vilma_mt

I agree! Also the slight chance of processing error (i.e. labeling)

Far too many mistake to ignore, it does not matter who caught the mistake. If it involves only 1 tech I say it's a tech/training issue. If it involved several techs, I suggest looking at your process before another mistake happens worst case involving transfusion. I have observed some techs reading their ABO tubes and then recording their interpretations based on their memory instead of holding the tube in front of them while recording results. I suggest be pro-active and observe each tech's technique and make it part of yearly competency/proficiency.

I posted this awhile back on a different thread...I thought it might help STATEMENT OF THE AMERICAN ASSOCIATION OF BLOOD BANKS BEFORE THE BLOOD PRODUCTS ADVISORY COMMITTEE ON THE EFFECT OF LEUKOREDUCTION ON CMV TRANSMISSION THROUGH BLOOD TRANSFUSION SEPTEMBER 19, 1997 Presented by Roger Y. Dodd, PhD Mid-Atlantic District Representative to the AABB Board of Directors The AABB is the professional society for almost 8,500 individuals involved in blood banking and transfusion medicine. It also represents more than 2,200 institutional members including community and Red Cross blood collection centers, hospital based blood banks, and transfusion services as they collect, process, distribute, and transfuse blood and blood components. Our members are responsible for virtually all of the blood collected and more than 80 percent of the blood transfused in this country. Throughout its 50-year history, the AABB’s highest priority has been to maintain and enhance the safety of the nation’s blood supply. The AABB appreciates the opportunity to comment on the effect of leukoreduction on CMV transmission through blood transfusion. Over the past year, an ad hoc committee of the Association has reviewed the issue in detail and has reported that both retrospective and prospective data support the conclusion that the leukocyte reduction level currently accepted for the reduction of alloimunization to HLA molecules (that is, to fewer than 5 X 106 per transfused component) reduces transfusion-transmitted CMV to a level at least equivalent to that observed with the use of CMV-seronegative components. The data supporting this conclusion reflected a number of different studies, encompassing a variety of technical approaches to leukocyte reduction. These studies are reviewed in some detail in AABB’s Association Bulletin #97-2, dated April 23, 1997, and entitled “Leukocyte Reduction for the Prevention of Transfusion-Transmitted Cytomegalovirus (TT-CMV).†A copy of the Association bulletin has been provided to committee members. The AABB therefore endorses the use of leukoreduced components as a measure to reduce the risk of transmission of CMV to susceptible patients. The Association encourages the use of procedures which can be performed in a fashion which assures that current Standards for leukoreduction are consistently achieved.

Not voting on this one I think current name is perfectly fine to me

This question has come up before and I don't quite remember where I read it, most likely an AABB ask the FDA forums. Syringe is not an approved storage container for blood. They've allowed the use of it only for immediate transfusion, therefore giving it 4 hour expiration. Check your manufacturer's insert it probably states "refer to current AABB Standards" which states "Cellular components stored in syringes have an expiration of 4 hours...". I think this should apply to all blood components including Plasma since it not an approved storage container, whether a facility uses a SCD or not.

I agree tube method is a lot faster and cheaper, one can even perform an IS XM while waiting for Antibody screen hoping it would be negative . The only advantage of having a second method (gel method) would be if you do electronic XM on patients with no history and only one tech on shift. With one centrifuge multiple patients and phone calls good luck on setting up ABO types before it's time to centrifuge AB Screen cards. I myself prefer setting up ABO typing one patient at a time even if I've set up AB Screens on multiple patients. I would not suggest gel typing on donor re-types I'd rather do slide method (as far as I know this is still an acceptable practice) and use tube on re-typing Rh Neg.

I don't think there's going to be a significant harm to patient. Not a whole lot different from giving a type O single donor platelet to a type A/B patient which is a common practice. Basically packed red cells have small amount of plasma left in the bag. As far as I know donor centers clearly label this units and most often offer them to big facilities with a lot of patients with antibodies. The hospitals then use these units on patients that match antibodies.

Not reportable since no blood was issued. Even if it was part of a crossmatch, if the error was caught and corrections made prior to issue of any unit... still not reportable error.

We can discourage patients from using Directed Donors but we can not refuse, it's the patients choice/right. We just need to remember to Irradiate Directed Donor units from a blood relative. Having a child myself, I would put us her parents first as possible donors. When we're pulling a unit off the shelf we don't know if the donor just walked in that day or if he's hundred gallon donor. There is no such thing as "Risk Free Transfusion".

I would like to add this simplifies handling your inventory... most small facilities always keep fresh units for neonatal transfusion. Lekoreduced (and/or CMV Neg), Irradiated O neg Packed red cells.

I think it's more a "techs don't have to think" approach to neonatal transfusion. A lot of facilities provide type "O Neg" units instead of type specific even if neonates do not have passive Anti-A/B./D antibodies. Which is not bad in some cases....nowadays all techs (willing or not) have to rotate through blood bank and this is a good way to avoid transfusion errors on our most "precious" patients.

yes... performing antibody screen including detection of passive ABO antibody is included in the initial testing. If neonate has passive antibody, units need to be negative for that antigen whether it's Direct donor or random unit.

