Category: Teaching

Teaching medical and technical staff transfusion medicine

Physician Comments in Medinfo

drzeyd

Principle:

There are several different types of comments in HIIG:

  • Donor Global
  • Patient Global
  • Analytical Comments
  • Result Comments

Physicians may enter any of these comment types.  Comments may be entered before or after a test is authorized/verified.  If entered after authorization, the test must be modified to accept the comment.  Only result comments are visible in the patient’s medical record.

Policy:

  1. Physicians should use comments in the following situations:
    1. Interpretations of DAT, antibody identification, ABO discrepancies
    2. Instructions for the selection of specific and/or modified blood components
    3. Donor eligibility issues (e.g. donor marker testing abnormalities and disposition)
    4. Donor reactions
    5. Telephone call documentation
    6. Donor counseling documentation
    7. Any special instructions to staff
    8. Any other situation where the transfusion physician determines it is desirable to enter a comment
  2. Copy all result-comments and also enter then as global comments against the patient or donor record as applicable.

Procedure—Patient Result Comments After Results are Authorized/Verified:

Sign into HIIG and select Patient module, Patient Consultation, and enter the patient hospital HC number.

Comments in Medinfo Hematos IIG

drzeyd

This post is the policy for using comments in Medinfo software.  A subsequent post will show the process of entering comments.

Principle:

There are several different types of comments in HIIG:

  • Donor Global
  • Patient Global
  • Analytical Comments
  • Result Comments
  • Contraindication Comments

Global Comments appear on the first main screen of either the donor or patient record.  The presence of comments is indicated by a bar at the bottom of the screen (in yellow or blue saying Presence of Comments.  Double-clicking opens the list of entered comments.

Examination/Results Comments appear only when you open the result to which it is attached.  You must know in advance to which result they are linked to find them.

Contraindication Comments appear when entering a donor deferral code

At HMC, we will enter examination/results comments again as global comments (donor or patient) so it is easy for staff to retrieve them and see them with all other comments.  You can do this by cut and paste.

Physicians may enter any of these comment types.  Comments may be entered before or after a test is authorized/verified.  If entered after authorization, the test must be modified to accept the comment and require a special password (not the user sign-into HIIG).  Only results/examination comments are visible in the patient’s medical record.  Global, analysis, and contraindication comments are visible only in HIIG!  Donor comments are only visible in HIIG.

The presence of comments documents physician review of abnormal results as required by the various accreditation standards.

Policy:

  1. Only designated staff may enter comments.
  2. Comments entered after authorization/verification of results will modify the donor/patient record and require a special, high-level password distinctly different from the normal user password.
  3. Enter comments in the following situations:
    1. Telephone call documentation (e.g. critical values).
    2. Interpretations of donor or patient test results, transfusion reactions, etc.
    3. Instructions for the selection of specific and/or modified blood components
    4. Donor eligibility issues (e.g. donor marker testing abnormalities and disposition)
    5. Donor reactions
    6. Donor counseling documentation (e.g. donor counseled at 0930 on 24/3/14 about his abnormal result).
    7. Any special instructions to staff
    8. Any other situation where the transfusion physician/supervisor or designate determines it is desirable to enter a comment
  4. Copy all results/examination-comments and also enter then as global comments against the patient or donor record as applicable.

References:

  1. Standards for Blood Banks and Transfusion Services, Current Edition, AABB, Bethesda, MD, USA
  2. Workflows 1001-1005, Medinfo Hematos IIG, 2013-2014.

Documenting Physician Review of Abnormal Results

drzeyd

International accreditation standards require physician review of certain abnormal results such as transfusion reaction and antibody workups.  This post describes how such review is documented in Medinfo Hematos IIG dedicated blood bank software.

In general there are three main ways to do this:

  1. User ID associated with each transaction
  2. Comments against results, analysis, or globally
  3. Physician direct entry of results (e.g. transfusion reactions)

This applies to all modules of Medinfo, including donor and patient.

User ID:

The system records the User ID of the staff member who performed an action—this includes the authorized transfusion physicians  This covers everything in the system, donor or patient.  However, it may require a specific query by user ID to list all of that person’s transactions.  This is not easy to show an external assessor/inspector unless the query is performed in advance.

