I was wondering if anyone out there has guidelines as to how many products can be ordered/issued at a time? Or cardiac surgeons want to request 20 platelets at a time (could be more depending on the case). Our blood issue policy states that we will only issue 10 at a time. There are no rules from a regulatory standpoint that I am aware of, but we want to do this on an inventory manangement basis, as we have Oncology and other departments requesting products as well. Can anyone tell me what is a regular request within their hospitals cardiac OR? Do they monitor platelet counts? Any information would be very helpful. Thanks in advance.

Seems like a lot of plts for cardiac surgery . . . the standard transfusion (20+yr ago) was 2 rbcs and 4 cryos. Yeah, some go bad but a standing order for 20 seems archaic (unless I am reading your question incorrectly). Tell them to try fibrin glue . . .

By 20 you mean: 20 x 0.5 x10^11 absolute count, thats 4 times the standard dose. why??

We do give plts if the pt did not have time to be put off plavix. Moreover, with AAA and on bypass open hearts we know that the plts lose their function as they "hit the clamp", but we give a standard or double dose. To see what that is the optimal standard dose (either refer to AABB or) read my review when it come out:redface:

Our cardiac surgeons often ask for 20u plts (for us 4 pools, or 4 pheresis units) to be on standby. They normally transfuse in groups of 10 (2 pools). At our facility platelet transfusion for CABG is a rare occurrence, maybe 1 in 15-25 patients. They have a "point of care" instrument in the OR to help them figure out the appropriate dose, and to check on the outcome.

Our surgeons usually order 1 apheresis unit for regular CABG's and 2 if it is a redo or if it is a PLAVIX situation. We keep them in the BB and do not dispense unless and until they are ready to transfuse them. Most of the time they don't use any. Same goes for open hearts on our babies "1 apheesis" unit usually used when they come off pump. If a surgeon orders 10 plts we simply give them 1 apheresis unit. If there is a shortage of platelets we call the CVOR first thing in the morning and make sure they know if they use on one case they may not have any for the next.

Our surgeons usually order 1 apheresis unit for regular CABG's and 2 if it is a redo or if it is a PLAVIX situation. We keep them in the BB and do not dispense unless and until they are ready to transfuse them. Most of the time they don't use any. Same goes for open hearts on our babies "1 apheesis" unit usually used when they come off pump. If a surgeon orders 10 plts we simply give them 1 apheresis unit. If there is a shortage of platelets we call the CVOR first thing in the morning and make sure they know if they use on one case they may not have any for the next.

I agree.

BTW what is one1 apheresis unit that you recieve from your supplier: is it 3x 10^11 ?

I agree.

BTW what is one1 apheresis unit that you recieve from your supplier: is it 3x 10^11 ?

Liz - that is usually the minimum for apheresis plts (AABB?FDA std). The one's I receive areat least 3.5-3.8 x 10^11.

Our cardiac surgeons often ask for 20u plts (for us 4 pools, or 4 pheresis units) to be on standby. They normally transfuse in groups of 10 (2 pools). At our facility platelet transfusion for CABG is a rare occurrence, maybe 1 in 15-25 patients. They have a "point of care" instrument in the OR to help them figure out the appropriate dose, and to check on the outcome.

Don,

We are using the same amount (4 pools or 4 apheresis units = 20 plts). I am interested to know what your point of care instrument is used at your facility. Thanks!!

By 20 you mean: 20 x 0.5 x10^11 absolute count, thats 4 times the standard dose. why??

We do give plts if the pt did not have time to be put off plavix. Moreover, with AAA and on bypass open hearts we know that the plts lose their function as they "hit the clamp", but we give a standard or double dose. To see what that is the optimal standard dose (either refer to AABB or) read my review when it come out:redface:

Not to sound stupid, but when you say hit the clamp what exactly are you talking about?

They use the "GEM" in our OR's, and I'm informed that this machine gives blood gases and Hct, but NO platelet count. They have so send a sample to the main lab to get that result.

If they need plts at all our surgeons usually give them to patients "coming off the pump." From what I understand the bypass pumps sort of beat up the plts and they get activated so don't stay effective. They sometimes give 2 pheresis at the same time. If a patient goes bad, they may use more than 2 units but that would be very rare.

Not to sound stupid, but when you say hit the clamp what exactly are you talking about?

Good question: The surgeons must make the blood circulation bypass the heart and go to the bypass machine to use it as the pump instead of the heart so as to work on a quiet (asystolic) heart, so they clamp the large vessels situated before and after the heart.

Mabel is also right about the platelets losing their efficiency when in contact with the bypass machine synthetics.

Well, if this will make you feel any better:: our former cardiac surgeon requested 6 apheresis with EVERY case. Then wouldn't use them all. He wouldn't listen to me, our pathologist, our regional ARC medical director, NO ONE. All I can say I'm glad he's our former cardiac surgeon.

i would have made him a statue in gold.. because he would have increased my inventory for the other patients!!!

- - - Updated - - -

PS: no centralised BB, we are 100% reliant on ourselves.

I agree.

BTW what is one1 apheresis unit that you recieve from your supplier: is it 3x 10^11 ?

That is the minimum. I am not sure what the average is, but is higher than that. If it is 2.8 or 2.9 it is considered for pediatric use only. Our supplier sends those to us as "extras" because we have the children's hospital and can usually use them up.

Thank you to everyone who replied to this thread!!!