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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

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blood bank transfusion committee tutorial

Blood Bank/Transfusion Committee Tutorial

Marc Zumberg MD

The Shands Transfusion Committee

November 2007

  • 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

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
  • 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
  • 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
  • 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
  • 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

  • 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

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