[Exchange Transfusion for Sickle Cell Patients]

When you do an exchange for SCD - do you have to reconstitute the unit to a certain Hct like a neonatal exchange transfusion or do you infuse FFP separately or is FFP necessary since is not a total exchange??

[ABO incompatible platelets for children]

Mobea,

Would you share that SOP about SDP for children with me? My e-mail is uzpan@yahoo.com

I've been struggling with a platelet policy.

[Helmer waterbath temperature]

Trust me- if you set the alarm for 37.3 and the set temp is 36.5, the product will not be in the water for long if your Helmer is working properly. It will lift the product out promptly. The biggest problem is getting the Helmer to stop alarming after you test it.

[Helmer waterbath temperature]

Ours is set at 36.5 and it goes off at 37.3 or 37.4 C.

[Incompatible plasma]

At my hospital we keep track with an attached sheet of paper stabled to a patient record card. We haven't gotten rid of patient record cards yet. I have found in the literature that only type O platelets have caused hemolytic transfusion reactions. There have been 25 documented cases in 30 years of HTR from O plts transfused to non-O patients and 6 deaths reported to the FDA in the past 10 yrs. according to Mark Fung, MD in the Arch Path Lab Med, Vol. 131, June 2007. It is not frequently reported, but there may be a lot of under-reporting. It is a concern & I certainly do not want it to happen where I work and I want to be compliant with the regs. Unfortunately you need a policy for incompatible plasma and I want a reasonable policy--but none of the regulating agencies tell you what the standard of care is??

[Incompatible plasma]

So you titer a B SDP? I would think it would only be necessary to titer O SDP because it is my understanding that the O SDP is the only one ever implicated in a hemolytic TRXN.

[Incompatible plasma]

I am trying to change our incompatible plasma policy. Our former Medical Director wanted us to tally all incompatible plasma. So if an AB patient gets several doses of non- AB platelets or cryo & even A red cells -we tally up all the incompatible plasma. The A red cells are considered to have 50 mls of incompatible plasma. If we transfuse over 750 mls we have to contact a pathologist. So when we have a trauma or open heart that is a AB or B we have to haul out the calculator & oftentimes call a path. If we transfuse > 750 ml in a week then we have to obtain volume-reduced pheresis for a month!

Our blood supplier only has a limited amount of platelets. I want to concentrate more on providing the oncology patients and infants with type specific platelets.

Tallying the type O plasma seems more reasonable. We also do a 1:25 Initial Spin anti-A & anti-B titer on the O pheresis and never transfuse a O pheresis with high titer to an A, B or AB patient. Does anyone else tally the plasma in red cells and cryo?

What are other facilities doing to address incompatible plasma?

[Gel Prewarm Crossmatches]

My experience is that the prewarm Gel does not work. Once you put the card in the MTS centrifuge the card is no longer warm. We revert to the tube methodology and in the case of a strong cold antibody Rest may be necessary..