jayinsat

What is the patient's Rh type?

What is the patient's transfusion history? Did you perform a DAT or elution? These tests need to be done next. My initial thoughts are you may have a warm autoantibody and, if the patient has not been recently transfused, try a W.A.R.M. adsorption. What enhancement medium are you using? Try to run the screen using a different enhancement (ie LISS vs PEG).

At our facilities last week, we implemented a temporary "no return" policy during this COVID crisis. Only exceptions are those issued in ice chest to O.R., massive transfusion, or ECHMO, provided they are not COVID patients or patients under investigation. The nurses have become much more compliant with completing the pre-transfusion checklist before picking up the unit as a result.

South Texas Blood and Tissue Center.

UTMB is an excellent program. I have not been through it but, living and working in San Antonio TX, I know many CLS and SBB's that have. I considered it myself but decided to go a completely different way and pursue ministry, earning my M.A. in Theological Studies and working on a PhD now.

Our supplier is looking at adding a COVID modifier like CMV to existing plasma products. Thant was the direction they were leaning in our conference call yesterday.

We are not AABB accredited. Only CAP. We do, however, comply with the two determinations of blood type. My point is, we would never issue plasma products based on historical blood type ONLY. We require a current blood type on that admission before plasma products can be issued to mitigate the risk of erroneous admissions due to name similarity. sorry for the late reply.

This may be a silly question but are you sure the patient was treated with DARA (CD38)? Could they have received the new CD47 drug that is not neutralized by DTT?

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?