Non-RBC transfusion reaction

[CMCDCHI]

How much work do you perform for transfusion reactions called on non-RBC products?  My interpretation is that ALL transfusion reactions should get a post-transfusion blood type and DAT.  The tribal knowledge in my lab says that non-RBC reactions do not need to have a post-transfusion sample collected.  They will send the product for a gram stain/culture if there is a temperature increase or a BP drop, but otherwise, not much is completed.  

Thanks!

[Malcolm Needs ☆]

It very much depends on the symptoms amd time of onset after transfusion.

 

TRALI, for example, is very dangerous and certainly needs to be investigated, but is rarely caused by red cell components.

 

I think that having a blanket "don't test/investigate" is asking for trouble.  I kow that things such as TRALI are rare; but it is better not to get caught out.

[AuntiS]

You don't set anything up after a PLT product or IVIG?

[SMILLER]

We do a DAT and ABO/RH and clerical check on all possible reactions, although I would agree this is probably overkill for most non-cellular transfusions.  The only extra thing might that our pathologist would direct us to perform a culure on plts or FFP for a febrile reaction.

 

Scott

[Joanne P. Scannell]

We do everything except require a Post-Transfusion specimen (hence, no post-transfusion specimen DAT, ABO/Rh Recheck, Antibody Screen repeat).

 

'Everything Else' = Clerical Checks, Inspection of the unit/IV tubing/IV Fluid, Documentation and Pathologist Evaluation.

Yes, as some of you have stated, it is important to consider 'all those other things' that can cause adverse reactions ... it's not all about RBC Incompatibility.

 

[DPruden]

Our techs only do the clerical check and unit/tubing inspection on reaction investigations for non-RBC components, they will send the product for a culture if directed to by our medical directors, but the medical directors do the investigation to determine if TACO or TRALI or some other non-hemolytic reaction occurred.  

 

AABB is pretty vague, just states that you have to have a policy.  And CAP requires post-transfusion DAT and ABO on potential hemolytic transfusion reaction investigations.  So, I suppose if you thought you had a hemolytic reaction involving a non-RBC product, then you would have to get a post-transfusion specimen.

[R1R2]

Same as DPruden

[CMCDCHI]

Thanks for your input.  We do "Everything else" as JPCroke said.  The investigation of TRALI and/or TACO is largely clinical but we will certainly get our pathologists involved to help the clinicians if needed and they sign off on all suspected reactions.  

I almost just called your directly, DPruden   .  I can sleep better now knowing that we are doing the right amount of work. 

[kate murphy]

I am a big fan of using standardization.  Especially in this age of generalists. 

That said, we do the exact same thing for every reaction workup - clerical check, post ABO/Rh, DAT, visual hemolysis inspection, other tests as indicated by reaction. 

Less confusion for the techs - a reaction is a reaction. 

[David Saikin]

I agree with Kate - it is one thing if you have a dedicated blood bank staff on all shifts but when everyone is a generalist the more standardized the better.

[MAGNUM]

I treat them as I would any other reaction.

[L106]

I agree with Kate also.

 

 

Donna