John C. Staley

I think I missed something. Did you really imply that you are putting platelets in the same cooler as the RBCs??

From my experience a lot depends on the team of surgeons and their philosophy and training in respect to transfusion. In the last facility I supervised the blood bank in we had a group of surgeons who believe the less transfused the better and they rarely transfused anything. About the only time they actually used any blood products was during a "redo". It didn't hurt that my blood bank medical director was married to one of the lead surgeons. On the other hand, a sister hospital in the same corporation about 60 miles away used a lot of products on virtually every procedure, especially platelets. They would use more platelets in one procedure than we would in over a year. The suggestion to be involved in the initial meetings is an excellent suggestion. It's the only way to find out the surgeon's expectations ahead of time.

I have to ask, how many times when the DAT is negative and you can elute the antibody from the babies cells does the infant show symptoms of a significant case of HDN (old guy, old nomenclature) resulting in an exchange transfusion or even phototherapy? Seems to me you are doing an awful lot of work for little, if any, benefit. See Malcolm's technical discussion above.

If you put "Secondary Blood Bags" in the search box you will find a past thread on your question.

As long as you validate/verify the digital, I believe annually is the requirement, you should be fine without a second thermometer hanging around waiting to get broken.

So...... utilizing the same scenario, are you going to screen every pretransfusion patient to determine their K status to determine if you can use those K+ units or just throw them away, it might be cheaper or just let them set on the shelf until a suitable patient comes along to use them on or are you going to extensively antigen type every patient with one antibody to determine what else they can make and then screen every unit for them for antigen compatibility??? I never had enough staff to accomplish this kind of CYA!

Scott, you are kind of contradicting your self here. In one sentence you are advocating avoiding the production of anti-c which can only be accomplished by screening units and transfusing c= units. Then you say it would be nice if you did not have to screen for units. I see a conflict here. Bottom line, it's a gamble. Either you screen for c= units now to prevent anti-c or you take the chance they won't make anti-c and if they do you start screening units then. The latter was always my choice.

Just curious but are you referring to a single patient massive transfusion or a mass casualty situation? I would classify Malcom's examples as mass casualty while a single patient massive transfusion could be the result of any number of things. Then there is everything in between. In the two facilities (both approximately 350 beds) I supervised I left it up to the staff involved to decide what and when they needed help. When help was required I was usually the first one called. Even got a call while fishing in Alaska once. Wasn't much help with that one.

I'm sure Malcolm can give you the hard numbers and details but keep in mind that not every D- person responds the same when given D+ RBCs. Some will develop anti-D with as little as 100 microliters of cells or less while others will never develop anti-D no matter how many units of D+ RBCs they receive. Then everyone else is scattered around in between these 2 extremes. Then throw in the males and women who are beyond child bearing and it becomes even more complicated. I fall into the category believing that try to prevent the formation of anti-D after a transfusion event, especially one of multiple units is counter productive and an effort in futility.

Actually, if you look back at the responses you will see that the best answer is all three in the proper sequence.

Thanks for the Info Neil. I appreciate you taking the time for the explanation. I'm happy to see things moving forward even if I'm no longer actively involved. It sounds like something I could get behind.

I'm curious. Since I've never heard of a Patient Blood Management program, what is it and what is it supposed to provide?

Just a thought that maybe your process is more complicated than it really needs to be and the nursing staff fail to see the need for it to be so complicated beyond you telling them that's how is has to be done. Sorry but I have never been a fan of blood bank specific arm bands or blood samples (pink top tubes). If I said it once I've said it hundreds of times, complicating a process NEVER makes it better. My first blood bank supervisor, bless her heart, instilled in me the importance of the KISS principle: Keep It Simple Stupid! and I tried my best to adhere to it even in the face of adversity (corporate Transfusion QA)!! OK, I'll get off my soap box before I fall off.

Not sure how I missed this discussion when it first came out but here's my 2 cents worth. It is the physicians responsibility to inform the patients of ALL risk / benefits of every aspect of their treatment to include transfusions of any and all blood products! Granted, this is not always possible due to the situation but that does not absolve the physician of the responsibility! In no way should this responsibility ever be dumped on anyone else.

Before I answered the question I wanted to wait and see what other people had to say. BankerGirl, thank you for your last sentence. It is a philosophy I had followed all of my career. I understand the argument that everyone is responsible for the patient's well being but at some point you have to draw the line and make everyone responsible for their piece of the process.