BB Protocol 1

Question 1

CRAS & Phone ward? (4)

Answer 1

CRAS: Ab+
Phone ward: Ab+, XM+, D- after unmatched issuing

Question 2

ABO current-history discrepancy? (3)

Answer 2

1.Repeat with same sample
2.Repeat with new sample

If 2nd = History, hold last 6h T&S & repeat those without history

If 2nd = 1st != History, confirm patient identity with ward, deactivate ABO history, report T&S, inform Hematologist & SMT

Question 3

Inform hematologist? (7)

Answer 3

1. ABO anomaly / current-history discrepancy
2. Mixed field
3. Need blood before AbID / Phenotyping finished
4. Issue Incompatible-IAT before hematologist Authorize
5. HB<7, AutoAb case, Phenotyping done but unit not requested
6. D+ unit to D- patient
7. TR discrepancy

Question 4

hematologist review? (4)

Answer 4

1. Request >2 D- RBC / week
2. Request D- PLT
3. Reserve >8 PLT
4. Rare blood group

Question 5

Autologous? (2)

Answer 5

1. Physician should confirm with RC first
2. Autologous units are separated & should not be transfused to other patients

Question 6

Post-BMT? (2)

Answer 6

1. ABO depends on both the donor & the recipient
2. RBC should be irradiated +-CMV

Question 7

Storage time? (3)

Answer 7

Patient T&S sample: 21d, discard 1 week each SUN
Pilot segment: 40d
Hardcopy (WS, Report, IQC): 4y

Question 8

TAT? (2)

Answer 8

Unmatched O: 5min
Unmatched group-specific: 20min

T&S: Urgent = 1h, non-Urgent = 2h, Ab+ = >2h

Question 9

PAC? (2)

Answer 9

1. PAC form is required for registration
2. If Ab+, Repeat T&S <2d before OT
3. PAC case is valid till OT+1 / 14 days, after 12th day, extension by 1 day is possible

Question 10

Demographic? (1)

Answer 10

Merging UC to HKID is not acceptable.

Question 11

Product recall? (1)

Answer 11

BST done for day 2 PLT
day 3 PLT release to BB
day 3 ~ 4 BST become + / Donor sick
Shift MT should check email at the end of each shift

Question 12

Product Lookback? (1)

Answer 12

Donor NAT- become NAT+ in later testing due to viral window period.
Recipient should be informed

Question 13

Emergency release? (1)

Answer 13

units without BST & NAT are released to BB due to shortage of supply

Question 14

TR & TI? (1)

Answer 14

Transfusion reaction is investigated using pre, post, and used bag of unit.

Transfusion incident is reported through AIRS by both BB & ward.

Question 15

Rare blood group & special phenotype (2)

Answer 15

Rare blood group: ParaBombay
Special phenotype: unit required for Ag-Neg / Phenotype matched has a chance of <1/1000 when picked randomly. Ag distribution program is available for this calculation

Question 16

Used blood bag? (1)

Answer 16

Stamp transfusion note
PCA sign, MT sign
blood bag store at 4C
discard after 1d

Question 17

OT delivery & return? (1)

Answer 17

OT 0900~2030 MON~SUN (~1800 if PCA on leave)

Question 18

unit return? (2)

Answer 18

1. PI173
2. Fit unit if it meets storage condition (leave 4C within 30min for RBC, within 2h after issued for PLT, always unfit for plasma & CRYO), & actual condition (cold to touch for RBC, not cold to touch for PLT)

Question 19

Collection of unit? (3)

Answer 19

1. RBC >1 unit is for OT only
2. 1 container for each unit type
3. ice pack can keep 4C for 150min, validation annually
4. downtime bearer memo PR40
5. IAT-incompatible PI335, Unmatched PI337

Question 20

ABO anomaly? (3)

Answer 20

1. Confirm patient ABO / Transfusion / BMT history with ward
2. New sample for Ix during office hour
3. Refer to RC when necessary
4. Report Unknown & AbID pending
   reserve IAT-compatible O RBC (request RC in case of Bombay/ParaBombay)
   issue AB plasma if required
   issue AB PLT / other group without Anti-A & Anti-B PLT if required (AB PLT only for <1y)
5. ABO will be Authorized with T&S remark indicating subtype, FXM / CXM of group-matched / O RBC according to the remark

