Another Interesting Article.

[Malcolm Needs ☆]

Hi All,

 

On this site, it is often debated how hospital B will know that an antibody was detected in patient X at hospital A.

 

There is an interesting, if very short, "Transfusion Medicine Illustrated" in the November issue of Transfusion, which may be of interest to people, as to just how useful an antibody card carried by a patient may be.  It is:

 

Haspel RL, Driscoll A, Kurbaj H, Andrade F, Kaufman RM.  The antibody identification card in action.  Transfusion 2015; 55: 2551.

 

       

[goodchild]

Thanks Malcolm. I've wanted to initiate something like this for years now.

[mollyredone]

Patient Antibody Letter.docThe Red Cross used to send out cards for reference work they did for us.  I decided to do it for our blood bank.  Once a month I send out a generic letter which I am attaching.  We also send a card for them to carry, and we have received faxed copies when the patient is seen in the ED.

[Auntie-D]

Turns out we don't have a subscription to that or any other journal - guess what I now have to do? Yep that will be to put a business case in...

[goodchild]

Patient Antibody Letter.docThe Red Cross used to send out cards for reference work they did for us.  I decided to do it for our blood bank.  Once a month I send out a generic letter which I am attaching.  We also send a card for them to carry, and we have received faxed copies when the patient is seen in the ED.

 

This is perfect !

[mollyredone]

antibody card.pdf  Goodchild,  We had our printing department modify the hospital business cards.  The front has our logo and address and a statement and the back has the areas to fill in for the patient.

 

Sorry it's upside down

Edited November 13, 2015 by mollyredone

[goodchild]

antibody card.pdf  Goodchild,  We had our printing department modify the hospital business cards.  The front has our logo and address and a statement and the back has the areas to fill in for the patient.

 

Sorry it's upside down

 

I love it when all of the leg work is done for me in a process improvement project !

 

I have a few questions:

 

How do you track the issuance of the cards/letters? e.g. comment in history.

Do you send out updated cards for patients with previous history and new antibodies are identified?

Do you send them out for clinically significant antibodies only or would you also send them out for something like anti-Lu^a or an antibody of undetermined specificity?

[mollyredone]

Goodchild,

 

I make a copy of the signed letter and card and put it in the patient's folder.  Maybe I should enter it in the computer as a comment in their history...Yes, I send out updated cards if they have new antibodies.  I don't send out cards for clinically insignificant antibodies or antibodies of undetermined specificity or an anti-D presumed due to Rhogam (we always contact the doctor's office to verify the patient received Rhogam)

[galvania]

Yes, the cards are a brilliant idea - but they really do need quite intensive patient education to go with them.  I remember years ago working in a hospital that issued cards, eons before the advent of computers, and when investigating a transfusion reaction due to anti-Jka the patient's husband seemed to remember that the patient might have had a card somewhere in a drawer but didn't think it was relevant because it had been issued by a different doctor......

[Malcolm Needs ☆]

We had one once that was sent in to us because it was getting a bit battered and bruised, and the lady wanted a new one.  The original was signed by a certain Dr Ruth Sanger!!!!!!!!!!!!!!!!!!!

[galvania]

Do you think Antiques Road Show would have put the correct value on that one, Malcolm?  (Sorry if that reference is a bit obscure to anyone who doesn't get the BBC)

[AuntiS]

We do cards as well.  We attach the card to a letter that we send to the physician.  Hopefully (!!!) the physician reads the letter, explains everything to the patient and then gives the card tot he patient.

 

1. we do issue a new one if there is a new antibody

2. we issue one every time we have a new antibody to our hospital

3. we keep a copy of the letter/card on the patien't file

4. only clinically significant antibodies

 

Sometimes people wander into our hospital with a card from another facility AND let the phlebotomist know.  But, I often wonder if most people forget they even have it. 

 

I LOVE the idea of the hospital business cards!  Something to look into!!!!  Thanks!

 

Meditech can generate a "card".  It is not the prettiest card tho

 

s

[tricore]

Do you think Antiques Road Show would have put the correct value on that one, Malcolm?  (Sorry if that reference is a bit obscure to anyone who doesn't get the BBC)

We have Antiques Road Show in the U.S. U.S. version.

[Dr. Pepper]

 

We had one once that was sent in to us because it was getting a bit battered and bruised, and the lady wanted a new one.  The original was signed by a certain Dr Ruth Sanger!!!!!!!!!!!!!!!!!!!

