The blood banks at my site have encountered an interesting situation, and I'm hoping someone has some insight on how to handle it.  Here's the scenario:  one hospital in our system issues blood for air transport to take with them when they leave to pick up a patient, the blood is transfused during transport, but the patient isn't transported to the same site that issued the blood.  So, assuming that the air transport was able to collect a sample, who is responsible for crossmatching the sample, the site that issued the blood, or the site that received the patient, and logistically, how do you get the sample and the segments to the same place?  Do you even crossmatch the blood at all at that point?  What if the patient is delivered to a hospital outside your system?  In my heart, I really feel that even emergent transfusions should be crossmatched eventually, but I'm not sure how to make sure it happens. 

 

Thanks in advance for any opinions!

 

Sandi

Sandi, whilst I see your problem, I have never understood the need to perform a retrospective in vitro cross-match, when an in vivo cross-match has already taken place!  Surely, under such circumstances, if the blood were to be incompatible, you would know quickly enough from the in vivo situation?

Wow - this is complicated! In thinking this through, the hospital that issued the units should already have saved the segments from the products. So it would stand to reason, that the issuing hospital should get a specimen, in retrospect.

 

Now, that may not be possible, but what if an emergency release form signed by the responsible person ordering the blood were to make it's way back to the hospital. Then, the issuing hospital would have some demographics on the patient and be able to enter that information in the BB system. I have an emergency release function in Sunquest, where I don't need to enter serologic reactions, but can "issue" blood to a specific patient. Maybe add a comment - "transfused during transport to..." That might give a little more information as to the final disposition of the product??

I'll keep thinking!

Liz

If air transport returned the used bags to the blood bank where the patient went, they could use a segment from the bag and get a specimen from the patient.  I don't know how far away the hospitals are or if it would be feasible to transport a specimen to the issuing hospital.  I agree that there should be an eventual crossmatch, if only for root cause analysis if there is a problem.

I think it is a moot point, esp if I am not involved.  The transport people should have a policy on transfusing uncrossmatched blood.  If I have given the xm'd rbcs I document the transfusion and bill for it (I check with the transported to facility to see if they have rec'd the blood).  This again is a moot point as my helicopter will not take blood unless they are going to hang it.  No room for storage and they caryy a few O Negs in case.

The blood banks at my site have encountered an interesting situation, and I'm hoping someone has some insight on how to handle it.  Here's the scenario:  one hospital in our system issues blood for air transport to take with them when they leave to pick up a patient, the blood is transfused during transport, but the patient isn't transported to the same site that issued the blood.  So, assuming that the air transport was able to collect a sample, who is responsible for crossmatching the sample, the site that issued the blood, or the site that received the patient, and logistically, how do you get the sample and the segments to the same place?  Do you even crossmatch the blood at all at that point?  What if the patient is delivered to a hospital outside your system?  In my heart, I really feel that even emergent transfusions should be crossmatched eventually, but I'm not sure how to make sure it happens. 

 

Thanks in advance for any opinions!

 

Sandi

We crossmatch blood that leaves via ambulance.  we have found in the past if the blood is "not" hanging already the receiving facility will throw the blood away so we never send blood unless its already being transfused.  If its emergency released the Dr. has signed that he takes responsibility for the uncrossmatched blood.  I do remember one instance where the patient arrived here, got a unit of uncrossmatched but was gone via helicopter so quickly that the lab did not have time to draw any blood on the patient so it was never crossmatched.  If we have blood we always crossmatched emergency released blood.

We have sent blood via helicopter/ambulance as well.  My only follow up is to be sure that the authorization for uncrossmatched blood is clearly documented.