A FAIL-SAFE APPROACH TO INCOMPATIBLE BLOOD TRANSFUSIONS OBJECTIVETo develop a standard "fail-safe" system for managing incompatible blood transfusions.
METHODMinimum tests are specified for detection of incompatible blood transfusions. A salvage procedure is outlined and role-specific instructions are provided.
RESULTSA cross-check for Incompatible Blood Transfusion (IBT) consists of the determination of only two parameters which will be diagnostically altered if IBT is present: positive Coombs test and an elevateJ plasma hemoglobin, compared to pretransfusion specimens. With a positive diagnosis of IBT, mannitol, stocked at all stations as an emergency drug, can be used instantly to salvage the patient. Thereupon, a coexistent consumption coagulopathy is investigated and managed according to a panel of coagulation parameters.The principles of cross-checking at the operational level of the ward and the laboratory are embodied in segregated, delegated instructions, one for each member of the investigative team. Thus, rolespecific sets of instructions produce a synchronous, automatic effort, accommodating all types of blood transfusion reactions. A hospital-wide detection and salvage system for victims of IBT is thus made irrnediately available to the pathologist who will adopt these forms and instructions in toto. A form (Blood Transfusion Reaction Report) is developed which protects to a great extent physician and hospital alike from litigation.
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