Leaderboard

We have in place the following: 1. If the patient exhibits signs/symptoms related to transfusion reactions (there's a list), there is no choice ... the transfusion is discontinued and a Transfusion Reaction Investigation is ordered. Period. This is because the transfusion is under the license of the BB Medical Director who is thereby responsible for it. Besides, if MDs have the powers to 'instantly know' whether the symptoms are due to the transfusion or not and that the blood was completely compatible or not causing any allergic, TRALI, Overload, etc. without any testing/rechecking/investigation, then why do we need the Blood Bank investigations at all? It is safer to stop and do the investigation than to rely on a variety of MD 'instincts'. As much as they like to think they are, they (especially the residents) prove over and over again that they are not the experts in these matters. (e.g. some of them are not aware of the symptoms or how to treat TRALI.) I always think about 'how would this look in court?' The only exception is 'Hives Only'. If this happens, the infusionist is instructed by SOP to pause the transfusion, see if the hives subside, confer with MD to see if they want to administer medication, and then continue the transfusion. 2. When a Transfusion Reaction Investigation is ordered, a specimen is drawn that becomes a) the 'Post Reaction' specimen for comparison studies (color, DAT, etc.) and the new pretransfusion specimen for subsequent transfusions. All units that were crossmatched with the original specimen are released (i.e. not allocated to the patient anymore.) (n.b. we are on a BB Band system so each specimen is a separate entity)During the investigation, no units are issued unless the attending MD documents that there is a life/death situation where only the continuance of the transfusions will sustain life. We haven't had this happen yet, but when it does, we plan to issue the prior compatible units with this documentation ... not sure if we should call this 'Emergency Release' or not ... now that I'm focusing on it, we probably should.

We had a case recently where a patient came in through the ER, she gave the nurse an Antibody card for a Jka that was identified years ago in Texas. When we called to get more info we were told that the patient was not coherent and no family was available. We did the screen (positive), and antibody Id and found a E, K (no sign of the Jka). 2 units were set up(E,K,Jka neg) and transfused. The next day they ordered 2 more units, a nurse from the floor called to say that the patient was insisting she had another antibody card that she could not find. I spoke to the patient and she told me she had 2 cards from different hospitals, she was also able to tell me all (or at least several) of the hospitals she had been transfused at. I proceded to call all of them and found another hospital in Texas that had identified E, c. We antigen typed the units she was given and 1 was c positive. Post transfusion had a lovely c. Morale of the story...Always listen to the patient....