Blood Bankers Help me...

[Guest jatin.chaudhari]

I have a Query for all the Blood Bankers.

Can a patient coming for a blood requisition request for more than one components of blood. For e.g. can he/ she request for packed red cells as well as Platelet concentrate together???

[L106]

Sure. Lots of our oncology patients come to the hospital on an Out Patient basis (ie: they come in, receive the transfusions, then go home, all on the same day) for a couple units of Packed Red Cells and a Plateletpheresis. (The products are actually infused one after the other if the patient has only one IV line, of course.) Does this address what you are asking (or am I on the wrong track?)

[allahbaksh]

[Q] Can a patient coming for a blood requisition request for more than one components of blood.[/Q]

Sure, this happens in my blood bank too; think of a couple of scenarios:

1. replacement of blood loss, volume resuscitation and prevention of DIC after severe trauma / peroperative bleeding: this patient usually goes for whole blood, followed by FFP & platelets later..

2. Oncology, as has been stated above,

3. Bleeding diathesis in the ICU, or spontaneous bleeds in sepsis...

[Mary**]

:confused:I didn't think anyone transfused whole blood anymore.

[allahbaksh]

:confused:I didn't think anyone transfused whole blood anymore.

Well, here in India, component therapy is only slowly getting accepted; even in my tertiary teaching hospital, only the intensivist uses component on a logical basis.

Most blood banks lack the license and equipment for component separation, and it will take a lot of education to wean clinicians off whole blood, and get started on component therapy..

Surprising, but true! Would like to know how things are in other countries except for the West..

[Mary**]

Interesting.

[tbostock]

One more thought; it's only preferable to transfuse two different types of components at the same time if it's an urgent situation (massive bleed, etc). If there is only one IV site, that means the other component is sitting and waiting (probably not at the optimum temperature). If there are two IV sites and they can transfuse both together, what happens when the patient has a transfusion reaction? Which product caused it? You would have to discontinue both, and investigate both. So we usually recommend against it unless it is urgently needed, not just for convenience.

[Pelican1234]

I have a Query for all the Blood Bankers.

Can a patient coming for a blood requisition request for more than one components of blood. For e.g. can he/ she request for packed red cells as well as Platelet concentrate together???

Depends upon the situation. In Emergency or Open heart,dialysis, OR more than one unit is often released at a time (usually two)

At our facility for routine transfusions only one unit may be picked up.

[bloodthirst2009]

Same here. Usually, only one unit can be picked up to prevent transfusion to the wrong pt.. other cases are surgery and ER transfusion of uncrossmatch blood.

[eric1980]

My BB try to prevent them from getting all at the same time. Our reasons for it (and I believe in this) is that the unit that is awaiting to be tranfused, are usually kept at suboptimal conditions. And we have a few too many cases of wards forgetting that it's there. And when they realised it, the poor unit had been there for hours at room temperature. I am very near to the equator.

Of course, for bleeders (which I assume will have more than one IV site), anything goes.

Although it's not my BB's policy, I do try to preach physicians to get whole blood for massive bleeders instead of packed cells + FFP.

[geekay]

Hi there,

Im India, almost all the leading hospitals have started using Blood components some eight years ago itself. Only in the primitive areas where component preparations are impossible due to shortage of staff and Blood Banks, they resort to whole blood transfusions. Almost all the hospitals have the facility for doing apheresis too !

Any components in any combinations (PC + RCC, RCC + Plasma etc etc) are being issued to the patients, without any questions asked as the Clinicians hold the upper hand in Indian hospitals !

sincerely,

engeekay2003

[Brenda K Hutson]

Yes, depending on the circumstances. Some possible scenarios that come to mind:

1. For OR (especially if RBCs going in cooler); I have worked places that call it the "cocktail;" platelets, cryo and FFP

all at once.

2. Patients actively bleeding such that it is coming out as fast as it is going in

3. Patient has 2 lines going

4. Plasma products; these can be infused quickly so you don't have products just sitting around

5. We won't send 2 RBCs at a time to a Nursing Unit unless the patient has 2 lines (unless the patient is crashing;

usually in ICU)

Brenda Hutson, CLS(ASCP)SBB

[irshadaad]

yes, why not ....im working in kingfahad armed forces hospital jeddah ksa....this is a well renowned cardiac surgery centr everyday aat least 3-4 cases of CABG and AVR etc....some time the pts are profusly bleeding.....the doctors use PCS+FFP+CRYO+PLTS AND EVEN if the bleeding dont stop they use fresh whole blood instanly taken from the donor....as practiced by army in war zones like IRAQ and AFGANISTAN

[irshadaad]

hi BRENDA hope learn a lot from your knowledge and experiances im working in BLOOD BANK in king fahad armed forces hospital jeddah saudi arabia .as blood bank tech....basicaly im from sk institute of medical sciences soura kashmir india....bllod bank technologist

Edited July 20, 2009 by irshadaad

[irshadaad]

i went through an article in TRANSFUSION, relating usage of fresh whole blood by army in war situation like iraq....sory i dont remember the ref....ill look for it,

Also here in KING FAHAHAD ARMED FORCES HOSPITAL jeddah saudi arabia if a cardiac surgery bleeds profusily they bleed a known donor previously tested for all and transfuse the whole blood with out refrigirating it.

in addition it goes routinely in any huge bleeding cases doctors go for multiple componants

[lateonenite]

We only ever use autologous whole bloods, everything else is component therapy.

