Incompatible plasma

[Share]

I am trying to change our incompatible plasma policy. Our former Medical Director wanted us to tally all incompatible plasma. So if an AB patient gets several doses of non- AB platelets or cryo & even A red cells -we tally up all the incompatible plasma. The A red cells are considered to have 50 mls of incompatible plasma. If we transfuse over 750 mls we have to contact a pathologist. So when we have a trauma or open heart that is a AB or B we have to haul out the calculator & oftentimes call a path. If we transfuse > 750 ml in a week then we have to obtain volume-reduced pheresis for a month!

Our blood supplier only has a limited amount of platelets. I want to concentrate more on providing the oncology patients and infants with type specific platelets.

Tallying the type O plasma seems more reasonable. We also do a 1:25 Initial Spin anti-A & anti-B titer on the O pheresis and never transfuse a O pheresis with high titer to an A, B or AB patient. Does anyone else tally the plasma in red cells and cryo?

What are other facilities doing to address incompatible plasma?

[Eagle Eye]

we do not tally incompatible plasma in RBC, SDP & cryo(we try to give ABO ocmpatible cryo eg. B patient can get B or AB).

We do not give ABO incomatible SDP which has anti and/or anti-B titer of 64 or higher. (eg it patient is A and if we need to give B SDP, we make sure that anti-A titer is <64).

[Share]

So you titer a B SDP? I would think it would only be necessary to titer O SDP because it is my understanding that the O SDP is the only one ever implicated in a hemolytic TRXN.

[Eagle Eye]

Yes you are right but sometime you have to think about techs. who are working on the bench. To make their life simple and for consistency any time we have incompatible plasma we do titer. We also have a flag in our computer system so at the time of by passing flag they need to enter a reason for relase of incompatible plasma.

[geekay]

When the patients safety is concerned, it makes sense when we do the titre of O plasma....but for B plasma titration, only in selected cases/ patients only, it helps...and makes sense too...

with wishes and regards,

engeekay2003

[bbbirder]

WOW! I would think only doing this for the O's would be important.

I am looking for a good way to track O plasma (from Platelets) given to non-O's. Does anyone have a good way to do this that is not just hit or miss? Something in their comptuer?

Thanks,

Linda Frederick

[Eagle Eye]

I do nto know what computer system you have but in cerner classic you can write CCL to get a report of all those patient who receives non-O plasma(only patient whoes type is not O).

Check with your LIS manager or call your support and you should be able to get a report.

[Share]

At my hospital we keep track with an attached sheet of paper stabled to a patient record card. We haven't gotten rid of patient record cards yet. I have found in the literature that only type O platelets have caused hemolytic transfusion reactions. There have been 25 documented cases in 30 years of HTR from O plts transfused to non-O patients and 6 deaths reported to the FDA in the past 10 yrs. according to Mark Fung, MD in the Arch Path Lab Med, Vol. 131, June 2007. It is not frequently reported, but there may be a lot of under-reporting. It is a concern & I certainly do not want it to happen where I work and I want to be compliant with the regs. Unfortunately you need a policy for incompatible plasma and I want a reasonable policy--but none of the regulating agencies tell you what the standard of care is??

[Mabel Adams]

Wonder how those risks compare to the number of patients that die every year due to drug errors. Not that we BBers want to take increased risks, but it gives some perspective.