pbaker

Does anyone transfuse plasma products based only on patient ABO/Rh history? For example, if they had T & S done 6 months ago and they were a B+. Today they come in and the physician orders FFP to be transfused. Would you require a new ABO/Rh or would you issue plasma based on the B+ from 6 months ago?

We keep panel cells for 4 months. Our SOP states they are acceptable until they start to hemolyze or turn brown. We have never been cited by AABB for using them.

We do all our testing using automation unless the specimen is clotted. There is no washing involved there. If we do manual testing, we just make a cell suspension with no washing.

If the patient has no history, we require a second specimen before issuing any blood products (emergency excluded, of course). If the physician won't wait for a second ABO/Rh, we ask that he/she signs a legal release.

One of my pathologists is leaning toward some kind of Trypanosome.

I would send it back to the blood center and let them deal with the discrepancy.

For those of you that have OB departments, I am interested in how many KB stains you perform, what your turn-around time is (is it considered a STAT test??) and if you know what the doctors do with the information? We do a lot on Rh + women who have fallen, been in crashes, etc., so it is not for Rhogam determination. Have you had any instances where a clinical decision was made (ex. deliver the baby) based on this one test?

We collect pre-op specimens up to 30 days out. When they return day of surgery, there is a questionnaire completed and documented electronically by nursing asking about transfusion and pregnancy within the past 3 months. If either question is answered yes, then another TS is performed. If both questions are answered no, then we just do an ABO/Rh. Our computer builders made a test called PNEG (pretesting negative) that will allow us to crossmatch on the day of surgery specimen. Sometimes the blood bank can determine that the questions are answered incorrectly and we follow up with the person documenting the answers. Sometimes it is the patient answering incorrectly and sometimes it is a typo. Unfortunately, there is no perfect system. We have been doing it this way for years and have had no major problems and have passed all our inspections.

We only call if there is going to be a delay in receiving blood such as an antibody or a special need unit that must come from the blood center. We do electronic crossmatch on demand so we have trained (if they listened) the RNs to know that if the type and screen results are in the computer, the blood is ready. They place an order for "request for delivery" in our computer system when they are ready to hang the unit. Blood bank orders, crossmatches and issues the unit at that time. There is a second check of labeling by the blood bank staff and the blood is transported by pneumatic tube. A phone call is made to let the floor know that blood is on the way. The blood is sent by badge secure so we can track who sent it and who removed it from the tube station. Nursing policy states that only an RN or LPN may remove it from the tube station. If it does not get released on the floor in 5 minutes, it will automatically return to the blood bank. Blood administration is tracked/audited by nursing.

Does anyone have an opinion regarding which is the best plasma thawer on the market? We currently have a Thermogenesis that is on its last leg and really too big for our needs. Thermoline has a wet thawer similar to the Thermogenesis (think it might be the same company???) I have also received information about the Barkey Plasmatherm. Do you think wet or dry is better? Is there a product that you like better? Is one a better bargain over the other? Thanks for your help!!

We have a great deal with our blood center regarding antigen negative units. We request historically typed units and then we only have to retype what they send. If we send them a list of our inventory, they can look to see if we have any on our shelf and, if we do, we don't have to wait for them to be shipped. This reduces greatly the amount of reagent and time used versus screening. If we are looking for something simple like K, then we will screen our own inventory. I did have a really bad day once where 6 out of 7 of the O= I typed were K+. And my QC worked just fine, so that wasn't the problem. Just really bad luck!!!!!!!

It has now been almost a year since we "started" our blood management program and we are absolutely getting no where. The lab and hospital medical directors have totally changed their tune and are now hesitant to cross the physicians. We just keep gathering data about how many extra transfusions we give, but we do nothing about it! We have finally involved our blood supplier (which I suggested a year ago) and they are bringing some education to the physicians. I feel as if I am just banging my head against the wall!!!!!:disbelief

Same here regarding supply.

When we got a new pharmacy director, she about flipped out when she discovered that Rhogam, WinRho and coag factors were still in the BB. She stated that they were a drug and should be maintained, ordered, consented, etc. by the pharmacy. I'm sure every institution is different, but I was really happy to get them out of the BB.

We do a type and screen up to 30 days out. When the patient comes back day of surgery, we have a test called "P neg" meaning all pretesting was negative. If they have not been pregnant or transfused in the previous 3 months, we only perform an ABO/Rh and use the screen results from their pretest with a disclaimer stating that fact. Any units needed can then be added to this P neg specimen. If they have a positive screen, have been pregnant or transfusions, we do another TS day of surgery. If they pretest, we can be prepared if they have an antibody and get Ag screened units ready before the patient comes in for surgery.

When you have a current blood bank specimen and patient information changes, how do you deal with the change?

I know that standards require records of clinically significant antibodies to be maintained indefinitely. If our computer has a record of all antibodies and any other discrepancies, is it necessary to keep the folder with the actual workup? We pull them from our current drawer if we have not seen the patient for 2 years and have been having the workup scanned to a CD. Is this required or is the computer record sufficient?

For those of you who still hand label blood bank specimen tubes, do you allow corrections of name and/or medical record number on the tube? For example, if the phlebotomist realizes at the bedside that he/she has an extra number or letter, would they be allowed to draw a line and write the correction?

We also validated our system and the temps remained within limits. Ours are sent badge secure so we can document who sent it and who removed it from the tube station. This feature has come in very handy when nurses claim they didn't receive the product. Our system is also set up to auto return the product if not removed from the tube system within 5 minutes.

Yes, the one for uncrossmatched, Rh+ to Rh=, least incompatible, etc. etc. etc.

Does anyone have an emergency consent for release of blood products form that you would be willing to share?

I know of one hospital in the St. Louis area (not mine) that has portable refrigerators controlled by the blood bank. they are loaded by BBK and "driven" down to the OR. there is only 1 patient per fridge. Not sure of all the details, but it sounds like a better system than just 1 OR refrigerator.

Our go live date was supposed to be 1/1/11. As of this moment, all that has happened in the probes have been installed. It appears that the hospital has wasted a great amount of money for a system that doesn't work how we would like.

We have just organized our blood utilization committee. We started by revising the ordering practices and lowering the hemoglobin cutoff for red cell transfusion. It is almost ready to be rolled out to the medical staff, so we will see how it goes over. Our hospital chief medical officer is totally on board and says "just do it." We are trying to utilize products more efficiently and reduce the number of unnecessary transfusions (hgb 9.0 gets a unit of blood because "it will make them feel better."), as well as reduce cost.

We have no formal policy regarding release of units prior to specimen expiration. However, I look at the crossmatched units daily and release those with a stable hemoglobin of 9 or greater regardless if the original order was a surgical or medical request. I often find units still set on patients that have discharged or have expired. Those definitely get taken down. We use electronic crossmatches and as soon and I can educate the medical/nursing staff (and calm their fears) we will be going to crossmatch on demand as EXM was designed to be used. This will virtually eliminate the problem of units set for no reason.