[irshadaad]

nowa days multiple lines can be attached to the pt thru central line so what is surprising in it to release multi components in emergency situations...even in india componant theraphy has started long back...i did my diploma in pgi chandhigarh in 1982...we were doing componant fractionation that time and same we did when started working as blood bank technologists in sheri kashmir institute of medical sceinces soura srinagar kashmir....

[jcdayaz]

We also will issue multiple products on the same patient at the same time. Only in certain circumstances, however. As stated in previous posts, we confirm the patient has multiple infusion lines before doing this.

We have blood coolers for transporting blood to the OR, ER, dialysis, or in rare circumstances the ICU. We try to never send products in a cooler to the regular floors of the hospital. Of course, we use our judgement to ascertain whether or not the cooler request is one made out of convenience or true patient need.

We have had to discard several platelet pheresis units that were put in the cooler for "safe keeping" during surgeries. Therefore, we will not normally issue platelets with a cooler containing blood and/or FFP.

[jcdayaz]

Yes, depending on the circumstances. Some possible scenarios that come to mind:

1. For OR (especially if RBCs going in cooler); I have worked places that call it the "cocktail;" platelets, cryo and FFP

Brenda,

Have you had problems with the platelets and cryo being put in the cooler by the OR staff? If so, how did you address them?

My fear is I have NO CLUE what is actually happening to the products after they leave the blood bank. I have heard horror stories of FFP in break room microwaves, etc. Nurses going to lunch break after picking up a unit of blood with the unit in their pocket...etc etc. It can be horrifying!!

I know I can't control everything..but the things I can control I try to do so. "Try" being the operative word here....

[adiescast]

You can try putting the large, brightly colored "DO NOT REFRIGERATE" stickers on the platelets and cryo. Then, if you are fortunate enough to have OR staff who are capable of reading, who understand that placing the product in a cooler is refrigerating, and who do not assume that the sticker is not referring to them, the products might stay at room temperature (which, by the way, is probably cooler than 20 C in most ORs and MUCH higher than 24 C in some trauma bays even if you are not at the equator or near the arctic circle...).

Except in cases of massive transfusion, we don't send these products anywhere until they are going to transfuse them immediately. This, of course, assumes that they are honest. At some point you have to let go of the illusion of control.

[bb4me]

Our facility will issue multiple components at the same time to certain areas (OR, ICU, ED) as appropropriate, although sometimes a quick phone call to confirm a multiple issue is appropriate. We discourage multiple component issues to the floors.

One very important caution is that although we will issue components for multiple patients to a given location within a close period of time, we NEVER combine multiple patients in one issue (for example, sending a unit of packed cells for patient A and another unit for patient B in the same pnematic tube carrier.)

[Malcolm Needs ☆]

You can try putting the large, brightly colored "DO NOT REFRIGERATE" stickers on the platelets and cryo. Then, if you are fortunate enough to have OR staff who are capable of reading, who understand that placing the product in a cooler is refrigerating, and who do not assume that the sticker is not referring to them, the products might stay at room temperature (which, by the way, is probably cooler than 20 C in most ORs and MUCH higher than 24 C in some trauma bays even if you are not at the equator or near the arctic circle...).

Except in cases of massive transfusion, we don't send these products anywhere until they are going to transfuse them immediately. This, of course, assumes that they are honest. At some point you have to let go of the illusion of control.

Very cynical, and ABSOLUTELY true to life!!!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D

[jcdayaz]

Very cynical, and ABSOLUTELY true to life!!!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D

Unfortunately, VERY tue.

Ohhh, the horrifying things I have seen. I can not even begin to cover them all...here is but a small sampling... Went to the OR breakroom once while checking/changing the temperature graph on our OR remote storage refrigerator (long time ago)...and heard 3 OR nurses discussing whether or not it was acceptable practice to put the blood they had just picked up from the BB that they were going to need in a short while in the break room refrigerator. One of the nurses replied, "Well if it doesn't touch any of our food it should be okay". Countless platelet pheresis being placed in the OR cooler (even with labels that say DO NOT REFRIGERATE).---BTW, an anesthesiologist once said to me..."I didn't refrigerate the platelets, I just threw them in the cooler with everything else".

I could, unfortunately, continue on for hours....

[kate murphy]

We have worked long and hard to build relationships with the Nurse Educators. These Educators do just that - train nurses and perform annual competency training. Transfusion Med: importance of patient ID, reaction recognition and proper handling of components are included in all RN training and competency. We've had few issues since instituting this.

We also have a (mostly) non-punative hospital-wide Incident/Medication error reporting system. The goal is better patient care, not discipline. We are not incident-free, but are doing much more root cause analysis and looking at and fixing our systems.

It takes a while, but it does work.

[Malcolm Needs ☆]

We have worked long and hard to build relationships with the Nurse Educators. These Educators do just that - train nurses and perform annual competency training. Transfusion Med: importance of patient ID, reaction recognition and proper handling of components are included in all RN training and competency. We've had few issues since instituting this.

We also have a (mostly) non-punative hospital-wide Incident/Medication error reporting system. The goal is better patient care, not discipline. We are not incident-free, but are doing much more root cause analysis and looking at and fixing our systems.

It takes a while, but it does work.

Kate, despite some of my cynical, grumpy old man comments in many of my posts (most of which are slightly tongue in cheek) I am convinced that this is the right way to go.

The airline/aircraft business was, I think, the first (in the UK anyway) to take up a "no blame" system of reporting errors, and it has worked wonderfully in improving safety.

We are supposed to be working towards this in the NHS as a whole (and the NHSBT in particular), but your telling word is "mostly".

I'm yet to be totally convinced of "no blame", but I am totally convinced of "fair and proportional blame".

:)