How do you obtain a transfusion history?

[Janice Pareyt]

Hello Blood Bankers!

I have been reading this wonderful forum for a few years but today I'm posting for the first time! I work in a large hospital transfusion service and we've had some interesting cases lately which have led to many discussions about obtaining accurate and timely transfusion histories. We've had a few patients who we've never seen before, but later find out they've been patients in other local hospitals and have an antibody that we didn't detect. Or we detect two antibodies, call our local reference lab for antigen negative units and when we tell them the patient's name, they tell us our patient has more than just those two antibodies. So what does your facility do? Do you routinely get a transfusion history on all potential recipients? Only when you detect an antibody? What about those patients whose titers have dropped below detectable levels? I know we can't catch them all but it seems like there has to be something we can do short of creating a National Antibody database. Oh, and why don't we have one of those?

Many thanks in advance,

Janice

[Malcolm Needs ☆]

Hi Janice,

The obvious answer is a national database, but there are two drawbacks to that which immediately spring to mind.

The first is cost. We are finding this to be almost prohibitive in the UK. When you consider the size of the UK compared with the USA, the cost would have to multiplied a huge number of times.

The second sounds a bit insulting, but it is not meant so to be. If you do get a national database, but may be worthwhile restricting who can post on it. Not every facility will have the ability to correctly identify antibody specificities. It may be that there is a level of skill problem, but it is more likely that there is a lack of sufficient reagent red cells and/or typing reagents (unless, of course, the antibody is pretty basic, like an anti-Jka).

It would be much better if complex mixtures of antibodies or rare antibodies are posted only after their specificity has been corroborated by a third party, like a Reference Laboratory, but not necessarily a Reference Laboratory (we are not the be all and end all in these matters).

Other than that, I really do not have an answer.

[tbostock]

At my previous hospital, there was another hospital only 1 mile away and patients frequently bopped between the two. So our policy was that if we had a new patient with a positive antibody screen, we would give a call over there. Also, if we had a new sickle cell patient, we would try to talk to the patient ourselves to find out what hospitals they were treated previously and give them a call.

These phone calls were fruitful quite a few times. But other than that, most of the time you are unable to get a thorough history on a patient...also, some hospitals are unwilling to share ANY patient info, even antibodies, citing HIPAA.

So...we do what we can do, but short of having a national database, we're pretty limited.

[Eagle Eye]

...also, some hospitals are unwilling to share ANY patient info, even antibodies, citing HIPAA.........When I get this answer I give them big lecture and in the end we get a history. Most of the time if patient is able to answer we ask the nurse to ask a question to patient and then we call the hospitals patient went to.

We had a very interesting case recently. we have a sickle patient usually comes to us and he received transfusion at our place three weeks ago. patient came back and he has many allo antibodies and warm auto. we have been giving him phenotypically match best suitable(incompatible) blood. patients came back last week and we were going to order blood for him (all panel cells were strongly reactive). before ordering blood i called teh floor and founf out that patient went to a hospital in other STATE and they gave him 3 units incompatible(not negative for any antigen thinking that patient had only warm auto). .....this tells us that patient history is very important for us!!!!!!!!!

[Brenda K Hutson]

I have a couple of thoughts.

1. When we see a new patient who has antibodies, we do the best we can to get an accurate history. Just asking the Nurse and/or Physician, is not always the best resource. If you can get it straight from the patient themselves, or their family members, you will probably get a more extensive reply. However, you need to emphasize if you speak to a Physician or Nurse, that you are trying to obtain their history from "anytime and anywhere;" you would be surprised at the limited information you will receive if you don't. If the patient is consulted, I will usually ask the Nurse if the patient is coherent and competent enough to provide a response I can trust. Thing is, some patients don't realize they were ever transfused (i.e. OR).

2. Having worked in a couple of Reference Labs, we would send Antibody Cards to the patients, along with a letter explaining what the card means, the significance, what it "doesn't" mean (some people see the words antibody and blood together and the 1st thing they think is Aids), and emphasizes that they should carry that card with them and present it in medical situations. That doesn't always work either. I was working a graveyard shift once at a large Medical Center and a G.I. Bleed came into the ER. They took 2 units uncrossmatched. The Antibody Screen came up positive so I immediately called the ER and spoke to the Physician, making sure they understood the risk of continuing the transfusion. They were already on the 2nd unit and the patient needed the blood. Ok, that is there call. I asked the Physician to get a history from the patient. The minute I identifed an Anti-E and Anti-c, the Physician called back and said "the patient said something about having an antibody card; would that be helpful to you?" YES, especially an hour ago!! :rolleyes:The card was also just the E and c. Thing is, the Hospital is supported by its own Donor Center. When units are antigen typed at the Hosptial, the results are sent to the Donor Center and put in a database; next time the donor comes in, there is a white label on the top of the bag, listing all of the major antigens, with + or - after the ones that were previously typed. So, I could have found units historically negative for E and c, had the patient followed the instructions.

