Our blood supplier is wanting to send us some short dated irradiated units (Plateletpheresis, RBCs) as regular inventory. We do not get orders for irradited units units very often. We would have to be able to give these units to patients who do not have an order for irradiation. Is there any problems with doing this? We would not  pass on the additional irradiation fee to the patient.

Thanks,

Gerald

I would hope they would not pass on the additional irradiation fee to you - after all you are not requesting them.

 

But no, there wouldn't be any issue transfusing them to a patient not specifically requiring irradiated.

No, the blood center is not passing on the fee to us.

I don't know if this is still a requirement. At one time we had to have in our irradiated products policy a statement that it is OK to give irradiated products to persons for whom they were not ordered.

Billing: our system bills by the product code so for someone receiving an irradiated product if they don't need a credit has to be issued for the irradiated product and a bill for the unirradiated product needs to be generated.

Does anyone know if we can bill for the irradiated product if not specifically ordered for the patient?

In Meditech, PRBCs and PPH are ordered specifically: either PRBC or PRBC IRR or PRBC IRR CMV. If the patient requires such, then they are charged. If we just order it as PRBC and give an IRR unit, they are only charged for a PRBC. Usually we have more trouble the other way around-people forget to charge the right product so we get reimbursed correctly.

Yes, it's OK, but make sure that statement is in your policy that patients who don't require it may get one but won't be charged for it.

Have a care though.  Irradiation makes red cells "leaky", so they should only go to adults, in case too much in the way of potassium ions have leaked out into the plasma.

Thank you all for your responses.I really appreciate it.

We have a statement in our transfusion policies, OKed by the medical staff, stating that irradiated RBC can be used to fill an order for regular RBC for inventory control purposes. If you are concerned about billing, you can do as Mollyredone and get around the billing issue one way or another with your LIS, although with DRG patients it might be a moot point.

So Malcolm, if irradiation makes the red cells "leaky", why do we give our babies irradiated packed cells?

 

Inquiring minds want to know.

Well, it's a bit of a paradox.

 

Many of them need irradiated blood because their immune system is not well developed, and so they are more at risk of TA-GvHD, but, at the same time, irradiating makes the red cells leaky, so there is, as I say, a higher concentration of potassium ions in the plasma/SAGM than is desirable, because this potassium does their heart no good whatsoever.

 

The potassium ions do not leak out as a bolus dose, but, that notwithstanding, they leak out at a quicker rate than from non-irradiated blood, and so the irradiated blood is good for use with neonates for a short time (off the top of my head, I think it is 5 days, but I could be wrong, so don't take that as gospel), but after that should only be given to older children and adults who can stand the higher concentration of potassium ions in the plasma/SAGM.