Lab draws during transfusion

[tlorme]

My nursing education department recently posed this question to me: Is it appropriate for an RN to collect labs during a blood component transfusion? My medical director has asked me to discourage the practice, but has not offered any references to back the request up. Does anyone know if it is, or is not, appropriate to collect labs durign a transfusion, and if you have any references supporting either way I'd truly appreicate. Thanks!!

[tjohnk1]

I have no references but it's a big no-no the two places I have worked!

I've personally seen a platelet count jump from 8 to 120 because it was drawn during a plt transfusion.

[cplatt36]

It all depends what values you are looking at and if the specimen is collected from the oposite extremity of the blood product transfusion. Technically you should wait 1 hr for the blood products to reach equilibrium.

[Shadya]

We had the same rule: wait one hour post completion of transfusion if possible--I saw many examples of falsely elevated HCT etc. even though collected on the opposite arm with the tranfusion IV turned off. It really does take the blood a little bit of time to reach equalibrium. However, there are times (surgery, ER trauma, etc.) when this rule might have to be negated and just realize that the HCT etc. might be a little off.

[L106]

I agree with Shadya's response.

[Bill]

Without any published references, just from 30+ years experience, have seen discrepencies with Ca & K (in addition to Hgb/Hct) when drawn during transfusion vs waiting approx 1 hr.

[DAWNA1983]

We usually wait an hour to draw labs.

[Eoin]

From previous experience I also agree with Shadya - but in the ER (or A&E as we called t in Oz) sometimes there is a need for testing. Our rule was ONLY if necessary PLUS the report was annotated -with "INTERPRETATION CAUTION - TRANSFUSION IN PROGRESS" in big red letters - from LIMS standard comments. It usually meant the intensivist if not experienced would call the lab for our take on any particular result that was out of kilter.

Cheers

Eoin

[vilma_mt]

I think most places would wait 1 hour. But if you must, it is acceptable to draw blood from the opposite arm, if that's not possible then draw blood below IV line (follow your protocol regarding drawing blood below IV line) and document that specimen was drawn during transfusion.