Geriann

We have the instructions for possible transfusion reaction on the Transfusion Record Form. It list specific instructions for the RNs to look for and monitor and when to stop the transfusion and call the MD. The Nursing manual also addresses this issue. The instructions on the Transfusion Record Form are gone over during the annual Skill Faire for Nursing. Geri

How do you determine if the patient has been transfused or pregnant in the last 3 mos.....do you call on each order if you have no previous records or your records are greater than 3 mos old? We are not staffed to check on all of these....Our Pre-Admit department does document this information but none of the others do. I have added to the order the question "Transfused/Pregnant within the last 3 months" I get patients from L&D admit that the answer is either No or no infor available. As of yet I have not been able to inservice the entire hospital staff to properly answer this question.....As of now if the patient does not come from the Pre Admit department we hold specimens only 3 days. Any suggestions?

We use A,B to retype Group O units and for Cord Blood Workups. We have not done completely away with it but do not use it for routine testing with the exception of Cord Blood specimens. Geri

Hi Matthew, Our trasfusion service has applied for a california tissue licence. We are now responsible for tissue since our last JACO inspection. So far my department is responsible for storage of Frozen Tissue both allogeneic and autologous bone flap. Problems encountered so far: 1. Heart valves must be kept at temps lower than our -70 C freezer....the OR therefore orders them and does not open the containers....return to vendor if not implanted.....I found this out by accident. 2. Tissues that we do store---how long can the tissue be out of the transfusion service and still returned to storage. We send the tissue out in an Igloo or the original container with gel packs frozen at -70 C. With blood if it is greater than 10 C it cannot be put back into inventory....what are the regulations on tissue? At what temperature can I accept the tissue back? How do I know if the tissue was out of the container too long....are there hemotemp monitors that measure temps this low? The manufacture is of no help....all they say is that they will not accept tissue back if the original container has been opened. 3. A refrigerated tissue showed up in my blood bank refrigerator the other day.....rather have it there than in the or frig....but do we need to amend our tissue licence? I only have inventory control over the tissues that we freeze at -70 C and now 1 refrigerated tissue.....how do I monitor the ambient temp tissue and refrigerated tissue pastes etc. that the OR is still incontrol of???? Please help!!!!!!!!!!!!!!!!!! Thanks, Geri Ann

Thanks Cliff....I am still not sure what a podcast is I guess I would just have to see one to understand....I probably already have but didn't know it was called a podcast. Would this be something that if once downloaded could be used for CE? Thanks, Geri

Thanks Donna. It would be nice to be able to discuss in a chat room some of the questions, problems, etc that come up. I will try the float option and watch for scheduled discussions in the chat room. Geri Ann

what is a podcast?

Does anyone use the chat room....it would be nice to chat about these transfusion issues....also can you be in the chat room and also review threads? Please let me know. Thanks, Geri

Hello Marilyn, I went through your reference program in August 1999....what an experience...good to see you...can I still ask questions?

Hello Debbie I am a transfusion service supervisor in california....nice to meet you.

Hello Donna, anytime you want to talk let me know....we have been performing tissue implants for quite awhile but just last year became the responsibility of the transfusion service. It is a busy department. Looking forward to talking to you. Geri

I am a Transffusion Service Supervisor in a hospital with a designated trauma center, level 3 critical care nursery, surgical, neuro, and cardiac critical units, and tissue implants (autologous bone flaps and allogeneictissue implants).

When anti-M is suspected in Gel-AHG we use the tube method through the AGH testing phase. If anti-M is identified we run M- panel cells to rule out additional clinically significant alloantibodies. We perform a prewarm technique with screening cells (make sure to include at least 1 M+N- cell sample) to determine if the Anti-M reacts in the AHG testing phase under these conditions. If the prewarmed results are negative in the AHG testing phase we use prewarm technique through the AHG testing phase for crossmatching. We only screen units for M if the anti-M reacts in the AHG phase using prewarm technique. Rule outs for additional clinically significant alloantibodies are performed using M- cell samples in Gel-AHG. I have found many anti-Ms in Gel that do not react in the tube AHG testing phase using prewarm technique. I use Saline-AHG tube method for prewarm technique.

I needed a good laugh....I hope our quota is out of the way. The first case was by far the most severe...it was presented by our reference lab at a seminar last summer. The second case just occured and the patient appears to be ok thus far. Both cases in such a short time has made our pathologists want to reconsider IS crossmatch policy. In both cases our nursing staff was right on top of the symptoms and my transfusion CLS took immediate action. In the most recent case the patient presented with severe chills and abdominal pain just a little more than an hour into the transfusion. The plasma from the post transfusion specimen was very icteric (not red or pink). The pre and post DATs and ABSCs were negative. The pre and post crossmatches were both 2+ in the AHG phase. The earlier case the patient required dialysis...it was more severe reaction but may also have been related to his physical condition at the time of transfusion.

Our current policy and procedure is to use IS crossmatch when the Antibody Screen is negative. We recently have had 2 cases of hemolytic transfusion reaction involving antibodies to low incident antigens. The first case was late spring 2005 an anemic male with no transfusion historical record. The patient was found to have antibody to Wright A. The most recent was a multiparus Asian female. Our reference lab was unable to identify the antibody at this time but ruled out antibodies to common low incident antigens. In both cases the unit transfused was incompatible 2+ in the AHG testing phase for both pre and post transfusion specimens. Has anyone out there encountered transfusion reactions related to antibodies to low incident antigens not detectable using routine antibody screening techniques? Does anyone have different guidelines for using IS crosmatch for patients previously transfused and or pregnant? Any comments? Are there any statistics on patient's having transfusion complications related to antibodies to low incident antigens?