irraditated PRBC

[newBB]

at hospital where i work, patient in oncology ward get irradiated blood product . but when patient transfer to SICU or MICU or in operation room .the doctor or nurses there will not request for irradiated porduct any more > some time we remember the patient name wil ask them if they want irradiated . my questions; 1- is this blood bank job to remind the nurses and continued issue the pateint irradiated blood or is the job or doctor . 2- when patient stop using irradiated blood then when they go back to oncology ward they will go back to use irradiated product . any side effect or will not affect them ??

[tbostock]

The physician should be the one guiding whether a particular patient needs irradiated blood. Our hospital has criteria for irradiated, which coincide with the NYS Dept of Health guidelines for Irradiated blood usage. But there are some physicians who think all of their patients (for example, oncology) should have them. Others order them for hematologic cancers (leukemia, lymphoma) but not solid tumors.

There should be a way in your BB system that you "tag" a patient as needing irradiated blood products. We don't remove that if they go to a different ward, we only remove it if a physician calls and says that the patient no longer requires it, then we document his/her name in the patient's record.

So to answer your questions:

1. I think it's the job of both the physician and BB to keep track of who needs it.

2. I don't see the value of putting someone back on irradiated protocol just because they moved to a different area of the hospital.

[Malcolm Needs ☆]

It shouldn't be the Blood Bank's job to remind people in theatre that the patient requires irradiated products - but it often is.

If you are worried about any situation such as this, sit back and think to yourself,

a) there is a patient on the end of this, and

what if I were the patient?

It can be a pain to have to remind other people of their reponsibilities, but it may save a life.

TA-GvHD is very rare, but it is almost 100% fatal, and is a very, very nasty way to go.

:frown::frown:

[David Saikin]

You should have some system to "look up" past patients. This would be a good venue to add any "special" needs that the patient requires (irradiated, cmv=, etc). Once we get orders on a patient for these "special" considerations, we, in the BB, will order components that fulfill those needs. I require a written confirmation from an MD if such needs are no longer necessary - also, in an emergent situation, the special requirements are NOT going to be met - but then, exsanguination is not an acceptable outcome.

[RR1]

If you use a Blood bank LIMS there should be a facility to add comments/ notes against each patient to alert you to known special blood requirements.

It's a shared responsibility of clinicians, lab staff and even Pharmacy departments to ensure that any patient that is flagged as requiring irradiated blood due to particular conditions/drug regimes are managed properly and get the best treatment. We have a local agreement with our Pharmacy dept to inform us when they have dispensed Purine analogues, so we can update the special flags in our LIMS.

[newBB]

If you use a Blood bank LIMS there should be a facility to add comments/ notes against each patient to alert you to known special blood requirements.

It's a shared responsibility of clinicians, lab staff and even Pharmacy departments to ensure that any patient that is flagged as requiring irradiated blood due to particular conditions/drug regimes are managed properly and get the best treatment. We have a local agreement with our Pharmacy dept to inform us when they have dispensed Purine analogues, so we can update the special flags in our LIMS.

Thank you all for valuable information

[Liz]

I agree with the replies and this is our practice:

We have our patients on the BIS and wherever they are geographically in the hospital we will call and remind the doctor that this patient takes irradiated blood and that it was not ordered as such.

newBB, especially if you are an academic/teaching hospital, take it upon yourself to remind the nice teenagers in white lab coats called ":juggle:doctors-in-training "of what they should and should not do.

You know much more than they do in matters of the Blood Bank.

[newBB]

I agree with the replies and this is our practice:

We have our patients on the BIS and wherever they are geographically in the hospital we will call and remind the doctor that this patient takes irradiated blood and that it was not ordered as such.

newBB, especially if you are an academic/teaching hospital, take it upon yourself to remind the nice teenagers in white lab coats called ":juggle:doctors-in-training "of what they should and should not do.

You know much more than they do in matters of the Blood Bank.

i am glad you feel this way , cause if they dont know much about blood bank but everytime doctor will decide everything ! we have to explain to them but they dont wnat to listen to a med tech they only listen to doctor like them

[Liz]

i am glad you feel this way , cause if they dont know much about blood bank but everytime doctor will decide everything ! we have to explain to them but they dont wnat to listen to a med tech they only listen to doctor like them

I agree, you will continuously face this. So say "it is our policy to inform you that...... and upon the advice of the Medical Director the patient should receive ...."

But first clear it your Director, so that s/he backs you, and have such a policy.

Good Luck