Pretransfusion and Blood Adminstration Flashcards
What does AABB require on a pre-transfusion specimen?
Blood request and specimen must match exactly
The specimen must have 2 unique identifiers
-Can be name and DOB or name another unique number
There should be a mechanism to identify the date and time collection and who collected the specimen but does not need to be on the tube if in electronic record
Label must be complete, accurate, and legible
What does CAP require on a pre-transfusion specimen?
CAP required 2 identifiers plus when sample was collected on specimen
How long should specimens be stored?
Specimens should be stored for at least 7 days after transfusion at 1-6C
A segment from the unit must also be saved.
What products require pretransfusion testing?
Whole blood, RBC’s, granulocytes or any component containing more that 2 mL of RBC’s require a TS
What is included in pretransfusion testing?
ABO/Rh (weak D not required)
Antibody screen to detect clinically significant antibodies that includes 37C incubation and AHG phase
*Autologous transfusion only needs ABO/Rh
How long is a pretransfusion good for?
If a patient has been transfused or pregnant in the past 3 months a TS is for 3 days with the day it was drawn being day 0
What is reviewed in the patients historical record?
ABO/RH Difficulty in blood typing Clinically significant antibodies Adverse events to transfusion Special transfusion requirements
Can Rh positive blood be given to an Rh neg patient?
Rh neg should be transfused when possible
Facility must have a procedure for giving Rh positive blood to an Rh negative patient
This includes transfusion of plt’s that might contain small amounts of RBC (important for women of childbearing age)
How can the 2nd ABO be determined?
- Test a 2nd current sample
- Compare with previous records
- Retest the same sample IF patient verification was done using an electronic system or other process to prevent miss identification
What testing is required for a crossmatch?
Must confirm ABO and Rh type of D neg units (Not Weak D)
If no clinically significant antibodies are detected and no record of antibodies; at minimum a detection of ABO incompatibility must be preformed
What is required for an electronic XM?
Computer must be validated to detect ABO incompatibility and must have logic to alert user of discrepancies
System must have Donor #, component name, ABO/RH, confirmation of ABO/RH, 2 unique patient ID, Patient ABO/RH, ABS results and interpretation of compatibility
Possible causes of an incompatible IS XM?
ABO incompatible Donor is polyagglutinable Anti-A1 in patient RT allo antibodies Rouleaux Auto antibodies (Anti-I) Patient has passive Anti-A or anti-B check if patent massively transfused or rec'd PLT's
Possible causes of an incompatible AHG XM?
Donor cells have positive DAT
Dosage effect causes antibody to be missed
Antibody to a low frequecny antigen
Passively acquired anti-A or anti-B; check TRN HX
What is the requirement for donor units with clinically significant antibodies?
Antibodies are usually lower titer that anti-A and -B that is present in Group O frequently given to non Group O patients. Packed cells have little plasma and additive solutions dilutes antibody more.
Must have policy of how to handle this. Can wash RBC or antigen type patient.
What is required for Neonatal transfusion?
A pretransfusion sample should be collected to determine Baby’s ABO/RH (only forward type)
Mom’s specimen can be used for ABS
If same hospital stay and less than 4 months of age a 2nd specimen is not required
XM is not required; provide XM compatible or antigen negative
What is required to give non Group O blood to neonates?
Must test neonate for anti-A or anti-B in the AHG phase to determine if maternal antibodies are present
What is required for massive or emergency transfusion?
Must have ABO on current sample to give non Group O RBC’s
Must have a policy for when patients blood volume is replaced in 24 hrs and for release of blood before testing is complete.
Records should have a signed statement from DR. indicating emergency release of blood
Blood must clearly indicate uncrossmatched
What must be on the blood ID tag?
The intended patient with 2 identifiers
Donor ID number
Interpretation of compatibility testing if preformed
What should be checked upon issue of blood components?
The patients 2 identifiers and ABO/RH The donor number and ABO/RH Interpretation of XM Special transfusion requirements The expiration date and time Date and time of issue
What must be done before blood administration?
Verify order for transfusion Obtain informed consent Pre medicate in needed Obtain venous access Check vital signs
What size of needle should be used for blood transfusion?
18-19 g for a adult
21-23 g for a child
What must be on the informed consent?
Description of risk, benefits, and treatment alternatives
Opportunity to ask questions
Right to accept or refuse
Blood bank medical director must participate in developing process for consent
What does lactate ringers do if used to transfuse blood?
The high level of calcium in lactated ringers may overcome the citrate in the blood and cause the blood to clot or look like jello
What will dextrose do if used to transfused blood?
May cause cells to swell or lyse
What fluids are acceptable to be transfused in the same line as blood?
0.9% NaCl
Plasma
5% albumin
plasma protein fraction
What type of filter should be used for blood transfusion?
Sterile, pyrogen free transfusion set
Read package inserts carefully
Most filters are 170-260 micron
What is a microaggregate filter?
NOt used for routine blood transfusion and never for PLT’s or granulocyte transfusion
Filter is 20-40 microns
Typically used for cell saver
What is the suggested infusion rate for adults?
Red cells is 150-300 mL/hr
FFP/PLT’s is 200-300 mL/hr
Granulocytes is 75-100 mL/hr
Transfusion should be completed in 4 hours
What is the suggested infusion rate for pediatrics?
RBC's = 2-5 mL/Kg/hr FFP/PLT's = 60-120 mL/hr Granulocytes = 65-100 mL/hr
How should blood utilization be monitored?
ordering practices patient identification sample collection and handling near miss events usage and discard appropriateness of use usage and discard appropriateness of use blood admin policies the ability to meet patient needs compliance with peer review recommendations clinically appropriate lab results
Who requires transfusion audits?
Required be TJC and CMS
Facility should have a defined policy for scheduling audits
What is required for IRL to be a member of ARDP?
IRL must do at lease 1 of the following annually
-Ship 15 units to other labs through ARDP
-Register 10 donors in ARDP
-Provide antisera for identifying rare donors
-Preform at least 1 family study to identify rare donors
AABB accredited IRL’s serves as a portal for other facilities
How do you locate rare donors?
Screen donors at random or focus on specific ethnicity if known
Can prescreen donors with anti-c and and anti-e to find R1 and R2 donors and perform full phenotype
Generally screen Group O donors but can screen group A
What qualifies as a rare donor?
High prevalence antigen negative
multiple common antigen negative
IgA deficient donors
What defines a high prevalence negative donor?
Can be any blood type
Antigen negative must occur in less 1 in 1000
Must provide the phenotype of the common antigens and negatives should be confirmed by TWO sources when possible
What defines rare donor of multiple common antigen negative blood?
Only group O or A and K-
R1, R2, R0, or r and negative for one of each Duffy, Kidd, and Ss
R2, R0, or r and Fy(a-b-)
Antigen negative much be confirmed by two sources
What qualifies as an IgA deficient donor?
Level of IgA is <0.05 mg/dL
Must be performed on 2 samples from 2 separate draw dates and must send copies of test results
All ABO types accepted
ADRP will confirm IgA testing
Which antigens is molecular testing required for?
hrB-, hrS-, V-, VS-, U-, Do(a-) and Do(b-)
Which antigens is molecular acceptable as the sole source for testing?
Hy-, Jo(a-), Js(a-), and Lu(a-)
If serological antisera not available
