We want to start using low titer Type A liquid plasma as our initial set of plasma with our MTP. I am having a little struggle with wording our protocol for use after the blood type has been determined. For those of you that use Type A as a universal donor, when do you switch after immediately after you discover the B/AB blood type or later in the process?  Which makes me ask the second question, how do you comply with standards 5.15.4?

Thank you everyone!

We are not AABB inspected.  We got approval from the trauma committee to use type A liquid plasma as the first two units in an emergency release or MTP. If the patient has a documented historical blood type, we have to issue them in Meditech as emergency release, otherwise the computer won't accept the incompatible type of product.  We can also issue it using paper forms.  What does standard 5.15.4 say?  I'm not finding it in my book.

Thank you for the reply. 5.15.4 addresses having a policy for limiting ABO incompatible plasma. 

To me, this would fall under the "urgent medical need" heading.  The standard you are referring to indicates only that the blood bank needs to have a policy for transfusing components with "large amounts" of ABO-incompatible plasma, not that such components cannot be transfused.  As long as this is a policy approved by the necessary departments in your facility, and signed off by your medical director, and it is  followed, my opinion is that this would comply with the intent of the standard. 

Another example of invoking urgent medical need (which I had to do on several occasions in a large transfusion service) was to approve the transfusion of platelets >5 days old when there was NO supply of platelets coming in on a specific day, and there was a patient in urgent need.  These were signed out in the BB computer system as "urgent medical need", I was called as medical director to approve the release, and we had a policy in place to cover this. As the BB supervisor was heard to say, the platelets didn't all lay down and die at MN on day 5!  Never had a recipient reaction with this practice. 

 

 

1 hour ago, MJDrew said:

To me, this would fall under the "urgent medical need" heading.  The standard you are referring to indicates only that the blood bank needs to have a policy for transfusing components with "large amounts" of ABO-incompatible plasma, not that such components cannot be transfused.  As long as this is a policy approved by the necessary departments in your facility, and signed off by your medical director, and it is  followed, my opinion is that this would comply with the intent of the standard. 

Another example of invoking urgent medical need (which I had to do on several occasions in a large transfusion service) was to approve the transfusion of platelets >5 days old when there was NO supply of platelets coming in on a specific day, and there was a patient in urgent need.  These were signed out in the BB computer system as "urgent medical need", I was called as medical director to approve the release, and we had a policy in place to cover this. As the BB supervisor was heard to say, the platelets didn't all lay down and die at MN on day 5!  Never had a recipient reaction with this practice. 

 

 

Wonderful Mary Jo.  I believe it is called pragmatism, and, as you say, as long as it is policy, it is great.