Issue uncrossmatched red blood cells with historical record of clinically significant antibody

[Dansket]

In this scenario, RN has arrived in Blood Bank with a properly-completed MD-signed facility request form for uncrossmatched red blood cells.

User keys patient identifier into your transfusion services computer system and displays the patient demographics onscreen. User notices that the patient has a history of clinically significant antibody.

At this point, what is your facility’s policy/procedure/practice/response to receipt of a valid request signed by a physician for uncrossmatched red blood cells for a patient with a history of clinically significant antibody?

[L106]

I would call the ordering physician immediately and describe the situation and the risks involved with transfusion in this situation (and document that this conversation took place.)

If he still wants to transfuse this patient immediately, we have a special form he must sign that states he has been notified that the patient has a history of a clinically significant antibody and the risks of transfusing donor blood when the necessary testing has not been completed.

If he signs, we give the donor units and we notify our Pathologist of the situation immediately. (But if possible, we call the Pathologist before the blood is issued.)

Donna

[Mabel Adams]

Hope it's an anti-D. Seriously, as obove, communicate the risk, see if the risk of not transfusing is higher than the risk of transfusing in the MD's judgment, find the best blood you can in the time you have (Rh neg if it is anti-E, quick 5 min. Ag type for Jka even if it's not xmed & new screen not done), document and have the pathologist sign off on it when done. Communicate, communicate, communicate; document, document, document. Helps if you have some of those antigen percentages in your head.

[Auntie-D]

We'd explain the risk and then direct them to the ONeg rr cells - weighing up the risk between a delayed transfusion reaction and exanguination. At the end of the day you can debate the point to death with them - literally...

We have a fridge of a few units of flying squad for situations that they cannot wait for a group - they dont even need to consult the lab :eyepoppin:

Edited February 17, 2012 by Auntie-D

[Gnapplec]

We unfortunately just had this type of situation with one of our remote facilities where we provide their Transfusion Services. After two weeks of the facility knowing said patient had a significant antibody was again in need of emergency Oneg units. The same doctor somehow took the risk of transfusing just one unit to the patient with a known anti-K. The doctor was immediately contacted on the initial emergency transfusion when the antibody was first detected and didn’t want to hear anything the lab tech had to say by handing the phone over saying “here talk to the nurse.” To make things worse the lab manager called to complain about the charges for antibody ID workup. The whole situation was just embarrassing. Thank the patients lucky stars the second “emergency” brought a Kell neg unit… just by chance. Needless to say we’ve started providing historically Kell negative O Negs to this facility just in case.

Edited April 12, 2012 by Gnapplec