BB Protocol 1 Flashcards
CRAS & Phone ward? (4)
CRAS: Ab+
Phone ward: Ab+, XM+, D- after unmatched issuing
ABO current-history discrepancy? (3)
1.Repeat with same sample
2.Repeat with new sample
If 2nd = History, hold last 6h T&S & repeat those without history
If 2nd = 1st != History, confirm patient identity with ward, deactivate ABO history, report T&S, inform Hematologist & SMT
Inform hematologist? (7)
- ABO anomaly / current-history discrepancy
- Mixed field
- Need blood before AbID / Phenotyping finished
- Issue Incompatible-IAT before hematologist Authorize
- HB<7, AutoAb case, Phenotyping done but unit not requested
- D+ unit to D- patient
- TR discrepancy
hematologist review? (4)
- Request >2 D- RBC / week
- Request D- PLT
- Reserve >8 PLT
- Rare blood group
Autologous? (2)
- Physician should confirm with RC first
- Autologous units are separated & should not be transfused to other patients
Post-BMT? (2)
- ABO depends on both the donor & the recipient
- RBC should be irradiated +-CMV
Storage time? (3)
Patient T&S sample: 21d, discard 1 week each SUN
Pilot segment: 40d
Hardcopy (WS, Report, IQC): 4y
TAT? (2)
Unmatched O: 5min
Unmatched group-specific: 20min
T&S: Urgent = 1h, non-Urgent = 2h, Ab+ = >2h
PAC? (2)
- PAC form is required for registration
- If Ab+, Repeat T&S <2d before OT
- PAC case is valid till OT+1 / 14 days, after 12th day, extension by 1 day is possible
Demographic? (1)
Merging UC to HKID is not acceptable.
Product recall? (1)
BST done for day 2 PLT
day 3 PLT release to BB
day 3 ~ 4 BST become + / Donor sick
Shift MT should check email at the end of each shift
Product Lookback? (1)
Donor NAT- become NAT+ in later testing due to viral window period.
Recipient should be informed
Emergency release? (1)
units without BST & NAT are released to BB due to shortage of supply
TR & TI? (1)
Transfusion reaction is investigated using pre, post, and used bag of unit.
Transfusion incident is reported through AIRS by both BB & ward.
Rare blood group & special phenotype (2)
Rare blood group: ParaBombay
Special phenotype: unit required for Ag-Neg / Phenotype matched has a chance of <1/1000 when picked randomly. Ag distribution program is available for this calculation
Used blood bag? (1)
Stamp transfusion note
PCA sign, MT sign
blood bag store at 4C
discard after 1d
OT delivery & return? (1)
OT 0900~2030 MON~SUN (~1800 if PCA on leave)
unit return? (2)
- PI173
- Fit unit if it meets storage condition (leave 4C within 30min for RBC, within 2h after issued for PLT, always unfit for plasma & CRYO), & actual condition (cold to touch for RBC, not cold to touch for PLT)
Collection of unit? (3)
- RBC >1 unit is for OT only
- 1 container for each unit type
- ice pack can keep 4C for 150min, validation annually
- downtime bearer memo PR40
- IAT-incompatible PI335, Unmatched PI337
ABO anomaly? (3)
- Confirm patient ABO / Transfusion / BMT history with ward
- New sample for Ix during office hour
- Refer to RC when necessary
- Report Unknown & AbID pending
reserve IAT-compatible O RBC (request RC in case of Bombay/ParaBombay)
issue AB plasma if required
issue AB PLT / other group without Anti-A & Anti-B PLT if required (AB PLT only for <1y) - ABO will be Authorized with T&S remark indicating subtype, FXM / CXM of group-matched / O RBC according to the remark
Weak / Partial D? (2)
- Regard as Rh- before confirmation
- For confirmed partial D, considered as Rh- as recipient but Rh+ as donor
Unmatched blood? (4)
- PI337
- Unmatched O can be issued without T&S sample
