Franciscan8524

The norm for febrile reactions is 1C or 2F based on the pre-transfusion vital signs. Please keep in mind that some of the suggestions provided need to be evaluated by your medical director as he/she will determine what other tests (if any) need to be added to the work-up. Having said that, we do not culture every single transfusion reaction. I have worked at different blood banks throughout the years and this is what I have found. Some facilities based the use of an automatic blood culture on temperature increments from pre-transfusion vital signs of 1 C or 2F. Other implemented the same parameter but added chills to the mix, so if the patient presented with at least these two symptoms a culture was done. Other sites included the temperature ranges listed plus a drop in blood pressure of 30mmHg whether systolic or diastolic. If the temperature difference was 0.5C or 1F a culture was not generated. I have not seen any requirements based on pulse, however, pulse can be evaluated alongside other symptoms to determine a bigger or more complex reaction. I would not culture every single transfusion reaction regardless of blood component. I would, however, sit down with your medical director and nursing to establish different protocols as to when to order a transfusion reaction and what tests need to be run to fulfill regulatory suggestions and requirements. Transfusion reactions tend to be under-reported so transparency and transfusion administration education from healthcare providers is key to address these issues. I might have not provided specific answers but this is one of those processes that require your site to feel comfortable with work-ups and tests ordered. Patient safety and stewardship of resources is key to any process. I hope this helps. Thanks Frank

It is a good practice to draw a post-transfusion sample to identify a hemolyzed/ icteric sample and to verify the post sample ABORh and DAT status. As jojo808 mentioned, further evaluation will depend on the type of reaction, component given and amount given. Thanks Frank

Hello The process could be from 7 days to, let's say, 30 days or more. The point is to document that a patient had not been transfused or pregnant within the last three months. I think the reason why most people consider 14 days is to include the 7 days after transfusion a sample needs to be saved for and then add another 7 days. Another point is storage capabilities. Do you have enough space to hold samples for 30 or 45 days? We had a process in which a presurgical sample was drawn on day X and at that time the patient would be asked those two questions. Documentation of the person asking the questions (full name or employee code), the draw date, the surgery date, the answers to those two questions, patient's demographics and a disclaimer explaining that if one of the two questions is "Yes" the sample needs to be drawn within 3 days of the procedure. In some hospitals, this paper is, in fact, an order placed in the HIS and the blood bank will document the answer to those two questions. In other hospitals, a similar version of that form is filled out the day of surgery by the pre-surgical team documenting the same two questions. This second form help hospitals that extended the Type & Screen for a longer amount of time (let's say 30 or 45 days) to document any possible hospitalizations or encounters the patient may have had in between the time the presurgical sample was drawn and the surgery date. Maybe there are some strange cases where a patient may have had a visit to a hospital and blood was given (a hospital other than the one performing the future surgery) and this second form was the only tool that could have caught that. The Type and Screen can be extended on the presurgical day if both questions are "No". Those samples will be saved in a special rack and the forms filed in a special folder. I have not seen many cases in which I have to retrieve a presurgical sample to do extra testing. For the question regarding a blood bank ID band; this band, the presurgical sample, and the presurgical form can be sent to the blood bank on the day of draw. The blood bank will give the band to the presurgical team at some point before the surgery. Maybe the second form I mentioned earlier could be used as another verifying that a blood bank ID band is on the patient and the two questions are still "No". If for some reason a patient has a clinically significant antibody(ies) two RBC units can be set up the day the sample was tested this way there won't be an issue trying to use a sample that is 30 days old. This, however, will tie up two RBC units for that amount of time. Sorry I went on and on. I wanted to cover all the bases. Thank You Frank