John C. Staley

Some of the small rural facilities in our corporation have one refrigerator and one freezer. They are acceptable for blood products and everything else goes in them as well. So far no inspection agency has had any problems with it.

The only value I can think of is if your result is >16 you can be fairly certain that it is not the result of a RhIG injection.

Now that's interesting. Back in the olden days when I was involved with donors I seem to remember that the sets for the apheresis machines didn't vary only the settings on the machine changed based on what you wanted to collect. Of course my memory is failing daily so I could be really off base here. I hope some one does come up with the difinitive answer some day. Maybe it's just that nobody thought of it. Sounds like another good SBB student project.

Actually it dosen't make sense. Why would a platelet pheresis stored at room temp have a 5/7 day out date and the same technology producing the plasma stored at 1-6oC have a 24 hour outdate? Now the story I heard is that the anticoagulant used was different and had not been validated for use as 5 day plasma. I'm sure there are probably other stories out there as well.

We try to limit incompatible plasma in adults to 600 ml in a 24 hour period not to exceed 1000 ml in 7 days. Not sure where this came from. Think it was the corporate transfusion medical director.

We actually indicate a decrease of >15 mmHG in systolic &/or diastolic pressure. If this occurs within 90 minutes of the transfusion we are to culture the unit for possible bacterial contamination. This came from the corporate transfusion medical director. Not sure where she got it from.

No, I'm not concerned about previous postings. In the future I'll help as much as possible without actually posting an SOP. It's really too bad that I can't just post SOPs. I know I've been helped by others and think some have found help in those I've shared in the past. It's simply those folks near the top of the food chain being concerned I might share info that could get them in trouble one way or another.

Thanks Donna.

Cliff, I've replied to a couple of posts this morning and they are not getting posted. Any Ideas? One was in transfusion to the post about monitoring freezers. Thanks John

Correct me if I get this wrong but the only problem was the chart was running a little slow? If that is the case then docment that the chart was running a little slow, the temp never exceeded -18oC, and the alarms didn't go off and move on. As long as the chart was working and the temp recorded was accurate and no reason to suspect otherwise that would be documentation of constant monitoring. I personally think this is one of those mole hill / mountain things.

Believe it or not, if I told you what we paid and folks up the food chain found out I would be fired, no questions asked. They would prefer execution but so far HR has been able to convince them that would be unacceptable. Actually I've been told I can't even share my SOPs any more. Anyway back to your question. Our corporation, the biggest in the area has a contract with prices lower than you noted. This is in the Rocky Mountains.

Same here, we have nothing to do with infusion pumps. When they were looking for some new ones I suggested stongly that they make sure the manufacturer indicated they could be used for blood products. Other than that I'm completely out of the loop.

Your rational certainly makes sense. We may transfuse one or two pools per month so that is why I asked the question. I have to agree with Christie, your best option may be to convince your blood supplier to do it. Maybe the best process would be to pool it when the cryo is made from the FFP and then freeze it. That way the freeze thaw cycle would not change. Just a thought.

Personally I feel it is not "best practice" to provide NICU with a bag of blood products and then allow them to transfer it to a syringe. Too many possibilities for them to get creative. We load all aliquots for NICU into a syringe set that has a filter in the line. This allows the NICU to use a minimum of tubing because the blood product has already been filtered. By using a SCD we are able to maintain the original blood product for its normal life span. We label the syringes with all appropriate information. The syringes are loaded just prior to issue to minimize the concern of storage in the hard plastic. It actually makes life easier for everyone involved.

Actually the assessor did not need to "win". You could have smiled graciously, agreed to disagree and then in your response to AABB plead your case. If I'm not mistaken the standards read that the alarm needs to sound so as to give you time to take appropriate action. If the alarm goes off at 24oC or 20 oC and it is monitored 24/7 you should have plenty of time to take action unless the incubator has magically coverted it self to either a heater or refrigerator. Remember 20-24oC is the range formerly known as "Room Temp."

I'm curious. What advantage do you see in even doing this? It dosen't take all that long to thaw and pool cryo so I'm having a hard time in understanding why you would want to thaw, pool and refreeze.

We send all of our blood products through the tube system and have been for 4 years. Todate we have had no reason to be concerned. We have seen no increase in nonresponsive platelet transfusions or anything else that would suggest a problem.

I would suggest contacting the manufacturers. They will provide you with list prices which would make for a more realistic comparison. Also they should be more than happy to provide test methodology, test menu and anything else you would like to know. My corporate contracts will most likely not be a good comparision to what some one else might have to pay. If you can find some one to publish your work I'm sure there would be a number of folks that would love to see it.

At this point in time we perform an eluate if the physician requests it once they are notified that the DAT is positive. I can't remember the last time we did one.

The HemoTemp II that we use become irreversible at >10oC but between 6 & 10 there is no permanent change. Which HemoTemps are you using?

Kinda scary when us boss types start thinking alike. ;>) You never know what we'll come up with next! Let us know how it comes out. I know I would be interested it what you discover.

If you are going to go that far in the validation why not also do a set where you don't wash at all? If there is no difference then think of all the time and effort you will save by washing only when there is a problem instead of with every crossmatch.

We are ultra conservative when it comes to issuing blood products. We have to have a current type and screen (current defined as this hospital stay) at least started with the ABO/Rh completed prior to issue of any plasma products.

Our infusion therapy department performs the TPEs at our facility. Transfuison Service has nothing to do with it and I like it that way.

One more question has come up in our attempt to institute the use of Thawed Plasma with a 5 day outdate. What is your criteria for either accepting for continued storage and reissue or the discard of plasma that has been sent out to the floor and returned? Currently we are pretty loose with our criteria for FFP since it is discarded after 24 hours anyway. We felt that we should tighten the criteria if we are going to be keeping it for up to 5 days. Any suggestions? Thanks John