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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 It looks like the link on these posts is no longer valid.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.

Update: This was not cited by TJC but inspector really wanted to. We prevailed when we asked to read the requirement.

FMH Lot Confirmation.xlsx

Would anyone be willing to share their process for transfusion review? Specifically criteria and how review is documented (forms?).

Please! Epic with Softbank since 2016.

We are Level 1 Trauma Center with approximately 15 Massive Transfusion activations per month. We keep 6 O POS and 6 O NEG in our ER refrigerator with 4 Group A Liquid Plasma. We started stocking O POS units last summer when our blood supplier was struggling to keep up with our O NEG need. The majority of our traumas are male and about 80% Rh positive. It has made a tremendous impact on our O NEG usage. The biggest concern was the possibility of a mistake and grabbing O POS for female patient but (knock on wood) that has not happened yet. We have segregated the units by placing O POS in a Blue plastic bin and O NEG in a Pink plastic bin - and on a separate shelf. O POS units are wrapped in a paper stating "FOR MALES ONLY".

We just implemented testing Fetal Screens old lot to new lot. I don't think Safe-T-Vue would need Lot -to Lot verification under this standard since it is not a reagent. However, to meet other requirements, it would need to be inspected to verify that it meets supply qualifications

We do a complete type - both forward and reverse

We are a level 1 Trauma center that routinely gives Emergency Released blood products with approximately 15 MTP activations per month. We have difficulty obtaining MD signature on our Emergency Release forms after the patient moves to OR or if the bleed initiates in the OR. Does anyone utilize an electronic order and use the electronic signature for emergency release/MTP activation? Have you been CAP/AABB/FDA inspected using electronic signatures? If so, were there any problems with the inspection? I am in discussions with Trauma service about obtaining a physical signature and they are begging us to make it "easier" hoping to obtain better compliance with transfusion documentation in Epic. I know that transfusion documentation and physician signature are separate issues but they have presented questions linking the two topics.

We use them with no plans to stop. We also get a second sample for non-Group O patients that are not emergent.

Looked up CAMELLIA and it comes up on the ClinicalTrials.gov website as anti-CD47 and used for AML and MDS. Sponsor is company called Forty Seven Inc. and is currently in Phase 1 trials expecting to end August 2018.

For most species, freezing (even in liquid phase liquid nitrogen (-196C) will not kill the bacteria. There is a lot of literature concerning this subject for cell processing for BMT and I have personal experience with Staph species and Strep species being alive and perfectly happy in a thawed stem cell product. Even after lengthy storage at <-150C.

We are using both Epic and Softbank which, for the purpose of MTP , do not play well together. OR uses the MTP workflow which does allow realtime documentation for units that are selected to the actual patient -where we run into trouble is the units that are emergency released or in the first MTP cooler. These units are pre-selected to a 'dummy' patient and Epic will not allow unit scanning for the particular patient and gives the user a scanning error of something along the lines of "this unit is not intended for the patient" - always great to see on the transfusion end during a high-stress chaotic event where there is massive blood loss. We send paper transfusion records with all MTP units so that they can be scanned into Epic later. The OR flowsheet for MTP is fairly good for units after the first cooler once you have an experienced user doing the transfusion documentation. We have developed a similar flowsheet for emergency released red cells and plasma for use in the ER - could be expanded to other locations but it works differently than BPAM and requires user education.

Assuming that most patient samples are tested against screening cells that do not have a K+k- cell, is the exclusion of anti-K1 using a screening cell with heterozygous expression allowable if the antibody screen result is negative but not allowable if the antibody screen result is positive? If the facility endorses a computer "crossmatch" with a negative antibody screen (using a K+k+ cell) do you require additional testing with a K+k- cell to exclude anti-K1? Ours does not - but we also allow exclusion of anti-K1 with a K+k+ cell for any patient.

I must be misunderstanding - the initial workup showed that there was 2+ reactivity with R1R1 cells and anti-c was identified. I thought R1R1 cells would be c negative and am not understanding the designation "non specific anti-E and anti-c". This isn't a term that I am familiar with.

In my experience, if the platelet product is removed from the original container, the expiration period may be affected by the new storage container's ability to maintain optimal storage conditions. Apheresis platelets are collected in bags that are gas-permeable - if product is transferred to another type of bag (not validated for platelet storage), this should be considered when assigning the expiration date/time even if you volume-depleted using a sterile connecting device. I also consider this when removing the supernatant from CPDA or AS red blood cells (as in intrauterine or exchange transfusions) - you can do everything in a functionally closed system but when you remove the "food", the red cells do not exist in the same environment and cannot be expected to maintain the same functionality. The reason that the Technical Manual is not going to specify is that everything depends on the validation of functional survival of the stored platelet and there isn't data available to make a valid claim.

Homozygous unless demonstrating anti-D (heterozygous C, E). With anti-c or anti-e, uncomfortable with ruling out E, c on heterozygous cells. Would prefer to type the patient (if possible) and give phenotypically similar.

If non-Group O red cells are transfused, verify that there isn't demonstrating anti-A, anti-B or anti-A,B in the baby. Test reverse cells through Coombs phase or crossmatch the red cell unit. To avoid the need to do this testing, transfuse Group O, Rh compatible red cells. In my experience, it's best to limit donor exposure to the infant, if possible, for small volume transfusions. Most facilities I have worked in dedicate a unit to the neonate from the first transfusion request until the unit expires or is used up. CPDA or AS-, AS3 anticoagulant preferred - the fresher the unit when assigning to the baby, the longer it will last. We also only assigned 2 babies per unit and aliquoted the desired volume from the original bag with each transfusion request as close as possible to the time of transfusion. We only irradiated the aliquot ,not the original bag to avoid an increase in extracellular potassium that occurs after irradiation with storage.