Kym

I believe everyone responding and the AABB (if automatically, regardless of inventory, giving oPos to every non baby maker in every emergency request) missed the point of my concern. I have been a BBanker for 37 years. Lead tech for 10. Supervisor for 5. In large trauma hospitals and small community hospitals. I do question what I think is wrong or tunnel thinking. At work. At home. And here. These replies equate questioning with wanting or ignoring the life of the patient. That’s BS and never what I implied except in peoples minds. In the past, before what appears to be current universal policy, in emergencies our policies and our minds in an emergency went to balancing an unknown patients needs with inventory. Which this new policy is really all about: INVENTORY. My problem is no room in policy for considering inventory. In the past we all (I think. I know each of the 7 hospitals I worked) all had policies on when to switch to OPos in emergency. Ie: bleeding out patient. Low inventory of rh neg. That is not THIS. Automatic give Opos. Even if you have 3-4 times your minimum inventory of rh neg units. So what happened? Was there a believe that Anti D is NOT a risk to a patient in acute or later (getting more Opos in another emergency when one has Anti D) ? Was this believe based on stories other than extreme hemorrhage? Every study I read (and yes I investigated) discusses unstable hemolytic state why they don’t make antibodies. Ok I accept that. At what point is a person unstable? Loosing 1-2 units of blood. Or 1/2-full orig blood volume in their body? The massive was designed by the army. For blown off arms and traumatic injuries where all clotting and body fluid is a mess. The policy works very well for that. BUT that is NOT what I’m talking about. I’m talking about a dr only wanting to give 1-2 units of blood and that’s it. Patient is fixed. Where are those studies? Because no one I’ve heard says Anti D is non significant antibody (and yes don’t twist my words. I am not saying every patient will make anti D). But with routine not testing prior to giving blood in emergency: the % of population with anti D WILL continue to grow with this policy. I’ve already seen it. So giving OPos with no regard to history or testing: I think we just don’t see it yet in most practice. But that does not mean it will not become a problem. UNLESS Anti D is now considered clinically insignificant except for unborn babies. Can you tell Me if THAT has been determined? Because I haven’t read that in AABB technical manual at all. If it’s still considered clinically significant. Why are we ignoring it in our policy? Massive code is being used for straight emergency release (1-2 units). Someone posted all their emergency get OPOS. By that statement I am assuming 1-2 units only. No hemolytic state exists. I am having trouble reconciling our concern that even with good inventory We ignore Rh status. There are other solutions to managing Oneg inventory than by ignoring Rh status altogether. Ie: Get type with tube or slide immediately. Even getting tube to blood bank in 5 minutes. That’s a forward type. No spinning required. Just test your emergency after firstvisduing 2 units oneg. Before they get rest of massive (4-6 units) you will have Rh type. But no. NO other alternatives are being discussed or promoted. Makes me wonder why not?

To answer path labs question in my email today: did any of these answer my Question. Answer was no. But this came closer cuz gave me a couple statistics. 40% of “healthy” pts make anti D after exposure. And 2% of massive. Well my question was basically for people just getting 2 units opos who turn out to be oneg, How many make anti D. And if they make anti D how much does it affect them? And NO I’m not talking about pregnancy. That’s the ONLY part of the anti D I’ve ever seen a study on. And that’s only thing medicine seem to care about So basically on this older study of 40% getting Anti D after regular exposure (not bleeding out. Not getting tons of blood: JUST getting 2 units. Home the next day or 2 type patients). I still don’t know is this a risk to them. Or have we been too worried about antibodies all these years ? What type of transfusion reaction would it be if later they got more positive blood?

I’m old enough to remember when both asbb and arc have been wrong and later changed their policy. Giving opos to all Du Pos is one. Plts don’t give anti d is another. And more. I do not agree that this is best way to manage. I’m not much for going along just because everyone does. There is No certain harm of others here. That is a sales topic. ALL is unknown. and every body is equally important or equally unimportant. “First do no harm” doesn’t say ‘except’ when it’s inconvenient. First massive policy is very dependent on drs using it properly and yet most do not. All blood taken but ffp returned? Only 2 units taken no other products used? No plts/ cro taken The point was to make whole blood The army proved best way to handle true massives sure gushing out: opos goes on floor immune system not kick in I get it BUT that is not how it’s usually being used in hospitals across the US. I think better policy would be give 2 units oneg in emergency with unknown and get a type complete within 30 min I have proven in my less than educated hospital (as far as following massive or emergency policies) that you can easily get a tube of blood in CLS hands in 10 min do quick front type and bam 15 min can give positive blood to positives. So complete aborh and screen in 45 min So full group/type within 30 min when spinning that tube down education phlebs respond to bedside etc 80% of our massive are not massive at all. Drs just want a quick response

That’s reassuring. I hope you are correct. Goes against all the care and concern we used to have about giving blood before. “Unknown” by definition means just that. Nothing about their transfusion history or reactions is known so why oneg to begin with. I think the concern for a bad transfusion reaction or something that could affect their life (future emergency giving antigen positive to a pt with a significant antibody and cause harm) is just not there anymore it appears to me. Wonder why we tried so hard before. Maybe better care after transfusion reactions make it less dangerous 🤷‍♀️. I know I have no say. But risk giving opos when you have well stocked oneg? I just don’t get what we are saving it for. I always understood emergency as in no oneg available. But to plan on not caring is kind of mind boggling. So yes. I hope we have ok experience too. Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago. Thanks for your words of comfort.

Well i guess quality just not there anymore. Like all things. Not caring we are endangering future life. Going with the odds. You are right. Only things matter any more are cost and convenience. No wonder they don’t really train any more theory etc. it’s all technician work now. 🤷‍♀️

That is my problem. There will be no educating by blood bank on educating drs with current mgr. AND this policy NOT related to inventory shortage. Could have 20 oneg units (15 is our normal desired inventory of oneg) and still won’t use oneg in massive. Though our policy states pick up 2 pc first. Then if they want more other products on demand. like I said drs use this as the old “give me 2 units oneg unxm” policy. BTW totally different from my last job just last year where each pack is picked up together as a unit. What argument could I present to try to get them to change the policy that those first 2 units should be oneg like any unxm with opos to follow if more unxm needed ? I’m old school where first we do no harm so this makes me feel we are harming and not caring. Very hard for this old lady. After 37 years of thinking antibody formation on purpose is not a good thing.

Yes this is my issue. Most of our “codes” are truly the old 2 unit unxm. Ie: they are NOT bleeding out. Get 2 units of o Pos bleeders. also many of these people are repeat offenders. Ie. Here for more fights or racing car crashes. Young guys. Not all not most. But many. And 80% of our codes called. Give ONLY 2 units of PC. What kind of transfusion reaction does a person get if they receive 2 units opos blood when they have Anti D ? Is it no big deal? What are symptoms? How bad a reaction is it?

The small hospital I work per diem at recently switched all massive recipients to getting O positive. Even Rh men and women older than 50 whose Rh is unknown. I’m confused. Are we giving Anti D antibodies to 15% of our men now if doctors call a code massive ? I am retired with decades of experience and came back to work 2 days a week.

I am new to a machine (echo lumina) that constantly give equivocal (?) readings. This seems to make ABID reading harder. Have to go to tube here ( repeat screen). Then if positive go back to the machine we already were steered away from to run ready id. This makes no sense. So is this particular machine not calibrated in reactions sufficiently ? Is it normal to keep jumping methods to get around the ? Readings which in LISS are always negative.