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We currently wash red cells for IUT procedures. We have been having difficulty obtaining washed RBCs lately. We do not have a cell washer and our blood supplier has stopped washing cells. I saw a thread on the CBBS website indicating that washing red cells for intrauterine transfusion is actually contraindicated, because it lowers the hematocrit of the unit. Higher hematocrit levels are better for the baby. AABB does not state that washed red cells are required for IUT unless you are using mom's blood (in the event that she has an antibody to a high frequency antigen). I have spoken with our perinatologists. They are willing to switch to non-washed red cells if I can show them documentation. Is anyone aware of a study or book that support this? Thank you!

In addition to the above, we add instructions: Only blood products may be stored in the cooler. Do not put platelet products in the cooler. Return the cooler to blood bank immediately when blood is transfused or no longer needed. etc.... I think the only things you are required to put on the cooler are a unique identifier and a biohazard sticker.

I would recommend QCing some reagents if you also perform testing on the bench. You are not just QCing the reagents, but also the cell washer, centrifuge, heat block, etc. What methodology are you using on the bench? Much of what has to be QC'd will be depend on whether you are using the same methodology or a different methodology.

Does anyone know if there is data to support rinsing an empty bag with saline and culturing the saline following a suspected septic transfusion reaction? We are in the process of overhauling our transfusion reaction SOP and this question came up.

My blood bank stores and issues all RhIg doses for all OB patients. Our current outpatient (28-week dose) procedure is to draw a T&S on mom and armband her with a blood bank armband. If she is Rh-negative, we will recall her. If she returns within 72 hours with her armband on, we will give her RhIg. If she returns after the 72-hour window or cuts off her armband, we will re-armband her, redraw the T&S, and make her wait 3 hours while we test it prior to giving RhIg. This is a ridiculous procedure that makes both the patient and the physician mad. I am trying to get buy-in from the hospital to change the current process. However, I can't find any data to support the idea that the prophylactic, 28-week dose of RhIg does not have to be given within 72 hours of the T&S test. Our BB Medical Director firmly believes that the woman could develop an anti-D after 72 hours and that we would not be able to discern Anti-D from passive Anti-D due to RhIg at the time of delivery (not that it would matter for the current pregnancy). My biggest argument right now is that patients will forgo any RhIg and develop real anti-D if we make the process too difficult. This is the first hospital I have worked at that actually administered the antenatal dose of RhIg, so I am unsure if this is truly the practice in other locations. I have also tried to pull up the OB treatment recommendations for RhIg, but they just say "28 weeks." They don't list a specific timeframe from the ABO or antibody screen tests. Help! I need suggestions

We are a trauma center and run many K-B's on pregnant women who have had trauma. Our routine protocol is to monitor mom for 4 hours then discharge as long as there is no other reason to keep her in the hospital. Per our OB department, there is a very strong correlation between fetal demise and a positive K-B. Our physicians do not use this as their only monitoring method. However, they do increase the amount of time and level of monitoring when the K-B is positive. I admit K-Bs are not the most accurate test, but NSTs and ultrasounds can also yield false negatives with small bleeds.

We do not genotype ourselves, but we do send patients out for genotyping frequently through our reference lab. Do you have specific questions?

Question for those of you performing a fetal screen on pregnant moms....are you sure your results are accurate? For the fetal screen to work, the mom must be Rh-negative and the baby Rh-positive. How do you know the baby's type in utero?

We are in the process of implementing this testing. We are only testing group O platelets. We plan to use a dilution of 1:100 againt a and b cells in an IgG gel card. If the reaction is positive, the platelets can only be used for type O recipients. Those platelets that are negative can be issued to any type recipient. We chose the 1:100 dilution based on a cont ed program I attended that stated this is the European standard. Stephanie

Question.... I recently had a physician ask me if there is a way to tell whether a fetal bleed is acute or chronic. Does anyone have an idea of how to differentiate between the two? We initially looked at the babie's retic count, but that was not helpful. Can you think of a better way? Thanks! Stephanie

I have responded to this post off-line, but I do want to refer the rest of the group to the following journal article: Yazer MH, Cortese-Hassett A, and Triulzi DJ. Coagulation factor levels in plasma frozen within 24 hours of phlebotomy over 5 days of storage at 1-6C. Transfusion 2008;48:2525-2530. Stephanie

I will be happy to share our checklist with anyone who would like a copy. We added the requirement that we check all shifts (day, evening, and night) at least once per month and we now require the nurse manager to forward a copy of the transfusionist's training records to us following audit. This helps us ensure that nursing training is documented and ongoing to meet regulatory requirements. AABB has some checklists listed on their best practice website also. Does anyone have a tool to audit the blood bank end of things that you would be willing to share?

There is a 3rd edition of the Judd book available as of 2008. If you are trying to locate it, the actual name is Judd's Methods in Immunohematology. The authors are W. John Judd, Susan Johnson, and Jill Storry. I bought mine on the AABB website.

The Transfusion Service Manual of Standard Operating Procedures, Training Guides, and Competence Assessment Tools by Lucia Berte is available through AABB. It offers procedures, flow charts, and a training competency for txn rxns as well as a lot of other basic BB tasks. I would recommend this book to anyone looking for basic building blocks on which to develop BB procedures, etc.

We are in the process of reviewing the informed consent process at our hospital. During my review, I noted that the AABB Primer of Blood Administration says that hospitals are required to obtain informed consent prior to administering blood components and plasma products to include Factor concentrates (Factor VIII, Factor IX, etc). Recombinent Factor VII is specifically excluded and it is listed as a "pharmaceutical related to blood products." I have always thought of Factors as a pharmaceutical vs. a blood product, because I have never worked in a blood bank that actually dispenses these. However, I have learned that we currently do not obtain informed consent from the recipient prior to administering these products. I am wondering how other facilities are handling this. I think there is probably room for interpretation in the standard, but the Primer is very clear.