Leaderboard

I agree with the procedures above. But these are basic urgent communications required of any clinical service, and I wouldn't characterize them as critical values, which are emergencies. Perhaps it's just semantics :).

We have an Extended T/S form used in Pretesting. The nurse will ask the patient if they have been transfused or pregnant in the last 3 month. Nurse signs the form and answers Yes or No. The form along with T/S specimen is sent to BB. We do the testing that day and indicate on the form if the patient has a BB history. If not, we will need an ABO Recheck specimen collected the morning of surgery. We put a round sticker on top of the specimen so we don't discard accidently. We place a comment in the computer that the patient has an Extended T/S for our info on the day of surgery. Two days before scheduled surgery, we fax the forms to Surgery Holding. Holding wants these early so they can make up the charts the afternoon before surgery when it is not so hectic. Day of surgery-Nurse asks the transfusion and pregnancy questions again, signs the form and collects the ABO Recheck specimen if needed and faxes the signed form to us. We also send a list to Surgery Holding of all the patients we know needs an ABO Recheck collected while IV is being placed so we can be sure they get the message before the patient is rolled away The BB will find the preadmit specimen in storage & test the ABO Recheck, if needed. We have a special BB order we place in the computer to answer some of the questions about the pretesting. The XM now gets 3 days and the preadmit specimen has the sticker pulled off the top and is placed in storage with all of today's specimens. In this process, we remove the comment from the computer. We will extend up to a month, so 30/31 days so we don't have to count on our fingers. LOL. If the patient comes in for surgery past the 30/31 days, we request a new order and specimen. If the patient turns out to have an antibody, we will ID and write the info on the form and hang the form up for all BB to see. We will scan for Ag- neg units prior to surgery. We write a BIG note on the form that we want a FULL pink top collected on the day of surgery and redo the T/S and crossmatch the units. We don't redo the AB panel as long as the screen appears as expected, plus the patient hasn't been transfused. It takes 3 departments completing their tasks but it works like a charm after the initial learning curve. We do not use BB armbands so I'm not sure how that would work. I don't see people wearing an armband for a month or requiring a patient to bring the armband with them on the day of surgery. Maybe some of this info can help you.

Things I have listed in my procedure: 1. If we have discovered an antibody on a patient who is about to go to surgery, we call the nurse in charge of the patient in Surgery Holding to let the physician know blood may not be available. The doc needs to know before the patient goes under the knife. Sometimes they delay the surgery and sometimes they proceed with caution. (This issue can be avoided with a pretesting process that not all physicians use) 2. If we have a serious transfusion reaction due to ABO incompatibility, we would contact the patient physician and our pathologist immediately. 3. We can't ID the antibody and the physician has requested RBC transfusion. Depending on the condition of the patient, they may still proceed with incompatible or least incompatible blood and sign a Medical Release or will probably wait until we can ID. It is up to the physician to make the call based on the patient. 4. When we had babies, we considered a positive DAT as a critical result from the BB side and would call L/D.

I have no critical values in our blood bank. Although if we have a positive DAT on a baby we call it, and we call the floors to update them if we have antibodies.

We have no critical values in the Blood Bank and we have a cancer center that sees thousands of patients per month. And it is my recommendation that critical values be restricted to truly life threatening conditions that require treatment within minutes to hours (e.g., very high or low potassium). I would most definitely NOT have critical values for things like creatinine/BUN, liver function tests, MCV, white count, etc. Provides no clinically actionable information acutely, and wastes a lot of time in the lab and amongst practitioners.

Bring back minor crossmatches?

Just for the record, if the blood is leukoreduced, CMV testing is redundant and adds no benefit. One less thing to complicate life. We haven't used CMV seronegative blood for any patient in 20 years and have yet to have a case of CMV associated with transfusion after >2,000 stem cell transplants and greater than 1,000 transfused premature newborns. Passive reporting, obviously, but this experience is supported by a fair amount of randomized trial and observational data. We also use recently (as in within a few days) irradiated washed red cells <21 days in storage for our newborn intensive care unit. There is no evidence that red cells any shorter in storage provide any clinical benefit. Indeed, shorter storage red cells are associated with increased nosocomial infection in randomized trials.