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Probably not helpful, but there is not a shred of scientific or clinical evidence for the efficacy and safety of this time limit. Totally expert opinion based upon a group of white haired males (like me) sitting around a table eating tuna fish sandwiches 60 years ago :). We document such stuff for the two regulatory agencies and two accreditation groups we are inspected by. How's that for efficiency? Four inspections.

Yes to not wanting to worry about WB, but some of this is talking about actual transfusions in the field where fresh (<14 days) WB would be very useful and much easier to deal with for a field team. I have also heard that some Trauma centers have a procedure where FFP and pRBCs and all get mixed together as they are being transfused(?!!?) I have no clue how that works, but seems like it would almost be safer to give a WB unit than that procedure?!? Fresh FFP with more functioning Coag factors logically seems better, but maybe a fresh WB has enough to keep things going. I can't see us managing this though - the WB inventory, even with returning it for Packed RBC production, would kill us. Most of our "traumas" to date have used fewer than 4 units. It will be interesting to follow this trend. By the way - does anyone know if the WB is Leukocyte reduced? If not, still having white cells onboard the unit would cause problems too. Especially with WC degradation over time before packing and filtering. Would NOT want to go back to that!

It may be seen as modifying Ortho's method, which means you would a have to have a great deal of data to validate it. On the other hand, if you can get Ortho to state that it is equivalent to their centrifuges (which may actually be made by Diamed!), then it seems like it would be OK. Scott

Spell it out in your procedure, whatever your medical director considers appropriate, then follow the procedure. Shouldn't cause any problems as long as you do that. We did our H&Hs immediately prior to the procedure, but we didn't see patients without an order for the phlebotomy. We did occasionally have a patient with a Hgb from their provider that was quite a bit higher than our result - we checked with the provider prior to phlebotomy and he/she wanted to specifiy a lower cut off for phlebotomy we checked with our med director and kept that info on file for future procedures for that patient.

We try not to stick the patient a second time if at all possible. If the patient has a historical type performed by one of our facilities we use that. If no historical but the patient had another specimen that is suitable for ABRH testing i.e. a CBC, HH and was drawn at a different time than the current TYSC specimen we will obtain that tube and perform the testing on it. If there is no suitable specimen we can put our hands on and the patient is highly likely to require transfusion then we will request another specimen be collected. Until there is a second ABRH on file the patient receives group O RBCs.

We do therapuetic phlebotomies here at our hospital from time to time. For patients with polycythemia, we check the H&H just before the procedure. (For hematochromatosis, we also check ferritin.) The patient is then processed or deferred based on those results. I would say in both cases, if a phlebotomy is indicated by the lab tests, that is still going to be valid for some time, maybe even weeks. i don't think blood counts are not likely to drop by themselves in polycythemia, and likewise iron levels are not going to drop. You need to have you administrator establish a clear policy in any case.. Scott

Sorry guys but you've got it wrong about the witches. she was a witch if she DID NOT drown - in which case she was burned at the stake. whether she had anti-D or not!

In the UK, where this "rule" originated (I think!), our Guidelines do not "allow" the grouping of the same sample twice (what is the point of that, if the sample was taken from the wrong patient in the first place? It would mean that, for example, the sample would be grouped twice as group A, and would be found to be serologically compatible with group A units, even if the patient was actually group O - and so, dead!). We have to have two samples taken at different times (preferentially by a different person). Of course, we would certainly NOT stop blood being given in a situation where the patient is bleeding to death - but we WOULD only give group O blood until the second sample is received and typed (and the Rh type would depend upon sex and age) wherever we can (obviously, in the case of a major incident, we may have to modify this, but the Guidelines allow for such a situation). A VERY intelligent gentleman (Dr. Brian McClelland MB, ChB, ND Linden, FRCP(E), FRCPath), former Consultant Haematologist to the Scottish National Blood Transfusion Service, Edinburgh, UK) once wrote, "Transfusion has risks, but bleeding to death is fatal."

I am going to make myself VERY unpopular here. Firstly, there is no such antigen as Kell (the closest is K5 or Peltz), and there is no such antibody as anti-Kell (the closest is anti-K5 or Anti-Peltz). The blood group system is Kell Blood Group System, but the first antigen within that system is K, and the antibody directed against that antigen is anti-K. The ONLY individuals who can be described as being Kell Negative are those incredibly rare individuals who have the Ko phenotype. Secondly, ONLY genes can be either homozygous or heterozygous (or, in some cases, hemizygous). Antigens CANNOT be described as either homozygous or heterozygous (or, in some cases, hemizygous). As red cells do not contain a nucleus, but merely express antigens, as the result of the individual inheriting certain genes, red cells CANNOT be either homozygous or heterozygous (or, in certain circumstances, hemizygous). The correct way of describing such red cells is to describe them as having either homozygous expression, or heterozygous expression (or, in some cases, hemizygous expression). Having got that off my chest (BUT, IT IS VERY IMPORTANT), I will now address the underlying question of this thread. Without doubt, the reaction between an anti-K and the K antigen CAN show "dosage"; I don't think anyone would dispute that these days. However, the more important question is, over the years and years and years that we have been using antibody screening cells that are K+k+, and have, therefore, NOT detected an anti-K that only reacts with red cells that have (supposed) homozygous expression, and do not forget, some of those cells may actually have come about as the result of a genotype of KE02/KEN, which means that the red cells actually have hemizygous (or "single dose"expression), how many patients have actually suffered a haemolytic transfusion reaction that has been clinically significant, causing morbidity or mortality? I would contend that, having looked through as much of the available literature as I have been able, the answer is zero. Obviously, if there is an anti-K present in the first place, albeit, it is undetectable by routine serological techniques, then transfusing the individual with either K+k+ or K+k- red cells will boost the anti-K, but it has not, as far as I know, resulted in mortality or morbidity, but will, almost certainly, result in an increase in titre and avidity of the antibody (I recognise, of course, that this could have disastrous results in a pregnancy, but only if the pregnancy is not properly monitored). On top of all the above, it is well-known that there are mutations of the KEL1 gene, resulting in "unusual" amino acid substitutions, resulting in weakened expression of the K antigen, are not unknown. It is well known that almost all blood group systems have their "quirks", which means that nobody can rely 100% on their antibody screening cells, BUT WE ALL DO! I would politely suggest that an anti-K that is only detectable with red cells that are (genuinely) K+k- are not that important.

We review the time from release to transfusion end for all transfusions.

We do the same as above.

Same in Canada. 4 hours from when it leaves the lab.

Same in the US. 4 hours from when it leaves monitored storage. Pretty sure that is clear from the regs. Scott

In our case (the UK) it is from the moment the blood is issued from a controlled fridge.

The AABB Circular of Information for the Transfusion of Blood Components requires blood products to be transfused within 4 hrs. We do monitor this is and write up cases where the 4 hour limit is exceeded. Scott Scott

Prof. Theirry Burnouf, Prof. Axel Seltsam, Sue Johnson and some English guy ay Cressier in 2015.