Recently transfused patients

[Stephen]

Hello (first post!)

Have a quick questioni for you:

UK BCSH guidelines state that patients who have been transfused 3-14 days ago, must have been screened at most 24 hours before another transfusion. How long do you keep this blood at issue before returning to stock? Some sources say only 24 hours, some say up to 72 hours, and the guidelines do not mention this.

[Malcolm Needs ☆]

This is an excellent question. You are quite correct about the Guidelines.

I will give Clare Milkins (one of the authors) a quick telephone call (if she is in) and ask her.

[pluto]

we would keep no more than 48 hours will be interesting to see what the consensus is on this

[RR1]

The 24hrs is a very arbitary time frame. Do you start the clock from when the sample was drawn - in which case the blood must be returned 24hrs later- not one calendar day later. We could be forever checking times and performing stock returns throughout the day.

Everyones immune response is different, data from SHOT needs to be reviewed to see if any TX reactions can be attributed to antibody formation after the 24/ 72 hr periods.

But this also needs to be kept simple- because otherwise my head hurts!

[Malcolm Needs ☆]

This is an excellent question. You are quite correct about the Guidelines.

I will give Clare Milkins (one of the authors) a quick telephone call (if she is in) and ask her.

Hi Stephen,

I've managed to contact Clare.

As they stand, the Guidelines do indicate that the blood should be re-cross-matched every 24 hours, but this is recognised as being unachievable in almost every case.

I understand that the Guidelines are under review at this very moment, with a view to being published later in 2010, and this particular problem is one of the things that is being addressed.

It is likely that, with evidence gathered from all around Europe (and, indeed, other parts of the world) that the overall time will be extended to a 72 hour window, to bring us in line with most of the rest of Europe (although this is yet to be set in stone, as it were).

The 72 hour window will allow you to cross-match on a fresh sample, and keep the cross-matched blood for 72 hours, or to cross-match on a sample taken the previous day, and keep the cross-matched blood for 48 hours, or to cross-match using a two day old sample, and keep the cross-matched blood for 24 hours.

When, and if, this is agree and incorporated into the Guidelines, this will make life very much easier I think, particularly over weekends.

Please understand though, that this is not yet agreed, nor is it in the current Guidelines.

I hope this is, at least, of some help.

:):)

[pluto]

that also is easy to understand so lets hope they make it official

[Stephen]

Hi Stephen,

I've managed to contact Clare.

As they stand, the Guidelines do indicate that the blood should be re-cross-matched every 24 hours, but this is recognised as being unachievable in almost every case.

I understand that the Guidelines are under review at this very moment, with a view to being published later in 2010, and this particular problem is one of the things that is being addressed.

It is likely that, with evidence gathered from all around Europe (and, indeed, other parts of the world) that the overall time will be extended to a 72 hour window, to bring us in line with most of the rest of Europe (although this is yet to be set in stone, as it were).

The 72 hour window will allow you to cross-match on a fresh sample, and keep the cross-matched blood for 72 hours, or to cross-match on a sample taken the previous day, and keep the cross-matched blood for 48 hours, or to cross-match using a two day old sample, and keep the cross-matched blood for 24 hours.

When, and if, this is agree and incorporated into the Guidelines, this will make life very much easier I think, particularly over weekends.

Please understand though, that this is not yet agreed, nor is it in the current Guidelines.

I hope this is, at least, of some help.

:):)

Malcolm

Many thanks for hetting back:). I agree that a 72 hour window would be easier to manage out of hours, and it ties in with the multiply transfused patient guideline for antibody screening every 72 hours. Looking forward to the 2010 guidelines, so we are all "singing from the same hymn book"!

Stephen

[Malcolm Needs ☆]

My pleasure.

[janet]

Canadian here.....am I to understand that if "day 1" you crossmatch your patient, they get units that day then "day 2" (or 3) you need to redo the antibody screen before any more units can be issued?

We have 3 day (or 96 hour) rule here - we would use that 'day 1' sample for all 3 days then on day 4 start over.

Am I not understanding your rule?

[Malcolm Needs ☆]

Canadian here.....am I to understand that if "day 1" you crossmatch your patient, they get units that day then "day 2" (or 3) you need to redo the antibody screen before any more units can be issued?

We have 3 day (or 96 hour) rule here - we would use that 'day 1' sample for all 3 days then on day 4 start over.

Am I not understanding your rule?

Yes, you are understanding the rules, as they stand at present (although, I'm not entirely sure that we understand our own rules)!

Also, from what I understand, we are planning to go over to your 96 hour rule for the viability of the sample, as opposed to the viability of the cross-match (in other words, if you cross-match on the three-day-old sample, you have to transfuse the blood the same day), but, as I say, this has not yet been fully agreed.