We tried these years ago with limited success - our own patients wouldn't show them to nursing/MDs. A few years ago I did get a call from a patient in her late 80s who had received her card in the 1970s, and, 40 years later, presented it when she went to a neighboring hospital, who never gave it back! We got her a new card and wished her well. Her antibody, by the way, was no longer detectable, so I guess our old program was not a total failure.

Anna is correct about the patient education piece. And I liked the letter a lot, but I question whether the patient's doctor is the best person to give the info to. Our cards (we are trying this again) read "Should you require transfusions in the future, it is important to forward this information to the blood bank at your hospital."

You can get card stock and a template from Avery (#5871) and make the cards from any printer.

Edited November 16, 2015 by Dr. Pepper

[pbaker]

We once received a letter that the patient said "was VERY important" if he ever needed transfusions.  We had to call our interpreter service because the letter was all in German

[goodchild]

We once received a letter that the patient said "was VERY important" if he ever needed transfusions.  We had to call our interpreter service because the letter was all in German

 

My curiosity demands that I ask: did the letter ended up being VERY important for blood bank purposes?

[Auntie-D]

My mum recons she has been told she needs vein to vein transfusions - never did get to the bottom of that one... (She's just bog standard O Neg with no antibodies)

[Mabel Adams]

I posted a sample antibody card in the Library section of this site a few years back.  It had instructions on it about what to do with it when presented, but that does make it have to be 2 sided.  I never got the project off the ground where I worked before but I would use them occasionally for patients I knew were moving to another town or had an anti-Jka that was disappearing etc.  I usually got the nurse to give them directly to those patients while they were still in house. I don't think that would work well routinely because it would get lost among all of the discharge papers.

 

Where I work now we used to send letters with cards to the doctors but the cards were never presented when the patient came in again.  We queried the MDs a few years back and at that time they liked the letters but not the cards.  I suspect the cards were never getting to the patients.  By sending them to the patient's address you would bypass that problem but is there any HIPAA issue with mailing it out so anyone at that address could open it?  I guess it's no worse than an insurance EOB coming in the mail and some offices mail lab results.

 

We have since quit sending letters and started adding interpretive comments to the patient's antibody ID results in the computer and sending a copy to their primary care doctor.

 

About the only cards anyone has ever presented to us were Lewis antibodies from 1964.  

 

Below is the content of the article.  I agree with it that we should have a better system than paper cards in this electronic age, but whatever works, right?

An 87-year-old female presented to Beth Israel Deaconess Medical Center (BIDMC) with nausea and vomiting and a hemoglobin of 7.6 g/dL. The patient had no prior blood bank testing performed at BIDMC. An emergency room physician called to inform the blood bank that the patient had produced a typewritten antibody card from Brigham and Women's Hospital (BWH). The blood bank received a copy of the card (see figure) and a sample for a type and screen. The patient was last seen at BWH more than 14 years ago. The BWH blood bank was contacted and, aside from confirming a history of anti-E and anti-S, it was learned that the K– recommendation was based on BWH policy at that time for patients with evidence of a warm autoantibody. The BIDMC type-and-screen sample only demonstrated an anti-E (and no anti-S or warm autoantibody), but given the history, the patient was restricted to E– and S– red blood cell units. She received 2 units without incident.

Although BWH has sent antibody cards since the 1980s, this case represents, to the BWH blood bank director's knowledge, the first time a card has been documented to prevent a possible delayed hemolytic transfusion reaction. The Boston area is home to three medical schools, all associated with multiple teaching hospitals including BWH and BIDMC. No system links blood bank data among these hospitals. As such, although BIDMC is only 0.4 miles away from BWH and affiliated with the same medical school, communication of clinically significant antibodies was only accomplished through the acumen of the patient and the emergency room physician and a more-than-decade-old paper card. Also, while both BWH and BIDMC issue antibody cards, it is not standard practice at all hospitals. In the United States, there is no national database containing patient blood bank results. Privacy issues, including those related to the Health Insurance Portability and Accountability Act (HIPAA), limit such initiatives. However, this case clearly shows in the Internet age, at least in the United States, the need for better methods for sharing of important blood bank data.

[pbaker]

Turns out our German patient needed irradiated blood products as he was a BM transplant patient.