Mabel Adams

I think we would all use a serologic centrifuge for this at the usual RPMs for long enough to get all the cells to the bottom, which 30 seconds is probably adequate.

See the attached. SCHS Initial Training Checklist 2023.doc

The quote above is from Implementation of Alternative Procedures for the Manufacture of Cold-Stored Platelets TOOLKIT Updated 12/18/23 put out by AABB.

How are you all interpreting the FDA's guidance to use CSP "where room temperature platelets are not available or their use is not practical"? What is "not practical" for your site? If using the RT platelets means that the OP transfusion patient has to wait until more arrive from our supplier 4 hours away, that seems impractical to me. Is it "impractical" that we will have no platelets in stock that we can give the septic oncology patient (non-bleeding) because we gave them all to the MTP patient rather than giving the MTP our CSP and holding onto a RT plt for other critical, but non-bleeding needs? Should we give the CSP to the trauma and hold the RT plts only if we know we have such a patient in already who has been using platelets? If you have a policy to share, that would be great--especially if you aren't near your blood supplier.

I can't help with Soft. We bill for the plasma unit, thawing it, the RBC unit and probably pooling (but I would have to check on that).

We get these requests here for the machine they use to perfuse the organs after harvest. I think they always ask for O pos. We issue them to the organ donor (who by then should have an account that directs billing to the organ retrieval team). We add comments to the organ donor profile and each of the units that they went with the organs. If we got a recall etc., I hope we would notice the comments and then we would notify the organ retrieval people to determine what to do about it. They know who the organ recipients are, not us.

Some of our OB doctors are very confused about antigens vs antibodies and all of our case-sensitive allele terminology. They sometimes order antibody screens on fathers of babies carried by patients with antibodies capable of causing HDFN. Or recently, a screen got ordered in error in addition to the antigen typing and the doctor was very confused why the father was positive for c & C but had a negative antibody screen. Before I try to write up something succinct for them (and their MAs and midwives), does anyone know of any materials like this already in existence? It probably needs to have images. It can't get down in the weeds with us blood bankers. It needs to explain antigens and antibodies, alleles such as c & C, probably D and d genes, maybe how zygosity affects how baby inherits.

Aren't your crossmatch QC testing cells diluted in diluent 2 to 0.8%? That should cover QC of the dilution process. Also, we do tube QC on the 3% screen cells every day which should cover antigen integrity.

Do you use only one method for DAT testing? I don't see it on the list.

Can someone please cite a regulatory requirement that our workers need to document that they have read revised procedures? I consider this training if they can learn what they need from reading the new SOP (without more formal training), but I don't know if documentation of it is required or just tradition.

Can anyone explain the value of this effort to me? How do you change your tests if your results don't agree? (In Chemistry you probably recalibrate.) Do you just sign off when it is expected due to different sensitivity?

I feel like I saw that AABB added a standard that requires us to do correlation testing twice per year between antibody screening methods. Can anyone tell me which standard it is? I would also love to hear what you do for this standard when we expect Saline, Gel, PEG etc. to react differently and use those differences to avoid weak warm autos etc.

Hgb now 14.6 and I see this in chart (by different surgeon), "Puzzling picture following adequate resuscitation; pH is normal, lactate has cleared, UOP and hemodynamic parameters have normalized; and yet base excess remains -10 and serum bicarb remains mid-teens. Anion gap is normal due to hyperchloremia." I wonder if the surgeon yesterday was treating his base excess. I've heard her say (in the context of MTPs) that she doesn't really look at H&H but uses the base excess to determine if they need blood. We all know that H&H is a moving target during MTP. Not sure treating base excess works when patient not bleeding, but I am not the expert. Today's problem list (new surgeon) includes "septic shock", but I see no positive cultures and the list also includes some mostly resolved issues such as "acute blood loss anemia". Still, there was that "large volume of purulent fluid" pulled from his abdomen. At least we have filled him up with O neg blood now so maybe he will have less of the first 5 units of O pos that he got for the nosebleed circulating (2 units emergency issued and 3 more units over the next day or so) and not make anti-D.

We have a 71 yo male patient who has had a week of horrid nosebleeds requiring emergency transfusion of 2 units and later crossmatched units, They eventually fixed the nosebleeds via Interventional Radiology after nothing else worked. INR never above 1.4; Plt count always >100. Then he was found to have "coincidental diverticulitis complicated by perforation, ileus, and shock". They did a colectomy 18 hours ago, during which he was transfused 4 units RBCs. The op note includes, "A large volume of purulent fluid was evacuated from the abdomen.". That's 12 RBC units over 8 days, never more than 3 per day except during this surgery. No plasma and never a massive transfusion. Seven hours ago, ~5 hours after the last transfusion, his Hgb was 13.1. They have not run another CBC. The surgeon wants to transfuse 2 more RBCs because he is "still in shock" and the pathologist approved it. Nothing in the chart says he is currently bleeding, just "Acute blood loss anemia still not equilibrated". What do we blood bankers not understand that would justify this transfusion? Is he at risk of overload? @Neil Blumberg PS, our pathologists are generalists not transfusion medicine experts.

