The standards call for all suspected transfusion reactions to be called to the lab, whether the physician considers it a reaction or not. Our pathologist says that only the physician can decide if it is a suspected transfusion reaction. We are going in circles on this. How does your hospital handle this?

Guy L. Jones

Blood Bank

Central Texas Medical Center

Our nursing SOPs require the nurse administering the products to notify both the patients physician and the blood bank.

We too recently reviewed this AABB standard and feel it is very clear that the reactions must be reported to the blood bank.

AABB BBTS 7.4.1

When an adverse event is suspected to be transfusion related, personnel attending the patient shall immediately notify the blood bank or transfusion service and the responsible physician...

We document all reactions in the blood bank, as well as the physician response to the nurse's concern. The data are reviewed in transfusion committee.

It never hurts to do a quick clerical check ...

We also require that all suspected reactions be called to both the physician and blood bank. We have mandatory transfusion reaction criteria- if these are met then a workup is done whether or not the patient's physician feels it is a reaction.

We have the nurses who are monitoring the patient call the transfusion reaction. They call the physician and the blood bank. The physician who decides whether or not the observed reaction was due to the transfusion is the pathologist.

This was a decision made by a cross-sectional group and hospital administration. Often there is a significant delay in starting the workup if the physician has to order it. The nurses are pretty good at identifying reactions. We have not had any complaints.

Several years ago we made a concerted effort to have the "reaction" reported to the Blood Bank no matter what the physician decided to do. Even after 7 years, we still hear the nurses tell us that the doctor didn't want a reaction called. We've moved away from the word reaction and told the nurses they are just reporting symtoms, which indeed they are, and that the Pathologists and doctors will decide if it's a true "reaction". The syntax has helped a lot and the nurses are now not so reluctant to tell us what they have observed.

Not only is this an AABB standard but it is also a JCAHO standard. The purpose of this standard is for the blood bank to initiate a review of blood bank documentation, clerical check, to ensure that the right blood went to the right patient. Severe adverse effects can be seen with very mild symptoms.

Also some signs of a transfusion reaction may mimic reactions seen in the patients disease state, i.e. back pain in a sickle cell crisis patient.

I would also take this up with risk management as I am sure they would not concur with your pathologist's policy.

Good point conwaysbb.

Not only is this an AABB standard but it is also a JCAHO standard.

Our instituion requires that the physician and blood abnk be notified immediately. Currently, the physician has the final say, but we are in the process of changing the policy so that all concerns are investigated.