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Archive for the ‘Blood Bank’ Category

Massive Transfusion

As promised, see the attached Massive Transfusion Protocol Final.

Some important points are highlighted. The guideline for when a patient might need the MTP is:
· one blood volume transfusion over 24 hours,

· 50% blood volume in 3 hours

· ongoing blood loss >150 ml/min

· expected >10 pRBC units in 24 hours

Most of all, please remember, there are TWO ways to get emergent blood and they are both done by a PHONE CALL to the blood bank:
· Emergent release of blood

o This could be o-neg or type specific uncrossed blood.

o Be aware you might get O-pos blood for men and women over child-bearing years.

o Use this for unstable bleeding patients who need blood ASAP, but don’t meet the above MTP criteria

· Massive Transfusion

o Use this for patients meeting the above criteria.

o The blood bank will put an order into Epic saying which products were sent.

Pleased send a reply to me indicating that you have read and understand the policy.

Peter Shearer, MD FACEP

Written by phil

March 17th, 2014 at 3:11 pm

Emergency Release Protocol for Uncrossmatched Blood Products

1. Know the patient name and MRN
2. Call the blood bank, extension 46101
3. “This is Dr. Jones calling from the emergency department, may I speak with the blood bank supervisor or most senior technologist.”

4a. “We have a bleeding emergency, we need 2 units uncrossmatched blood immediately.”

4b. “We have a bleeding emergency, we need 4 units uncrossmatched blood immediately.”

4c. “We have a massive transfusion, we need a massive transfusion pack immediately.”
a massive transfusion pack is 4 u pRBCs, 4 u FFP, 1 platelet pack, and 1 pooled cryoprecipitate

5. The blood bank will immediately send you the products via pneumatic tube (The ED specimen desk is tube station #11), along with an emergency blood release / massive transfusion protocol form. Nothing has to be done in Epic to get the products.

6. As soon as you are able, fill out the form and send the form back to the blood bank, tube station #114. Fill out either the top of the form (emergency blood release) or the bottom (massive transfusion). The areas you need to fill out are conveniently highlighted in yellow. Signature, license number, reason for transfusion, and check the order.

ED Code Blood Scrip (pdf)

Blood Bank Emergency Release Form

Blood Bank Emergency Release and Massive Transfusion Protocol v5

Written by reuben

April 23rd, 2012 at 7:45 pm

Posted in Blood Bank

ABO Confirmatory Specimen & Blood Product Transfusion Check

March 13, 2012
Nursing Practice Alert

ABO Confirmatory Specimen

The 2nd ABO specimen practice is a patient safety measure to help prevent ABO hemolytic transfusion reactions and patient identification errors.

When this is needed, the Mount Sinai Blood Bank notifies the patient care area.

When a 2nd ABO confirmation specimen is requested,
it is important that a different person draw the sample at a different time than the first sample.

In the event of an emergency transfusion, the Blood Bank will provide type O red blood cells until the ABO blood type can be confirmed.

For any questions about this process, call the Blood Bank, x 46101.

Blood Product Transfusion Check
Requires 2-clinician independent check, each person verifying each element of the process on his/her own. Then, both must agree that all of the following are correct before proceeding.

> Check consent

> Check the blood product label against the patient’s order.

> Perform patient identification and check that patient’s name, date of birth and medical record number on the patient’s identification bracelet are identical with the Blood Product Flowsheet form #MR-151 and the Blood Product Label on the bag.

> Compare the Blood Product Flow Sheet Label with the
Label on the Blood Product. All elements must be
identical: patient name, date of birth, medical record
number, blood type, Rh and the Donation Identification
Number (DIN).

> If all elements confirmed as correct, both clinicians Sign the Blood Product Flowsheet and the blood product is administered. If not confirmed, STOP and do not administer the blood.

Nursing Education/Professional Practice x 57240

Nursing Education/Professional Practice x 57240

Written by reuben

March 18th, 2012 at 8:18 pm

Posted in Blood Bank

ABO Confirmation

What is an ABO confirmatory specimen?
ABO confirmatory specimen / 2nd ABO specimen policy has been in place at Mount Sinai since 2007. It is a patient safety measure designed to help prevent ABO hemolytic transfusion reactions due to phlebotomy / patient identification errors. Many patients have had at least two type and screens before any transfusion is ordered, and hence will never need an ABO confirmatory specimen, as their blood type has already been confirmed.
An ABO confirmatory specimen is needed only once, ever, to confirm a patient’s ABO blood type, in order to ensure the patient is given the correct blood type. An ABO confirmatory specimen is required on patients who have never had a type and screen while at Mount Sinai, and thus have no historical blood type on record to compare with the current specimen.
The only exceptions, for which a 2nd ABO is not needed, is for T&S specimens drawn in Perioperative Services (which has never had a phlebotomy error resulting in a mislabeled specimen). Perioperative Services areas that do not require ABO confirmatory specimens include: DAS, Cardiac Pre-Admission, Cardiac Cath, Ambulatory and Special Procedures.
All inpatient locations, outpatient locations, Emergency Department, Labor and Delivery, FPA and private physician offices require ABO confirmatory specimens. The Blood Bank will notify the patient care area when a 2nd ABO confirmatory specimen is needed. ABO confirmatory specimens do not include an antibody screen, and have a shorter turnaround time.
In the event of an emergency transfusion, type O red blood cells will be provided until the ABO blood type can be confirmed.

Written by reuben

January 30th, 2012 at 10:20 pm

Posted in Blood Bank

Blood Bank QI

Transfusion Services has a new director, Dr. Kathleen Leonard, who comes from another institution and is committed to improving the service we get from the blood bank. The first problem we’re taking on is the rapid procurement of un-crossmatched blood.

The blood bank cannot send blood through the tube system without a recipient defined by two identifiers; in an urgent situation, this is going to be name and MRN. In a patient who needs prompt resuscitation, if a name isn’t immediately available, a John Doe chart should be generated. This is a two-step process that involves a registrar (to register the patient) and a nurse (to triage the patient). Both of these tasks can be done in a minute or two, but in urgent cases it may be beneficial for a physician to encourage the BA and RN so that the process is expedited.

Once these steps are complete and the patient appears in IBEX, the order for uncrossmatched blood should then be put into IBEX and a phone call should be made to the blood bank (46101). When you reach the blood bank, you should ask to speak with a tech. Tell the tech that you need STAT uncrossmatched blood in the emergency department, the name age and gender of the patient, and your tube station.

If you have problems with blood bank, especially with regard to patients who need urgent products, send me the specifics so I can discuss them with Dr. Leonard.

Futhermore, Dr. Leonard told me that her cell phone is on 24/7 if you have urgent blood bank needs that are not being met. Her coordinates are below.


Kathleen A. Leonard, MD
Director, Transfusion Medicine
Mount Sinai Medical Center

Phone:    212/241-8810
Fax:         212/876-5994
BB:          917/596-0023
Pager:     917/205-5034
Cell:         516/445-3667

Written by reuben

December 6th, 2009 at 9:44 pm

Posted in Blood Bank