Debbie McCaskill

Our trauma team wants us to keep thawed FFP available at all times. Unfortunately, AB FFP is in short supply and as stated previously is apheresis FFP that cannot be converted to 5 day plasma. If you are a level 1 trauma center, please advise me on how I can possibly accomodate these physicians. They are wanting the 1:1:1 ratio as recommended by other trauma centers.

bxcall1, we did the same as you before being cited by CAP. We also used and still use the typenex armband. That STILL did not satisfy our inspectors! That is why we ended up asking for the second specimen. We will use a sample from another department if it was not collected at the same time as the crossmatch specimen to avoid another phlebotomy.

Approximately a year ago we were cited by CAP for not reconfirming ABO/Rh on patients. We began asking for second tubes for retypes on patients with no historical data. So far, we have yet to pick up any misdraws and we have not had complaints from the patients. I guess if we pick up one error it may all be worth it though!

We are a Level 1 trauma center. We are trying to update our MTP to provide FFP and Platelets as soon as possible. I have asked our supplier to think about providing us with liquid plasma of all types in a limited supply. They are not too keen on this. I like the idea of having thawed type A plasma available and may approach our trauma surgeon with this idea. Thanks for this idea! Does anyone have a supplier that provides pools of cryo in a frozen state? That was a suggestion I recently heard at an AABB teleconference recently.

We just give type specific cryo and we do not add anything to it. If the NICU department wants to add saline, they are welcome to do this but we do not add anything!

We have a 45 bed NICU department. Our supplier sterile docks pedi bags to the irradiated leukopoor CMV neg units that are type specific for each baby ( unless there is maternal Anti A or Anti B in the baby's plasma then we give type O). Since they are receiving small aliquots we do not worry about the K+. When a request is made for an aliquot, we split it off from the parent unit and then filter it using one of the Chartermed syringes and then issue the syringe. Our supplier only issues apheresis platelets. If it is for a baby we try and give ABO type specific and do not pay much attention to the Rh. Our supplier will sterile dock pedi bags to the apheresis platelet and we issue an aliquot in the bag for the transfusion. I do not know what filter NICU uses for the platelet transfusion. If we have several babies taking platelets, we sometimes will order an AB platelet pheresis to use for them. Thankfully, if we tell our supplier it is for a neonate they give us a better price on the platelet pheresis! We have had no complaints about these policies for as long as I can remember and I've been here for a very long time!

You may want to check your state board of nursing regulations. In the state of Louisiana, only registered nurses are supposed to transfuse blood products ( but I'm sure it is acceptable for M.D.'s to perform this also. However, I have medical technologists and a phlebotomist performing therapeutic apheresis and we had no formal training for transfusing blood products. Sad, isn't it?

We do not retest antigen typed units from our supplier either.

We have been using Adsol units that we invert upon receipt in blood holders for our neonates. They have 7 aliquot bags attached to them and the units are irradiated. For aliquots, we split off some of the blood into the bag and then put it in a syringe with a filter. The unit is allocated to two babies each ( although sometimes we will put three on a unit). The unit is used until outdate. Since most of the plasma and preservative is in the top part of the bag, the unit has a higher hematocrit and not much preservative is in the unit ( low K+). We have had no reports of a problem for many years thank goodness.

Sorry to hear about your flood! How terrible. We buy our hemotype segment devices from Fenwal. The number is 1-800-766-1077. The catalog number is 4r5126.

After our last CAP inspection we were cited for not meeting the intent of the requirement by typing the same sample twice. Now we request a second specimen for patients that do not have a historical blood type. It is working okay but there have been some instances where we did not get that second sample. This may be a good QA monitor.

For patients with no historical blood type we require a 2nd specimen to retype. This type is documented. For add on units, if a tech wants to recheck the type they are free to do so but it is not documented nor required. We only perform an auto control on panels when the screens are positive. If the auto control is positive we will do a DAT if the patient has been recently transfused. I am from a hospital in Louisiana that is a 500 bed hospital and is a level 1 trauma center.

Does anyone have a flow chart or guidance on when you perform a fetal screen? We always do them postpartum but I know there are exceptions such as trauma. I would appreciate any help you may be able to offer!

We also have had to spend quite a bit of money to purchase the stand alone software when in fact, by the end of the year we will have the updated Sunquest version to support the system. Is there some kind of money making conspiracy out there????

I agree. Our blood supplier has been virtually no help whatsoever in providing any guidance regarding ISBT. This has been a real dilemma for our hospital because we have no idea where to even begin!

Yes- When the bag gets depleted of most of the red cells, the remaining part is mostly adsol with a small amount of red cells. We then discard the remainder of the unit.

We have a 45 bed NICU department. We purchase irradiated, CMV neg, adsol units that have been sterile docked with 7 bags per unit. We give type specific if there is no circulating anti a or anti b detected at AHG. We allocate 2 or 3 babies to one unit and use it until it expires or is used up. When we get the units from our supplier, we invert them so the hematocrit will be higher once it settles out. This procedure has been utilized here for over 10 years.

CAP recently had an audioconference addressing changes in the checklist. TRM .30550 and TRM .30575 were addressed. At our facility we monitor mislabeled specimens and also follow transfusions on the floor as part of our PI process to comply with TRM.30550. However, TRM. 30575 addressed the typenex armband that a lot of facilities use. This does not comply with this checklist number. It specifically says that you must have a plan in place to implement either a mechanical barrier, a second draw from the patient, or an electronic id system. Therefore, we will develop a plan to satisfy this requirement. Hope this helps.

We perform a spun hematocrit on patients without a current H/H. On sickle cell patients we do not do this because they are transfused after the phlebotomy.

We reconcile our inventory of red cells daily. Other blood products are done monthly. I am not aware of any standards that cover this process. However, this method does detect units that were not issued in the computer which some consider to be an FDA reportable event.