Blood Bank Update

1. Blood Bank Update Brian Platz, MD AP/CP, BB/TM Department of Pathology Kaiser West Los Angeles June 17, 2010

2. Ordering in HealthConnectTesting/Crossmatching TATsSpecial NeedsCMV neg Leukoreduction IrradiationTransfusion Reactionsincluding TACO and TRALIInfectious Risks of Transfusion

3. Ordering in HealthConnect Ordering a transfusion involves the following: Order for Initial Blood Work Order requesting the Blood Product from the BB Order permitting the nurse to transfuse the unit

12. NOTE: A CHANGE IN WHAT I’VE SAID BEFORE We no longer can pre-crossmatch units if the antibody screen is positive….We need to have the crossmatch order in HC to process units in Cerner.

13. TYPE AND SCREEN TYPE—ABO and Rh (5minutes). SCREEN—For “unexpected” antibodies, (30 minutes).

14. Special Needs CMV Negative—Historically, based on Serology of donor, but Prestorage Leukocyte reduction is equivalent, for most situations. Used for pregnant women, intrauterine transfusion, low birth weight or premature infants, BM/solid organ transplant patients, and severely immunocompromised patients (including HIV infection). Not indicated if patient is CMV positive, (50-80% of population is positive). Leukocyte-Reduction (LR)—Prestorage LR reduces the number of white cells to <5 x 10^6/unit (>3-log reduction). Helps prevent febrile reactions and HLA alloimmunization. Irradiation—Treating a unit with 2500 cGy of gamma radiation destroys the lymphocytes ability to divide. The ONLY purpose is to prevent GVHD. Used for Directed donations to family members, HLA-matched platelet tx, intrauterine tx, organ transplant patients

15. CMV Negative Serologic test not 100% reliable— A “negative” unit can actually be positive either because of the window period, or because the antibody titer becomes undetectable. Leukoreduction— Appears to be as effective. Some Suppliers (ARC)— No longer supply them. THUS, When “CMV-negative” is requested, we will supply Leukocyte-reduced. If you really, really want CMV-seronegative units, you must call the blood bank.

16. Leukocyte Reduction “Pre-storage” Performed under controlled conditions, over a specified period of time, at a cooled temperature. Greater than 3-log reduction in lymphocytes. “Before-issue” Run through a LR filter in the lab, before being picked up. (We don’t do this here. I’ve never worked somewhere that did this) “At the Bedside” Run through a LR filter while being transfused to the patient. NOTE: a Leukocyte-reduction filter is different from the “microaggregate” filter that is used for all cellular products.

17. NOTE: A CHANGE IN WHAT I’VE SAID BEFORE When you order “Fresh Frozen Plasma,” you may not actually get it.

18. FFP Separated and frozen within 6 hours of donation. Prevents degradation of the “labile” factors (V, VIII). Must be used within 24 hours after being thawed. After 24 hours, must be destroyed or relabeled as Plasma, thawed Can be stored and used for up to 5 days.

19. Degradation of Coagulation Factors in FFP

20. Transfusion Reactions

21. Transfusion Reactions (Cont)

22. TRALI v TACO

23. Infectious Disease Risks

24. Keeping It in Context…

25. Donor Testing Donor tested for (antibodies): anti-HIV 1/2, anti-HCV, anti-HTLV I/II, anti-HBc Donor also tested for: HBsAg, Serologic Test for Syphilis Donor also tested for (Nucleic Acid Testing, NAT): HCV RNA, HIV-1 RNA, WNV RNA Donor also tested for anti-CMV, unless they are known to be anti-CMV positive.

26. Anybody New to Kaiser WLA? “Double-Check” system for ABO typing

27. brianplatz.com