I figure the odds of the specimen collected for transfusion being the wrong patient and matching the blood type on record from an OP draw are extremely small. If it doesn't match, we will recollect then for a tiebreaker. We use the Epic scan-print-scan for inpatients and our phlebotomists are very good at not overriding.

I remember hearing of a hospital that used clear bags, and some visitor fainted at the sight of blood and had a head injury. No regulations on that but squeamish people and the mess a broken unit makes are worth thinking about as well as HIPAA.

And WHEN are we going to get freeze dried plasma?!?!? Spray-dried plasma: A post-traumatic blood “bridge” for life-saving resuscitation Mark A. Popovsky1 | Nathan White Transfusion. 2021;61:S294–S300.

Plasma as a resuscitation fluid for volume-depleted shock: Potential benefits and risks Daan P. van den Brink1,2 | Derek J. B. Kleinveld1,2,3 | Pieter H. Sloos2,3 | Kimberly A. Thomas4 | Jakob Stensballe5,6 | Pär I. Johansson6 | Shibani Pati7 | Jason Sperry8 | Philip C. Spinella4 | Nicole P. Juffermans Transfusion. 2021;61:S301–S312.

Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes A Post Hoc Analysis of the PAMPer and COMBAT Clinical Trials Anthony E. Pusateri, PhD; Ernest E. Moore, MD; Hunter B. Moore, MD, PhD; Tuan D. Le, MD, DrPH; Francis X. Guyette, MD, MPH; Michael P. Chapman, MD; Angela Sauaia, MD, PhD; Arsen Ghasabyan, MPH; James Chandler; Kevin McVaney, MD; Joshua B. Brown, MD; Brian J. Daley, MD; Richard S. Miller, MD; Brian G. Harbrecht, MD; Jeffrey A. Claridge, MD; Herb A. Phelan, MD, MSCS; William R. Witham, MD; A. Tyler Putnam, MD; Jason L. Sperry, MD, MPH

We switched to emergency issuing 2 units of plasma, not RBCs on our "full traumas". That helps a lot. We also don't do the XM on any emergency issued RBC unit that gets returned. They usually order a T&S on these patients so that isn't a problem. We are also on SafeTrace. I have found some articles supporting this.

Under OSHA, tested donor blood is not considered biohazardous. For heaven's sake, we infuse it into patients! It would take me some time to find the regulation, but it is in the OSHA regs.

So, you would continue to do IAT XMs for the rest of their life even if the patient's Lewis antibody is not detectable?

Malcolm, that is fascinating to know why they change their Lewis types. We don't keep Lewis antisera. I just realized that the titer in 2018 was for anti-D, probably to figure out if it was too high to be due to RhIG (titer was 1). So, I will quit casting aspersions by suggesting they were ordering Lewis titers. I'm still interested in input on the IAT crossmatch with a currently negative screen question.

I just answered this question. My Score FAIL  

Resurrecting this thread because there is good information in here. We have a prenatal who had anti-Lea in 2018. Her screen is now negative. I know that it's insignificant for HDFN, but I was asked if we should add a comment to the Ab screen about the prior Lewis antibody. Now that so many of us can see other hospital's lab results (Epic users), there was concern that this patient could be transfused elsewhere without an IAT crossmatch if we don't somehow mention the prior Lewis antibody. I don't think other Epic users can see the comments easily on lab results, but it made me wonder. If a Lewis antibody is not currently reacting, is it important to perform IAT crossmatches? Or does that recommendation only apply when the antibody is currently detectable? We use MTS gel so are going to miss a lot of Lewis antibodies anyway. They made us titrate this antibody on this patient in 2018, so we really don't want to trigger that response from the OB again. Again, not sure that a comment about a prior antibody would make them order a titer but we don't think titers are appropriate in detectable Lewis antibodies much less those no longer detectable in MTS gel. I suppose it could react in the tube method we use for titers and really make things a mess. I prefer to turn out the screen as negative and not worry about it. If she comes here, our LIS will probably require IAT XM which is fine. Could we set the computer to allow electronic XM if there is a history of a Lewis antibody without a current positive screen or would that be inappropriate? (Sorry, Malcolm, our computer calls it electronic XM, not electronic issue.)