We report two rare examples of Epstein-Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) that manifests with variable severity. 1 A subset of symptomatic individuals develop proinflammatory or prothrombotic profiles requiring additional testing and interventions. [2][3][4][5] It is unclear which COVID-19 patients will ultimately develop severe disease that would have benefitted from early and aggressive interventions.A 63-year-old man was admitted with rapidly progressive COVID-19 pneumonia with hypoxia. Given the patient's worsening clinical status, laboratory coagulation analysis, including viscoelastic testing by rotational thromboelastometry (ROTEM delta, Instrumentation Laboratory Co., Bedford, MA), was performed immediately upon hospital admission. He subsequently developed acute respiratory distress syndrome and shock that required mechanical ventilation and vasopressor support.Routine coagulation testing demonstrated a prothrombin time (PT) of 12.2 seconds (normal 9.4-15.4 seconds), a partial thromboplastin time (PTT) of 30 seconds (normal 26-38 seconds), and D-dimers of 2143 ng/mL fibrinogen equivalent units (FEU; normal <600 ng/mL FEU), the last associated with severe COVID-19. 6 Viscoelastic testing demonstrated a hypercoagulable profile (see Fig. 1). 7 In particular, there was elevated maximum clot firmness observed on EXTEM (78 mm), INTEM Fig 1 Viscoelastic testing tracings from an intensive care unit patient with severe COVID-19. (A) EXTEM tracing; (B) INTEM tracing; (C) FIBTEM tracing; (D) APTEM tracing.

Background The availability of a safe blood supply is a key component of transfusion medicine. A decade of decreased blood use, decreased payment for products, and a dwindling donor base have placed the sustainability of the US blood supply at risk. Study Design and Methods A literature review was performed for blood center (BC) and hospital disaster management, chronically transfusion‐dependent diseases, and appropriate use of group O‐negative red blood cells (RBCs), and the Choosing Wisely campaign. The aim was to identify current practice and to make recommendations for BC and hospital actions. Results While BCs are better prepared to handle disasters than after the 9/11 attacks, messaging to the public remains difficult, as donors often do not realize that blood transfused during a disaster was likely collected before the event. BCs and transfusion services should participate in drafting disaster response plans. Hospitals should maintain inventories adequate for patients in the event supply is disrupted. Providing specialty products for transfusion‐dependent patients can strain collections, lead to increased use of group O RBCs, and create logistical inventory challenges for hospitals. The AABB Choosing Wisely initiative addresses overuse of blood components to optimally use this precious resource. Group O‐negative RBCs should be transfused only to patients who truly need them. Conclusions Collecting and maintaining a blood supply robust enough to handle disasters and transfusion‐dependent patients in need of specialty products is challenging. Collaboration of all parties should help to optimize resources, ensure appropriate collections, improve patient care, and ultimately result in a robust, sustainable blood supply.

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