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We would report the gram stain as negative and the culture as positive with the identified organism. Actually blood bank wouldn't be reporting anything....microbiology would since they are the ones performing the testing. Our BB and Micro departments worked together to set up a procedure for handling transfusion reaction workups that required micro so that everything is consistent with best practices. Micro even takes care of notifying the patient physician in accordance with their critical call policy. After they notify the physician then they notify the blood bank so we can notify our blood supplier etc.

Format: Abstract Send to J Allergy Clin Immunol. 1978 Jul;62(1):30-2. Allergy to a product(s) of ethylene oxide gas: demonstration of IgE and IgG antibodies and hapten specificity. Dolovich J, Bell B. Abstract Patient D.H., on chronic hemodialysis, developed severe allergic reactions after exposure to articles such as plastic tubing and hemodialysis supplies which had undergone cold sterilization with ethylene oxide (EO) gas. It was shown that human serum albumin (HSA) exposed to EO (EO-HSA) in the usual sterilization procedure selectively elicited positive skin tests and in vitro histamine release. It is now demonstrated that D.H. serum reacts selectively in a radioallergosorbent test (RAST) which utilizes discs coated with HSA and exposed to EO gas. In addition, D.H. serum contained IgG antibodies reactive with EO-HSA. This antibody activity was not detected in the sera of 27 normal subjects and 25 chronic hemodialysis patients. EO-HSA and ragweed RAST inhibition tests with a number of proteins in native form and after exposure to EO demonstrated the EO hapten specificity of the IgE antibody

Being a generalist with Microbiology experience, here is my take on this: The unit should be reported as positive for bacterial contamination. I would not, though, report the gram stain as "positive" because that is changing the result that the microbiologist reported. They did not see any organisms on the gram stain, so it is negative. If the transfusion reaction workup only allows for a positive or negative result of a gram stain, with no place to report the culture result, then maybe report it as negative with a comment that the culture was positive. Ultimately, the culture shows that the unit was most likely contaminated, and that needs to be part of the transfusion reaction workup report. If the report doesn't allow for both the gram stain and culture report, maybe it should be changed to being positive or negative for "bacterial contamination" as opposed to "gram stain" (which, technically, isn't really reported as positive or negative).

Old school thought was that you had to wait for 24 hours. I think that one to two hours is common practice. I also remembered reading something in a CAP publication that discussed this and actually managed to find that in one of the threads here. There are references associated. Quoted below.................... Q. How long should you wait after a unit of blood has been transfused before drawing a complete blood count, or doing other lab work, to ensure accurate test results? A. Optimum timing of post-transfusion phlebotomy is critical for ensuring meaningful laboratory testing results, and medical judgment is required in making this determination. Several factors must be considered, including the type and amount of blood product given, purpose of the test (that is, the question it is intended to answer), and clinical setting. In general, it is best to perform phlebotomy when the patient’s circulatory system is in homeostasis. A patient who is bleeding or undergoing blood product transfusion, or both, is not in a steady state. Whenever possible, samples for laboratory testing should be postponed until bleeding has stopped and transfusion is complete. One obvious exception to this rule, however, would be the setting of massive transfusion, during which monitoring certain laboratory values, such as cell counts and coagulation parameters, is essential to guide ongoing therapy. Variables such as patient blood volume, cardiac output, renal function, and volume of blood products transfused affect how quickly homeostasis is achieved following transfusion. For the evaluation of post-transfusion increments in hemoglobin, hematocrit, and platelet counts, a practical approach is to draw blood samples within 10 to 60 minutes after completing transfusion, as this time interval is aimed at measuring peak recovery.1 Results determined from blood samples drawn later than 60 minutes post-transfusion are increasingly affected by confounding conditions, such as splenic sequestration, sepsis, and consumption.1,2 If the intent is to determine the extent of such confounding processes on red cell and platelet counts, one should combine a 10-minute post-transfusion sample with sequential samples drawn at one hour and 24 hours post-transfusion. Alterations in chemistry test results following transfusion are not usually a concern in the low-volume transfusion setting. However, assay results may be affected for varying periods following transfusion of large amounts of blood products, as seen in massive transfusion, red cell, or plasma exchange—particularly if the recipient has impaired hepatic or renal function. Banked storage of red cells results in elevated plasma levels of hemoglobin, potassium, LDH, and iron in the blood unit that may, particularly in the metabolically impaired patient, be reflected in the post-transfusion laboratory values. In addition, citrate anticoagulant present in blood products may result in transient hypocalcemia in the recipient.3 Therefore, following large-volume transfusions or exchanges, waiting 12 to 24 hours before drawing samples for chemistry assays will provide results that are more reflective of the patient’s underlying metabolic state. References Choo Y. The HLA system in transfusion medicine. In: McCullough J, ed. Transfusion Medicine. New York, NY: *McGraw–Hill Book Co;1998:401. Legler TJ, Fischer I, Dittman J, et al. Frequency and causes of refractoriness in multiply transfused patients. Ann Hematol. 1997;74:185–189. Brecher ME, ed. Technical Manual. 15th ed. Bethesda, Md.:AABB;2005;649–650. Rita A. Reik, MD Pathology Consultants of South Broward Medical Director/Transfusion Medicine Services Memorial Healthcare System Hollywood, Fla Edited November 30, 2012 by Justina Added CAP website find Justina Posted December 7, 2012 Articles: Elizalde JI, et al.Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia. Transfusion. 1997 Jun;37(6):573-6 Wiesen AR, et al. Equilibration of Hemoglobin Concentration after Transfusion in Medical Inpatients Not Actively Bleeding. Ann Intern Med. 1994;121:278-280

CAP does do an ungraded evaluation for A subgroup, so you could do your anti-A1 with that. However, I think I would contest that citation because neither anti-A1 or weak D testing are specifically listed as tests which require proficiency testing.

We only run autos with problem workups.

It sounds as if the "real", actionable result is the 24-hour reading - this should be recorded in the medical files. The "quick-and-dirty" initial test, while not very sensitive, may still be useful in some cases of extreme contamination. It may give the physicians a leg up on treatment. Perhaps a two-field record could be designed? Test #1 = Immediate; Test #2: 24-hr. The interpretation algorithm would include both results.

Proficiency testing - for anti-A1 lectin? I think your inspector is having a laugh. Quite apart from anything else, Dolichos biflorus detects both Tn and Cad polyagglutination. I would LOVE to know where he/she got the red cells to test for those and, incidentally, where the person who cited the inspector in the first place got their Tn and Cad cells. Sounds utter nonsense to me (and, possibly, a lack of knowledge on the part of both inspectors).

We keep our transfusion orders in a binder and place a unit number sticker on the paper when we issue a unit. When the patient is discharged or the specimen expires, the order is removed from the binder. When we went to electronic issue, we were able to decrease our routine inventory significantly because we no longer moved units back and forth from XM to available to XM to available. We are still working to teach the physicians not to order products until they actually need to transfuse. However, we did get the "keep ahead" order removed from the order set. Baby steps

We went a few years ago to Physician's only ordering blood products for definite transfusion. So our only units that are crossmatched that we do not routinely use are either ER patients or OR cases that we set blood up for the procedure. After the procedure the OR cases have to get a transfusion order placed in our Hospital system. We do not have a Type and Crossmatch order - only a Type and Screen and we guarantee that blood will be available if they need it crossmatched in less than 15 minutes. The physician orders a Type and Screen and then when blood products are needed an order is placed for that. All transfusion orders are separate in our system. It took a long time for the physicians to get it and every once in a while we get a doctor that wants blood "on hold" or a "Type and Cross" order. We just explain how to order what they want and it works fine.