What is your policy for labeling a pool of mixed type cryo? Do you not assign an ABO and/or Rh to the mixed pool and list the individual units with their ABO/Rh?

If you assign an ABO/Rh to the pool, how do you determine it? A mix of Rh pos and Rh neg would be Rh pos but what about mixed ABO groups; do you use the red cell or plasma to determine the pool ABO? Example: is a mix of A and B an AB pool or an O pool (since it has both anti-A and anti-.

Fortunately, we do not often have to pool units of mixed ABO and our blood center hopes to offer pre-pooled cryo next year. First impression is a mix of A and B would be AB but since cryo is not a cellular product, doesn't it make more sense to consider the plasma ABO group instead?

We label the unit with the predominant type. The computer tag does not display a type, so the patient's medical record does not have a type in it. We can go into the computer and look up all the units and their types if we need to.

Even if you give it one type in your computer, I believe the FDA requires all blood types in the pool to be displayed on the bag, unless you are labeling with ISBT format. I don't have the reference right in front of me... I'll try to locate it.

Linda Frederick

We do not pool different ABO types together. If we pool Rh positive and Rh negative cryo together we label it as Rh positive.

I got this from the AABB Web page, Member Area, FAQ about the Bar Code Rule (responses from the FDA):

Q: In a pooled unit of Cryoprecipitate or Plasma, do all the blood types included in the pool have to be listed on the label? If so, must they all be machine-readable?

A. Yes. 21 CFR 606.121©(12) requires the donor’s ABO/Rh to be on the label of products intended for transfusion. The Rh may be omitted on Cryoprecipitate. 21 CFR 606.121©(13)(iii)(D) requires the ABO/Rh to be in a machine-readable format.

LF

We were cited on our last AABB assessment because we listed the dominant blood type on the label. We no longer pool mixed ABOs for this reason - we hope that a computer upgrade and ISBT will solve this problem, but until I see the upgrade, I do not know.

The past couple of weeks I went on three site visits to check out blood bank computers. One of the things that really surprised me was that 2 of the 3 facilities DID NOT POOL ANYTHING!!!

If the Doc ordered a 6 pack of platelets or 10 cryo that's exactly what they received. No more questions on why did you send me 1 when I ordered 6.

That would certainly address your mixed pool issues.

We quit pooling platelets years ago - a bit of a fight at first but less waste if not used and less chance of contamination during pooling.

But not to pool cryoprecipitate.....how did nursing get the cryoprecipitate out of the bag?

another option would be to request our blood center to give pool cryo...maybe pack of 5??

The system we are implementing prints a label with the ABO & Rh for each unit in the pool. fOR MIXED TYPE POOLS, we have the option of giving the POOL an ABO and/or Rh or leaving it blank. The problem is, the unit tag (label) that nursing puts in the chart has the blood type of the pool, not the individual units. A blank ABO or Rh won't work for us. We rarely have to issue mixed ABO types so I think we will make it a policy not to. Pre-pooled cryo from the blood center will solve this anyway.

If the nurses gave cryo one unit at a time, couldn't they run IV saline into the bag to flush the cryo out? I know they used to do this to increase the flow rate of red cells.