Question 21

Weak / Partial D? (2)

Answer 21

1. Regard as Rh- before confirmation
2. For confirmed partial D, considered as Rh- as recipient but Rh+ as donor

Question 22

Unmatched blood? (4)

Answer 22

1. PI337
2. Unmatched O can be issued without T&S sample
3. O- to
   Anti-D induced HDFN
   > Rh- with Anti-D
   > Rh- young female
   > Rh? white young female
   > Other Rh-
   #O+ can be given with physician consent
4. For Group-specific, ABO is done by tube method, including 2nd ABO

Question 23

ABO Rh consideration for PLT & Plasma? (7)

Answer 23

Plasma / CRP
1. Same group > ABO-compatible > AB
2. Rh irrelevant

PLT
1. ABO identical / plasma compatible for <1y
2. Any group, LT <6 unit / d for plasma ABO-incompatible
3. AB PLT for Unknown ABO
4. Rh+ PLT to Rh- require physician consent

CRYO
1. Same as PLT but Rh irrelevant

Question 24

PLT & Plasma request? (3)

Answer 24

1. Unlike the 3d validity for RBC, T&S record in CMC is always valid for issuing PLT & Plasma
2. After reporting, PLT is reserve till stated date, Plasma is 7d, CRP/CRYO is 3d

Question 25

Thawing Plasma & CRYO? (2)

Answer 25

Thawing start after receiving PI174 by fax Plasma: Thaw 20min, store at 4C, used within 1d CRYO: Thaw 5min, store at RT, used within 4h

Question 26

Blood reservation for adult and <120d? (7)

Answer 26

Adult: 3d &

Question 27

T&S validity is 1100 at 3rd day, which sometimes determine the RBC reservation validity, can I extend the RBC reservation validity? (1)

Answer 27

Yes. The 1100 can be extended to 2100 if necessary, T&S validity is extended accordingly

Question 28

I request special RBC unit from RC, 3 hours later the unit arrived, can I perform FXM using plasma from the same T&S sample? (1)

Answer 28

Yes. As long as the plasma quantity is sufficient & collection time <1d

Question 29

Storage temperature of RBC, Plasma/CRYO/CRP, and PLT? (3)

Answer 29

RBC: 2~6C Plasma/CRYP/CRP: <-30C PLT: 20~24C

Question 30

Visual inspection of unit? (6)

Answer 30

1. Donor blood group (verification) 2. Any leakage 3. Any abnormal appearance 4. Large blood clot 5. Discoloration 6. Missing administration port

Question 31

T&S validity? (3)

Answer 31

If Ab-: 3rd day 1100 (start from day 0) For infant <120d, 119th day 1100 (start from day 0) T&S valid = CXM issue ok For Extension of T&S validity, patient should be Ab-, No transfusion & Not pregnant within 3m. Max. extension is +3days each time, & should not exceed 12th day. PI334.

Question 32

Ab+, new case, AbID pending, compatible-IAT not available, what would you do? (1)

Answer 32

Inform ward, if blood is required as emergency, group-matched least incompatible blood may be issued.

Question 33

Ab+, old case, what would you do? (1)

Answer 33

Reserve random/Ag-/Phenotype matched compatible-IAT according to T&S remark.If T&S remark said AIHA case, reserve phenotype-matched incompatible IAT according to phenotype described (/self-performed phenotyping result?). Ask physician to sign PI335

Question 34

baby case Ab status? (1)

Answer 34

baby plasma DAT+, mom plasma Ab screen- = Ab+ DAT turn -, Ab turn - automatically

Question 35

Ab screening? (3)

Answer 35

1. Panel cell 1&2 included Rh, Kk, Duffy, Kid, MNSs, Lewis 2. Panel cell 3 is Mur+ for Anti-Mi detection

Question 36

Special consideration regarding Rh

Answer 36

1. Rh- Anti-D -, consider Rh- for pregnant women only 2. PLT Rh- is usually not available, for patient with Rh- Anti-D - , consider RhIg to prevent immunization, for patient with Rh- Anti-D +, Rh Ag in PLT is insignificant so HTR probably won't happen.