Includes registration, questionnaire, physical exam and arm check, collection, marker testing, component separation, donor immunohematology testing
This is a sample of the stem cell therapeutic apheresis form that my apheresis team and I developed. It can be readily made into an electronic form. I want to thank Dr. Saloua Al Hmissi, Apheresis Consultant, and Ms. Mini Paul, Head Apheresis Nurse, for their efforts in making this form a success.
Principle:
Use of anti-retroviral therapy as prophylaxis for pre- or post-exposure (PrP or PEP) HIV prophylaxis may lower the viral load below detectable levels.
Policy:
References:
Principle:
When you cannot establish a direct link to the live Medinfo program, you must arrange for the local Medinfo engineers to create a local server that will have the current Medinfo donor database for use at outside campaigns where the internet connection cannot be used. This can also be used if for some reason the Blood Donor Center link is down in order to register donors and check the donor deferral database.
Policy:
Note: When the offline data is uploaded into Medinfo main database, it will be checked against the latest donor deferral database. The latter will be applied for the donation.
Principle:
Performing antibody panels using both enzyme (ficin, bromelin, and/or papain)-treated and routine panel cells may be necessary to detect most clinically significant antibodies
Policy:
Example 1:
Antibody to High-Incidence/Prevalence or Public Antigen:
Reactions destroyed by enzyme (typical of anti-Ge2):
Example 2:
Antibody to high-incidence antigen, reactions unchanged or enhanced by enzyme—VERY DANGEROUS PATTERN: Examples: Anti-H, Anti-Tja (PP1Pk), anti-k (cellano), anti-U
Principle:
The development of Transfusion Medicine will include recruitment of technical staff with external qualifications, often higher or more advanced than current on-site staff who normally would make their competency assessment. This policy addresses an interim approach to making a fair, unbiased assessment of these highly qualified staff and avoid conflicts.
Definitions:
External Qualifications: BB(ASCP), SBB(ASCP), MT(ASCP), MLS(ASCP), RT, ART, AIMLS, FIBLS, or equivalent
Designated Assessor: Supervisor, SBB, Specialist Physician, or other staff designated by the Head, Transfusion Medicine to perform the assessment
Scope:
This policy applies to all initial (probationary), annual, and all other competency assessments across ALL HMC transfusion services and the Donor Center.
Policy:
References:
Standard 1.1.1. and Section 2, Standards for Blood Banks and Transfusion Services, 30th Edition, AABB.
As our hospital network expanded, there were many patients who moved between locations. They might first start in an emergency room and then be transferred to a specialty hospital. These locations might be served from different hospital blood banks/transfusion services. What happens if work is progress from one site when the new site receives the patient. Must the previous workup be repeated or could it be used for transfusion at the next site?
For example, the ABO typing could be performed at one site and the antibody screen at a second site, and the antibody identification at still another site. Could the results be used across the entire system?
I had multiple hospital blood banks and blood donor centers. The general and specialty laboratories had multiple sites. The hospital information system was set up so that the various tests could only be performed at specific designated sites. This posed problems as patients were moved around or if some site(s) became inoperative since the specimens then had to transported at great distances for testing. Only a few basic STAT tests were available at all sites.
It was my decision to allow all test categories at all sites, e.g. a DAT request from any site, any methodology, could be used to satisfy the order. Similarly, all donor processes were available at all donor centers (the processes could be completed at one or more sites). Different hospital blood banks had different equipment but all the test categories were the same across site—the methodologies might differ. We had at least four different DATs across our system.
The interface between the blood bank and hospital system worked as follows: In the hospital information system HIS, test orders pointed to a category of testing and any methodology for that category at any site could be used in the blood bank system for testing and reporting back to the HIS. Any test in a category from any site could be used to satisfy the test request. Blood bank staff would choose the particular test methodology to use. It was NOT specified by the HIS!
In summary, for blood banks and donor centers within our system, the work could be flexibly moved between sites. There was no need to repeat testing when a patient transferred to a new site. The only type the work was repeated if testing was done at an institution outside our system.
In a previous post, I discussed transfusion training for hematology fellows and general pathology residents. I have no expectations that most of them have any interest in the field so I suggested concentrating on the interpretation of the direct antiglobulin test DAT and turn-around-times for services.
In contrast, the transfusion medicine physician in-training needs to understand in detail all processes, donor and patient—especially test interpretation so that he/she can make medical decisions and variances.
During my training, I was fortunate to be in a residency training program that also had an American Specialist-in-Blood Bank SBB training program. To a large extent, I attended the SBB program and even worked on the “wet” specimens.
I had no delusions that I would ever function as technologist or SBB in the blood bank. However, that extended blood bank training has made me the physician I am. I can correlate advanced, even reference, procedures to my medical knowledge and thus provide a unique offering. In contrast, even the SBB is not a physician and cannot make the medical correlations. Recently, I was flattered at an AABB meeting when the speaker thought that I was an SBB.
In certain regions where reference immunohematology laboratories and SBBs or equivalent are rare, the transfusion medicine should have sufficient technical background to help fill this gap. In my practice, I review all antibody and DAT workups and make interpretative comments for the physicians and nursing staff. These comments are entered into the blood bank computer system.
I personally tutor the trainees and make certain that they understand potentially dangerous patterns such as antibodies to high-incidence antigens, significance of the autocontrol in panreactivity, and assessing for fatal acute transfusion reactions—both hemolytic and non-hemolytic.
It also helps when I can discuss with my technical staff my interpretations and choices for clinical management. They get a better idea how important their work is for patient care and understand how any errors may adversely affect the patient.
In regions where there are good immunohematology reference laboratories, some of this may be less necessary. I lament that transfusion medicine physicians may not maintain these skills and must rely on others to their detriment. Even if one is comfortable with this, the physician is still ultimately responsible for making the clinical decision.
Principle:
Organ donors with a history of RBC transfusion within the past three months must have ABO subgroup (weak A as detected by A2 cells and anti-A1 lectin) if the transfusion included group A RBCs.
Policy:
Reference:
Standards for Blood Banks and Transfusion Services, AABB, Current Edition, Bethesda, MD, USA
Changes to donor criteria can occur at any time. This example is the change in donor criteria for males to 13.0 g/dl based on AABB Bulletin #16-05.
I made a validation protocol, which was subsequently performed by a Donor Center Medinfo Super-User. The data was then sent to me for review and then accepted.
Note that females were included in the testing for regression purposes. Females were only permitted to donate RBCs—all other components were discarded in production. Contraindication information appears in RED.
Principle:
Any nonconforming product that is released for patient use must be reported through the official channels. Since there is no equivalent to the US CBER, this policy outlines the process for the HMC organization, the only provider of blood components for the State of Qatar.
Definition:
Nonconforming Blood Component: Any blood component not meeting the production criteria set in the policies, processes, or procedures of Transfusion Medicine. Some examples include:
Policy:
References:
Dr. Zeyd Merenkov 