When you issue blood that is "least" incompatible for a patient with a warm auto antibody, is the ordering physician required to sign a release for that blood?

At every facility I've work at they have been required to sign

YES!

Yes, we have a High Risk form where one of the boxes that can be checked off states: This patient has a warm auto-antibody rendering this

            unit incompatible and we discourage the transfusion of such a unit. The doctor must sign before transfusion.

Yes

From our P&P: "If a patient's life may be jeopardized by waiting the time necessary for completion and resolution of required pretransfusion tests, or if other conditions exist which create risks greater than those normally associated with transfusion, blood may be issued upon the request of a responsible physician, who then takes full responsibility for the consequences of the transfusion under those conditions." This would certainly qualify.

Yes.

Yes, but we just call it incompatible.

Yes but we call it "best matched".

Using a term other than "Incompatible", comforts you and your staff and is misleading. It is the patient who makes the final decision.

I heard of one place that calls it "serologically incompatible". Not a bad option, because as Dansket mentioned, the patient might like it just fine.

We would use the term "least incompatible" on the consult form for the attending to sign only after determining that the problem with the crossmatch is likely due to a warm auto or something like that (that cannot be cleared up to our satisfaction).  The units themselves are recorded as "incompatible".

 

Scott

Our form is for release of incompatible blood and provides our explanation of why we believe the blood is such.  I don't like "least incompatible" because it is a meaningless statement.  Incompatible is incompatible. 

We have our pathologist give approval.

Dave

 I don't like "least incompatible" either, but we only use it when the pathologist has consulted with the attending  about the impossibility of getting a "testable-compatible" unit for someone with a warm auto that cannot be cleared up, and must have a transfusion to survive.  This is pretty rare.  These units are actually recorded and tagged as "Incompatible".

 

Scott

We get approval from the physician and pathologist and this approval is documented in the LIS.

We have a concessionary release form but try to discourage them from transfusing wherever possible.

Just as an aside to this - I was at a seminar where this topic was discussed.  The feelings were that if you can autoabsorb out the autoab and there was no evidence of sensitization to other blood groups, you could get by with just an immediate spin (and therefore compatible) crossmatch.  Kind of goes against the grain but makes sense too! 

 

Food for thought!

Edited March 17, 201510 yr by David Saikin

involved with discussion: history of warm autoantibody, no alloantibody. Currently antibody screening is negative.

What do you do? Immediate spin crossmatch or extended crossmatch?

I still do the ahgxm using PeG autoabsorbed plasma . . . haven't broached this subject with my new Medical Director.

Computer crossmatch.

involved with discussion: history of warm autoantibody, no alloantibody. Currently antibody screening is negative.

What do you do? Immediate spin crossmatch or extended crossmatch?

If the warm autoantibody is historical only and not detected on the current sample (current negative antibody screen, Gel method), we would revert to Computer Electronic Crossmatch/Electronic Issue.

Our pathologist and the ordering physician must both approved transfusion.  The approval from the pathologist is usually verbal and is documented in the patient's history, as is the report from the reference lab regarding underlying alloantibodies.  The ordering physician must write a communication order that states "OK to transfuse least incompatible."  We use this terminology as it is usually a recommendation from the reference lab (the recommendation is preceded by the phrase, "If transfusion becomes necessary").

We would call it "Least Incompatible", because we were told to do a complete XM on several units. We would usually see variance on the reactions and would pick the least incompatible units. We would do a complete XM with the non-absorbed  plasma, pick our least incompatible units, and complete XM with the absorbed plasma.

Is there a Joint Commission or AABB standard that says you have to get a conditional release signed for 'least incompatible' blood?

Also, suppose you have a patient with warm auto-antibodies and no allo-antibodies. The patient is transfused and the subsequent specimen still has a positive antibody screen but at strengths not stronger than the pre-transfusion specimen, do you do the entire workout every 72 hours?