specimen requirements for plts and ffp

[bevydawn]

I am just curious as to what other blood banks require for transfusing FFP and platelets. For instance, if a patient has a type from a year ago and FFP or platelets are ordered today, does your facility require that a new specimen be drawn and typed before giving the products or does the type from a year ago suffice?

Thanks for any input!!

[donellda]

We need to have a blood type for that admission so we would need to get a specimen if they did not have a current one even if we had typed the patient on a previous admission.

[jssa1891]

To transfuse platelets or plasma, we require an ABO/Rh on the current admission, regardless of prior history.

[Cathy]

We also require a sample from the current admission for ffp transfusion. For platelets, we do a type initially, but do not require a new sample for further platelet transfusions.

[adiescast]

We are currently not requiring a sample for platelets and ffp if we have a type on record.

[skopti]

If a historic ABO/Rh is already on file, we do not require a new sample for FFP and Plts transfusions.

[John C. Staley]

We require a current type and screen, current is defined as this hospital stay. The FFP or Plts can be issued prior to the completion of the antibody screen. I thought that one of the AABB standards indicates that you can not issue blood products based on a historical type. Don't have a copy at my desk to quote from but that's what our SOP is based on. But then if you are not AABB accredited, no worries.

[Sue Miller]

It would be interesting to take a poll on this topic.

[Cliff]

That's very easy to add. Please post the possible poll selections and I'll add a poll to this post.

Or: If there could be many different questions related to this topic, I can create a new survey. That allows members to answer many questions on one topic. Again, just post the different questions to ask here, or send them to me in e-mail, and I'll create the survey.

[janet]

We require a blood type for this admission for plasma only. Platelets we require a group on file.

We don't keep a big supply of platelets so usually whatever we have is what the patient gets....often ABO incompatible.

[Rita]

If we have two types in the patient's file that agree with each other, we do not require another type in order to give FFP or platelets. Otherwise, we will do a type.

[tar1heel]

AABB standard 5.13 states - "Bbood submitted for compatibility testing shall be tested for ABO gourp, Rh type and unexpected antibodies to red cell antigens." I don't know any one who is performing compatibility testing with FFP or PLT products. I believe the AABB does not want to take a stand regarding this issue.

To those who have replied that they get a specimen for FFP every admission but not for a PLT, I think this is hypocritical. If you are concerned about the possibility of transfusing incompatible plasma in an FFP if the patient's historical type (determined in the previous 12 months) is incorrect, why are you not worried about incompatible plasma in a PLT? The plasma volume in a PLT is as much as an FFP - so what's the difference?

To conclude, we do not require a specimen every admission for FFP or PLT if the patient has an historical type that was determined in the previous 12 months.

[bbkdiane]

We require a Type and Screen on any IN house patient for which plasma products are ordered and we have no history or current sample that can be Typed and Screened. Why the Type and Screen?? If the patient is sick enough to be an IN house patient, and sick enough to warrant coagulation therapy, then they are sick enough to bleed or be ripped off to emergency surgery and need RBC therapy. We used to require only an ABO/RH in these cases...but one night, after 4 days of giving FFP to a patient based on ABO/RH, the patient had a major GI bleed which necessitated release by third shift of uncrossmatched type specific RBCs. When the tech performed the followup screen and crossmatch he encountered a positive antibody screen and two subsequent incompatible units. The antibodies were anti-c and anti-E. The patient had a reaction and physician and nursing staff could not understand how we missed them or why we didn't do the antibody screen. Our response was that the screen wasn't needed because only plasma products were being issued; it wasn't policy to perform the screen in this situation. I remember feeling really dumb giving that explanation to the perplexed physician. We decided that we never wanted to be in that situation again so we mandated the Type and Screen for IN house patients for whom we have no current history. Our patient population is 70% Medicare and many have been multi transfused.

We also missed a Tja on an O+ patient for Labor and Delivery when only ABO/RH were ordered on incoming OB patients. Lots of fun when the patient bled at delivery.

I know these are off the wall cases and there are those who will criticize this missive, but we are influenced by our own experiences and have to do what we are comfortable with. The Type and Screen is the tech's best friend. It is the cheapest insurance policy that you can provide for a patient who may need blood.

We do handle OPTs differently: upon first visit, a base line Type and Screen is performed. Chronic plasma product users (platelets usually) have a second sample drawn for ABO/RH. Once we have 2 types on record, the OPT can come in, get their platelets, FFP, or Cryo without further testing. Since these folks are considered stable and are deemed okay to be treated on the OPT basis, they are low risk for emergency transfusion of RBCs.

Thank you for listening.

[labgirl153]

My past experience is in agreement with BBKdiane's (and she did a great job of conveying it). Whenever a new admission pops in and the physician wants "only" FFP, I take the initiative and request a "type and screen" for all the reasons BBKdiane mentioned...because all of those scenarios occur and they're not rare in the least.

...plus, who wants to perform a screen on some patient's plasma that's been significantly diluted after having pumped several units of donor FFP into that person ... and now they want to infuse 3-4 units of blood to make up for the hemodilution that they didn't foresee? I sure don't. I agree...nip it in the bud at the get-go and if they do have an antibody but don't require packed cells right away, it buys you time to work it up and find units down the road.