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SOP for Heparinized Whole Blood Collection


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Hi all,

We have a patient that has severe transfusion reactions to CPDA blood. So we have been collecting directed donor blood for him in heparin and washing the whole blood prior to transfusion and documenting the process as a Variance.  However, the patient has been requiring more and more frequent transfusions, so it has come time that we write a SOP for the collection of heparin whole blood.  Does anyone have a SOP that they are willing to share? or a suggestion of where I might find one?  Just something that we could start with and adjust for our specific needs.  Thanks for your help!

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Is the fact that he is having to receive so many transfusions related to his reactions?  Or is he bleeding because of the heparin?  Is it not possible to look at the cause of transfusion requirement and try to work on solving the underlying problem, rather than just keep transfusing him with heparinised blood?

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The reaction is severe hypertension, so the rxn is not causing the bleeding.  We also wash the unit before transfusion, so the heparin is not the causing bleeding either. The patient has anemia due to chronic disease- mitochondrial metabolic syndrome (PLCyZ null mutation) and Von Willebrand disease, among multiple other disease states.

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Anna,

I had never heard of the disease either until we got this patient.  From looking it up on the internet, I learned that it is basically a malfunction of the mitochondria (where the Krebs Cycle takes place), the "power house" of all functions and processes in the human body and is acquired genetically. It is called a metabolic syndrome because it is associated with multi-organ failure including neuropathy and muscle degeneration as is the case for our patient. The only treatment is to support each organ systems symptom, i.e.. dialysis for kidney failure, insulin for diabetes, appropriate nutrition, meds, and or surgery for GI malfunctions, therapy and meds for neuro-muscular disease, blood txf for chronic anemia etc So, not a good prognosis for these patients. And, Unfortunately our patient acquired VWD genetically along with this syndrome. I'm glad you asked, it inspired me to learn more about it myself.

Perri

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Actually, the patient is only nine years old : (.  I believe the vWD is under control, so the anemia is probably from all of the disease states, including GI bleeding, liver adenoma, dialysis, etc. not to mention constant blood draws to monitor all of the meds he's on and yes, manufacturing too.

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Yes, it was determined to be the citrate that was the problem.  Haven't tried SAG-M, not sure if our Transfusion Medicine Medical director considered it, but the washed heparinized blood has been working well for the patient.  And we have a checklist style variance process for the collection of the heparin WB, but I was asked to write an SOP for it, so I was just looking for some input for it from the "community" for that procedure. Perri

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