Sandy Smietana

This is the criteria we've established for the product Criteria for thawed plasma transfusion includes: è -PT and PTT >1.5 x the mean normal value in a non-bleeding patient scheduled for surgery or invasive procedure; è -Diffuse microvascular bleeding, transfusion of >1 blood volume, and PT and PTT >1.5 x the mean normal value or not yet available; and è -warfarin overdose with major bleeding or impending surgery. Other indications may include: è emergency reversal of warfarin, è treatment of plasma anticoagulant deficiencies such as protein C, protein S, or antithrombin III when specific therapy is not available Advisable exceptions include è Inpatients with Factor VIII deficiencies, è Severe DIC, è Thrombocytopenia Purpura è Hemolytic Uremic Syndrome. Hope this helps Sandy Smietana Genesis Clinical Lab MacNeal Hospital

We're getting ready to upgrade to Misys 6.2 with a implementation date of April 2008 which coincides with the ISBT128 implementation date of our Blood Center. We are an AABB laboratory in a 500 bed hospital. I downloaded the AABB plan and it is extremely detailed and seems more suited for a blood center than for our transfusion service. Our Blood Center has an ISBT128 Task Force and we've looked at different implementation plans. We used an article published in the AABB News, Connecting the Transfusion Medicine World Through ISBT128. March/April 2006 as a basis to develop an generic implementation plan. The article written by Marianne Silva, MS<MTASCP(ASCP)SBB,CQA(ASQ) Developing your ISBT128 Implementation Plan is a 12 step approach for writing a plan. It is simple, easily understood and will work for any size blood bank. I found it very helpful and was able to write a plan that met with the AABB/CAP inspectors approval. I would suggest talking to a representative from your Blood Center to see if they can't provide you with a copy of the article. If you would like a copy of our plan, I'd be glad to share, email me at ssmietan@macneal.com. I would strongly suggest you read the article because it's very insightful and really covers everything that you need to think about in writing a plan.

We have Sorval Cell Washers, do not blot and have not had any problems with CAP proficiencies or internal proficiencies.

In addition to plasma frozen within 24 hours our Blood Center also provides an FFP pheresis product. We've been using all the FFP products for our patients. We placed the products into use without any introduction except for blood bank staff training. Since the AABB placed restrictions on the use of female donors for FFP the availability of FFP products is limited and we use what ever we get from the Blood Center. We had to developed specific product code for our computer system but that should disappear with the implementation of ISBT128 in May of 2008. We convert all our FFP products to Thawed Plasma if not used within the expiration time. We had the labels printed by our label supplier. I'll be glad to provide information, pictures etc. concerning the label suppler. One of our staff took before and after digital pictures of the product that we use as part of our procedure. Helps a lot when you have Generalists rotating through the blood bank on second and third shift. Sandy Smietana ssmietan@macneal.com

We also have a communication log book that staff are required to sign and read. We have generalists on second and third shift and they go back to the last time they were in the department so they can keep up to date. It has worked very well for us. We've never had a problem with enforcement, the staff find it helpful to know what's happening. They will often document a problem with a member of the nursing or medical staff "just in case" to avoid misunderstandings.

We also report the patients as Group A and will crossmatch Group O if Anti-A1 is present, otherwise we use Group A red cells.

John We dropped weak D testing for all patients except processing autologous donors, cord bloods and infants under 6 months. Basically what I have to say has been said by other people. We did not see an increased usage of Rh negative blood because the units were crossmatched before the weak D test was completed so the few Weak D positive patients we had received Rh negative units. Many of our OB physicians prescribed Rh Immune Globulin for their Weak D positive patients "just in case". Dropping the test has been a savings in time and money. It was a constant source of confusion for the doctors and nurses when they had patient testing performed at laboratories that had dropped the weakk D testing while we still performed it. They had conflecting results on the patient's chart, this has eliminated a lot of confusion for both the blood bank staff and medical staff. We have not receive any negative responses from the medical staff to date. Sandy

We send the patient sample out to be worked up. If there are no underlying antibodies we give least incompatible crossmatched blood on a Release Form requiring the patient physician's signiture. We provide blood for transfusion for the 72 hours the patient sample is viable with no additional workup regardless of the number of units requested. If additional blood is needed after the sample expires, we send a new sample out for another antibody workup. We do basically the same thing if the patient has clinically significant antibodies - provide antigen negative least incompatible blood for the 72 hours the clot is viable requesting the patient's physician signiture on a Release Form. For patients with no history of clinically significant antibodies,we do not antigen type the patient to give blood that matches the patient phenetypically nor will we give Anti-e negative blood if the patient has an Auto Anti-e. We've found this is a waste of resources - reagents and staff and the patient doesn't respond any differently to the transfused product. This is a situation that has to be decided by your Medical Director. We've never had any problems with the physicians accepting our protocols. Our patients usually have Hematology Consults and the Hematologists are comfortable with the protocol It will be interesting to see what other people are doing in this situation. Sandy Smietana

Hi John, The Illinois Association of Blood Banks did a benchmarking survey in 1999 and Transfusion Reactions were included as part of the survey results released in 2000. It was very difficult to interpret and compare the survey results with our internal results for the reasons stated in Pat's response. Our nurses are trained on the reaction criteria, both the blood bank and the patient's physician are notified when a reaction is suspected. We collect our data and present it by type of reaction and products transfused. we then compare our findings against previous years looking for trends. I have data starting in 1996 and our reaction rates are basically the same each year. I've never seen any benchmarking data published except for hemollytic reactions, I'll have to check the Technical Manual and see if I can find the 2% rate. If anyone has any information I would also be interested in benchmark data.

Our ID band is similiar to the "Hollister" band with a preprinted blood bank id number. we do require patient information on the id band - patient name, Medical Record number. The nurses/patient care techs that draw the samples usually attach a pre-printed patient label to the band instead of hand writing the information.

We have about 433 beds and the majority of our samples are drawn by Patient Care Techs or the Nurses. The protocol is to check the armband, properly identify the patient etc. then draw the sample, sign and date the patient specimen label,label the tube at bedside, apply the blood bank armband with the unique blood bank id number (similiar system to Hollister) etc. There isn't enough staff to have two individuals check the identity when the sample is being drawn. To date the system has worked for us and we will continue in this manner. I am interested to discover what other people are doing in case this becomes an issue.

The Nursing Unit will call the blood bank when they want blood/products for a patient. They must provide us with the patient name, Medical Record Number and the blood bank Identification (wristband) number. We document the information along with the caller's name and location. We have a sign out log where we record the information, then we tube the product. We call after the product is tubed to let the nurse know the product is tubed, document the name of the individual that we called. Then we issue the product in the computer. We just went up on the computer system and we're making a determination as to whether we want to eliminate the sign out log. We've also developed a form that we send with the blood that is returned to us when the product is removed from the tube to meet the CAP requirement for tubing blood.

I once supervised an AABB Reference Laboratory and an active Transfusion Service. We only ran controls on the day of use. I continued to follow that practice at other transfusion servies that were both AABB and CAP approved with no adverse comments from the Inspectors/Assessors.

Our blood bank is staffed by Generalists for second and third shifts, we choose to use a mini pH meter with a digital read out. It was easier and faster than to try to train everyone on the dip stick method. We're still waiting for an "approved" test.