GSD2SABSAL

I do not believe there is a code to bill for a re-type. We also perfrom a second confirmatory patient type, but do ot bill for this test.

We consistently validate our transport coolers to house up to 6 units of packed red cells for a period of 6 hours. It is our current policy to have there products returned to the Transfusion Service no more than 4 hours after their release.

We currently us 52 as a cut off.

In our institution, the Transfusion Service Director signs off on Nursing policy regarding transfusion. The Transfusion Service is responsible to monitor that all transfusions are infused withiin a maximum time frame, usually four hours. The component is the respponsibility of the service and although nursing would take the heat for a type 1 from JCAHO for improperly handling, I am certain JCAHO would hold the Transfusion Service somewhat accoutable. This would include auditing potential problems. The fact that you are allowing nurses to modify the product by transferring into a syringe is a definite problem unless you have audit data to say everything is perfect. Don't forget the new FDA re-lalebing issues. Is the new information barcoded ?

I also use our Gel incubator to activate the Hemotemps. We slide one iin one of the slots and it only takes a minute to activate. Ray

I am very strict about this. Each workstation has a computer system built into the station and the technical staff is required to enter the data as they determine the reaction strength. I don't believe there can be any substition on this topic. Its almost like labeling at bedside.

This is a very difficlut question and there are many different opinions on the subject. When we encounter these patients, we sometimes ( depending the the frequency and amount of units transfused) , extend the work-up for up to 2 weeks as long as the DAT reaction is consistent. If possible we try to phenotype the patient and provide a phenotypically matched product, although many times this is not possible. Given that the body may respond to these antigens at any point and given the fact that we don't want to make our job more difficult down the road, it is prudent to do this. We have had patients as you describe that have developed three or four antibodies after multiple transfusions. Others do not develop any. This policy is typically made after some lengthy conversations with the blood bank director.

I don't believe there are any reported cases of HCV transmission from albulin therapy. I think it has to do with the fact that albumin undergoes heat pasteurization which kills any virus. In addition, it is sometimes good to check other family members, especially if the patient is on some type of home infusion program. You may find that the patient was infected by blood from another family member and not the infused product currently in question. The references listed below may assist you. Tabor E. The epidemiology of virus transmission by plasma derivatives: clinical studies verifying the lack of transmission of hepatitis B and C viruses and HIV type 1.Transfusion 1999;39:1160-8. Colgan K, Moody ML, Witte K. Responsible use of blood products in response to supply and demand. Am J Health Syst Pharm 2000:57:2094-8. McClelland DBL. Safety of human albumin as a constituent of biologic therapeutic products. Transfusion 1998;38:690-9.

We currently have a policy that defines a massive transfusion as >10 units of PRBC in a 24 hour period. Since we can perform IS crossmatches, we have elected to continue to perform these procedures unless emergency blood is necessary. Taking the negative screen into account, we would release uncrossmatched type specific units during those emergencies. With good communication it is not difficult to keep ahead of these cases. There are many opinions about this, but I think its important to have a documented policy, regarding of which way you go.

The AABB bulletin reference is probably the best. We used those in conjunction with some additional data on the net to provide clinical and diagnostic information to our physicians. It's a good idea to make it short and to the point or else very few will read it. We recently had a suspected TRALI after transfusion of three FFP. The donors are currently being tested.

Our instituion requires that the physician and blood abnk be notified immediately. Currently, the physician has the final say, but we are in the process of changing the policy so that all concerns are investigated.

Our hospital policy changed several years ago as the Technical shortage became more prevelent. Today it is difficult to hire Blood Bank personnel, MT or MLT, but I will evaluate any candidate I feel can contribute to the department and provide quality patient care . In addition, we test all prospective candidates especially in panel interpretation and thought processes as they pertain to problem solving in the Blood Bank.

We have found that nursing administration has helped us a great deal. I now send these incompleted forms to our VP of nursing. It seems that receiving a note from her is a re-education that works. We too, have the SafeTrace system. I am not sure you will be able to track any better when you go live. Good Luck, Ray