Max LowT WB units timeframe post-MTP

[RRay]

Anyone else use LowT WB for emergency release or MTP?

 

Our current facility SOP states a maxiumum of 4 WB units to be issued.  However, it doesn't list a time frame.  I'm having trouble finding any study or recommendation on when a patient would next be allowed to receive WB.  Never?  For the life of the current specimen? For the current admission?  24 hrs?  90 days?  Anyone know?

I'm also making the assumption that this would be for those patients who are not Opos if all we issue is Opos WB.  Is there any reason we would have to stop at 4 Opos WB units if the patient is Opos?

[SbbPerson ☆]

I have never heard of that. What is LowT? I assume WB means whole blood? 

[RichU]

I guess low titre anti-A and anti-B.

We don't have any whole blood. The usual major haemorrhage pack provided is 4 red cells and 4 FFP for transfusion in 1:1 ratio.

During the TT motorcycle road racing we keep a box of 2 O neg red cells and 2 group A FFP for immediate use. This hopefully gives us time to test a sample and issue group specific if further units are required.

[RRay]

Oh, sorry. Yes.  Low titer anti-A and anti-B, group O Whole blood.  This is probably a question for the lvl 1 trauma centers.

 

Or alternatively, does anyone have maximum out of group limits for emergency release?  And if so, what's the time frame on that?

[jshepherd]

There is an AABB standard that your facility has to have a policy on how many out of group PLASMA transfusions are allowed. This very broadly encompasses LTOWB. It's 5.15.4. 

That said, our level 1 adult center will give 4u of LTOWB once MTP is activated, then switch to component therapy, of which our packs consist of 4 reds and 4 type A liquid plasma. Obviously, we end up transfusing incompatible plasma on occasion to B and AB patients with our normal process. Once we have a patient type we switch to type compatible plasma of course. Our policies state this, but there is no maximum number  we have defined of how many units we'll give, as sometimes we don't ever get a sample until much later than we'd like, which means we're giving A plasma for a bit. 

We capped our LTOWB at 4 units, mostly due to inventory constraint when we started this program, but also to ensure we weren't overloading patients with too much O plasma if they weren't type O! Our supplier has a low titer cut off of 256. I track all of the patients who have gotten our WB, including their native blood type, and we are monitoring for issues, but have had none yet. I have heard of programs that will give up to 8 units of LTOWB per patient. 

[RRay]

17 minutes ago, jshepherd said:

There is an AABB standard that your facility has to have a policy on how many out of group PLASMA transfusions are allowed. This very broadly encompasses LTOWB. It's 5.15.4. 

That standard is addressed here as the 4 max WB and as outlined within MTP and emergency release policy.  

 

A previous facility I worked at used WB for MTP until they ran out or were able to complete the Type and screen +ABOconf.  Then XM PRBCs/FFP/PLT/CRYO rounds. The time frame there was per MTP, with unknown blood type.  Tricky thing at my current facility is that WB is first two rounds of MTP regardless of current testing or blood type, so theoretically they could qualify for WB again with a new MTP activation, or under a new admission per se.

Maybe I'm thinking about this too hard, but the SOP I'm working with seems a little thin and hasty.  Why give uncrossed Opos WB to a patient you know is Apos (current T&S) just because they're initiating MTP?  Only thing I can figure is that it's quicker to issue 2-4 units of WB versus a 4/4/1/ or a 6/6/1 MTP round.

[jayinsat]

1 hour ago, RRay said:

 Why give uncrossed Opos WB to a patient you know is Apos (current T&S) just because they're initiating MTP?  Only thing I can figure is that it's quicker to issue 2-4 units of WB versus a 4/4/1/ or a 6/6/1 MTP round.

Not only is it quicker to issue 2-4 LTOWB, it is also easier for rapid infusion. The products are supposed to be infused through blood warmers rapidly. This is important to avoid that "lethal triad" of hypothermia, coagulopathy, and acidosis in traumatic bleeds. Whole blood has been shown in studies to be more effective than components in these cases as they can be given quicker and through only one iv access. With 4/4/1, you need at least two lines and possibly more than one rapid infusion pump.  

[jshepherd]

@jayinsat makes a great point about quickness. 

If we had a current TYSC on a patient, we would prefer to give XM'd products, type specific, if able to be done quickly. If not, we would go for quickness with our pre-made trauma packs of O pos or O neg RBCs and A or AB liquid plasma, depending on the patient. 

We only do WB as part of the MTP for our trauma patients, which is upon arrival usually, so there isn't a known blood type, and if they were to stabilize and need MTP again later in their admission, we would do component therapy as described above. We've only been live with WB as part of our MTP for a year and half, so other centers doing this longer may have more input!

[RRay]

Just to follow up, this is what we decided with the medical director.

Max 4 LowT Group O WB per MTP event.  If pt types and confirms as Opos there is no max (inventory would be the limiting factor here).

I think this is the meet in the middle with meeting standards and quickness in issue/infusion.  It is also an amalgam of previous employer SOPs and other facilities in the area.