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We require a type and antibody screen on the neonate and transfuse according to any demonstrating antibody. Rh positive infants born to mothers who received antepartum RhIG usually have positive DAT with anti-D eluted from cord red cells. The majority of these infants don't require transfusion in my experience.

We use SoftBank and Epic BPAM as well and have encountered this issue a few times. We primarily handle MTP patients usage on 'dummy' patients to get uncrossmatched units to the patients more quickly. Because we have so many activations - we assign an expiration date to the dummy patient's MTP order number. Orders are renewed on Mondays for the dummy account to help with preventing the interface crash that happens when too many units are assigned to a single order.

I might be dating myself - years ago I worked for a transfusion service that manufactured packed red cells. CAP had required proficiency testing for the manufacturing process - if I remember, it was measuring the hematocrit. Just looked on the test menu and it seems that is no longer 'a thing'. So use the word 'competency' instead. Our trauma program uses a lot of blood and liquid plasma before we know the patient's blood type - I don't think I would choose Group O liquid plasma even though it is low-titer. As I write this, I realize that I'm looking at the problem with a distinct bias against more work for my team so please forgive. When we implemented whole blood, I was definitely averse to splitting the product to create components because of the work - both physical and intellectual - and I am still thinking that way. If it is feasible for you and you embrace the process, go forth!

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You will need to develop a validation and QC plan to ensure that the hematocrit on the RBC product meets pre-defined criteria and regulatory standards. You will need to have proficiency testing program as well. We transfuse LTOWB as well but consider the wastage as part of the provision of products meeting the Trauma programs needs - I do not want the headache of manufacturing regulation (I might have skipped over the FDA inspections as well- don't forget that....)

Our pathologists have authorized O POS for adult males and females 56 or older without requiring permission - we have this written into our MTP and Emergency Release policies. Younger females or pediatric patients would require a phone call. Since we average 25 MTP monthly, this is a tremendous help in conserving O NEG.

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