We are looking for a template similar to one in Lucia Berte's bood Transfusion Services Manual that would provide a script for our techs to use when they consult the pathologist. Also, I'd like to find out at what point does everyone contact the pathologist? When a reaction is first called or after we have completed our workup? Thanks.

After the initial workup . . .

Our contact depends upon the scenario. For example under the clerical check portion of our policy:

3.2.1.2.5 If a hemolytic transfusion reaction involving the administration of blood or blood products having major blood group incompatibilities has occurred, immediately notify the following:

A. The ordering physician

B. The laboratory pathologist

C. The lab manager

D. The Vice President of Patient Care Services

Most of the other situations are less likely to require the pathologist be contacted immediately. If the tech performing the investigation needs a consultation with the pathologist, the option always is available. If the attending requests consultation we put them in touch with the pathologist too. I rely on my techs using their own best judgement and erring on the side of conservative to contact the pathologist. Truth is they have most likely already called me if I am not present to ask questions anyway. I will not hesitate to punt to the pathologist here (he is great to work with and extremely sharp!). Hope this helps:)

We do not call the pathologist unless the inital work up findings are abnormal. This means a positive post DAT when the pre was negative, post hemolysis, clerical error etc. He always reviews every one, eventually but we don't make the immediate notification unless something is found. Also but request as Deny says above.

We do not call the pathologist unless there is something unusual (suspicion of hemolytic reaction, suspicion of TRALI, possible bacterial contamination, positive post transfusion DAT with negative pretransfusion DAT, or request from the physician). Otherwise, the pathologist reviews all workups and can request further work if she deems it necessary.

I have a separate procedure for when to contact the pathologist. I have attached it here.

consult.doc

:)Interesting, I was looking for a place to document the checks etc. when a suspected reaction has been called.

Let me know your thoughts on this please. We are a small generalist lab.

Attach transfusion reaction documentation form and all current laboratory results to this form. When complete send form with results to SCMC Pathology. If there is a major concern of patient condition, call the pathologist on call for further instructions.

Patient Name

SSN/ID#

Location

Physician

Date

Time

TO BE COMPLETED BY LAB PERSONNEL

Patient Diagnosis:

COMPLETED BY LABORATORY Tech initials_________ Date______ Time________

Clerical Check

Yes

No

Laboratory Testing Results

Micro Results

Patient id matches on tube and blood bag?

EDTA sample:

Pre

Post

Gram Stain:

Compatible blood types on log and blood unit?

ABO/Rh Type

Pre/Post vital signs on transfusion form?

Antibody Screen

Is IV Solution 0.9% Normal Saline?

Cross-match

Culture:

Perform a clerical check of transfusion documentation: correct interpretation?

DAT

Urine (blood Y/N)

COMPLETED BY PATHOLOGIST

Transfusion Reaction (Check that apply)

None

Febrile Non-Hemolytic

Hemolytic

Fluid Overload

Anaphylactic

Bacterial

Other _____

__________________

Comments:

Printed Name of Pathologist Reviewer:

Signature and Date:

We do not call the pathologist unless there is something unusual (suspicion of hemolytic reaction, suspicion of TRALI, possible bacterial contamination, positive post transfusion DAT with negative pretransfusion DAT, or request from the physician). Otherwise, the pathologist reviews all workups and can request further work if she deems it necessary.

I have a separate procedure for when to contact the pathologist. I have attached it here.

This form looks really great!

My one minor comment is that it could possibly be a good idea to add in suspected hyperhaemolysis, particularly, but not exclusively, in the case of a patient of Black ethnic origin, as further transfusion could be fatal, but the DAT and antibody screen could also be negative.

On the other hand, I suppose that could come under any transfusion misadventure - but it does require immediate clinical intervention.

:confused::confused:

Yes, we did have one instance of suspected hyper hemolysis, but I always felt that fell under the "suspected hemolytic reaction" and so it was covered. That was a scary time!

Edited May 10, 201015 yr by adiescast
Flying finger disease!

Yes, we did have one instance of suspected hyper hemolysis, but I always felt that fell under the "suspected hemolytic reaction" and so it was covered. That was a scary time!

Fair comment.

Yep, they are scary!!!!!!!!!!!!!!

:eek::eek: