This is the third part of a teaching lecture for nurses, medical technologists, medical students, and pathology residents/fellows on how to write basic apheresis orders. It was originally given at National Guard Health Affairs in Riyadh.
This is a teaching presentation to nurses, medical students, and pathology residents that I used at National Guard Health Affairs in Riyadh.
This is a teaching document for pathology residents on how to write basic apheresis orders.
Established automated component production using Atreus technology, plasma and platelet pathogen inactivation (Mirasol)—made HMC component production Good Manufacturing System GMP compliant
Qatar is the first to adopt non-PCR-based NAT technology (Grifols/Novartis Tigress) and becomes world reference site for this
Based on the above, Qatar can now completely process all whole blood into blood components (red cells, platelets, and plasma) in as little as 5 hours from collection!
I established policies and procedures for the hospital blood banks/transfusion services, blood donor center, therapeutic apheresis, and laboratory information systems to bring HMC in compliance with the Council of Europe, international AABB, and other standards. I customized our own standards for our local needs based on them.
Implemented custom build of the multilingual blood bank computer system (Medinfo) for both patient and donor services, including development of interfaces to all production equipment including Atreus and Mirasol (world’s first) and a direct link to Ministry of the Interior to obtain patient demographics in English and Arabic—Qatar became the world’s first site to combine fully-interfaced, automated component production with pathogen inactivation: Qatar becomes world reference site for this.
Built, validated, and implemented laboratory build of hospital information system, Cerner Millennium
Replaced and updated Atreus with Reveos automated component production to allow faster throughput and capacity with a full bidirectional interface (world’s first), introduced platelet
additive solution PAS with pathogen inactivation (Mirasol)—Medinfo interfaces updated to Reveos for all equipment: this doubles the capacity to process whole blood into components using the same physical space
Updated dedicated blood bank software Medinfo Hematos IIG by several versions using Division Head, LIS, and internally trained Super Users—at great cost savings to HMC by not using outside consultants (e.g. Dell Consulting)
Established column absorption technology using Terumo Optia therapeutic apheresis machine for treatment of ABO-incompatible renal transplants: I validated using the Ortho Vision MAX to perform ABO antibody titers for this system and correlated it with the reference method at Karolinska Institutet in Stockholm (manual gel) to bring rapid throughput and labor savings—Qatar being the first-site in the world to do this. We saved money by using the same apheresis machine to use this column absorption technology (no need for second machine to use the columns)
Expedited setup (two weeks total) of COVID-19 convalescent plasma production, initially manual and then fully integrated into the Medinfo computer system as a customized module with separate quarantine collection, production, and transfusion service functions
I was awarded two HMC Star of Excellence Awards:
2013—Liver Transplantation Transfusion Support
2019—ABO-Incompatible Renal Transplantation Support
These are the answers to the previous post.
This is the third-year hematology fellow examination I prepared for NGHA Riyadh:
This is an update of a previous post.
All therapeutic apheresis procedures are potentially life-threatening and must only occur by an order from a transfusion medicine physician with experience/competence in such procedures.
- Referring Physician is the clinical physician requesting a therapeutic apheresis procedure.
- Transfusion Medicine Physician is a physician in the Transfusion Medicine Section with medical privileges for therapeutic apheresis procedures. This includes the Head, Transfusion Medicine, consultants in Transfusion Medicine, and designated specialist physicians in Transfusion Medicine. The final decision to accept/reject the patient is made by the transfusion medicine physician.
- Covering Physician is the clinical physician designated by the referring physician to be physically present and covering the patient in case of any adverse reactions during a therapeutic apheresis procedure.
- Apheresis Nurses are nurses in Transfusion Medicine who are designated by this section for performing therapeutic apheresis procedures.
- Medical Privileges are determined by the Department of Pathology and Laboratory Medicine in conjunction with the medical staff medical privileging by the Hospital Medical Director.
- The referral physician will discuss the request for a therapeutic apheresis with the designated transfusion medicine physician. The referral physician must certify that the patient can tolerate the procedure based on his medical condition.
- The transfusion medicine physician will review the patient’s clinical and laboratory data, with special note of the history of allergies, medications, previous transfusion reactions, and current vital signs.
- Vascular access will be initially assessed by the apheresis nurse. Any questionable situations will be reviewed by the transfusion medicine physician.
- It is the responsibility of the referring physician to provide vascular access.
- The following laboratory values (less than 24 hours old) must be available before the procedure may begin—additional tests also as per transfusion medicine physician:
- CBC including platelet count
- PT and APTT
- Serum calcium
- Serum protein and albumin
- LDH for TTP cases
- A valid type and screen must have been done within the previous three (3) days of the procedure.
- Upon review of # 2 through 5, the transfusion medicine physician will determine if the procedure is indicated and will communicate this to the referral physician, who will sign written order in the patient chart. Appropriate replacement fluids will also be mutually agreed upon in advance of the procedure and ordered by the transfusion medicine physician. The order specification must include:
- Name of procedure and specification (e.g. therapeutic plasma exchange, isovolemic)
- Replacement fluid type and volume (e.g. 3 liters 5% albumin, 2 liters, FFP, cryoprecipitate, normal saline)
- Blood component orders if indicated (e.g. RBC exchange) and timing (before, during, and/or after the procedure)
- Calcium replacement (e.g. 2 grams calcium gluconate IV in 100 ml normal saline to run during the procedure)
- Any special laboratory testing post-procedure
- Use of a remote vital signs/oximeter/EKG device such as the Umana T1 should be considered in high-risk patients.
- The apheresis nurse takes orders ONLY from the responsible transfusion medicine physician.
- If the referring physician wants any other orders or changes, he must get the approval of the responsible transfusion medicine physician. He does NOT give orders to the apheresis nurse
- The apheresis nurse will follow the orders of the necessary prescribed replacement fluids (FFP, albumin, PPF) in the quantities necessary for the exchange..
- The referring physician (not the apheresis nurse) will obtain the signed, informed consent from the patient.
- If vascular access is unsatisfactory, the referring physician will obtain the proper access (central line, AV shunt, etc.).
- The referring physician will arrange for a physician member of his team to be present at the actual therapeutic procedure. This physician designate will be responsible to treat any complications arising from the procedure.
- Vital signs and weight will be obtained before starting the procedure.
- When approved by the Blood Bank Director or designate with proper venous access and informed consent, the apheresis may start the procedure in the presence of the patient’s covering physician. The procedure will be performed in a designated hospital area.
- The procedure must be documented on the appropriate therapeutic apheresis order and procedure worksheets.
- Standards for Blood Banks and Transfusion Services Current Edition, AABB, Bethesda, MD, USA
- CAP Standard TRM.42245 regarding therapeutic apheresis procedures