Blood Bank Ebola policy

[stradfam]

Our hopsital is in the process if completing a SOP for Ebola patients. 

 

As of today:

• Blood/Blood Products will be issued using a modied Emergency Issue Procedure(no sample will be accepted in the Blood Bank). Group O rbcs and AB plasma
• The units of blood/blood products will only have an affixed label containing the required patient information
• The Emergency Blood Pack or Massive Transfusion Protocol can be activated by physicians
• Blood components will be delivered in a disposable, non-returnable container with ice
• The container and all of its contents are to be discarded and not returned to the blood bank
• The blood bank will call the nursing unit in order to obtain the status of each product(transfused/discarded)

The newest information from the AABB convention:

 

www.aabb.org/annual-meeting/attend/2014/Pages/Ebola-and-Transfsuion-Medicine.aspx

 

We are trying to find the safest way to type Ebola patients if we need to transfuse  with "convalescent plasma".  Any suggestions? 

 

Thanks,

[Karrieb61]

What does your emergency release protocol say about FFP, cryo, and platelets? Ours says to give AB plasma products in those cases so why not just stick with that?  I also added in our  "Ebola" directive that if we have a historical type on the patient which is absolutely confirmed by the ED staff, then we can give out type specific non crossmatched products. This is a gamble and hopefully it will never happen. I may end up taking that back.

 

 I'm grateful for your post as I had released the directive to our techs about sending over un-crossmatched, emerg release products to the ED for these patients but it didn't occur to me to address returned products. I'll do that now and will follow your directive. Thanks!

[stradfam]

     We are a level 1 trauma center and planned on transfusing AB plasma to Ebola patients. 

 

   "Convalescent Plasma"  is donated from a patient who has recovered (28 days after discharge) from EVB and had 2 negative PCR tests.  An "AB" convalescent donor is ideal, but will probably not be a reality.  Our pathologists and infection control staff are asking us to typing the patient if we need to transfuse convalescent plasma.  We are thinking about an ABO(only) slide test under a hood or not testing the patient and trying to get a "A" convalescent plasma donor.  We are just looking for suggestion from other hospitals.  All input welcome.

 

Thanks

[Auntie-D]

We will send O Pos for males and women over 60 to preserve stocks of O Neg for those that need it most. As far as products go will will send AB where available, moving to A if unavailable.

Edited November 4, 2014 by Auntie-D

[AuntiS]

We are doing the same - O Pos for males and women over 45 and O neg for women of "childbearing age".  Those O Negs would probably get switched over to O Pos fairly quickly if someone was bleeding out.  AB plasma - A if we run out.  I know that our regional coordinators (ORBCoN) here in Ontario and CBS would LOVE us to come up with a better policy, but we aren't a huge facility and I don't feel like the time spent on creating  new protocols for  the super slim possiblity of getting an Ebola patient warrant my time

[Karrieb61]

Oops, sorry, I didn't understand the term convalescent plasma- dumb me!

[AMcCord]

Nebraska Medical Center's protocol for treating Ebola patients (they've received 2) says type O blood and AB plasma. For convalescent plasma they would consider incompatible plasma - performing a titer for anti-A and/or anti-B on the donor. They say that non-aerosolizing tests could be safely performed under a hood, such as a slide type. They have a stat lab in their biocontainment facility, so they are a lot better set up to handle lab work under those circumstances than almost all of us.

 

If we get an Ebola patient and we can't transfer them to Omaha, we will not be doing any testing for blood bank - we would give type O red cells and AB plasma.

 

WHO recommends that no crossmatch be performed.

 

There is a discussion about Ebola at the end of the topic 'Disaster experiences shared?' in the Transfusion Services section. There is a link posted for the AABB Hot Topics discussion on Ebola that you might find useful.

[AMcCord]

Oops, sorry, I didn't understand the term convalescent plasma- dumb me!

 

Convalescent plasma is plasma collected from someone who has recovered from a disease. The thought is that there are antibodies in the plasma directed against the organism that causes the disease which could provide a boost for the patient until his/her own immune system starts producing antibodies.

[Townsend]

We are also giving group O rbc and AB plasma, emergency issued and no testing done in the BB.  I have attached our guidelines. Guidelines for Blood Product Support for Ebola Patients BLADM FS9.doc

 

After attending the AABB meeting, we have decided to perform an ABO slide test for blood type for convalescent plasma only.  This will be done in an isolation lab that we have planned to set up (would be in an adjacent room on the floor near the patient's room in ICU).  If we have a history of a blood type, or if we can obtain one from another hospital at which the patient was seen, then we would NOT be repeating it in-house.  ABO slide training for a select few volunteer lab staff is underway.  I have attached our procedure. COMPAT SER 38 ABO Type by Slide Method for Patients with Ebola.doc

 

Hope this helps... the plans seem to change almost daily!!!

Stephanie

[Karrieb61]

Got it AMcCord, as soon as I saw it later on I thought Daahhhh, Karrie, what the heck do 'ya think they meant. Slow brain cells that day

[AMcCord]

Got it AMcCord, as soon as I saw it later on I thought Daahhhh, Karrie, what the heck do 'ya think they meant. Slow brain cells that day

 

Some days are like that !

[John C. Staley]

For some reason I'm surprised at the extreme measures mentioned above.  I probably should not be but I am.  I would have thought that strict compliance with universal precautions would be sufficient but apparently, once again, I am wallowing in my ingnorance.  Is the concern due to the increased virulence of the virus, the highly contagious aspect of it, or the high mortality rate?  Probably all three I imagine.  I can't help but compare this to the AIDS crisis we went through in the mid '80s only this time death comes much quicker.  To quote an old Chinese curse:  "May you live in interesting times!"  Apparently those times are once again upon us.

[Auntie-D]

We can't compare it to HIV though - it is much more virulent and more easily transmissible. The fact that enough of a viral load to infect via sweat is quite worrying. Also the majority of cases of health care workers becoming infected aren't due to direct exposure, but due to failure in decontamination ie improper removal of glove. That, for me, is the worrying thing.