Comments:

For those cases requiring review, comments can be placed with the results, which will be visible to anyone viewing that record.  Additionally, internal comments can be added to the analysis and globally within the record.

Direct Physician Entry of Results and Interpretations:

For transfusion reaction workups, physicians may directly enter their interpretations and results in the system.

Subsequent posts will show how comments and direct physician entry of results are performed in the system.

Transfusion Medicine Lectures for Pediatric Fellows

drzeyd

In my time at the Saudi National Guard Health Affairs and at HMC Qatar, I offered the pediatric fellows a series of lectures of 1-2 hours duration.  The following list has been updated to cover current topics of interest, including COVID-19 convalescent plasma.

  1. Transfusing blood components for physicians—what do you need to know
  2. Recognizing and treating adverse effects of transfusion
  3. Blood components and derivatives—what you need to know
  4. Blood filters, irradiation, aliquoting, and washing blood components
  5. Pathogen inactivation and platelet additive solutions
  6. COVID-19 and the blood supply, COVID-19 convalescent plasma
  7. Indications for blood components and monitoring efficacy
  8. Patient blood management:  minimizing transfusions
  9. Blood group serology and compatibility—what you need to know
  10. Adult vs. pediatric transfusion medicine:  special considerations for the pediatrics
  11. Hemolytic disease of the fetus and newborn
  12. Rh immunoprophylaxis:  RhIG, fetomaternal hemorrhage
  13. Platelet refractoriness:  prevention and treatment
  14. Hemoglobinopathy:  component selection for pediatric patients
  15. Therapeutic apheresis, focused on pediatric age group
  16. Stem cell transplantation
  17. Transfusion-transmitted diseases
  18. Emerging pathogens:  ZIKA, Chikungunya, Dengue

25/2/21

Blood Component Transport Temperature Monitoring

drzeyd

Principle:

Blood components must be maintained at specified temperatures to avoid hemolysis, bacterial contamination, and maintain full efficacy (e.g. coagulation factor activity.)

Policy:

  1. Freshly collected whole blood for blood component preparation must be kept between 20-24C if  platelets are to be made.  Otherwise, it must be maintained between 1 and 10 C.
  2. Prepared RBCs and thawed plasma must be transported between 1 and 10 C.
  3. Platelets (pools and apheresis), thawed cryoprecipitate, and granulocyte concentrate must be transported at 20-24 C.
  4. Frozen components (frozen RBCs, FFP, FP24, cryoprecipitate) must be kept frozen during transport.
  5. There must be an appropriate means of documenting that the proper temperature was maintained.  Examples of compliance may include:
    1. LCD stickers that change color if the component goes outside the selected temperature range.
    2. Digital temperature recording systems—Examples:
      1. TempTale ® or other temperature recording devices (added to a transport container without a temperature-controlled container)
      2. Temperature controlled transport containers with integral recording systems
      3. The recording session for each transport episode should be downloaded, reviewed and saved.
  6. If the temperature goes outside the specified temperature range, the components cannot be used for transfusion or manufacture.
  7. All devices must be validated to meet their specified temperature-recording capabilities before being used.
  8. Specific SOPs for the use of the selected monitoring devices must be prepared and in use.

Note the different temperature ranges for refrigerated components stored in the blood bank (1-6C) versus transport (1-10C).

References:

Section 5.6.5, Standards for Blood Banks and Transfusion Services, Current Edition, AABB, Bethesda, MD, USA

DAT-Positive Hemolytic Anemias

drzeyd

This is a helpful Medscape diagram showing causes of direct-antiglobulin-test-positive hemolytic anemias.  Note that not all cases of the conditions may consistently be DAT-positive, especially the ones that fix complement.  Again, a negative result means non-detected, not necessarily not present.

In my own test algorithm, if hemolysis is suspected, I would perform monospecific IgG and C3 DATs.  I might also include a special DAT card detecting both C3c and C3d and heavy-chains mu (IgM) and alpha (IgA) if the initial DAT is negative.  C3c positivity would tell me that active complement activation is occurring.