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Showing content with the highest reputation on 05/17/2018 in all areas

  1. Plasma is hard to keep track of just by temperature alone. If you are in a hurry - there is a good chance the plasma is going to be warmer that 1-6C when it leaves the Blood Bank to start with. Even in a separate cooler, that means the temperature monitoring tabs won't work and there is no way to know what happens to the plasma that way. Data loggers wouldn't work either. Difficult situation. We will only accept plasma back if it is cold and in it's own cooler and will only keep it for 24 hours. We do not extend FFP (any type) that was issued and returned into a Thawed Plasma product either.
    2 points
  2. Unfortunately, NHSBT RCI reports now use "coded comments", rather than free text. The "coded comments" are, almost universally, ungrammatical, reflect poor scientific (in particular, blood group) nomenclature, are frequently clinically inaccurate and are totally confusing, so I am not surprised you are not familiar with the term, because, in reality, it shouldn't exist, especially in a report from a Reference Laboratory. The reason "canned comments" are used are two-fold. Firstly, they can be put in quickly (striking one key can put in a complete sentence - although, as I said above, most of them are far from grammatically correct sentences - and, of course, hit the wrong key, and you have a comment that is even less relevant than hitting the correct key), so this is "LEAN". Secondly, and much more insulting, is that one of the senior managers thinks that, if a CORRECT free text report is provided, the poor souls who work in a hospital laboratory will not be able to understand it. How would you feel about that applejw? Of course, in this case, there is probably an auto-antibody, directed against an antigen within the Rh Blood Group System, such as anti-Rh17 or anti-Rh18, that mimics more "common" Rh antibody specificities, such as anti-c and anti-E. In this case, the antibody reacts with all antibody panel cells, but reacts more strongly with those cells expressing the c and the E antigen, hence the inaccurate, and scientifically poor (appalling) comment about "non-specific anti-E and anti-c". I hope you are sufficiently intelligent to understand this. THAT LAST SENTENCE IS MEANT AS A JOKE (although, not necessarily, if the person reading this happens to be the senior NHSBT manager who thinks hospital staff are thick)!
    1 point
  3. I would tend to disagree - you don't know how the product is handled after it gets where it is going (OR, ER, wherever). I don't believe that the temperature monitoring tabs are approved for plasma. If they are, I think you'd have to use them to document that the product was stored appropriately while out of the BB. I'd cite you otherwise.
    1 point
  4. The Last Chance Review is now called PASS. It looks like handouts for the 2018 session are available for purchase at http://www.passbbexamreview.org/
    1 point
  5. AMcCord

