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I have had this conversation numerous times with Anesthesia manager - do we really have to have 2 people verify? Yes. Stop asking. As for scanning, we have Epic BPAM which does not function in the OR. OR has their own process that does allow scanning of units during massive transfusion but it isn't perfect. If they scan the units from the cooler and somehow the unit isn't transfused and is returned to the BB, there seems to be a glitch where unit status in Epic thinks the unit was transfused when it actually was not and did not update when returned to the BB. Later, when trying to scan for another patient, BPAM gives a warning "Unit not intended for this patient". This statement is an almost guaranteed nurse "freak-out."

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem. Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen. I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

Not advertising but there was a good podcast from BB Guy this month on implementing use of low-titer WB at University of Cinncinnati and their experience from both trauma and blood center perspective.

If there is anyone who has implemented the use of Group O LTWB for trauma that would be willing to share SOP? How are you monitoring recipients for adverse reactions to incompatible plasma? What types of patients are approved to get stored WB transfusions? What happens to the unit if not used - do you manufacture RBC or waste the units? Do you use O+ or O Neg (or both)? Do you have a set limit on the number of units a patient can receive while the ABO/Rh type is unknown? My trauma surgeons are pushing hard to move forward with the plan to implement, blood supplier is willing to provide product but I have lots of questions and not a lot of resources and don't want to reinvent the wheel.

My interpretation is that containers used for transporting blood products must be validated to ensure that the blood products are maintained at appropriate temperatures including extreme ambient temperatures (winter and summer). This validation would need to be done by the blood supplier since it is their container that is used for the transport and would be verified by the FDA during their routine inspections of blood manufacturers. As a recipient of incoming critical supplies (blood products, reagents, etc...), I must have established criteria that are used to verify that the incoming products are acceptable. If my criteria include measuring the temperature of all or part of a blood shipment, then that needs to be performed at the time the shipment is received. My blood supplier must pack products to maintain the correct temperature for a reasonable time period so that, should I choose to measure it, the units would be at the appropriate temperature.

Agreed. We had a recent positive DAT on Group O baby born to Group O mom with negative antibody screen. Eluted anti-Cw. After we went back and tested Mom with Cw + cells, 3+ reactivity. Actual practice on testing babies varies from hospital to hospital - and I think most is dependent on the volume of deliveries at that hospital and the Blood Bank workload.

Our admit order set includes performing Newborn Evaluation when Mom is group O, no prenatal care history, or history of positive antibody screen. Almost 100% moms have an admission ABO/Rh type and antibody screen. If mom has a negative antibody screen, what are we expecting to find when performing a DAT on ABO identical mom and baby?

We have built several different "dummy" patients that allow us to quickly get emergency-release blood issued - we routinely keep pre-labeled Group O RBC in the ER, OR, helicopter, and a remote satellite lab at a smaller rehab facility as well as units labeled for Massive Transfusion Protocol in the Blood Bank. We currently use a paper form where the actual patient name or Trauma ID and MRN is documented for our record keeping and traceability. TJC seemed to have the most interest in how emergency-released units were labeled last year during multiple rounds of inspections - they were happy with our system since it does allow tracking of units from issue to transfusion. DHEC was also interested but not as focused.

Thanks!

Thank you all for your invaluable input - does anyone know of literature referencing a mL/Kg formula looking at safety in transfusing incompatible plasma?

If you are in a Massive Transfusion situation and the patient is bleeding so profusely that you run out of available (aka thawed or liquid) ABO compatible plasma - the only available plasma is Group O. You have a specimen and the patient is Group A. What would you do?

We have Helmer D8s and recently installed 2 Sahara III - Sahara has little to no maintenance, easy to use - but VERY SLOW (24-35 minutes for 2 units) compared to thawing 8 units in Helmer (16 -20 minutes for E2555 products). Great if you are thawing a couple of units for routine transfusion - not useful in hemorrhage/trauma situations.

Has there been any questions regarding the manufacturer's QC instructions for polyspecific gel cards if you are only testing with IgG coated red cells? I thought I understood from the Ortho instructions for QC that a positive and negative control were required and C3 coated cells must be used to verify anti-C3 reactivity. I'm not saying that is what we are doing but the question has come up in our BB leader meetings about QC for the poly DAT gel cards on the Vision.

Could someone re-post the link to the NYCBC poster? It looks like the link on these posts is no longer valid.

When do you perform an elution? (e.g. all positive DATs, all positive DATS within 3 months of transfusion, IgG positive only) - Positive DAT with anti-IgG if elution has not been done within previous 30 days or performing a transfusion reaction investigation What method is utilized for the elution? Elukit What method is utilized for testing the eluate? Gel How is the eluate tested? (e.g. screening cells, full panel, specially selected cells) Panel Feel free to mention any special notes/criteria for which I may not have though to ask. If the plasma antibody is very strong (particularly with cord blood eluates), I am very careful to change tubes between washes and test Last Wash before proceeding further with adding the acid to red cells. Once eluate is prepared, at least two centrifugations in clean test tubes to make sure that any stroma is removed as it will cause major headaches when performing gel testing.