Blood draws during transfusion

[KarenJ]

I am looking for any help regarding drawing blood for testing during transfusion. For hemoglobin we recommend wating 30 minutes or so after the transfusion is complete. We had an incident where an unstable patient was receiving blood and the doctor(s) ordered a whole battery of tests. The phlebotomists asked if we can draw during transfusion and were told it is preferable to wait. Of course we didn't get the rest of the information until much later. After polling all the technologists and checking policy and procedures we discovered that while no one thinks it is a good idea, there is nothing in our policy to cover it. So what we seem to have is a case of conventional wisdom. Any info at all would be great. Thanks

[rescyth]

Hi!

The best recommendation to draw blood after transfusion is usually 2 hours after to allow the body to complete the "distribution phase" if drawn earlier it can either cause False High/False low result of the H/H.

Edited March 16, 2009 by rescyth
wrong spelling

[jbrun]

Do you have a reference for the 2 hours?

[David Saikin]

You can draw anything during a transfusion . . . while not ideal, you can surely do it. The patient's physician is the one who has to interpret the results, not you. (I always remind the docs that I only report data, not interpret). Make sure your Medical Director is available . . .

[tbostock]

Our policy states that we recommend 2 hours (I'm sorry, don't have a reference for that, we've just always used that). But if the physician wants it sooner, or even during the transfusion, we do it and append a comment to the result in our LIS so the physician can be aware that the results may not be as accurate as they could be.

[jhaig]

While we strongly discourage drawing any bloodwork during a transfusion, the doctor can still request that the work be drawn. We just use a comment attached to the patient's results stating that the results must be interpreted with caution.

I cannot find a reference anywhere dealing with this topic. It all seems to fall under the un-written rules of the lab.

[rescyth]

I'm sorry but i can't remember where i read that one but i found a link here on the net which may shed some light on this topic https://www.entrepreneur.com/tradejournals/article/160221123.html hope it helps

[KarenJ]

Thanks to all. This will help some, and we are still looking. Karen:p

[John C. Staley]

David, I like the way you think! The only result I would really take with a grain of salt if drawn during a transfusion would be an H&H. As long as the blood samples were collected in the "other" arm most analytes should be affected little if any. I would still report the results with the caveat (sp?) that the sample was collected during a transfusion. Let the physician decide what it means.

[jcoburn]

While I agree that the attending clinician is the ultimate interpreter of the data that laboratories provide, I think that we, as scientists, have an obligation to make sense of the data before we report it. We cannot just blindly take results from machines and report them (lab assistants can do that, no need for a CLS).

On the other hand, while obtaining specimens during transfusion is not optimal, John is correct: other than H/H, little else would be significantly affected. The need for data may well outweigh the risk. Give the clinician a clear picture by attaching the "collected during transfusion" caveat to the results.

[ckcheng]

I agree with David cuz we do not know the purpose and what data the physician wants at that moment. One thing I wanna add is make sure the sample is not collected from the transfusion site. Otherwise most of the blood you draw will be the donor blood.

Preferably the other arm, otherwise, lower than, and do not close to, the transfusion site or artery, but dangerous!!

Hope that helps.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

Hong Kong

Mar 19, 2009