When a patient has a warm autoantibody for whom you can't produce crossmatch compatible blood do you notify the ordering physician, require that they sign of on giving the transfusion or just turn it out as incompatible (least or otherwise) and notify the nurse or doctor without any documentation?

We give formal notification via a copy of the reference lab report (always after the fact for the final report) and the physician signs for incompatible units prior to transfusion. When they are required to sign for incompatible units they usually become much more conservative with transfusion and look for any other method possible to avoid it.

This process turned into a huge debate at my institution when I was going through procedure review and updates last year. When we have least/incompatible blood to release, the patient's physician is notified and documentation is made in their record of the notification. The physician is also required to sign a release (same form as our emergency release documentation) prior to the release of the blood, unless it's an emergency situation where the physician is simply notified of the circumstances, blood released and paper signed after the fact. The medical director is notified the next working day unless there's a conflict where they need to be notified sooner. If it's not an emergency transfusion the patient's history should have a comment indicating least/incompatible blood is acceptable, or a reference consult or for brand new cases there should be a supervisory level review.

We require approval from the ordering physician and our on-call pathologist. This approval is documented on our transfusion record. Also, the ordering physician must sign the transfusion record marking the reason for giving incompatible units.

When a patient has a warm autoantibody for whom you can't produce crossmatch compatible blood do you notify the ordering physician, require that they sign of on giving the transfusion or just turn it out as incompatible (least or otherwise) and notify the nurse or doctor without any documentation?

We notify the ordering physician and require a physician to sign a serological incompatible units.The serological incompatible units order can be signed by physician electronically.

- - - Updated - - -

When a patient has a warm autoantibody for whom you can't produce crossmatch compatible blood do you notify the ordering physician, require that they sign of on giving the transfusion or just turn it out as incompatible (least or otherwise) and notify the nurse or doctor without any documentation?

We notify the ordering physician and require a physician to sign a serological incompatible units.The serological incompatible units order can be signed by physician electronically.

we have a protocol in our hospital that in such cases the least compatible unit is arranged and all the reactions and their interpretation are written on the x-match request- Blood bank work up section with recheck done by pathologists.

instructions to transfuse under strict clinical observation after the treating doctor signs the note by blood bank as acknowledgement that he is aware of the risk associated .

We send WAAs to our blood center reference lab. Usually we are provided blood that is compatible after absorption.Once in a while just phenotype matched if the situation is more urgent. Either way, the physician has to sign an incompatible release form.We will fax it to them and they can fax back, or give a copy to the nurse so the doc can sign when making rounds. Several of the hem/onc docs are proactive and come and sign the form before we even have the blood, just so they don't have to do it later. One release works for the entire admission. If they leave and come back we require a new release be signed. A pathologist can approve letting the physician sign the form after the fact if they have personally discuseed the situation with the MD.

At our hospital we would report out the transfusion as 'least incompatible' and require teh ordering physicians signature on designated form before units would be allowed to be given out. If a physician is not available the form can be signed by two witnesses-one who actually heard/witnessed the ordering physician indicating his o.k. to give blood product that is not entirely compatible.

At our hospital, we don't call these units "least incompatible", they are labelled as "best matched" units. The physician / treating consultant usually refers such cases to a hematologist. Usually they try to put off transfusion as long as possible, but if imminent, one of them must sign a consent for release of such a unit. If they order a next unit then another consent is again taken, just so that the treating physician is in the loop, lest a nurse make a mistake and order for next unit to be released for transfusion based on the previous hb record.