Massive transfusion protocols may contain large numbers of different blood components all to be released simultaneously as quickly as possible:
- Packed RBCs
- Low-titer group O whole blood
For an adult, it might include 6 RBCs, 1 adult platelet dose, 6 plasma, and 10 cryoprecipitate—23 components at one time.
For liver transplant, I had a protocol with 20 RBCs, 3 adult platelet doses, and 20 plasma units—43 components in all.
Even if the blood bank software prints all of these release forms, it requires considerable time to check the identity and serial number of each unit. This is the rate-limiting step for their release to the critically ill patient.
Our clinicians wanted release within 5 minutes of ordering; however, it was physically impossible to sign out so many components within this time limit.
Medinfo has facilitated the release by offering pools of one component type (platelets, cryoprecipitate, or plasma). A pool number is generated to cover the components and this ONE number is used for release.
I would like to see the pooling concept expanded to allow multiple component types to be included in the pool. Then, at release from the blood bank, only ONE number can be used to sign out the components.
Additionally, the individual units in this mixed pool should be treated the same way as if the units had been released individually including:
- Apply all protocols for the components.
- Return individual units back into stock or discard.
- Use the mixed pool number to view the contents of the pool.
- Query using the mixed-pool number for its contents.
- Query the individual unit(s) (e.g. for look-back).
- Quarantine the unit(s) as needed.