carolyn swickard

To Nancy C - would it be possible to share your policy for plasma products? We do as L106's hospital does - we essentially work up plasma exactly the same as RBCs. Since going to to all Leukocyte reduced RBCs and plasma products, we see more "reactions" to plasma products than we do to RBCs anyway - and we see very few reactions either way. Last CAP inspection, I was told to make sure the DAT was done with Polyspecific AHG and told to add backtyping to my pt ABORH testing (pre and post) because so many of our platelet transfusions are not type specific and are even type incompatible. We also had one suspected TRALI case - the adverse reaction paperwork for the report to United Blood Services of Phoenix AZ was extensive!! You might be able to pick it up from the document portion of their website under the hospital/physician area. I have also felt that doing only one kind of workup is better for team members that maybe only see a workup once every 2-3 years (!) now.

We use the Credo Thermo coolers too. I have 10 liners (units) for 5 coolers - you will need the extras to keep up with the rotation. We freeze the units for at least 8 hours in a -30C freezer to recharge them. I keep 4 units in the refrigerator at all times. After you remove them from the freezer, they will take 2-3 hours in the refrigerator to come to the proper temp (this can be determined to be when there is no frost left on the outside of the unit), but since I am rotating 4 of them at all times in the frig, we always have one ready to go. (In moist climates, they sweat a lot - place them on towels to soak up the water.) If they have been in the frig over 24-48 hours, you can always rotate some back to the freezer and replace them with ones from the freezer (this happens after the weekend when they don't rotate out as fast). Hope this helps - they are small coolers and will take only 2-4 units, but the RNs love them. The Thermo-Safe coolers are much heavier and require 3 ice blocks to keep them at temp - the RNs hated carrying them. Make sure you label the Credo lids - "Don't lose this Lid" and label the back of the lid with "Return to Blood Bank" it will help you keep up with the lids - if they are lost, the unit has to be replaced - expensive.

My question on this subject deals with the casual statement in these articles, especially the news articles, that we can "easily fix" this storage lesion by adding nitric oxide, I think it was, to these units. Does anyone have any idea at all what they are talking about????? Another question - is this anything the anesthesiologists could adjust in the gas mixture they are giving the cardiac patients during the cariac surgery????

350 ml really doesn't work well as a default amount anymore. The pheresised RBC units range from 270-290 ml. The RBCs from the whole blood units range from 300 - 420 ml, based on our experience, at least. Though, give how small an amount 50 mls really is, I'm not sure it makes all that much difference.

When the RNs had to start recording all volumes In and Out; they asked us to start giving volumes on the RBCs too. We also estimate the bag wight at 50 Gms (weighed many empty ones) and then just weigh the bag and subtract 50 gms (1gm:1ml Ratio). It seems to work well and we have a check against the volume recorded by our Blood Center on Pheresised RBCs - they are pretty close to one another. The Plasmas all have the same kind of weight recorded on them from the Blood Center, so we don't weigh them.

We have 3 new Helmer (Hettich) EBA 21 centrifuges, one for specimen tube spindown and 2 for serological work. We also have 2 new Helmer (Hettich) UltraCW cellwashers. All are excellent. Work with the Helmer Inc reps online or by phone - very fast answers and very fast response with quotes. The EBA 21 has approximately 10-15 different heads (2 for serological work - fixed or swing out).

We occasionally use expired panel RBCs (3 months or less) in the final ruleouts/confirmations of new or known antibodies. Has anyone else had any problems with this procedure for AABB, CAP, FDA or JCAHO inspectors? In an SOP detailing this specific use - should the expired RBCs be restricted soley to ruleouts/confirmations - does mentioning them at all cause problems? Does anyone use rare antigen typing reagents to prove viability of the expired RBC before it is used to rule out an antigen? Any help would be deeply appreciated.