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Blood Bank/Transfusion Committee Tutorial. Marc Zumberg MD The Shands Transfusion Committee November 2007. Goal. Help us to help you: Obtain blood necessary for surgeries and patient care Obtain blood in a timely and efficient fashion Obtain blood safely By:

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blood bank transfusion committee tutorial

Blood Bank/Transfusion Committee Tutorial

Marc Zumberg MD

The Shands Transfusion Committee

November 2007

slide2
Goal
  • Help us to help you:
    • Obtain blood necessary for surgeries and patient care
    • Obtain blood in a timely and efficient fashion
    • Obtain blood safely
  • By:
    • Ordering pre-operative type and screen (T&S)
    • Understanding the role of RBC alloantibodies
    • Ordering type and cross only when necessary
    • Ordering only the number of units that are needed
red cell transfusion
RED CELL TRANSFUSION

Type and Screen:

  • Used preoperatively if transfusion is possible
  • Verifies ABO and Rh type of the patient and screens the patient for alloantibodies

Type and Cross:

  • Used when transfusion is very likely or imminent
  • Compatible RBCunits secured for the patient
type and screen
Type and Screen
  • Tests for the presence of alloantibodies in your patients plasma against red blood cell antigens that may be found in the donated blood
did you know
Did you Know?
  • A T&S takes approximately 45

minutes to perform

  • If the T&S is active a Type and Cross (ie obtaining units of PRBC) only takes about 15 minutes
    • This may be delayed if RBC alloantibodies are noted on the T&S

Result: If the T&S is kept up-to-date PRBCs can be obtained very quickly

did you know6
Did you know?
  • Most delays in obtaining PRBC

in a timely fashion are due to:

    • Delays in physicians writing the orders
    • Delays in the order getting placed into the computer system
    • Delays in the pick up and delivery of the blood from the blood bank
    • The presence of alloantibodies on the T&S
      • Can be prevented if pre-operative testing is done and good communication is kept with the blood bank
slide7
Keys
  • Communicate
    • With the attending physicians and members of the medical team concerning transfusion needs for planned surgeries and ongoing patient care
    • With the ward clerks the urgency of transfusions
    • With nursing and couriers if transfusion is urgent
    • And especially with the blood bank
      • Urgency of the blood product
      • If known alloantibodies
problems
Problems
  • Preoperative Type T&S are

not always ordered

    • In the surgery clinics
    • In the anesthesia pre-op clinics
    • On the wards
  • This can lead to significant delays if alloantibodies are present and the blood type is rare
alloantibodies
Alloantibodies
  • Antibodies in your patient’s

plasma directed against incompatible RBC antigens of the blood donor

    • More common in females with prior pregnancies
    • Anyone previously transfused
alloantibodies10
Alloantibodies
  • When an alloantibody is detected

for the first time the blood bank will:

    • alert the ordering physician
    • Try to obtain 2 compatible units
  • If the alloantibody is rare then Lifesouth has to screen their stock of RBCs and rare donor registries to find compatible blood
    • If not available may have to be shipped in from other areas of the country

Please note that alloantibodies can lead to significant delays in obtaining compatible blood products

problem
Problem
  • The Crossmatch:Transfusion ratio

(C:T ratio) at Shands is too high

    • Lots of blood is being

crossmatched and never transfused

    • We are failing to meet JAHCO recommended standards and are at risk of citations
why is a high c t ratio bad
Why is a high C:T ratio bad
  • Securing blood that is never transfused is taxing on the blood bank
    • Non-transfused blood has to be placed back in the general inventory which is costly and time consuming
    • Takes time and effort away from the blood banks ability to secure blood for other cases
    • Replacement blood has to be ordered from Lifesouth when units are secured for Type and cross
solutions maximum surgical blood order schedule msbos14
Solutions: Maximum Surgical Blood Order Schedule (MSBOS)
  • Located on the back of each Blood Bank order form for preoperative blood ordering
  • The MSBOS is approved by the respective division chiefs of each service as the recommended units of PRBC to order for common surgical procedures
c t ratio goal is 1 5
C/T RatioGoal is <1.5
  • C/T Ratio = 1.0

when the number of red cell units crossmatched or setup for the patient is equal to the number of red cell units transfused

  • Many services at Shands are far over the goal of <1.5
keys pre operative ordering
Keys: Pre-Operative Ordering
  • Order pre-OP Type & Screen (T&S) during pre-surgical evaluation and lab testing
    • Blood can be ready in <15 min if a pre-OP T&S has been done and found to be antibody negative. Otherwise, the entire process takes 45-60 min.
  • Order Type & Crossmatch (T&S w/ units) at least 1 day before scheduled surgery cases which will require greater than 6 units to be transfused during surgery or if the patient is know to have an antibody.
good practice
Good Practice
  • Keep Type & Screen order current (every 3 calendar days)
  • Order blood products only when transfusion is certain to keep your C/T Ratio less than 1.5

(C/T Ratio = crossmatch to transfusion ratio)

  • Plan in advance and communicate with the blood bank for patients with antibodies to minimize delay
slide18
Goal

Help the blood bank to help you obtain blood for your patients in a safe, timely, efficient, and cost effective manner