I would not consider releasing non-irradiated products during an emergency situation a reportable event provided it was considered an 'emergency release' with the approval and signature of the patient's physician. Red Cross in our area do not even provide irradiated products STAT. It is necessary to inform the patient's physician so that he can take the necessary measures to prevent the disease, there are some drugs used for GVHD prophylaxis. It may not be a reportable event but physician notification is essential even if it's your Medical Director's decision to switch to non-irradiated products.

i agree!!! washing and combining RBC and FFP are considered manufacturing and needs FDA registration. Although sometimes it's welcoming to have different pairs of eyes to review the facilities' process...depends on the knowledge and experience of inspector of course.

I would say yes....provided you still follow your neonatal transfusion protocol. Perform initial type and screen, antigen typing of the unit. Other facilities perform a second typing before giving type specific unit. Irradiate the unit if low birth rate or if the donor is a blood relative. The unit still has to pass your screening process as if it was a random unit.

The tech's day ends when they go home for that day. It did not matter whether AM tech performed it for that day a PM tech still have to perform the QC. And if it happens same tech comes in the next day...they would have to perform the QC. You can still set up your LIS to have the minimum QC per day (also set up LIS to allow your techs to enter QC results more than once per day) which meets the minimum standard BUT your techs have to follow your QC policy (i.e. frequency)... no ifs and buts about it. Nobody can say I don't have to perform QC because it was done 23 hours ago. These tests are rarely done that's why most techs are more comfortable performing the QC. Nobody have to worry about the hour and minutes the last QC was done, The only thing the daily and QC reviewer have to check was...if tech A performed the test, did tech A perform QC for that day. Other techs do not have to verify if someone else performed QC before using that particular reagent.

The place where I've set up the QC.....it is "each day of use per Tech" Because they are rarely done most likely it would be once a day. It gives the techs who rarely rotate through blood bank confidence and you can use it as part of competency etc... Nobody has to keep track of who did it last and when. It will be easier also for the QC reviewer. It also solves some LIS problem...wherein the system won't let you proceed unless QC result has been entered. It sounds a little overkill...but if you find QC is being done on each shift then I think it should be part of daily QC.

yes, i've heard some hospitals and some doctors do order washed units for neonates for same reasons and also reduce wbc,leukoagglutinins etc mainly removing the plasma, wbc and platelet that could be harmful to the patient....nowadays this practice is almost non-existent in most cases or indication there are alternative method or prophylaxis (which is more cost effective) to achieve the same goal.

This information came from a reliable source who works for the FDA. Yes they do need to monitor Cryo at room temp while awaiting to be picked up by the floor. CFR 606.122(n)(5). As for the platelet incubator; the incubator is a controlled environment, so as long as the temp is within the acceptable temp range for thawed Cryo, it’s ok. But rotation while in the platelet incubator is something FDA would disagree with. No regulation given…I would expect it would come under some non-approve method.

I think first thing to do is write a letter of understanding or memo to Docs that your facility will start the 5 day expiration date.....product will no longer be FFP after 24 hrs. Because of coagulation factor difference between FFP and thawed Plasma, Docs need to specify FFP if they want only FFP. 2nd, product need to be relabeled as 'thawed plasma' after 24 hrs and cross out product license (5 day thawed plasma is not a licensed product) make sure product does not cross state lines.

Saline Replacement Technique though rarely used is still acceptable for use to resolve Rouleaux. Check what your policy states if there is any and make sure it is accurate. If there is none, I think one should be made to better understand rouleaux and the proper usage of saline replacement technique to avoid future errors. It's obviously a training issue. You should never turn a blind eye and ignore anything that would jeopardize patient's health whether it's policy error or employee training bring to your supervisor's attention.

Transfer Bags usually from Pall are used for transferring, aliquoting or pooling blood/blood products. This was used way before pedi-bags.

This practice is only done at IS phase. Rouleaux is caused by abnormal proteins and 'adding' or 'replacement' of saline is used. Never used in the IgG phase since the cell washing would have done the trick.

Separating red cells and plasma is a practice that's been discouraged because of the possibility of mislabeling. I referred to the Electronc crossmatch Guidance on my earlier post because it's something a policy can be built on.....minimun 2 ABO Types. There is nothing wrong with testing a specimen gazillion times but it's a waste of resources and increases turn around time. "We believe that the published literature and observations of safe use over the past 13 years support the safety of properly implemented computer crossmatch (Refs. 3, 4, 5, 6, 7, 8, 9, and 10), and we regard computer crossmatch to be an acceptable method of compatibility testing when it is properly designed, validated, implemented, and monitored. However, there are many issues that could affect the safety and effectiveness of blood products when you use computer crossmatch in your blood establishment. The quality of the process depends on careful user validation and proper quality management." This is so true in any process!

I think it would be ok to place thawed Cryo in a platelet incubator only if the agitator is turned off. Again I will refer to the Circular "Thawed Cryoprecipitated AHF should be kept at room temperature and transfused as soon as possible after thawing......". I think you're more likely be cited for placing Cryo in an unapproved storage environment specially if the agitator is turned on than keeping it on Blood Bank countertop waiting for pick-up. We thaw Cryo for immediate transfusion only and not for any further storage compare this with Fresh Frozen Plasma wherein the word "stored" was used.