Kathy H

We have 11 remote refrigerators around our facility. Most wastage occurs in the operating room areas, especially the fridges in the two CVOR suites. Because of this, we decided a few months ago to pilot a new process for the OR's. They have been very motivated to reduce wastage but very frustrated with the rate at which the temp indicators turn color on their red blood cells. We acquired a bunch of small, conventional coolant gel packs and we started to sandwich each red blood cell unit between two of them and wrapping with a rubber band. We positioned the unit label, tag and temp indicator in such a way that the unit could be checked before storing it in the OR fridge. We send the blood to the OR through the pneumatic tube (which sometimes results in slight delays of someone retrieving them. After several months, we have seen significant reduction in the temp indicators changing (wastage) and it was relatively easy to train the OR staff to be compliant with this. They will sometimes take the unit out of the gel packs before putting it in the fridge (along with the get packs) so they can send the unit back to blood bank in the gel packs if they don't transfuse it. This may all sound cumbersome but it has been generally successful and much cheaper than throwing away units of fresh O Neg!

I agree - this is reportable. The situation must have been quite urgent for the nursing staff to transfuse units that did not match up on the clerical checks. I'd also point out that the FDA finds it quite suspicious if your facility never reports anything. That can put you it a worse position with them than the things you would have reported.

That bilirubin is rather shocking. Considering the baby's cardiac anomalies, might there also be some congenital liver issue (biliary atresia comes to mind). There are, of course, babies whose bili's elevate due to mother's milk or other physiologic causes. This is really puzzling. What is the baby's Hct?

Babies sick enough to require a blood transfusion will almost always have other lab samples drawn at a different time from the initial blood type. They also typically have IV's or other venous access and a sample could be drawn from there just before starting the transfusion to avoid sticking the baby. We have a policy to first look for another sample in the lab (usually Hematology) before requesting more blood from the child. We also use cord bloods for the 2nd sample when available.

Our policy is as follows: Up to 19 kg: 1 prbc, 1 FFP, 1 plt per batch 20 kg - 50 kg: 2 prbc, 2 FFP, 2 plt per batch 50 kg and above: 5 prbc, 5 FFP, 1 apheresis platelet pack per batch

Got money to buy all those fancy analyzers? I suggest you spend some of that and hire AABB Consulting to come in and help you get your shop in order. Being an extremely satisfied customer of them myself, I say that their fees are very reasonable and their work product is excellent. Can't hurt to call them and ask.