I wanted to find out how other hospital blood banks are complying with CAP checklist question TRM.42000 (Has the transfusion service medical director established a documented protocol indication under what circumstances additional testing will be done after a transfusion reaction, and the nature of that testing?) Our policy states additional testing can be ordered by the pathologist as he sees fit when reviewing a transfusion reaction. Is that enough?

Our policy states extended workup is at the pathologist's discretion, but it also lists possible tests that could be part of the extended workup, such as pre and post antibody screens, antibody identifications, elutions, re-crossmatch of transfused units, TRALI workup, serum bilirubin, haptoglobin, etc.

Our policy states that if the patient experienced significant symptoms (ie: shock, hemoglobinuria, etc.) or something in our Preliminary Transfusion Reaction Investigation testing (ie: positive DAT, etc.) indicates that a hemolytic transfusion may have occurred we should perform Extended Transfusion Reaction Investigation testing (pre and post antibody screens, antibody ID, elutions, recrossmatch of transfused units, etc.)

Then we have a statement that other, additional testing may be performed at the discretion of the pathologist (serum bilirubin, creatinin, haptoglobin, etc.)

Our policy also states that if certain tests are postivie, ie, pos DAT and or hemolysis or if the abs was negative and is now positive, we continue to the next set of labs. We run an LDH, and bilirubin and send off a haptoglobin, we also collect a urine.

Our reaction form is created in a flowchart manner; if certain tests are positive, then other tests are done. Our procedure lists those tests and under what circumstances they are to be performed. Other comments in the procedure itself allow for futher testing as deemed necessary by our pathologist. The pathologist of course, "signs off" on the procedure.