tbostock

From the CAP website:
Optimum timing of post-transfusion phlebotomy is critical for ensuring meaningful laboratory testing results, and medical judgment is required in making this determination. Several factors must be considered, including the type and amount of blood product given, purpose of the test (that is, the question it is intended to answer), and clinical setting.
In general, it is best to perform phlebotomy when the patient’s circulatory system is in homeostasis. A patient who is bleeding or undergoing blood product transfusion, or both, is not in a steady state. Whenever possible, samples for laboratory testing should be postponed until bleeding has stopped and transfusion is complete. One obvious exception to this rule, however, would be the setting of massive transfusion, during which monitoring certain laboratory values, such as cell counts and coagulation parameters, is essential to guide ongoing therapy. Variables such as patient blood volume, cardiac output, renal function, and volume of blood products transfused affect how quickly homeostasis is achieved following transfusion.
For the evaluation of post-transfusion increments in hemoglobin, hematocrit, and platelet counts, a practical approach is to draw blood samples within 10 to 60 minutes after completing transfusion, as this time interval is aimed at measuring peak recovery.1 Results determined from blood samples drawn later than 60 minutes post-transfusion are increasingly affected by confounding conditions, such as splenic sequestration, sepsis, and consumption.1,2 If the intent is to determine the extent of such confounding processes on red cell and platelet counts, one should combine a 10-minute post-transfusion sample with sequential samples drawn at one hour and 24 hours post-transfusion.
Alterations in chemistry test results following transfusion are not usually a concern in the low-volume transfusion setting. However, assay results may be affected for varying periods following transfusion of large amounts of blood products, as seen in massive transfusion, red cell, or plasma exchange—particularly if the recipient has impaired hepatic or renal function. Banked storage of red cells results in elevated plasma levels of hemoglobin, potassium, LDH, and iron in the blood unit that may, particularly in the metabolically impaired patient, be reflected in the post-transfusion laboratory values. In addition, citrate anticoagulant present in blood products may result in transient hypocalcemia in the recipient.3 Therefore, following large-volume transfusions or exchanges, waiting 12 to 24 hours before drawing samples for chemistry assays will provide results that are more reflective of the patient’s underlying metabolic state.

We have seen this too quite a few times. We jokingly call them "gelibodies".

We have seen this too quite a few times. We jokingly call them "gelibodies".

Yes I would cease and desist, for all the reasons above. 
 
100% in agreement with Scott's comment: your new job is to look at everything and evaluate all old practices and determine:
Are they in line with the regs and package inserts?
Are they now considered best practice, or is this just an old thing that we keep doing?
Does it add value?
Does it add unnecessary cost to the organization?
Is it delaying care by doing unnecessary procedures?
 
It's very uncomfortable to get people out of their comfort zones, but it's very important to do it when needed.

We use 3 different blood warmers/rapid infusers in my hospital. All 3 say they are "FDA approved for blood products". However, one of them (the rapid infuser that they use for massive transfusions) says that it is contraindicated to transfuse platelets because "warming may make the platelets ineffective". I have been cited for this and am working on a corrective action. Some anesthesiologists say that they were always told it was OK, some say you shouldn't, but nobody seems to have a concrete reference.
AABB recommends against it, but it's a Guideline, not a regulation: I have ordered this:
AABB Guidelines for the Use of Blood Warming Devices (© 2002). This AABB publication lists the following as one of the few "absolute contraindications" to use of a blood warming device: "Administration of Platelets, Cryoprecipitate, or Granulocyte suspensions (Warming may render these products less effective.)" Additional references are cited in this publication.

This is what I have in my validation procedure.  The IQ (did we "install" it the way the manufacturer wants us to?) and OQ (does it do what the manufacturer says it does?) I get from the user's manuals.  The PQ is to make sure it opererates the way YOU need it to at your facility.
Equipment only: prior to validation, the BioMed department will inspect the equipment and perform an electrical safety check.  The equipment will then be assigned a unique tracking ID#.  The following elements will be performed: Installation qualification: demonstrates that the equipment is properly installed in the environmental conditions specified by the manufacturer. Operational qualification: demonstrates that the equipment operates as intended. Performance qualification: demonstrates that the equipment performs as expected for its intended use and that the output meets expectations in a normal working environment.

Staffing in NYS labs right now is reaching catastrophic levels.  Can't even find generalists.

Oh no...hope your wife is OK, Malcolm. And I hope for your sake that she does not EVER see your comment about your dinner.

3rd day at midnight, with day of draw being day zero.

3rd day at midnight, with day of draw being day zero.

3rd day at midnight, with day of draw being day zero.

And to give credit where credit is due, whatever I have achieved has been with the invaluable contributions of my collaborators, including physicians, scientists, medical technologists and nurses.  In particular, my most important collaborator has been my wife, Dr. Joanna Heal MBBS, MRCP, whose brilliance and dedication to patient care made all the difference. That's her in the picture :).

Malcolm, my sincere appreciation of your kind words.  I've enjoyed and learned from your comments on this website.

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.  

Congratulations Malcolm!!!

Yes, our policies say "current edition".  We have a cover page in our SOP manual that lists the current editions we are currently using.  It's updated with each new edition, and after review of changes.

Fantastic.  Can't say I'm surprised, it's been a honor honour having you here.

I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year.  It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK.  Sorry if this sounds egocentric, but I am very excited.

Booooo, "Just Say No to FB!". 

The patients should be genuflecting to the FDA inspectors.  I know I would were I a patient who required a transfusion!

I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes.  You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation.
BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!

Worse than last year when I posted. Pretty dismal outlook in NY State.

Staffing in NYS labs right now is reaching catastrophic levels.  Can't even find generalists.

Staffing in NYS labs right now is reaching catastrophic levels.  Can't even find generalists.

Probably not helpful, but there is not a shred of scientific or clinical evidence for the efficacy and safety of this time limit.  Totally expert opinion based upon a group of white haired males (like me) sitting around a table eating tuna fish sandwiches 60 years ago :).  We document such stuff for the two regulatory agencies and two accreditation groups we are inspected by.  How's that for efficiency? Four inspections.