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Transfusion Reaction-Issuing additonal units


wellspl

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I am in the process of updating our Transfusion Reaction Workup procedure.  The current procedure is divided into 2 phases.  Phase 1 testing consists of a clerical check, DAT (Pre and Post), visual examination of patients serum, ABORh retype of post-transfusion specimen and a visual examination of the unit and any solutions hanging with it. 

 

If there are no clerical errors, visual inspection is okay, DATs are negative, and there is no drastic change in the serum/plasma  we are to call nursing/physician with results and additonal units of blood may be issued for transfusion.

 

An administrator (fresh from a presentation of JACHO surveys) wants a statement added to the procedure stating the transfusion cannot be restarted unless the Medical Director approves. 

?????  I am looking for clarification about why the Medical Director would need to approve additonal transfusions if everything is negative. 

(I think the physican should decide if additonal units should be transfused.)

 

If there are any errors detected, DATs are positive, or post transfusion is icteric/hemolyzed we would proceed with phase 2 of testing, notify the nurse and/or physician immediatly, and notify the blood bank senior tech or Laboratory Medical Director. The Medical Director/Pathologist review all transfusion reaction workups. 

 

Thank you for your input!

 

 

 

 

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I don't have a copy of the laboratory accreditation manual for TJC but maybe it says it there?

 

We already have a similar policy, which the attending physician can override. Overriding is handled under our emergency release policy, considering that the transfusion reaction workup & interpretation would now become incomplete pretransfusion testing.

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For decades we did as the original post.  Recently, we changed our SOP and now the techs need to get approval from the Transfusion Medicine physician prior to the release of additonal units for any transfusion reaction.  We added a comment to the Transfusion Reaction computer entry to document this.  The issue procedure was changed to include a computer check for a recent HTRXN reaction test and if one, they are to look at the results to see how the comment was answered (ie, TRM notified-OK to transfuse).  If the comment is pending, they are to resolve before issuing additional units. Surprisingly, this has been working fine :)

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Yes, as Terri has mentioned the Medical Director is the one who interpretes the Transfusion Reaction,so untill he/she interpretes NO further Transfusions.

And we put a note for that to alert coleuges.

The reaction could be from Anti- IgA that requires either IgA deficiency blood or washed RBC's OR  FNHTR that may require Leukoreduced or HLA match in case of Platelets. 

Edited by Abdulhameed Al-Attas
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The reaction could be from Anti- IgA that requires either IgA deficiency blood or washed RBC's OR  FNHTR that may require Leukoreduced or HLA match in case of Platelets. 

 

I guess we are quite lucky in the UK, with using SAGM there is very very little plasma left for it to be an issue, to the point where they are no longer specifying HT neg on blood.

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"If there are no clerical errors, visual inspection is okay, DATs are negative, and there is no drastic change in the serum/plasma  we are to call nursing/physician with results and additonal units of blood may be issued for transfusion."

 

I would think that if all of the above is true, then there is no transfusion reaction, and the policy should state that the transfusion can be restarted at the discretion of the attending physician.

 

There may be some confusion on your administrator's part between a reaction workup and a transfusion reaction. Just because a workup is done, does not mean that a transfusion reaction has taken place.  Rather, the workup is to determine if one has taken place.  If one has  not taken place, you do not need  specific approval (to restart or give other units) from the Lab director as long as BB is following their P&Ps.

 

Scott

 

 

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Don't forget that the standards also include as a requirement for the evaluation:

 

Review and interpretation by the medical director.

 

 

"If there are no clerical errors, visual inspection is okay, DATs are negative, and there is no drastic change in the serum/plasma  we are to call nursing/physician with results and additonal units of blood may be issued for transfusion."

 

I would think that if all of the above is true, then there is no transfusion reaction, and the policy should state that the transfusion can be restarted at the discretion of the attending physician.

 

There may be some confusion on your administrator's part between a reaction workup and a transfusion reaction. Just because a workup is done, does not mean that a transfusion reaction has taken place.  Rather, the workup is to determine if one has taken place.  If one has  not taken place, you do not need  specific approval (to restart or give other units) from the Lab director as long as BB is following their P&Ps.

 

Scott

 

 

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Whoa Auntie-D.  Abdulhammed Al-Attas was talking about anti-IgA, not anti-A.

 

Although our blood is SAGM and leukodepleted, and so you are correct in saying that we do not have to worry about high titre anti-A in our red cell components, we do, nevertheless, still have to worry (big time) about IgA in the remaining plasma.  If the patient is IgA deficient, and has high titre anti-IgA, there is sufficient IgA in the remaining plasma to cause a very severe transfusion reaction, and so Abdulhammed Al-Attas is completely correct about that.

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Whoa Auntie-D.  Abdulhammed Al-Attas was talking about anti-IgA, not anti-A.

 

Although our blood is SAGM and leukodepleted, and so you are correct in saying that we do not have to worry about high titre anti-A in our red cell components, we do, nevertheless, still have to worry (big time) about IgA in the remaining plasma.  If the patient is IgA deficient, and has high titre anti-IgA, there is sufficient IgA in the remaining plasma to cause a very severe transfusion reaction, and so Abdulhammed Al-Attas is completely correct about that.

 

Oops misread - sorry about that!

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  • 1 month later...

Wanting more answers!!

 

Looking at the 1st scenario posted by wellspl:

So let's say the transfusion of additional units is at the discretion of the MD (either lab medical director or attending). What would he/she consider before making a decision? Anti-IgA testing? What else could be considered if all the clerical and testing rechecks are correct? 

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The Medical Director (or designee) may put recommendations for future transfusions in their interpretation report. They could recommend additional testing, or recommend pre-medication to limit reactions, etc. It's their call. The attending physician can't proceed without the Medical Director's approval.

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