Leaderboard

Vel, as always, I appreciate your response, Malcolm. Scott

I would agree with your first point Scott, but only because the sample being used is a plain tube, and, therefore, the liquid phase would be serum, rather than plasma. If, on the other hand, the sample was in an EDTA anticoagulated tube, and the liquid phase would, therefore, be plasma, you no longer see in vitro haemolysis, as EDTA will chelate the Ca++, Mn++ and Mg++, all of which are required as cofactors at the beginning of the classic complement pathway. I certainly agree with your second point, unless, as Anna says, there is in vivo haemolysis in the original sample (which is very often seen in cases of CHAD, even if the sample is kept at 37oC).

Wow, this is sad; I am replying to my own e-mail! In this same Edition of the Technical Manual, page 294 also "clearly" states: thawed single and closed-system-pooled cryoprecipitate concentrates should be transfused within 6 hours of thawing. This is all very conflicting and very confusing! Maybe by the time I get pre-pooled Cryo., they will have it figure out! Brenda Hutson, CLS(ASCP)SBB

I can only reply in this way: 1. The Guidance I cut and pasted in previous responses, came directly from the AABB and FDA Regulatory divisions. 2. Both the AABB and FDA state that the wording needs to be clarified 3. Until both regulatory agencies clarify their wording, it is up to you all to decide if you want to choose 4 hours, just to be on the safe side. I only passed on what I was told. Brenda Hutson, CLS(ASCP)SBB

See my responses which direct you to the Technical Manual. While the Technical Manual is not a regulatory book per se, it was trying to elaborate on regulations for this. As the reply from the FDA/AABB stated, the FDA wrote their regulation before their were pre-pooled Cryos. so they need to revise theirs. Brenda Hutson, CLS(ASCP)SBB

In looking at that Standard, you are correct in stating that it only discusses a single unit of Cryo. and Pooled Cryo. However, I guess that I am wondering (in light of the reference I made from the Technical Manual), if the issue of "pre-pooled" Cryo. being thawed, just was not differentiated in the Standards?? I don't know what to so; it just seems to me that the way the Technical Manual reads, it does differentiate between Cryo. that was pooled prior to thawing, and that which was pooled after thawing. I think I will look into that some more; espeically given that this Hospital I used to work at, does receive pre-pooled cryo. and does give it a 6 hour expiration. But, let's find out the truth! I will call the AABB for clarification. Brenda Hutson, CLS(ASCP)SBB

Good idea with A plasma! I still maintain that no one will die from a 5-15 minute wait for thawed plasma. I've been busy lately dishing out statistics on TRALI and other reactions when we have a case with borderline coags and a desire to keep FFP flowing like water. Correcting the numbers is often impossible and attempts to do so can cause a multitude of other problems, the most common being fluid overload. Yes, this can happen even in a trauma patient losing blood by the bucketful. Surgery & anesthesia staff have a unique talent for transfusing folks into cardiac failure to "correct" coag values that won't budge one iota for the duration of the calamity. BP, I would be really careful with the Factor VIIa before making this part of a trauma protocol. AABB has recently had a couple of articles in its daily mailings (Smart Briefs, I think??) regarding venous thromboses, pulmonary and cerebral emboli in troops in Iraq given Factor VIIa for bleeding, or, scarily, in anticipation of bleeding. Many trauma docs in the US are backing away from the enthusiasm they had about this product when it first was being used for this "off label indication".