Editors: Raymond D. Aller, MD & Dennis Winsten
When purchasing a smart refrigerator is, well, smart
March 2025—Delays while a courier is sent to the blood bank. Errors in judgment. Omission of steps in tracking who received a unit of blood. Wastage of blood product because clinicians were cautious and overordered or ordered too soon. Staffing issues. All of these potential blood bank-related problems can be mitigated with smart blood-storage devices, also called smart refrigerators or blood vending machines.
New York-Presbyterian Hospital/Weill Cornell Medical Center knows firsthand how smart blood-storage devices can benefit an institution as it operates five HaemoBank systems, which store up to either 20 or 80 units in individual locking compartments that can only be accessed by authorized personnel.
Three locations—the health care system’s main surgery center, an ambulatory surgery site, and the labor and delivery unit at the New York-Presbyterian Alexandra Cohen Hospital for Women and Newborns—have deployed the refrigerators at the point of care for the emergency release of red blood cells. The outpatient infusion center and a satellite blood bank also house smart refrigerators, to streamline the RBC transfusion process for hematology patients and to issue RBCs and plasma for patients at its hospital for women and newborns, respectively.
The storage devices are integrated with Haemonetics’ BloodTrack software, which is interfaced with New York-Presbyterian’s blood bank information system to facilitate emergency blood management, remote blood allocation, and just-in-time blood delivery through electronic crossmatching. For eligible patients, RBCs can be electronically crossmatched at the time of order, provided the patient has no red cell antibodies or special requirements beyond cytomegalovirus-negative or leukoreduced blood components and as long as the appropriate units are in the refrigerators.
“It was crucial to develop a comprehensive standard operating procedure and training material before going live [with the refrigerators],” says Robert A. DeSimone, MD, director of transfusion medicine at New York-Presbyterian/Weill Cornell Medical Center.
“We were fortunate to have a dedicated team that anticipated and addressed potential issues.”
One of the staff members on the lookout for potential issues was Dennis Chen, MPA, MLS(ASCP), information technology project lead for transfusion medicine. “Education extended beyond the blood bank to include IT and clinical staff,” explains Chen. “Mock runs were essential to validating the system and addressing workflow gaps. In addition to validating the instrument itself, we had to create ancillary processes that people may not immediately think of.” For instance, it was apparent that an inventory-management protocol would be needed to ensure that blood products were rotated in an efficient manner, thereby reducing waste while maintaining availability.
Protocols were also established for laboratory information system and electronic health record system downtime. “We worked with clinical stakeholders to create a clear process, documented on the hospital’s Infonet [information-sharing] site, ensuring continuity even during rare system outages,” says Melissa Cushing, MD, director of clinical laboratories, transfusion medicine, and cellular therapies, and executive vice chair for clinical affairs, Department of Pathology and Laboratory Medicine, New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine.
It took only a short time for clinicians to see the value of the remote blood-storage devices.
“Our colleagues advocate for expanding the [availability] of smart refrigerators based on their success in existing locations,” Dr. DeSimone says.
One area in which implementation has had a big impact is New York-Presbyterian’s outpatient infusion center. “Previously, significant coordination was required between the blood bank and infusion center staff to synchronize patient readiness [for transfusion] with availability,” Dr. Cushing explains. Now, the blood bank evening shift loads the device with pre-crossmatched units for the following day, reducing daytime disruptions and improving workflow.
Forty-two percent of RBCs issued in the infusion center now come from point-of-care remote refrigerators, reducing time to transfusion by up to 50 percent for patients receiving units from those devices, Dr. DeSimone said in a presentation on smart refrigerators at the 2024 annual meeting of the Association for the Advancement of Blood and Biotherapies. (Patients on monoclonal antibody therapies, such as daratumumab, are not eligible for remote blood allocation.)
Successes such as these underscore the efforts that have gone into determining how to stock the remote refrigerators. “We examined historical blood product usage patterns by patient population to establish a periodic automatic replacement inventory model,” Chen says. The model minimizes blood shortages and wastage.
