providing blood to dialysis centers

[SRMC BB]

We provide blood to our local dialysis center. The center draws the blood and sends to us for crossmatch. A courier from the dialysis center picks up the blood and it is transported with activated hemotemps and in a small insulated cooler with ice. In our AABB facility pre-assessment information we received it asked us if we provided blood to a diaylsis center. This was new from the last one I filled out. I cannot find any standards that relate specificially to this, other that temperature during transport. Since we do not transfuse the unit, I do not know what policies the dialysis center uses. Does anyone know what AABB might be looking for with this? Do we need copies of their blood transfusion policies? ANy suggesstions would be greatly appreciated.

Natalie

[L106]

Well, I don't know for sure, but the AABB assessor might be checking whether the Transfusion Procedure/Transfusion Policies of the Dialysis Center mean AABB requirements. The accreditating agencies hold the Transfusion Service (& the Transfusion Service's Medical Director) accountable for all facets that affect blood transfusions.

I would suggest you get a copy of the Dialysis Center's Transfusion Procedures/Policies and review them. (Example: Make sure they talk about what form of identification checks they do before transfusion, time limits for transfusion, statement about "no drugs or solutions other than normal saline can be added to the blood", have a section on signs & symptoms of transfusion reactions & what to do, etc.)

I think your transportation procedures / coolers are probably fine. (Of course, make sure you have validated the coolers.)

[SMW]

AABB Standard 4.2.2 addresses this. It would all be dependent on how the responsibilities have been identified in the agreement for services. If the sample collection/identification, transfusion criteria, administration procedures, recognition of reactions, etc. are identified in the service agreement as the responsibility of the transfusing facility, then the only standards which are applicable to you would be those related to your contractural responsibilities, e.g., compatibility testing. Be careful what you ask for. If the agreement specifies that the transfusion facility is responsible for the blood administration process but you require them to provide those procedures to you for review, I believe you may have taken on additional legal responsibilites related to those activities as a result. It may be worth a discussion with your risk management/legal counsel. The dialysis center can elect to be AABB accredited for the activities that they perform and would only be assessed for those activities.

[adiescast]

The other thing we did when we took on a dialysis center was extend refresher training on recognition of transfusion reactions to all of their transfusing staff. I kept a list of who attended the training. You do not have to be responsible for their procedures, but you may have to show that you have been involved in the procedure development. You will have to have an agreement with them defining who is responsible for what, giving expected turn around times, etc.