Brenda Hutson, CLS(ASCP)SBB

[Malcolm Needs ☆]

Brenda, we too have trouble with the fact that patients forget ot carry/present their antibody cards to the doctors/nurses, and with the fact that the doctors/nurses do not take the slightest bit of notice of them when they do.

Have you also noticed (and I am sure this is the same almost around the world) that if there is an antibody present, then group O RhD Negative blood is the panacea!!!!!!!!???????? Makes you wonder why we are employed sometimes, when all problems can be solved with group O RhD Negative blood!

:confused::confused:

[Brenda K Hutson]

Brenda, we too have trouble with the fact that patients forget ot carry/present their antibody cards to the doctors/nurses, and with the fact that the doctors/nurses do not take the slightest bit of notice of them when they do.

Have you also noticed (and I am sure this is the same almost around the world) that if there is an antibody present, then group O RhD Negative blood is the panacea!!!!!!!!???????? Makes you wonder why we are employed sometimes, when all problems can be solved with group O RhD Negative blood!

:confused::confused:

Yes, sadly I have noticed that.

"Dr. X, the patient has a positive antibody screen; it is risky for you to continue to transfuse." "That's ok says Dr. X, I am giving O Negative blood!" Downright scary!

Brenda Hutson, CLS(ASCP)SBB

[Eagle Eye]

Yes....I do get that answer typically from new resident...when we tell them is blood is not available..." can we get O negative???" I can not write here how I feel about that answer.....

[Malcolm Needs ☆]

Yes....I do get that answer typically from new resident...when we tell them is blood is not available..." can we get O negative???" I can not write here how I feel about that answer.....

You could try, but if it's like my feelings, it would be censored!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:rolleyes::rolleyes:

[Brenda K Hutson]

Yes....I do get that answer typically from new resident...when we tell them is blood is not available..." can we get O negative???" I can not write here how I feel about that answer.....

You know what would be a really fun Thread on here sometime: The funniest and/or scariest remarks we have heard from Hospital staff. We could call it "Just For Fun." Here is mine, just for fun (and it is not Blood Bank oriented; I will think more on that):

A Physician calling at one Hospital (called the wrong dept.) asking: Is it ok if I draw the Peak and Trough at the same time (drug levels). The Tech. responded: I am going to hang up now and I want you to think about that for a minute.

Brenda Hutson, CLS(ASCP)SBB

[Malcolm Needs ☆]

Last post before I go on holiday! HONEST!!!

Superb idea!

:D:D:D:D

[JOANBALONE]

A few years ago, we called an OB doctor and told him his patient, who just had a baby, had an anti-c. "Thanks for the info" he said "but I already knew that.". He went on to say that he had been monitoring this lady for months (using a different lab, of course). We said it would have been nice to get a heads up in case she needed blood. He said that if things got bad that they would just ask for O negs.

JB

[Brenda K Hutson]

Ok, I am going to add a Thread to Hot Topics called Just for Fun; hope you will all join in.

Brenda Hutson, CLS(ASCP)SBB

[swede]

Yes, sadly I have noticed that.

"Dr. X, the patient has a positive antibody screen; it is risky for you to continue to transfuse." "That's ok says Dr. X, I am giving O Negative blood!" Downright scary!

Brenda Hutson, CLS(ASCP)SBB

We've had the same response with a lady with 8 known antibodies...."Dr., it will be probably be a day or two before we can have compatible blood."

"okay, can I have O negative Irradiated blood until you find some?"

We decided that "deep frying" it must take the antigens off!

[JOANBALONE]

Did you know that washing removes all the antigens too!

JB

[Brenda K Hutson]

I personally prefer the "scorch and vortex" method of Antibody ID! And when I was a Reference Lab Supervisor, I would swear we had clients who did something along those lines...Aaaaahhh

Brenda Hutson, CLS(ASCP)SBB

[jlemmons]

To get off subject, I will tell you my favorite story that truly happened to me. An anesthesiologist called the Blood Bank to request some FFP. I told him it would take me 20 minutes to thaw. He said not to bother, he would put it in the microwave in the OR break room. I handed the phone to my supervisor who informed this doctor that we had an inspector on site ( and we did) and we would have the FFP available in 20 minutes. He said nothing else! Scary huh?

[L106]

Touche!!!! Beautiful! (There really was an inspector on site??)