- O- to
Anti-D induced HDFN
> Rh- with Anti-D
> Rh- young female
> Rh? white young female
> Other Rh-
#O+ can be given with physician consent - For Group-specific, ABO is done by tube method, including 2nd ABO
ABO Rh consideration for PLT & Plasma? (7)
Plasma / CRP
1. Same group > ABO-compatible > AB
2. Rh irrelevant
PLT
1. ABO identical / plasma compatible for <1y
2. Any group, LT <6 unit / d for plasma ABO-incompatible
3. AB PLT for Unknown ABO
4. Rh+ PLT to Rh- require physician consent
CRYO
1. Same as PLT but Rh irrelevant
PLT & Plasma request? (3)
- Unlike the 3d validity for RBC, T&S record in CMC is always valid for issuing PLT & Plasma
- After reporting, PLT is reserve till stated date, Plasma is 7d, CRP/CRYO is 3d
Thawing Plasma & CRYO? (2)
Thawing start after receiving PI174 by fax
Plasma: Thaw 20min, store at 4C, used within 1d
CRYO: Thaw 5min, store at RT, used within 4h
Blood reservation for adult and <120d? (7)
Adult:
3d & <T&S&unit expiry
<120d:
1. ABO-compatible with both mom & baby
2. 2359 of T&S&unit expiry for Minipack
3. max. 3d, <T&S expiry / <=5th day of unit collection for WB
4.test infant plasma for Anti-A,Anti-B for cases with non-group specific transfusion
5. If baby Rh+ mom Rh-
-If DAT- & Mom Ab screen-, reserve Rh- ABO compatible / Rh+
-Otherwise we must reserve Rh- ABO compatible until Anti-D induced HDFN is rule out
Theoretically Rh+ is not problematic only when baby & mother are both Rh+
6. For abandoned baby, determine Rh based on baby’s plasma DAT & Ab screen. reserve group O.
T&S validity is 1100 at 3rd day, which sometimes determine the RBC reservation validity, can I extend the RBC reservation validity? (1)
Yes.
The 1100 can be extended to 2100 if necessary, T&S validity is extended accordingly
I request special RBC unit from RC, 3 hours later the unit arrived, can I perform FXM using plasma from the same T&S sample? (1)
Yes.
As long as the plasma quantity is sufficient & collection time <1d
Storage temperature of RBC, Plasma/CRYO/CRP, and PLT? (3)
RBC: 2~6C
Plasma/CRYP/CRP: <-30C
PLT: 20~24C
Visual inspection of unit? (6)
- Donor blood group (verification)
- Any leakage
- Any abnormal appearance
- Large blood clot
- Discoloration
- Missing administration port
T&S validity? (3)
If Ab-:
3rd day 1100 (start from day 0)
For infant <120d, 119th day 1100 (start from day 0)
T&S valid = CXM issue ok
For Extension of T&S validity, patient should be Ab-, No transfusion & Not pregnant within 3m. Max. extension is +3days each time, & should not exceed 12th day. PI334.
Ab+, new case, AbID pending, compatible-IAT not available, what would you do? (1)
Inform ward, if blood is required as emergency, group-matched least incompatible blood may be issued.
Ab+, old case, what would you do? (1)
Reserve random/Ag-/Phenotype matched compatible-IAT according to T&S remark.If T&S remark said AIHA case, reserve phenotype-matched incompatible IAT according to phenotype described (/self-performed phenotyping result?). Ask physician to sign PI335
baby case Ab status? (1)
baby plasma DAT+, mom plasma Ab screen- = Ab+
DAT turn -, Ab turn - automatically
Ab screening? (3)
- Panel cell 1&2 included Rh, Kk, Duffy, Kid, MNSs, Lewis
- Panel cell 3 is Mur+ for Anti-Mi detection
Special consideration regarding Rh
- Rh- Anti-D -, consider Rh- for pregnant women only
- PLT Rh- is usually not available, for patient with Rh- Anti-D - , consider RhIg to prevent immunization, for patient with Rh- Anti-D +, Rh Ag in PLT is insignificant so HTR probably won’t happen.
