PaulSunV

When I stated donating plasma I was referring to PHF and FFP, which here is being restricted to male donors as much as possible. My thought really was about deferring any person willing to donate products when it is becoming much more difficult to obtain willing donors.

In addition to the posts by others Immucor's Panoscreen cells does not require any QC to be performed other than a visual inspection. It does indicate that the cells MAY be checked periodically for antigens likely to deteriorate. The key word being may and not shall and therefor no requirement to do so. "Quality Control: In addition to visual inspection for evidence of deterioration, the reactivity of the red blood cells maybe checked periodically by testing antigens likely to deteriorate, such as Lea, with a weakly reactive antibody of the same specificity. If such red blood cells are found nonreactive, the product should not be used."

Harev, Why would you defer a donor from donating plasma if they have a "high-titer" anti-A/A,B. I would assume that only O patient's receive O plasma. So I don't see the harm in giving a patient that already has an anti-A/A,B a high titer of the same.

I thought the question was if the units were prepooled in a closed system then there isn't really any reason that a pre-pooled unit of cryo shouldn't be good for the six (6) hours the same as a regular unit of cryo receives upon thawing. I presented that question to my supplier and their answer was four (4) hours.

The questions asked as I see them are as follows: How many facilities are still doing weak D's on all their patients? Of the three hospitals I have worked at in the last 6 years all of them still require a weak D testing be performed on all patients. It is my understanding that the entire corporation of hospitals I am currently working for which includes 19+ different hospitals/medical centers/Clinics of varying sizes also do weak D testing on every patient. But because these facilities are interconnected electronically and as they are all required to perform history checks on all patients they are only required to perform the weak D testing if it has not been performed at least twice before at any one of the other locations. How many facilities are still doing weak D's on women of childbearing age? See answer above. Some of the weak D patients show weak 1+ reactions on immediate spin that become 2-3+ if carried through IgG.Is this a problem for anyone else? This is not a problem as the weak D testing is performed on all samples that appear to be negative at immediate spin. Secondarily if a reaction is less than 2+ the tech is required to perform a D control or a DAT on the patient sample. Suggestions are welcome. The previous answers relating to tech training is the only way to obtained the desired result. Now as to the reasoning behind the continuation of weak D testing I have none. There is always the answer that old blood bankers are hard to change as are conservative pathologists. I have on several occasions suggested as did my predecessor that weak D testing is only needed on a limited bases. I am more curious as to the quality of the platelet pherisis that are being produced. I am very doubtful that with the current equipment used to collect pherisis plts that there is any need for a Rhig to be given as the red cell count is negligible.

I am interested in the titer approach to incompatible plasma and would be interested in any references you can provide. With platelets being in short supply on a regular basis what do you do if there aren’t any type specific platelets available and all you have is a high titer product. We have a policy relating to incompatible plasma and a limit that we have placed upon it based upon volume. “No patient shall receive more that 1000 mls of incompatible plasma per 7-day period or approximately 600 mls per 24-hour period unless approved by the pathologist on call.”

A workable solution, not necessarily the best, that we had at one of the hospitals I worked for in the past is a unique Blood Bank numbered band, with patient’s name hand written on the card at time of the phlebotomy is placed on each patient that requires a transfusion specimen to be drawn. That unique numbered band is to remain attached to the patient during the entire hospital stay. Each sample is only good for 72 hours and if any additional blood, RBCs, is required then a new sample is collected for a new TS. If the unique numbered band is removed, anywhere other than surgery, then a new TS will be required for any new blood products requested. The unique number is on an embossed card that is placed in a label maker. In surgery they can cut off the band and reattach it with a new band but the same numbered card. That number made from the card is required on all transfusion tubes. It is not ok to have anyone hand write that number on subsequent samples. So if we have a patient that is going to surgery on Monday and is present to have the pre-operative lab work performed on Friday with the intention of returning on Monday then no Blood Bank #ed band is placed on the patient and the most that would be performed is an antibody screen. On Monday prior to surgery the patient is banded and redrawn for the TS and crossmatch as needed. The unique number on the band can only be used once and the computer prevents it from being changed to a new number attached to the patient without someone authorized in the Transfusion department making the adjustment.

Thad, What authority did you use to justify the immediate relabeling to 5 days. I am having difficulty trying to convince the Transfusion Med Director that it is ok and is less likely to cause a problem with having a product out of compliance in the fridge if an inspection were to occur.

My current hospital has the staff cross out the expiration date and then it is initialed by the tech. There is another label that is placed over the temperature storage area that lists the new expiration date and time and the appropriate temperature for storage. The testing time and date are listed on the transfusion bag tag but not the expiration date and time. At my last hospital they have a revised outdate that covers the original outdate, with a new date and time. They have a secondary label that covers the storage temperature that tells everyone the new storage temperature requirements. The transfusion tag contains the date and time of expiration as well.

Actually the issue is back on the agenda for next week and we will see how far we can go. Dr. I may be willing to entertain the issue as she talked to someone at the U and they have apparently been using it for about two (2) years and she considers the pathologist at the U to be more conservative than she is.

Yes, I got it thanks. Paul

drsbright, John, has retired but I would like a copy of the study, My fax no. is 801-387-7362, or if you can attach it to an email my email address is Paul.Greiner@imail.org Thanks, Paul

Do any of you that are using 5 day plasma have any restrictions on what type of patient can receive the product. I believe that the restriction as it relates to neonates is appropriate but the Medical Director in her infinite wisdom has tentatively agreed to allow the use but only on emergency room patients. For my facility it would hardly make it worth while and the savings probably wouldn’t be there under that restriction. Any input would be greatly appreciated

We are using Ortho Gel for the ABSC and tube on the Type/Rh and IS x-match

You can add me to the list of those who have never even heard of this type of practice.

Our STAT TOT for TS is 45 minutes and 60 minutes on TS & Crossmatch 1-6 units with no complications.

We do not perform an Auto Control on ABSC but do when we are doing ABID.

We have agglutination viewers and use them for all routine tube testing (we are also doing most of our testing in gel). We use microscope only for Fetal bleed testing, DAT, and questionable readings.

We give type specific leuko reduced units or the next best type final call it the Doctor's - we don't worry about Rh type as the units are leuko reduced and irradiated. Filter is the Baxter 4C2223 Blood Component infusion set that fits our BD Luer-Lok Syringes. Irradiated products are only good for the amount of time the product is still good after being in an open system as each of our products is irradiated just prior to transfusion. We use a Terumo Sterile Tubing Welder as does our supplier when the need arises. We dispense in a Syringe and each product is placed in the Syringe just prior to issuing. Platelets are not placed on rotator after being placed in Syringe. The floor places the Syringe in a Pump. We provide an extra 5 mls to each product dispensed for waste in the tubing, which only needs about 3 mls. We use our sterile docker to remove enough platelets apheresis into a separtate bag to be irradiated and to be used for transfusion to baby. Oftentimes the volume removed does not reduce the volume of the original pheresis to prevent it from meeting the necessary requirements to be an adult apheresis platelet. Cyro is given to neonates so infrequent and we only maintain A & O cryo any saline. Paul

We use Gel for our DATs on cord bloods and yes our procedure it to give only O neg units to a baby. I feel that Gel works well for IgG testing on our DATs