Smarty pants

You should contact the bag manufacturer. It's on the bag and google will get you a contact. You may be destroying the plastic or leaching it into the blood product. Assuming bleach or alcohol is safe is a huge mistake. Our manufacturer is recommending distilled water ONLY on platelet bags. Coolers SHOULD NOT GO IN ISOLATION ROOMS. Period.

Just to clarify... there were several webinars last week with AABB, ASFA and US FDA. The collection of CCP (COVID Convalescent Plasma) is no different from the collection of ANY plasma. So blood centers can collect it as they would like. It doesn't require anything special if you've been collecting plasma. Most centers are collecting as much as they can once they get a donor (up to 1L) as a standard "dose" seems to be somewhere in the 300-400 mL range. It is the TRANSFUSION of the product that requires the IND, and the FDA has promised that they will be approved in 4-8 hours. They need to be submitted and approved on a per-patient basis. Many blood centers are working now to locate recovered patients and collect plasma. It can then be frozen and a standing inventory in place. In Australia, if you want to start doing something now... I would start getting an inventory of CCP. In the US, because of HIPPA (patient privacy) blood centers are having to contact doctors to contact their patients to see if they would be willing to donate and those donors then need to call the blood center. They are testing these "donors" for antibody titers and if it's been <28 days since the onset of symptoms, they are also testing to make sure the virus itself isn't present (so a negative RNA test). Locating these donors and doing the required testing is taking some time. Once found, it's pretty quick and easy process to get the plasma. Then it's a normal process to get it to the hospitals. It's looking like it's best to transfuse them earlier than later. There is no standard of care... but I would suspect that the best results will be seen if they can be transfused as soon as they're admitted to the hospital (those not admitted may not be sick enough to need this?). As for billing... your guess is as good as mine.

Pineapple juice mixed with orange juice (the "pulp" that looks like platelets) makes for an excellent platelet product!

If the MD has evidence that the unit has been opened and risks bacterial contamination - the unit shouldn't be used. If the MD doesn't have evidence, he should be taught about the steps the blood bank takes to eliminate that risk. If it is possible that the unit is contaminated, and is a rare group with no other unit to meet the patient's needs... it would be within his medical decision to use it or not. If he chooses to use it, it might make sense to administer some prophylactic antibiotics. But there are some very rapid tests for bacteria and it seems like taking the extra 10 minutes would be worth it to know for sure what the actual risk is before actually giving the unit.

Each manufacturer of platelet bags has validated conditions that must be met for 5 day storage. The AABB/ FDA cannot give you a standard because each bag is slightly different. Talk to your supplier to find out the storage requirements for the bag you are using. (I know Terumo is validated up to a concentration of 2,100,000 and Fenwal has a minimum volume requirement for a range of concentration). If you're outside of that storage recommendation... you probably will need to short-date those products, or at least test the pH prior to issue to ensure a quality product.

I think Verax is the only one available.

We learn something new from every war. Plastic bags are better than glass bottles. Additive solution prolongs the life of RBCs. It seems that the lessons learned in the current gulf conflict is the valuable use of whole blood in traumas. There are multiple studies, and they're pretty compelling. That said, I don't see much change in maintaining an inventory of WB. I see the change in ordering more FFP along with the pRBCs to treat traumas in order to get the component to be "more like" whole blood. The benefits of freezing the plasma are pretty apparent. There is also some interesting research being done on platelets stored at 4c. They have a longer shelf-life (the cold slows down their metabolism a bit). And they're already slightly activated, so they work faster when transfused to plug the holes. I think the DoD is actively doing some research on this, and there are a few articles published. Still a lot of work towards the feasibility on how this would be managed, because it is a whole new product with a specific indication. It would need ISBT products, FDA approval... we're still years away.... but it's interesting to read about.

The question is how the pedi pack/ transfer pack is attached. Not how it is removed. If it is attached via sterile technique so as to not jeopardize the sterility of the product, it should retain it's original outdate. When you remove it, you just need to ensure that it is a "permanent seal" not just a clamp with can accidentally open. Those grommets are generally considered a "permanent seal".

In my experience, one of the reviewers needs to be licensed (RN, MD...) the 2nd person does not. They're reviewing to make sure the paperwork matches the recipient, anyone can do that. The person to hang the unit and start the transfusion needs to ensure that the blood type is compatible and matches.... I struggle to find a single nurse who really understands that (unforrunately).

Could you store hot water in a 10 gallon thermos? It seems that replacing a valve shouldn't be more than an hour or two right? ("shouldn't") It seems that keeping hot water in a thermos to fill up your bucket might meet your need for that short time frame???

Are you talking about RBCs? I think most people are using flow for all WBC counts, but this is an interesting idea!

Terumo also makes a T-Seal... which might meet your need, it can be linked together (multiple devices with a single power source) to do a full line of segments in a single action which is quite handy if you're looking to do that too.

Intercept can be used on platelets in PAS and Platelets in Plasma. Make sure you got the right code!!

Can you please share with me the current practices of your hospitals for neonatal thrombocytopenic patients? Are you transfusing antigen negative units? Are you transfusing randoms vs apheresis? Do you collect from the mother for a directed transfusion? Thanks!

