Mabel Adams

Novel concept about giving ABO incompatible blood. I would think that giving B FFP would also provide some B substance that might adsorb out some anti-A,B and anti-B. Makes you want to give AB plasma in case there would be more A & B substance in it. Or give the plasma first. I guess creating immune complexes would be the least of anyone's worries in that situation.

Anyone know the names of these computer systems for tissues? We have similar problems as everyone else is mentioning.

The unit had an attached compatibility label that was printed from the Meditech computer. It stated the patient ID, the unit info (including name of product), the fact that it was compatible--all the stuff AABB requires be attached permanently to the bag. We just didn't also have a printed form for the nurses to document on. Maybe it made more sense to me because always before we had used the Hollister banding system unit label (stuck "permanently" on the blood bag) and a separate slip just rubber banded to the unit that could be removed for the nurse to complete it. I understand that some places attach a multi-copy form to the unit so one copy of the same form stays attached throughout the transfusion while nursing pulls off one copy for documentation. I think some might even expect the nurse to document on the form while it is still attached to the unit (I always figured they would find a way to take it off.) As for issuing the wrong product type--nursing had to send a request form via the tube stating what product they wanted. One of the required checks by the BB tech was whether the product being issued was what was marked on the request form. I guess I am having trouble imagining a system where getting the product mixed up would have anything to do with whether the transfusion record went out with the unit. Our lab records of the unit and its issue were in the computer so we didn't need to retain anything paper. We did keep the request form for a few months just in case someone forgot to accept the issue screen in the computer and it took us awhile to discover it. Isn't it amazing how many systems there are for issuing blood and documenting it?!

OSHA has a special category for tested blood products and does not consider them biohazardous. Bob Currie could tell us where the reg is if he hadn't gone off to play with trains. A nurse recently told me she worked somewhere that the floor brought down a small cooler for any blood they were checking out. Each floor had several coolers and they couldn't get blood without them. I can't imagine the plts in a bag being any more affected by oxygen deprivation than they are during transport from the blood center. For some of us that is many hours. The concept is correct, but for the limited time involved, probably not an issue.

Run them both again to see if it was just an aberrant result.

What fun is that, John? I have a long tradition of hunting for unicorns--haven't found any yet, though.

One more point. It seems like this will be an easier transition when nurses start recording transfusions in the computer system.

At my prior workplace when we decided not to have nursing return a copy of the transfusion slip to us, I started wondering why we were providing them with a piece of paper for their charting when they had to turn around and put most of it in the chart on some other form anyway. Why not just have them have a form for their chart on which they document vitals, ID checks etc. to which they added the unit number? We worked with them to modify their existing transfusion flowsheet form to have all the stuff that was on the transfusion slip. Part of it included trx info. Then they have to send us a copy of the form with that section completed as well. There wasn't much to validate since the form contained all needed info. Training was pretty easy. A couple of issues came to mind afterwards. We issued almost all blood via pneumatic tube; checking the unit with 2 people as was done at face-to-face issue when the tube was down and by the 2 nurses at the bedside, required both people to look at the unit and the compatibility tag on it to check those parts that were common to both. It could get a little cozy. Also, they sometimes sent the original for trx which took all of their documentation of the transfusion out of the chart. We had to make a copy and return it. They liked not having BB checking their paperwork for completion and breathing down their necks about it never being right. We liked not expending our energies on such a futile endeavor with so little patient care impact. There are more important things for us to monitor. Hope that answers your questions.

I'm pretty sure the 1:1:1 ratio is using random plts not pheresis. For pheresis, it would be more like 6:6:1 for RBCs, FFP & plts. This is certainly the trend we are hearing about.

Looks like I should either retire or cut back on posting. Wouldn't be the first time it was suggested I be quiet. John, we have had a long on-line run all these years. I feel like I know you though we have never met. Enjoy the change and keep in touch.

I am now in Bend OR and just met my Biotest rep a few weeks ago. Cool that Ortho still has those antibody slide things. Are they still the 1970's version?

I should point out that we do the gel screen and identify anti-D first before proceeding to testing the 1:4 dilution. Sorry for the confusion.

JPCroke, can you please tell us what is in your packs, how frequently you issue them, whether you are a big trauma center and how you adapt the protocol if they don't use all the products in earlier packs.

