Post-transfusion testing

[LynK]

How long after transfusing fresh frozen plasma and cryo do you recommend testing the patient for effectiveness? Does anyone out there perform a platelet count 30 minutes post plate transfusion?

[David Saikin]

It only takes about 5 minutes for a good mix of plasma products . . . you could check Mollison to see what they recommend. I usually say 30 minutes post. I only check post-plt if the pt seems to be refractory.

[DOGLOVER]

We ask for a 30 min post plt ct if we are using crossmatched or HLA matched plts due to refractoriness. Otherwise we don't do this. It is a challenge to actually make it happen, as we do not have a laboratory phlebotomy team for inpatients. Nusrsing does the blood draws so it is difficult for us to control what happens. But, we try.

[tbostock]

We ask for a post for all products, but we don't specify a definite time. If we thought a patient was refractory, we would recommend a 30 minute post for platelets.

[LynK]

Thanks, Guys. Anyone else requiring post transfusion tests for cryo and plasma? If so, what is your time frame?

[Annadele]

We request a current platelet count prior to and within one hour post platelet transfusion but the policy is only "enforced" (and I use that in the most mild sense) if a second platelet is requested after the first. We have a collection of "Please take platelet count within one hour post-transfusion" stickers that a technologist can put on a bag of platelets before dispense to help remind the nurse.

As others have mentioned, this is mostly just for the sake of being able to document counts in case the patient seems to become refractory. It's nice to be able to give a patient a second piece of a unit that they experienced a particularly good "bump" for so the information can be useful. We don't ask for post-transfusion Fibrinogen for cryo or coags for FPP as far as I know but one of our techs does collect data on those values prior to cryo/FFP transfusion (and other reasons for transfusion).

I've definitely found it helpful from the perspective of inventory management to check fibrinogen, platelet counts, coags, etc. before transfusion of components if the product that I'm about to prepare has a 24-hour-or-less outdate. Particularly in late summer after new residents arrive, it seems as though it's not uncommon for us to get orders for products that are later cancelled or delayed.

[Eagle Eye]

Our docs are really good. they would write an order to transfuse FFP, let's say transfuse 4 FFP for INR of 3.2

they always repeat coag before requesting additional products. We audited this in past. And since INR was 3.2 BB will not question the order.

For platelet if the order is for 2 and we do not have an indication for two we ask for repeat count.

We do ask for 10-60 mins post count for patient who are refractory so we can calulate CCI.

[Malcolm Needs ☆]

There is an excellent article by Sunny Dzik on this subject. Unfortunately, I can't get to it at the moment, and I have a pile of authorisation to do on cases that is, quite literally, two feet high. Once I have trawled my way through this lot, I will try to hunt it down.

From memory, however, he does say something like FFP takes its time to fully work (rather in the same way the 2-3-DPG needs time to recover before transfused red cells reach optimum oxygen carrying capacity). BUT, be warned, that is just from memory.

[Eoin]

Any post workup would be directed by patient's condition. If there was no improvement in S&S we would suggest a full workup. Like others, we perform platelet count post infusion of plt packs - again to check to make sure patient is not refractory. No good pouring more good platelets in if they are being wiped out. Consultant Haematologist would then suggest IVIg in that case.

Cheers

Eoin

[Liz]

We request a current platelet count prior to and within one hour post platelet transfusion but the policy is only "enforced" (and I use that in the most mild sense) if a second platelet is requested after the first. We have a collection of "Please take platelet count within one hour post-transfusion" stickers that a technologist can put on a bag of platelets before dispense to help remind the nurse.

As others have mentioned, this is mostly just for the sake of being able to document counts in case the patient seems to become refractory. It's nice to be able to give a patient a second piece of a unit that they experienced a particularly good "bump" for so the information can be useful. We don't ask for post-transfusion Fibrinogen for cryo or coags for FPP as far as I know but one of our techs does collect data on those values prior to cryo/FFP transfusion (and other reasons for transfusion).

I've definitely found it helpful from the perspective of inventory management to check fibrinogen, platelet counts, coags, etc. before transfusion of components if the product that I'm about to prepare has a 24-hour-or-less outdate. Particularly in late summer after new residents arrive, it seems as though it's not uncommon for us to get orders for products that are later cancelled or delayed.

how much of the unit do you usually have left?

[Annadele]

Oh! By "second piece," I mean another full bag of platelets collected by pheresis from the same donor. Sometimes such a significant amount of platelets are collected that we get up to three full bags all from the same donation. These have the same unit number with a different "part" number.

[goodchild]

We do a 15-60 minute platelet count on all platelets transfused outside of hemorrhage scenarios and the OR.

It was challenging at first because they often need to be nurse draws due to limited phlebotomy team availability. We managed to create a test order set in our LIS (Meditech) so that when a doctor orders for platelets the order set includes: the blood bank order to get the platelet ready, the nurse order for the nurse to transfuse the platelet, and the nurse order for the nurse to draw a post-platelet count within 15-60 minutes post-transfusion. After monitoring this and documenting occurrences as they arose and close communication with nursing administration we're at essentially 100% compliance. Now if only transfusion documentation could be so easy.

Edited February 18, 2013 by goodchild
add'l info