL by postoperative day 7 and remained stable at 30 days. At 10 months posttransplant, her course remained uneventful, with stable renal function and no signs of rejection or intolerance. Conclusions Kidney transplantation across the A1/A2 blood group barrier may be safe in the setting of low-titer anti-A1 antibodies, even when detectable in the antiglobulin phase, and may not require desensitization.
Abstract Objectives ALK-rearranged renal cell carcinoma (RCC) is an exceedingly rare subtype of molecularly defined RCC. Since the first reports of VCL::ALK rearrangement in 2 pediatric cases with sickle cell trait, ALK fusions with multiple non-VCL partners have been identified in ALK-rearranged RCCs from patients without sickle cell trait. Given the rarity of this subtype of RCC, continued reporting of individual cases is essential to better our understanding of the heterogenous clinicopathologic features of ALK-rearranged RCC. Methods Here we report the histologic, immunophenotypic, and molecular characteristics of an adult case of ALK-rearranged RCC. Results The tumor not only displayed diverse histologic growth patterns in a mucinous background but also exhibited a small focus of intratumoral osseous metaplasia at the periphery. Besides an atypical signal pattern found in a fluorescence in situ hybridization assay, a novel ARNT::ALK fusion with unusual breakpoints mapped to exon 19 for ALK was identified by targeted next-generation sequencing and subsequently confirmed by Sanger sequencing. More interestingly, molecular tests demonstrated the coexistence of TPM3::ALK and ARNT::ALK doublegene fusion. To our knowledge, the case presented here is the first case of ALK-rearranged RCC harboring 2 coexisting ALK fusions in the same renal tumor. Conclusions Our case demonstrated a mixed growth pattern and overlapping morphology of ALK-rearranged RCC, harboring 2 concomitant ALK fusions. It provides additional evidence for promiscuous fusion partner usage and multiple breakage hotspots of ALK rearrangements.
