davenoso

Hi Kay! We feel the solution is to move FMH testing to the Flow Lab - but that process is proving to be fraught with peril -- hang in there! Diane

Hi everyone - I was also at the assessor's training and "Ask the FDA" sessions in Montreal 10/08, and I agree with mobea's interp. Sounds like very few places are continuously monitoring cooler temp and recording at 4 hours (regardless of how one defines storage vs. transport - although FDA seems to side conservatively with any device not actively being moved as constituting "storage"). AABB's explanation for this new Standard was not clear or definative, in my opinion, and after finding very few workable (and cost effective) solutions on the web or at TXPO, I decided to take a "wait and see" approach since we already validate our coolers to 8 hours and use 1-6C temp dots on all products issued in coolers. I did not attend the "Ask the Standards" session and wonder if this issue was addressed there? Best Regards, Diane

Like everyone, I think each situation/conditions/Dx mandate what action to take (this is difficult in these times of cross-trained staff and need for "one size fits all" policies. The important issues to consider are the 1) volume of the transfusion, 2) the rate in which products are transfused, 3) when (or if) the RBC products were irriadiated, 4) facilities ability to wash products, and 5) Dx/procedure (OHS, ECMO, hyperkalemia, heart issues?). Also keep in mind the accumulative effect of several small volume (60ml) transfusions. Donor exposure has become much less of an issue with improved ID testing (and relatively stable O neg donor popultation) according to our blood suppliers, so we try to keep things in perspective. We use fresh (<5d, if fresh not available wash an older unit), LR, irradiated upon issue, HbS neg units for large volume transfusions (>60ml). Our pediatric cardiac team is much less interested in donor exposure than K+. Our PICU and NICU are more interested in limiting donor exposure. We are lucky that we can irradiate and wash units in-house and we are one block from our blood supplier, but it's still a complex process and requires a moderate level of decision-making not possible with all staff - all the more complicated by our litigeous society and healthcare industry run out of (cost) control. Good luck everyone! Diane

I really feel betrayed by both vendors (Immucor and Ortho) and our blood supplier to be honest. The Blood Banks and hospitals will find a way to cost shift and stay in business - it's the private payors, uninsured, and medically indigent who will take the hit. We all have blood on our hands ....