

Recruitment and Collection
Principle:
This policy is based on the 19/1/21 CBER document Updated Information for Blood Establishments Regarding COVID-19 Pandemic and Blood Donation.
Policy:
Note that these rules do not address the special case of COVID-19 convalescent plasma donors.
References:
Updated Information for Blood Establishments Regarding the COVID-19 Pandemic and Blood Transfusion, CBER, US FDA, 19/1/21
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:
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:
References:
Principle:
Therapeutic phlebotomy is a medical procedure that requires a written physician’s order and review/approval by a transfusion medicine physician. Transfusion Medicine is responsible for the procedure and makes the final decision of the conditions of the procedure (volume of whole blood and venue).
Policy:
References:
Standards for Blood Banks and Transfusion Services, Current Edition, AABB, Bethesda, MD, USA.
Annual Review: Therapeutic Phlebotomy Criteria and Treatment Goals
This a revised version of a previous post for the processes of autologous transfusion that I developed at HMC Doha. It can serve as a template for other sites and was also a teaching document for the Transfusion Committee members.
Background:
There are four basic types of autologous transfusion: preoperative, perioperative hemodilution, intraoperative, and postoperative drainage/collection. The use of all of the above techniques can significantly decrease the need for homologous blood and as an added benefit reduce the risk of the disease transmission and immunosuppressive effects of such homologous transfusions.
Preoperative collection can make available packed red blood cells, whole blood, platelets, FFP, and/or cryoprecipitate. However, at most two units of blood per week can be collected. RBC’s can be stored for up to 42 days in the liquid state, frozen RBC’s up to ten years, platelets up to five days, and fresh frozen plasma and cryoprecipitate up to one year. The last collection cannot be less than 72 hours prior to the surgery time. Units can be collected as long as the patient’s hematocrit remains above 33%. Supplemental iron and erythropoietin can increase the number of units harvested. The biggest obstacle to using this service is the coordination of the patient scheduling for this procedure. The blood bank does not have the resources to prospectively analyze the surgical scheduling and make the various appointments, contact the attending physician, etc. Thus, this service is vastly underutilized.
PHD or Perioperative hemodilution (also called acute normovolemic hemodilution) is useful in cases when the anticipated blood loss is at least one liter and the initial hematocrit is at least 34%. This includes essentially all types of surgery, but in particular cardiac, vascular, orthopedic, and urologic cases. The patient’s hematocrit Hct. is lowered to the range of 20-25% and the blood is replaced by crystalloid in a ratio of 3:1–i.e. three times as much fluid as blood, or in the case of colloid replacement, a 1:1 ratio of colloid plus 0.5 to 1.0 ml. of crystalloid. Crystalloid has the advantage of being readily removed by diuretic use. However, this technique should not be undertaken when vascular access is inadequate or appropriate monitoring devices are lacking. The physician performing PHD must be familiar with the compensatory mechanisms normally invoked when the hemoglobin is acutely lowered.
Another new twist to PHD is the perioperative collection of platelets by a special attachment to a cell-saving machine. This could allow collection of a typical apheresis load, about 6 to 10 units of fresh platelets for potential use. There are currently studies underway to determine if this has particular clinical advantages to warrant the additional cost.
Intraoperative salvage may be performed with a number of canister or automated devices. The latter is usually used when there are large volumes (usually 3 or more units) of blood to be salvaged. Depending on the body site, the recovered material is at least filtered and may or may not be washed. Care must be taken to collect the blood at a low suction rate and with minimal turbulence to minimize hemolysis.
Postoperative drainage collection of certain sites such as post-knee replacement surgery or chest wounds involves a canister collection device. This blood may or may not be filtered before reinfusion.
Note that perioperative and intraoperative material can only be transfused up to six or eight hours at room temperature or 24 hours if refrigerated at 1-6 degrees (depending on the method used) post collection to minimize the risk of infection. Intraoperative collection may be contraindicated in cases of cancer and if the bowel has been violated.
Other Issues:
The transfusion criteria for autologous blood is the same as for allogeneic units.
The same compatibility testing algorithm applies both the autologous and allogeneic units.
Policy:
References:
When I started my COVID-19 convalescent plasma CCP collection in early March, 2020, there were few antibody tests available. However, I anticipated that eventually we would want to include antibody results with the donor record. Antibody results were not used originally at all in the criteria for CCP acceptability for release.
There are many assays by type of antibody (total, IgG, IgA, IgM) and quantitation by titer and/or signal-cutoff ration S/CO. Any of these parameters may be used to define rules for acceptability to complete production and/or allocate to patients. Instrumentation used for titering/quantitation may be interfaced to the blood bank software.
Here is my generic approach to including these results with the donation record. In Medinfo HIIG, it is possible enter test results retrospectively and these can be used set rules for acceptability. Please consult with my detailed post on using rules against parameters.
All of this is easily implemented since all test information will be stored as parameters. From these parameters we can construct rules for:
Also, one can override the rules if the clinician and the transfusion medicine physician agree. For example, there is a severe shortage of group B CCP so use of low-COVID-antibody titer group B CCP could be allowed.
The key is to build whatever test methodology you use and include the manufacturer’s cutoff for low versus high titer interpretation. These results can be printed on the ISBT label as well. One can easily build multiple methodologies and acceptability criteria if different tests are used at different testing sites in your system—just as can be done for other tests (ABO/D, antibody screen, etc.) If one changes methodologies in the future, Medinfo will still use the same rules that applied for the day of production.
Here are some sample test rules:
Example 1: Total COVID antibody > 160 is high titer:
Example 2: IgG antibody with S/CO ratio > 12 is high-titer:
Example 3: IgG and IgM antibodies must have S/CO > 12:
Another option would be just to record the quantitation for each antibody type and list this on the ISBT label and permit its release regardless of the value. One could also permit low-anti-B titer group A plasma with whatever rules you set up.
This is the early Qatar experience of treating severe COVID-19 using locally produced Covid convalescent plasma CCP. At that time, the plasma was not tested for SARS-CoV-2 antibody levels.
https://drzeydbloodbank.files.wordpress.com/2021/01/jmv.26537.pdf
Principle:
Fresh group O whole blood has viable platelets, plasma, and RBCs. Fresh whole blood may provide better resuscitation than individual components. It can replace MTP component therapy of separate RBCs, plasma, and platelets. We will use low ABO-titer whole blood units (here called O universal OU) in selected trauma cases, based on availability.
Testing for low-titer (both low-titer anti-A and anti-B) units is time-consuming and monopolizes the automated immunohematology analyzers. This is the rate-limiting step.
Policy:
References: