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I just started at a lab that does not have a clear transfusion reaction workup protocol. I would like to get a checklist together for the techs and the nursing staff so we can all be on the same page, does anyone else do that? Does anyone use an order set that automatically orders DAT, UA, Bilirubin, or Haptoglobin etc... when a transfusion reaction is expected or do you leave it up to the docs to order as they see fit?

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Nursing is required to call Blood Bank and also to order Request to Investigate Suspected Adverse Reaction to Blood Transfusion in their computer.  The computer request is sent to Meditech (Lab and BB computer) to order Transfusion Reaction Investigation.  Blood sample is collected ( and blood container with Transfusion form) and routed to BB for DAT and Visual Inspection.  Clerical Check is done comparing information on blood container label, transfusion form and pretransfusion blood sample for any discrepancies.  This process is documented as the STAT Investigation.  An EXTENDED Investigation (repeat Type and Screen, Crossmatch, chemistries, etc.) is done only if clerical discrepancies, serological discrepancies or Visual Inspection are noted.

 

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We have two forms I could send you if you want to message me your email address.  Most of ours is now in the computer also, but the forms have more instructions, both for Nursing and the techs.  Good start.

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    • By new2BB
      Hello everyone.
      Please let me know what you think about this.
      Recently we sent a unit to micro for a gram stain and culture.  we do this for all the febrile transfusion reactions (>2 degrees F temperature rise).  Micro called back and reported no organisms seen, no WBCs.  After 24 hrs, they reported gram positive cocci in clusters.  The next day the organism identified was S. aureus.  My question is:  how would you report the gram stain?  Negative or positive?  Some of us believe it should be reported as positive, other techs say we should go by the initial call and report it as negative.  we informed the medical director and she contacted the patient's physician.  Our disagreement is on how to report the gram stain in the computer.
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    • By SusieQ132
      Sorry for the novel!  I have an odd case that I wanted some input on.  
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    • By goodchild
      Consider that a transfusion reaction workup has completed and no evidence of hemolysis was noted.
      The medical director or designee has been contacted and provided their evaluation and further transfusion is acceptable.
       
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      We have an extensive initial phase transfusion reaction workup that I'm not entirely happy with:
       
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    • By wellspl
      I am in the process of updating our Transfusion Reaction Workup procedure.  The current procedure is divided into 2 phases.  Phase 1 testing consists of a clerical check, DAT (Pre and Post), visual examination of patients serum, ABORh retype of post-transfusion specimen and a visual examination of the unit and any solutions hanging with it. 
       
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      Thank you for your input!
       
       
       
       
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