At my new workplace the policy is to do a tube antibody screen of a 1/4 dilution of plasma to determine if a patient that has received RhIG in the past 6 months should be considered as having passive rather than active anti-D. If negative at a 1/4 dilution it is determined to be RhIG, if positive it is titered as a likely anti-D.

Point taken, but if I have a patient with an auto and an allo, I am not going to drop back to unscreened, uncrossmatched blood when at least screened units are safer. Maybe that is not what you meant by "uncrossmatched blood."

I got one from the Biotest rep a few weeks ago.

The key is positive patient ID, however you can attain it adequately. Many of us also end up using the form later to troubleshoot if someone didn't accept the computer issue screen so issue didn't get recorded.

Ask your QA person to poll 5 doctors about WAA and have her report the results to you. I bet your average hospitalist would be hard pressed to tell you what our different test results mean. I bet a fair number of them would be grateful for us providing them with additional info. Hematologists are pretty knowledgeable but they have so much experience with transfusing warm autos with no repercussions they probably forget about this risk. Wow, do they expect the patient to decide whether to put in a heart stent or to do an open vs. laporoscopic abdominal surgery too? I think that is practicing medicine without a license! Info for patient: You have an autoimmune problem that is detroying your own RBCs. If we transfuse you it will also destroy the transfused cells, maybe at the same rate as your own, or maybe it will increase the rate of destruction. Only rarely does it make the destruction so much worse that it becomes life-threatening. If we wait to transfuse and treat you with drugs instead, you may have an increased risk of cardiac arrest (for Hgb < 7) but we aren't sure because those studies weren't done with patients with your illness. Otherwise, you just will have the symptoms of anemia. If you do get worse while waiting for the drugs to work, you could always get a transfusion then. The drugs should start to make some improvement in your anemia in a day or two. Of course, this all depends on whether you have a bad heart or bad kidneys that might either be damaged by the hypoxia or might increase the risk of circulatory issues. (Depending on our testing) You also may or may not have antibodies to other people's red blood cells (blood donors) that will make them incompatible in your system. This incompatibility may be less or greater than the autoantibody destruction. We can't be sure. If it is severe, the consequences can be a collapse of your blood clotting system, kidney damage or failure and even death. Every patient reacts differently. This is partly tongue in cheek and I am sure I have forgotten key points that would need to be in a real patient consent form.

Wow. Wouldn't some other patient desparately in need of blood be better off with washed antigen negative cells? Giving cells with a pos DAT and Hep C sounds like a bad idea to me. Maybe if recipient was Hep C pos. Still, do we know how DAT pos cells would survive if transfused (I am assuming stronger or different than a usual DAT pos donor)? The FFP might be another deal, but the Hep C seems like a huge block. If it were her at another hospital, I would either find out from the FDA what it would take to do this (is she across a state line?) or wing it at the time using the best medical and ethical advice available. Easier to ask forgiveness than permission theory. Can't a medical director approve about anything as an emergency measure as long as he can justify it?

As with Rh, we may be safer NOT finding weak antigens on our recipients' cells.

If they would let us consider coolers transport instead of storage, we wouldn't have to log the temps every 4 hours. I am sure the ambient conditions are much more stable than during some transport conditions. I had better be quiet or soon they will have us put data loggers in all blood shipments!

If you use New Reply instead of Quick Reply there is a box at the bottom that says Manage Attachments. Click that and then browse for the file just like attaching to an email. Even as posted it is useful info. Thanks.

Attached is a release form I developed for my last job in case it is of use to anyone. WARM AUTOADSORPTION - FORM.doc

We had a warm auto patient at my prior workplace that they transfused and she started to hemolyze more actively and died. The doc said there were some other unusual things about that patient but it was enough to make a believer of me that transfusing warm autos occasionally "ramps up" the hemolysis and it is worth making sure the doc is aware that is a risk when he signs what is often considered a rather routine release form.

Remember that this is a public site when you post your email address. Also, there are evil programs that skim the web finding email addresses to sell to spammers. One way to bypass them is to type AT for the @ sign--although they will probably catch onto that soon. You can always send private messages on BBtalk also or post a gem that others might need as an attachment. Yours in avoiding spam. Mabel