    Allergic Reaction

    Nice power point. I'm going to save it for my students. We actually had one of these patients within the last 18 months or so - full anaphylaxis. First one I've seen and at the rate we transfuse, hopefully it should be the last, statistically speaking.
    1 point
  6. There are no data. When we wash platelets or red cells, the outdate is 24 hours because of the open system (ancient COBE/Terumo type 2991s). Patients do better in terms of key clinical outcomes (mortality, infection, thrombosis) with washed platelets so I'm not concerned about the container, length of storage, etc. Ultimately clinical outcomes are more important than any of those surrogate in vitro markers. We routinely wash to remove incompatible ABO antibody and soluble antigen, FYI. We do not wash red cells more than 21 days of storage due to increased hemolysis, and poorer clinical outcomes with these components (washed >21 days). We currently wash with normal saline, but Plasma-Lyte A (AJCP in press) causes less hemolysis and we will be moving away from normal saline. Hopefully we remove normal saline from use for all transfusion service and clinical uses, due to recent data that normal saline causes increased mortality and renal failure in ICU patients (in NEJM). See references below. A randomized trial of washed red blood cell and platelet transfusions in adult acute leukemia [ISRCTN76536440]. Blumberg N, Heal JM, Rowe JM. BMC Blood Disord. 2004 Dec 10;4(1):6. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Henrichs KF, Howk N, Masel DS, Thayer M, Refaai MA, Kirkley SA, Heal JM, Blumberg N. Transfusion. 2012 Mar;52(3):635-40. doi: 10.1111/j.1537-2995.2011.03329.x. Epub 2011 Sep 2. Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions: results of a prospective, randomized, controlled clinical trial. Cholette JM, Henrichs KF, Alfieris GM, Powers KS, Phipps R, Spinelli SL, Swartz M, Gensini F, Daugherty LE, Nazarian E, Rubenstein JS, Sweeney D, Eaton M, Lerner NB, Blumberg N. Pediatr Crit Care Med. 2012 May;13(3):290-9. doi: 10.1097/PCC.0b013e31822f173c. ABO identical and washed blood transfusions as candidate strategies to reduce early mortality in acute promyelocytic leukemia. Sahai T, Henrichs K, Refaai M, Heal JM, Kirkley SA, Schmidt AE, Mendler JH, Masel D, Liesveld J, Aquina C, Blumberg N. Leuk Res. 2017 Nov;62:1-3. doi: 10.1016/j.leukres.2017.09.011. Epub 2017 Sep 23. Improved outcomes in acute myeloid leukemia patients treated with washed transfusions. Greener D, Henrichs KF, Liesveld JL, Heal JM, Aquina CT, Phillips GL 2nd, Kirkley SA, Milner LA, Refaai MA, Mendler JH, Szydlowski J, Masel D, Schmidt A, Boscoe FP, Schymura MJ, Blumberg N. Am J Hematol. 2017 Jan;92(1):E8-E9. doi: 10.1002/ajh.24585. Longer RBC storage duration is associated with increased postoperative infections in pediatric cardiac surgery. Cholette JM, Pietropaoli AP, Henrichs KF, Alfieris GM, Powers KS, Phipps R, Spinelli SL, Swartz M, Gensini F, Daugherty LE, Nazarian E, Rubenstein JS, Sweeney D, Eaton M, Blumberg N. Pediatr Crit Care Med. 2015 Mar;16(3):227-35. doi: 10.1097/PCC.0000000000000320. Transfus Apher Sci. 2018 Feb;57(1):127-131. doi: 10.1016/j.transci.2018.02.021. Epub 2018 Feb 21. 0.9% NaCl (Normal Saline) - Perhaps not so normal after all? Blumberg N1, Cholette JM2, Pietropaoli AP3, Phipps R4, Spinelli SL5, Eaton MP6, Noronha SA7, Seghatchian J8, Heal JM9, Refaai MA9. Crystalloid infusion is widely employed in patient care for volume replacement and resuscitation. In the United States the crystalloid of choice is often normal saline. Surgeons and anesthesiologists have long preferred buffered solutions such as Ringer's Lactate and Plasma-Lyte A. Normal saline is the solution most widely employed in medical and pediatric care, as well as in hematology and transfusion medicine. However, there is growing concern that normal saline is more toxic than balanced, buffered crystalloids such as Plasma-Lyte and Lactated Ringer's. Normal saline is the only solution recommended for red cell washing, administration and salvage in the USA, but Plasma-Lyte A is also FDA approved for these purposes. Lactated Ringer's has been traditionally avoided in these applications due to concerns over clotting, but existing research suggests this is not likely a problem. In animal models and clinical studies in various settings, normal saline can cause metabolic acidosis, vascular and renal function changes, as well as abdominal pain in comparison with balanced crystalloids. The one extant randomized trial suggests that in very small volumes (2 l or less) normal saline is not more toxic than other crystalloids. Recent evidence suggests that normal saline causes substantially more in vitro hemolysis than Plasma-Lyte A and similar solutions during short term storage (24 hours) after washing or intraoperative salvage. There are now abundant data to raise concerns as to whether normal saline is the safest replacement solution in infusion therapy, red cell washing and salvage, apheresis and similar uses. In the USA, Plasma-Lyte A is also FDA approved for use with blood components and is likely a safer solution for these purposes. Its only disadvantage is a higher cost. Additional studies of the safety of normal saline for virtually all current clinical uses are needed. It seems likely that normal saline will eventually be abandoned in favor of safer, more physiologic crystalloid solutions in the coming years. N Engl J Med. 2018 Mar 1;378(9):829-839. doi: 10.1056/NEJMoa1711584. Epub 2018 Feb 27. Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW1, Self WH1, Wanderer JP1, Ehrenfeld JM1, Wang L1, Byrne DW1, Stollings JL1, Kumar AB1, Hughes CG1, Hernandez A1, Guillamondegui OD1, May AK1, Weavind L1, Casey JD1, Siew ED1, Shaw AD1, Bernard GR1, Rice TW1; SMART Investigators and the Pragmatic Critical Care Research Group. BACKGROUND: Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. METHODS: In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first. RESULTS: Among the 7942 patients in the balanced-crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04). In-hospital mortality at 30 days was 10.3% in the balanced-crystalloids group and 11.1% in the saline group (P=0.06). The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P=0.60). CONCLUSIONS: Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779 .).
    1 point
  7. Technically, they cannot as they are not a law setting organization like the FDA. I would not go past the 4 hours, but we do not volume reduce. Platelets are living, "breathing" cells and you are greatly increasing their concentration and ability to transport oxygen.
    1 point
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