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:
–
–
–
–
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 RBC units secured for the
patient
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?
• 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 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
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
• 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
• 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
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
• 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
• 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 (MSBOS)
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 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
• 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
• 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
Goal
Help the blood bank to help you
obtain blood for your patients in a
safe, timely, efficient, and cost
effective manner