Danielle

Wondering what everyone's Blood Bank procedures are for when a Trauma rolls in, what is current standard practice. We are a level 2 trauma center. We currently emergency release two units on every Trauma Priority 1 and 2 that comes in the door. This has proven to be a huge waste of time and resources, (we need a T&S and usually a retype on these folks so that we can perform the XM in Safetrace) but our ER and/or Trauma docs (not sure which ones) insist on this. We have been collecting data to show that only a fraction of these patients receive blood, (usually the trauma 1's or a patient who progressed to and MTP ANYways) to hopefully move to only emergency issuing units on Trauma 1's, or even moving to a "we set up emergent units if you call the BB requesting them" kind of policy. We would like to have an emergency fridge down in the ED but this will not happen for the foreseeable future, and in the meantime we have set up blood needlessly on 15 patients in the past 10 days alone! I have also calculated the cost to a patient for a T&S, retype, and 2 electronic XM's. If I was a patient that was called as a trauma 2 and then downgraded to a 3 almost as soon as I got here I would not be happy about paying almost a grand for a bunch of totally unnecessary testing. I would say we are lucky at this point for not coming under fire for this policy from a billing/ethics perspective. What are some thoughts on how we can resolve this while placating the docs / what are some policies other trauma centers have in place and is there a current standard of practice we can show our docs to help them see? I tried searching Uptodate and wasn't able to find much about this general of a situation. Of course, we provide blood FAST when it is really needed.

Yeah I am referring to detection of fetal cells in maternal circulation. We had a limitation to proceed straight to a KB if either mom or baby was DAT positive. This limitation was being discussed and I think we will be getting rid of it altogether. We do not routinely run DAT's on Rh negative mom's so we wouldn't know if it was positive when performing the fetal screen, and in any case, a false positive fetal screen will reflex a KB just like a true positive will! I think was just hung up on the Baby DAT being positive, wondering if that would effect moms fetal screen but the package insert did not mention anything. I am thinking along the lines that if Baby DAT is positive it could cause a false negative fetal screen, if baby cells are already being bound by maternal antibody (but this would more likely be due to an abo incompatibility rather than Anti D and therefore not effect the fetal screen method?), but in that case those cells are also likely being destroyed already and so seems to me that the KB would also be falsely decreased.... thoughts? I may just be overthinking this... Side note, I totally love the snowflakes and Christmas lights going on! Tis the season! Thanks!

Hi all, Our Fetal Screen package insert says that a positive maternal DAT can cause a falsely positive Fetal Screen. Does a positive Fetal DAT have any effect on the validity of the Fetal Screen? The package insert does not mention any. Thanks in advance!