Mabel Adams

I just saw that the FDA approved the use of Keytruda (anti-CD47) for a type of lymphoma so wondered if anyone has newer information for managing these patients if they need transfusion. Does the Immucor AHG work reliably? How are you resolving typing discrepancies?

We turn out a negative DTT-treated screen and do electronic crossmatch. If the screen has gone out as positive our computer won't allow EXM so we would do IS as Malcolm suggests. More complicated if there are alloantibodies but we haven't seen that yet.

Catherine, I am looking for a reference lab that can do this testing for around $300. If you wouldn't mind letting me know who yours is, I would appreciate it (PM, email, or phone call are fine).

I have a note: AABB 2015 (Ask the FDA... question 18) that issued plasma must be stored in a container that maintains proper temperature but that it is acceptable for return regardless of its temperature if properly stored. You are really debating the "properly stored" question but I found the above interesting and useful for those units issued warm and brought back promptly before they cooled down. I will be defining some circumstances in which we will accept them back. This is a more common problem now that the "trauma packs" with plasma go out more routinely.

Thanks all. He seemed so convinced that there was an article and he is a respected practitioner. It could be the article was something he remembered from 1985 and he hasn't had a case in recent years.

I think I read that platelet function lasts longer than we would expect--even longer than the accepted 7-10 day life span. Cold storage slows the platelet metabolism and extends their life??? I'm not sure what you've got on day 21 for platelet function.

What little info I have says they are testing 2 tubes, A & B tested separately. I think IS but I am not sure. If you contact dragonlady on this site, she should know.

Our ARC is starting to offer these products. They are using a titer cut-off of 200. The whole blood units will cost 3 times the price of a RBC. It's good for 21 days. Oregon Health Sciences University will be stocking them for traumas. They are the 4th hospital in the country supplied by ARC to use WB in their trauma program. Our ARC is the Pacific Northwest region in Portland.

We recently had a mom with anti-D deliver and the OB insisted on doing a fetalscreen and giving RhIG. He said he had an article that giving RhIG was recommended to suppress further increase in the titer. He was driving when the pathologist phoned him so we never got the reference. Does anyone know of recent research that recommends this? I feel like I'm back in 1984.

Someone once posted a story of a visitor fainting from the site of a unit of blood being transported so they switched to opaque bags.

March issue of Transfusion has a "How Do I" article on this. How do I implement a whole blood program for massively bleeding patients? Mark H. Yazer,1 Andrew P. Cap,2 Philip C. Spinella,3 Louis Alarcon,4 and Darrell J. Triulzi1 I am working on trying to figure out something for rural hospitals who seldom have massive transfusions but whose patients we would like to save just as much as those who can get to big trauma centers. Any suggestions would be appreciated.

John, it's hard to believe that you have to explain who you are after all these years but I guess there are lots of newbies and you aren't on here as much as you were "back in the day." We've probably been talking online for over 20 years now. Wow! Remember Y2K??? We probably hashed that out together online.

We are a system of 4 hospitals and we collect a new specimen when the patient is transferred to the bigger site. We use a blood bank banding system and the ED is instructed to cut off all bands a patient comes in with so that would make the original sample unusable by us. Also, if serologic crossmatches or a transfusion reaction workup are needed, we need a specimen here, at our site. Besides that, we are not responsible for training and competency of the testing staff at our small hospitals so would not accept responsibility for their work. We share a computer system so historic blood types count toward electronic crossmatches but we would want the patient ID to be for this facility for the specimen of record. Many of our transferred patients are emergencies and the logistics of getting a blood bank specimen transferred here in time to be of use for the patient make it pretty much impossible. We also don't want nurses to start thinking that it is okay if ID numbers etc. on patient bands don't matter in cases like this so they end up ignoring them on other cases when there is an error. We do allow pre-ops to be drawn at any system draw site because have a consistent phlebotomy competency program across all sites.

Ortho provides a template DAT procedure for gel you might want to look at. We now do our cord DATs in gel, on the Vision mostly. We have long done only IgG DATs on cord blood so use the IgG cards for this.

So what do all of your hospitals do for plasma, stock thawed, liquid or only frozen plasma?