Eman - do you defer ALL donations for those medications? Or just platelets? (are the medications things like Ibuprofen or Naproxen? or something else?)

There is for platelet donation. I'm not aware of any for RBC/Plasma donation.

Quality guy.... are we saying the same thing? The Trima platelets have a volume of 400 mL (max yield <5.2) per bag. Their product bags are more clear and pliable. Amicus has a more detailed yield/ volume ratio (The volume depends on the yield, they have a table your supplier could provide you. If they yield is "x" the volume needs to be between "y" and "z"). I know their bags have a more "milky" color and hold their shape a bit more, less pliable. If that helps at all.

the maximum volume depends on the device the product is collected on. That is how the FDA clears the product. I know that the Trima max 400mL. I think Amicus' maximum volume is dependent on the yield of the platelet.

I've seen people do this. Your disinfecting wipes should be fine for that without too much pain. I've also seen people do it at the end of the day, so depending on how many cuffs/ donors you have it would be every few donors. Maybe you could go with a daily wipe down unless there is a visible rash or open wound on the cuff??

FYI... this product has been in use in the US for a few years now. In fact, demand is starting to die down. It's incredibly expensive, (some reports in the range of $90k) and data shows it is extending life by about 4 months. They're hoping to get FDA clearance for additional protocols, not just prostate cancer. In my experience this product never touches the blood bank, and therefore wouldn't be managed by them. The MNCs are collected similar to a stem cell collection. The product is shipped off to Dendreon for processing and is then shipped directly back to the doctor for administration. I guess if it's being shipped back to the blood bank and distributed through them, it should be monitored similar to any other blood product. If it's being shipped back to the doc, it falls under the practice of medicine and is not subject to blood bank review/ investigation/ work up.

Only moderate or severe AEs require MD review. All minor events are reviewed by nursing staff to ensure that they're properly categorized and were appropriately managed. (Moderate/ Severe are categorized as LOC, additional medical intervention (call 911)...)

Auntie-D ... just to clarify. There is a minimum Hgb to allow donation, there is also criteria required by each device to ensure that a donor's hgb does not drop below a specified level (Trima is configurable down to 10g/dL. Haemonetics is somewhere around 10.3). The "anemic" designation that MJDrew is talking about isn't always the Hgb level, but the donor's ferritin level. The problem here is not necessarily the cost to test the ferritin, but what to do with the information once you get it. My blood center initiated ferritin testing on all apheresis donors (assuming increased frequency would have larger depletions - although we do NOT collect apheresis RBC products at all). In the first month we deferred between 30-40% of our donors for low ferritin levels (all donors had 12.5 hgb or higher prior to donation, and only lost RBCs in samples and kit residuals. More than 8 weeks (often more than years!) since their last WB donation). If we continued deferring donors with ferritin levels outside the "normal" range, there would not be enough products to meet our patient needs. Ever again. Of note, again, we were NOT COLLECTING RBCs from this donors. So, if we want to continue meeting our patient needs, we need to be more selective in who we defer. FDA/ AABB have no suggestions on what that number is, and talking to other centers who are testing donor ferritin levels, there is a wide range of numbers used to create this deferral. One blood center only is concerned about ferritin levels in women of child bearing years. Their argument being, that (as the FDA/ AABB report) we DO NOT know the impact of low ferritin on our donors, and it seems that a large population walks around daily with low ferritin levels (and normal hgb levels) there IS data that lower iron stores can impact a developing fetus. To me, that seems like a good place to start. As with all decisions regarding blood donors, while our first approach is always to first do no harm, there is also a balance between an unknonwn risk, and meeting patient needs. As I understand it, what the FDA/ AABB is asking for is some help in trying to determine what is a sane and logical point to start deferring donors that is not going to defer 30-40% of a normal, healthy population and create a health crisis in this country of epic proportions. (p.s. I've seen a donor with a hgb of 16, and crazy low ferritin levels. It's a fascinating measurement that defies logic).

Not to take away from the fantastically inspiring Christmas stories... But I would recommend you find a tour guide to visit the Vatican. (You can pre-arrange, or there is a bus area where they are lined up and you can grab one and go in with them). There are back doors and NO LINES for tour groups. It is money well spent!! A friend of mine spent 4 hours in line.... I would rather be transfixed by the Pieta for 4 hours... or circling in awe at the Sistine Chapel.... NOT standing next to a brick wall !!

I spent a couple of weeks in Italy about 5 years ago, so I shall warn you now .... no cameras allowed in the Sistine Chapel. As you said, everything goes commercialized... they have contracts, and you have to buy the photographs rather than take them. (Plus the old time flashes did a number on the frescoes). Be sure to get a picture of the columns in the square... you stand at the right angle and the 2nd ones disappear. Move one step, and it looks like a solid wall of columns. AMAZING architecture!! You're going to have an amazing time!! The history, the architecture, ... we walked through Circus Maximus (currently a dog park) then had dinner overlooking the plaza where Julius Caesar was stabbed ... you just don't get that kind of stuff loving in the Western US!!

Since there are no endemic areas in the US ... I don't know of a blood center that does ANY malaria screening of donors.I am unaware of any ABBB/ FDA regulation surrounding malaria testing for donors. I think you're on your own on that one. Sorry can't help.