Our institution has been fine-tuning protocols for suspected ebola patients and one of the hot topics has been point of care testing.  I thought it might be interesting to hear how other institutions are handling this topic.

 

 

No clue, but for what its worth, I have asked our Medical Director to approve a Blood Bank protocol that will say that if a sample comes into the Blood Bank and the patient is documented as a suspected Ebola patient, that we release uncrossmatched, emergency release O neg blood only. I am trying to avoid the issue of what to do with contaminated tubes and  avoid contaminated fluids (saline from manual cell washings) being dumped down our sinks. We are a small hospital in a poor community which has a large population of people from various African nations. So there is the off chance that such an infected patient could walk into our ER after returning from his/her native country.

I believe that's the route we'll be going too Karrie but we're still in a planning phase that is continuously evolving.

Guidance from our State Dept of Health has been (so far): no Blood Bank tests, and everyone gets O Neg uncrossed. 

O neg uncrossed for the BB.  As far as point of care there isn't much they can do besides glucose, blood gasses and protime and a UA .  We don't have the proper centrifuges for chemistry tests.  I guess they said our Hematology analyzer is a closed system so they could run a CBC.    We have a level 2 hood in micro to do any of the set up for a malaria smear.  They have the suit and goggles etc. with a log in Micro should a properly labeled sample come to the lab.  We have an org policy and a specific lab policy in place.

Sko - CBc may be a closed system but where does the waste go? thats a risk in itself.

UK guidance - seems despite those on telly using containment suits, it's OK for us in the lab just to use gloves and eye masks

 

https://www.gov.uk/government/collections/ebola-virus-disease-clinical-management-and-guidance

This morning we also adopted the policy of no Blood Bank testing.  Suspected Ebola patients will receive uncrossmatched O Negative packed red cells.

 

Donna

What if a patient has a transfusion reaction?!

It is interesting that they are only addressing red cell transfusion, when in reality, if they go into DIC, they will need all blood components.

haemorrhagic fever!!!

They will need all components

In the UK it seems gloved and a facemask is deemed enough protection for handling the samples and we are 'allowed' to run any as long as it is on a closed system. Looks like all the samples will be going on the analysers and EI will be done. Any open samples are supposed to be done 'with care' ie if a patient has no back group or a positive antibody screen and we can't EI.

 

I'm not sure I'm actually comfortable with this though...

It is interesting that they are only addressing red cell transfusion, when in reality, if they go into DIC, they will need all blood components.

 

We will give uncrossmatched O Negative Packed Red Cells, Group AB Frozen Plasma, and Plateletphereses of any ABO/Rh.

Edited October 15, 201410 yr by L106

What if a patient has a transfusion reaction?!

 

Oh, goodness!!  Good question, but with Ebola (hemorrhagic fever), how in the world would you tell he/she is having a transfusion reaction?  (It seems like the disease itself pretty much looks like a hemolytic transfusion reaction!)

Emory limited testing to point of care instruments in the patient's suite of rooms with testing done by laboratory personnel.  We do not have an instrument to run POC CBC so that is not an option.  We have limited testing to CBC with diff, BMP, hepatic panel, PT/INR, Fibrinogen, blood and urine cultures, and malaria in the main laboratory. 

Emory limited testing to point of care instruments in the patient's suite of rooms with testing done by laboratory personnel.  We do not have an instrument to run POC CBC so that is not an option.  We have limited testing to CBC with diff, BMP, hepatic panel, PT/INR, Fibrinogen, blood and urine cultures, and malaria in the main laboratory. 

 

 Quick! Get one... 

Sko - CBc may be a closed system but where does the waste go? thats a risk in itself.

 

 

Management and the company say that the reagents used for the CBC etc will kill anything so I guess waste isnt a worry.  Personally...I'm not so sure about any of this.  Apparently the manufacturer of the PT/PTT analyzer says the same thing- however after every use you have to call the company to come and decontaminate the analyzer before using it again.

Well I would just like to say hats off to all those people who are actually involved in caring for patients with Ebola - we're worrying about testing, but someone has to bleed the patients and set up drips - more dangerous.

Pity the industrial world only got interested after thousands of Africans had already died...........

Well I would just like to say hats off to all those people who are actually involved in caring for patients with Ebola - we're worrying about testing, but someone has to bleed the patients and set up drips - more dangerous.

Pity the industrial world only got interested after thousands of Africans had already died...........

 

Malcolm - they're doing it in full protective gear though. In the lab we are expected just to get on with it...

The transfusion reaction comment was tongue in cheek, but it should be something addressed in your blood bank's protocol.

UHC had nice webinar today...

^{Eagle eye - did they release notes from it?}

Edited October 17, 201410 yr by Auntie-D

Our current protocol states that if there are clinical symptoms or laboratory testing results that indicate that a hemolytic transfusion reaction may have occurred a pathologist must be notified immediately.  He or she will consult with the patient's physician and decide on treatment and any further action that is warranted.  In the situation involving a suspected Ebola patient, I am sure the decision would also involve the infection specialist physician.

 

I would also expect that "where do we go from here?" would depend a lot on the patient's medical condition, etc.

 

Donna

^{Eagle eye - did they release notes from it?}

it was by Emory hospital physician who accepted first two patients , back on July 30,2014.

they explained how thy treated the patient etc. I do not know about the slides or webinar itself, BUT

by end of this week they promised to post their protocols and video about PPE.  

It was excellent how they took care of those two patients and they did it so well!!!