jayinsat

We require a current ABORH for all plasma products. The reason is not because of the possibility of a blood type change due to bone marrow/stem cell transplant, it is because of the probability of an erroneous admission. Every facility I have ever worked have had instances where admitting has registered a patient as someone with a similar name or merged a record with a similar name, resulting in an inaccurate blood type on record. We mitigate that risk by requiring a new blood type each admission before giving plasma products. Once the type has been verified, we will issue plasma products until discharged, regardless of how long ago the type was done.

I just answered this question. My Score FAIL  

You are absolutely correct Lablion, which is why our transfusion services medical director put the brakes on our implementation just last week. From our perspective, it seems that the push to use whole blood after arrival at the hospital is to decrease waste and continue treatment with like product. I want to underscore that pre-hospital whole blood use has been a positive change. We had a patient arrive by helicopter last night from a rural area that received 2 units of LTOWB en route. The patient would not have survived the trip without it and it turned what would have been a massive transfusion activation into a semi-routine (but emergent) transfusion.

True for the first 14 days in CPD or CPD A-1 according to STRAC's literature. Our supplier go with a 28 day expiration and, with leukoreduction, even with at platelet-sparing filter, the platelet function (as measured by thromboelastography) is significantly diminished. Keep in mind, these are the conclusions of STRAC and our blood supplier. We are not using it yet because of many of the concerns you and others have mentioned. What is being pushed is non-leukoreduced for longer shelf life and platelet activity.

Have you reached out to your vendor? The vendor usually provides an excellent validation guide for this. At least Meditech and Orchard did. It has hundreds of scenarios that test the system.

South Texas seems to be the vanguard on this issue. It is worth time reading through their information at www.strac.org/blood. In response to Lablion's points: Leukoreduction reduces platelet function drastically on whole blood therefore it is not leuko reduced. Some data suggests that platelet function rapidly deteriorates after 21 days in CPD. However, STRAC's data shows the units are adequate up to 28 days with CPD-A1 Titers on our donors are < 1:250. All of these questions were addressed in depth at the National Whole Blood Summit. I think we will all be feeling the push. I can tell you from personal experience, its use pre-hospital (ambulances, air life helicopters) have been very successful. By the time patients arrive, the transfusion need is minimal if at all! Use in hospital is pretty much for to continue care and rotate out expiring units. Wastage has been > 30% when used pre-hospital alone.

Does the patient have thrombocytopenia? Could they possibly be treating him for ITP using WinRho?

We are a 7-in-1 system and our committee meets quarterly. We provide blood usage statistics on a common spreadsheet monthly.

Mabel, helicopter (and ambulance) use is the ideal place for LTOWB. The main reason we are even considering its use is to cut down on wastage. Without trauma center and other hospitals becoming a rotation site, LTOWB wastage can easily exceed 30%. Like you, the cost is the reason we have not moved forward.

Here is a link to excellent resources regarding studies and risks for Low Titre O Whole blood. https://www.strac.org/blood. I think this may help answer a lot of questions. Here in San Antonio, I have seen great results from pre-hospital (ambulance and helicopter) use of cold-stored LTOWB. Patients who have received units have arrived stable where, in the past, would have surely been an MTP activation. Our local trauma centers are using it, up to 8 units before switching to components. The results have been positive.

Yesterday I attended the first of what I am sure to be many National Whole Blood Summits here in San Antonio. https://strac.org/summit/ If your facility or trauma surgeons are not already pushing it, be prepared. It is coming back. The conferences was excellent. The information and statistics presented was compelling. Low Titre O whole blood is coming (back) and will be the preferred product in traumas and hemorrhagic shock. Get ready!

Considering the push to using Low Titre O Whole Blood for MTP and trauma's, i'd say the benefit outweighs the risk. I have personally seen two incidents where a panicked Blood Banker accidentally issued O FFP in emergency release situations. In both cases, the patients turned out to be incompatible blood types (one A one B). Guess what, there was no adverse effect whatsoever in either case. No sign of hemolysis or transfusion reaction weeks later.

We are evaluating this as well. It will be an emergency release product only meaning no pre-transfusion testing. If our patients have a current Type and Screen or have already been transfused, they will not receive whole blood. We will stock O pos Low Titer whole blood that will be given to Adult men and woman >50, only for hemorrhagic shock. We do not receive traumas at our facility. Currently, our EMS ambulances and helicopters stock the O pos Low Titer whole blood and administer it en-route. They do not do any pre-transfusion testing. Our trauma centers are the same. Whole blood is issued as emergency issue only without pre-transfusion testing. Post-transfusion monitoring for hemolysis is done per AABB recommendation.

Reviving a dead post.... I am growing increasingly concerned about staffing shortages in the Blood Bank. I'm in Texas and most of our good techs are aging out of the field. It is almost impossible to find and experienced blood bankers that are not already working full time somewhere. Filling positions with techs that have blood bank or micro experience is HARD! New techs are not staying in the field and lack the experience to work alone. At 51, I am at least 10 years younger than blood bank staff on all shifts and am worried about filling those roles over the next 5-10 years. What are your experiences?

I had been a MLT (ASCP) since 1991 and recently completed my Bachelor's degree. I have worked exclusively blood bank for the last 12 years. I wrestled with whether to take the BB (ASCP) or the MT (AMT). I went with the MT (AMT) because the hospital systems here in San Antonio prefer the more generalist MT level certification for supervisory and off-shift positions. My HR department said they would only be able to hire me at the MT level for BB only if I went that way. Having an extensive generalist background, I decided MT (AMT) was the best option for me. I used LabCE's Medialab practice tests and Patsy Jerreau's CLS Review to prepare for the exam. I studied about 2 months and passed first time around on November 30th 2017.