Pooled cryo of mixed types

[bmarotto]

What is your policy for labeling a pool of mixed type cryo? Do you not assign an ABO and/or Rh to the mixed pool and list the individual units with their ABO/Rh?

If you assign an ABO/Rh to the pool, how do you determine it? A mix of Rh pos and Rh neg would be Rh pos but what about mixed ABO groups; do you use the red cell or plasma to determine the pool ABO? Example: is a mix of A and B an AB pool or an O pool (since it has both anti-A and anti-.

Fortunately, we do not often have to pool units of mixed ABO and our blood center hopes to offer pre-pooled cryo next year. First impression is a mix of A and B would be AB but since cryo is not a cellular product, doesn't it make more sense to consider the plasma ABO group instead?

[adiescast]

We label the unit with the predominant type. The computer tag does not display a type, so the patient's medical record does not have a type in it. We can go into the computer and look up all the units and their types if we need to.

[bbbirder]

Even if you give it one type in your computer, I believe the FDA requires all blood types in the pool to be displayed on the bag, unless you are labeling with ISBT format. I don't have the reference right in front of me... I'll try to locate it.

Linda Frederick

[donellda]

We do not pool different ABO types together. If we pool Rh positive and Rh negative cryo together we label it as Rh positive.

[bbbirder]

I got this from the AABB Web page, Member Area, FAQ about the Bar Code Rule (responses from the FDA):

Q: In a pooled unit of Cryoprecipitate or Plasma, do all the blood types included in the pool have to be listed on the label? If so, must they all be machine-readable?

A. Yes. 21 CFR 606.121©(12) requires the donor’s ABO/Rh to be on the label of products intended for transfusion. The Rh may be omitted on Cryoprecipitate. 21 CFR 606.121©(13)(iii)(D) requires the ABO/Rh to be in a machine-readable format.

LF

[kate murphy]

We were cited on our last AABB assessment because we listed the dominant blood type on the label. We no longer pool mixed ABOs for this reason - we hope that a computer upgrade and ISBT will solve this problem, but until I see the upgrade, I do not know.

[John C. Staley]

The past couple of weeks I went on three site visits to check out blood bank computers. One of the things that really surprised me was that 2 of the 3 facilities DID NOT POOL ANYTHING!!!

If the Doc ordered a 6 pack of platelets or 10 cryo that's exactly what they received. No more questions on why did you send me 1 when I ordered 6.

That would certainly address your mixed pool issues.

[janet]

We quit pooling platelets years ago - a bit of a fight at first but less waste if not used and less chance of contamination during pooling.

But not to pool cryoprecipitate.....how did nursing get the cryoprecipitate out of the bag?

[Eagle Eye]

another option would be to request our blood center to give pool cryo...maybe pack of 5??

[bmarotto]

The system we are implementing prints a label with the ABO & Rh for each unit in the pool. fOR MIXED TYPE POOLS, we have the option of giving the POOL an ABO and/or Rh or leaving it blank. The problem is, the unit tag (label) that nursing puts in the chart has the blood type of the pool, not the individual units. A blank ABO or Rh won't work for us. We rarely have to issue mixed ABO types so I think we will make it a policy not to. Pre-pooled cryo from the blood center will solve this anyway.

[Mabel Adams]

If the nurses gave cryo one unit at a time, couldn't they run IV saline into the bag to flush the cryo out? I know they used to do this to increase the flow rate of red cells.