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Logan51

Issuing plasma based on historical type

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Hello,

I have a question for the group regarding a practice that I've been familiar with throughout my career.  Due to an unexpected departure, my facility has had to name an acting Blood Bank Medical Director who has previously not had any experience in Transfusion Medicine.  The plan has been to find a replacement but I've been informed that a hiring freeze will prevent that for some more time. In the meantime I've been asked to "probe" our current practices and determine if there is anything that should be urgently evaluated.  In doing so, I've come across a question for which I don't really have an answer to.

For facilities that do not require an active specimen (current admission and/or 3 days elapsed) before issuing Plasma for a patient with a historical ABO type on file, how high is the risk of encountering a patient who has received an allogeneic bone marrow transplant and now has a different ABO type than their historical record?  I've worked in multiple facilities where this was the practice and have never given it much thought but I have to admit that I find myself curious as to what level of risk this poses.  My guess is that the odds of encountering such as scenario are relatively low.

Please know that I am by now means questioning or criticizing anyone's practice, and that I am simply attempting to familiarize myself with whatever factors should be considered.

Thank you all in advance for any insight, the people in this group have really been a big help.

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   The other hospitals in our system do not require a current specimen. We don't do it at our hospital. I worry since I have seen it too often someone using a relative's Health Insurance Card and having a complete different type. We don't need a specimen though form 3 days. If they have had a specimen during the stay, we will thaw plasma.

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From what I've seen, these patients normally have type-specific instructions for all products listed in their file. For example, for current in-process transplants, an OtoA Pos patient may have an O Red Cell Products instruction, an A or AB Plasma instruction, and an A, AB, or washed platelet instruction. If they have fully switched over to the donor type, their file notes that instead, and then it's type specific from there...

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We issue Group A Plasma (or whatever is shortest outdate as long as it is not Group O)  until we have a BB Specimen and the ABO/Rh is verified.  Then we switch to ABO compatible/specific.

The expiration date of the specimen does not apply to non RBC containing blood products, so as long as the patient is wearing the corresponding BB Band, we will issue Plasma, Platelets and/or Cryo.

I agree, the non-ABO match allogenic stem cell transplant recipients are a challenge, but as someone pointed out in an earlier post, these patients become obvious and we can deal with their 'new' blood type 'in the moment' according to our current protocol.

Edited by Joanne P. Scannell

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18 hours ago, Ward_X said:

From what I've seen, these patients normally have type-specific instructions for all products listed in their file. For example, for current in-process transplants, an OtoA Pos patient may have an O Red Cell Products instruction, an A or AB Plasma instruction, and an A, AB, or washed platelet instruction. If they have fully switched over to the donor type, their file notes that instead, and then it's type specific from there...

Off topic, but why washed platelets?  I have been told washing decreases your volume, expiration time, and quality of the products.

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We have to have a current ABO/Rh, otherwise its going to be AB plasma.  Patient ID is not 100% reliable as pointed out above. (If  patient is arm banded and comes in later, that is a different situation.)

Scott

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On 1/22/2020 at 10:35 AM, tkakin said:

Off topic, but why washed platelets?  I have been told washing decreases your volume, expiration time, and quality of the products.

Yes, there is a fair modest platelet loss in washing, and the expiration is shorted to 24 hours, or the original date (whichever is sooner); however, we (I work with @Ward_X) don't always have A or AB platelets and for transplant patients of mismatched types, we always honor the requirement to provide compatible products.  Something that means washing a product.

An interesting side note.  We recently started accepting PAS platelets and if needed will wash them.  ICCBBA did not have a code for that so our IT people had a new code created.

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We use  an ABORh from the current admission to cover all possibilities. Stem cells patients or using someone's else insurance. For FFP and Platelets. 

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Some of you have already specified this, but for those of you who require a current specimen for plasma, do you have the same policy for platelets?

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On 1/26/2020 at 11:09 AM, Cliff said:

Yes, there is a fair modest platelet loss in washing, and the expiration is shorted to 24 hours, or the original date (whichever is sooner); however, we (I work with @Ward_X) don't always have A or AB platelets and for transplant patients of mismatched types, we always honor the requirement to provide compatible products.  Something that means washing a product.

An interesting side note.  We recently started accepting PAS platelets and if needed will wash them.  ICCBBA did not have a code for that so our IT people had a new code created.

I have read many of your posts and value your opinion.  I understand if you are honoring the requirement (can you point me to the requirement?)to provide compatible products for these patients, but in your opinion do you think it is better to give a non washed incompatible plt or a washed incompatible plt?

I have received these patients and it is recommended they get washed platelets.  My blood supplier argued not to wash platelets, and I see their point, but if it is a requirement I need to be able to present it, so that when I request it, they will fill it. :) 

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5 hours ago, tkakin said:

I have read many of your posts and value your opinion.  I understand if you are honoring the requirement (can you point me to the requirement?)to provide compatible products for these patients, but in your opinion do you think it is better to give a non washed incompatible plt or a washed incompatible plt?

I have received these patients and it is recommended they get washed platelets.  My blood supplier argued not to wash platelets, and I see their point, but if it is a requirement I need to be able to present it, so that when I request it, they will fill it. :) 

Sorry, the requirement is internal, I should have been more clear.  We manage many transplant patients as we support a large cancer center.  They often get ABO mismatched transplants and we don't want to hemolyze the new cells or create more back type confusion than needed.  All mismatched transplants have some type of ABO restrictions on their cells and plasma and we always honor it.  That requires us to wash platelets.

Are they an inferior product, I assume so.  Are there fewer platelets than in the original bag?  Of course.  Our medical staff have determined this is the best product for the patients.

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We require a current ABORH for all plasma products. The reason is not because of the possibility of a blood type change due to bone marrow/stem cell transplant, it is because of the probability of an erroneous admission. Every facility I have ever worked have had instances where admitting has registered a patient as someone with a similar name or merged a record with a similar name, resulting in an inaccurate blood type on record. We mitigate that risk by requiring a new blood type each admission before giving plasma products. Once the type has been verified, we will issue plasma products until discharged, regardless of how long ago the type was done.

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On ‎1‎/‎31‎/‎2020 at 9:18 AM, jayinsat said:

We require a current ABORH for all plasma products. The reason is not because of the possibility of a blood type change due to bone marrow/stem cell transplant, it is because of the probability of an erroneous admission. Every facility I have ever worked have had instances where admitting has registered a patient as someone with a similar name or merged a record with a similar name, resulting in an inaccurate blood type on record. We mitigate that risk by requiring a new blood type each admission before giving plasma products. Once the type has been verified, we will issue plasma products until discharged, regardless of how long ago the type was done.

How does your facility comply with the newer AABB standard 5.16.2.2? Wouldn't compliance with having two determinations of an ABO group prevent erroneous admission?

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