r/medlabprofessionals • u/Dizzy6119 • 12d ago
Discusson Blood Transfusion
So my wife recently got told their EMS company wants to start giving out blood products, Looking over the procedures it says if they suspect a transfusion reaction give the product to the receiving facility. This seems like it can cause problems with one no initial sample and accepting a unit that wasn't administered by the lab. Have any of you guys had this happen or currently deal with it? Thank you
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u/drm1125 12d ago
As a person who works in a hospital lab and does blood bank. They want the unit of blood to go to the receiving facility because the lab has to do studies on it, if there's a suspected transfusion reaction. Basically, they want to know if the unit was the blood type is said and if the unit was contaminated. Taking it to the receiving facility will keep the info with the patient that they think had a transfusion reaction. Now, it will be a bit of a pain with no initial sample but you can get a sample afterwards.
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u/Crazy-Dimension6538 MLT 🇺🇸 12d ago
I have a link to when a hospital I used to work for wrote an article on when EMS started to carry products, idk if it’s any help or will give any insight
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u/KuraiTsuki MLS-Blood Bank 12d ago
If there's a reaction during transport, the receiving lab needs the product for the transfusion reaction investigation. Not having a pre-transfusion sample is no different than when a patient gets uncrossmatched products before a sample has been collected. Or if a patient was transfused at the sending hospital and the reaction didn't start until they were mid transport.
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u/BusinessCell6462 12d ago
I’ve heard some labs are concerned about having a unit ( or remains of a unit ) that was never in the lab inventory being brought into the lab…
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u/TropikThunder 12d ago
That’s silly. The unit is going to be clerical checked and possibly tested for bacterial contamination, not given to another patient. It’s already been spiked for god sake.
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u/BusinessCell6462 12d ago
It does seem silly, but it was told to me as concerns over FDA regulations…I’ll try to find out more when next I work.
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u/KuraiTsuki MLS-Blood Bank 12d ago edited 11d ago
I work at a Level 1 trauma center where units arriving with patients is not uncommon. We just add them to our inventory and then discard them unless they're inside an unopened tamper-proof container and with the acceptable temperature range. It's that simple.
We also supply our 4 helicopter teams with blood products, but the patients don't always come to us. When they use products, but don't come to us, we electronically ship the units to the helicopter teams so they're no longer in our inventory in the LIS.
ETA: If it wasn't clear, I'm talking about unused units that come in with patients, not partially or fully transfused bags that were used during transport.
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u/TropikThunder 11d ago
The unit in question in the original OP was already spiked and transfused, and the advice was to give it to the arrival facility because of a transfusion reaction. It’s not going to be put into inventory or used on another patient so that’s why I said the “regulatory” concern was silly.
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u/DookiePootie 11d ago
Had a sister hospital in a different county in my state call and tell us we needed to do the transfusion reaction workup because we were the ones that transfused the unit that caused the reaction. Uh, no, they're your patient now in your facility, what do you mean? We can antigen type and check the pre transfusion sample if we still have it, but after that, it's all you.
People just seem like they don't want the hassle.
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u/KuraiTsuki MLS-Blood Bank 11d ago edited 11d ago
I was speaking in generality for units received with patients, not spiked units, because like you said, obviously you aren't going to transfuse that spiked unit/empty bag to someone else. The person I replied to mentioned both used/partially used and completely unused not even spiked units in their post. Their regulatory concern is indeed silly.
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u/TheRopeofShadow 11d ago
Has it been spiked? Discard.
Did it arrive in an unsecured container with no temp documentation or tracking? Discard.
Did it arrive in a secured, tamperproof container with temp documentation or tracking? Bring it into inventory.
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u/Zodnick11 SBB 12d ago
I worked for a blood center that supplied whole blood units for air evacs. The contract that was signed mandated that the flight crew had to draw a pre-transfusion sample prior to administering. Now that’s under perfect conditions and we know trauma situations are far from it.
The air company’s needed to have contracts with the hospitals to where they would accept the patient and perform the workup. The air evac nurses were to hand over the empty bag of unit(s) or if they were still being transfused the units were transferred to the lab to complete the testing once the transfusion was complete.
We had 3 or 4 different air evac bases and we never really heard any grumbling or issues, but being on staff and not upper management I’m sure there was some. The FDA and AABB have started to become heavily interested in prehospital transfusions as the years ago it was a grey area.