It’s also “important to take a multidisciplinary approach—to listen to the physicians and nurses who are in that space,” Dr. DeSimone explains. For example, he says, the anesthesiologists in labor and delivery at the Alexandra Cohen hospital requested that thawed plasma be available via the smart refrigerators, so two units have been added for peripartum patients.
The labor and delivery team was initially expected to access the smart refrigerators directly, adds Dr. Cushing. But because the protocols related to dispensing blood products can be complex, lab assistants trained on use of the devices were assigned to guide clinical teams and coordinate retrieval of the products. If a needed product is not in a remote refrigerator, a lab assistant uses the chat functionality in the institution’s Epic EHR to alert the requesting clinician and dispatches a courier from the blood bank with the necessary units.
Yet, as with any technology, the smart refrigerators have limitations. For example, they cannot print blood product labels during massive hemorrhage protocols or reserve fresh blood for neonates. However, having lab assistants pre-label emergency release units and stock fresh O-negative blood for women and babies has addressed these concerns, Dr. DeSimone says.
New York-Presbyterian’s use of smart refrigerators, concludes Dr. Cushing, “provides clinicians with greater peace of mind, knowing that blood products are safely stored and readily accessible.”
—Faith Reidenbach
Ibex system for detecting prostate cancer gets FDA clearance
Ibex Medical Analytics has received Food and Drug Administration 510(k) clearance for Ibex Prostate Detect, its in vitro diagnostic artificial intelligence-powered digital pathology system to identify small and rare missed prostatic cancers.
Ibex Prostate Detect is a software-only device that analyzes scanned histopathology whole slide images from prostate core needle biopsies prepared from H&E-stained formalin-fixed, paraffin-embedded tissue to identify tumors that may have been missed by the pathologist. The system provides case- and slide-level alerts for tissue suspicious for prostate cancer and a heat map directing the pathologist to areas that likely contain cancer.
Myriad Genetics to incorporate tests in Lumea platform
Lumea and Myriad Genetics have signed an agreement to integrate Myriad’s Prolaris prostate cancer test and MyRisk hereditary cancer test into Lumea’s BxLink digital pathology platform.
Prolaris quantifies the aggressiveness of prostate cancer to guide treatment decisions at the time of cancer diagnosis. MyRisk evaluates 48 genes associated with specific hereditary cancers to guide patient treatment and identify risks to a patient’s family members.
Lumea, 844-960-3658
FDA clears digital pathology image viewer from Paige
Paige’s FullFocus digital pathology image viewer has received Food and Drug Administration 510(k) clearance for use with the Leica Aperio GT 450 DX scanner and Hamamatsu NanoZoomer S360MD slide scanner system.
FullFocus was previously FDA cleared for use with the Philips IntelliSite Ultra Fast digital pathology slide scanner.
Paige, 646-849-5088
Vanderbilt to use Pramana whole slide imaging system
Pramana recently announced that it is deploying its autonomous whole slide imaging system in the pathology lab at Vanderbilt University Medical Center.
The system will allow VUMC to digitize glass pathology slides, enabling pathologists to easily reference historical slides in patient treatment decisions. The digitized slides will also be used to advance research initiatives and explore artificial intelligence-driven diagnostic applica-
tions.
“By leveraging a digital pathology system to create accessible whole slide images, we can empower our researchers to uncover new insights into complex diseases and accelerate the development of innovative diagnostics and therapies,” said Adam Seegmiller, MD, PhD, in a press statement. Dr. Seegmiller is professor of pathology, microbiology, and immunology, vice chair for clinical pathology and clinical affairs, and executive medical director of the pathology and laboratory medicine clinical service center at VUMC.
The whole slide imaging system’s modular design can be scaled for a variety of research and clinical lab uses.
Dr. Aller practices clinical informatics in Southern California. He can be reached at rayaller@gmail.com. Dennis Winsten is founder of Dennis Winsten & Associates, Healthcare Systems Consultants. He can be reached at dennis.winsten@gmail.com.