A colleague reports that her facility documents on the compatibility tag of each blood product the anticoagulation system used; this documentation also appears on the accompanying paperwork which is placed in the patient's chart. For instance, leukocyte reduced RBCs suspended in AS-1 will have a different component description listed on the compatibility tag and accompanying paperwork than will CPDA-1 suspended leukocyte reduced RBCs. Furthermore, at the time of dispensing these products they verify that the name of the product on the compatibility tag matches the component information on the unit barcode. They also state on the compatibility tag and paperwork for the chart the method by which the product was manufactured. For example, FFP might be described as "single unit removed from a unit of whole blood", "single unit obtained from a divided apheresis collection" and "double" or " triple" units collected by apheresis. The inquiring colleague would like to know if other sites practice a similar documentation scheme, or if institutions merely record on the compatibility tag and paperwork for the chart when an RBC unit is leukocyte reduced without distinguishing between the various anticoagulation options (CPDA-1, AS-1 AS-3, AS-5, etc) and if they merely refer to FFP as FFP, without indicating it is split or not split, etc.

The following comments have been received.

ADDENDA Feb. 23, 2007

1. A medical technologist in Iowa reports that in 35+ years, he has not seen or heard of an approach like that described by the inquiring colleague above. However, with the advent of routine apheresis collections, he could entertain a discussion of it.

ADDENDA Feb. 26, 2007

2. An experienced MT(ASCP)SBB who will soon become a physician reports that over the many years that he worked in various transfusion service laboratories, he was unaware of any institution that included the level of detail on the compatibility tag that is described by the inquiring colleague. He cautions that placing too much information on the compatibility tag may actually mask critical data, such as patient identification. He is of the opinion that the anticoagulation/preservative system should appear on the unit label and possibly on the chartable document, while a third location adds complexity and probably risk of error. He adds "While most of us include compatibility testing interpretation and unit number on this tag, I would favor a discussion to eliminate these redundancies since a separate chartable document includes this detail. In my opinion, the 'compatibility tag' (if separate from the chartable document) should be used only as an 'identification tag', i.e. should have the patients name and identifier only." He continues saying "In the interest of reducing complexity and thereby reducing the risk of error, I would extend my minimalist approach to the chartable document and critically evaluate every data item on this form for clinical importance. In general, anything beyond the following may be unnecessary: patient name and identifier, unit number, expiration date/time, blood types, interpretation of compatibility, blood product name, volume or dose. For example, designating that an apheresis unit is part of a double or triple collection is less important than the platelet count in the particular bag. I qualify this, of course, by specifying that there must adequate traceability of the manufacturing/modification processes from recipient (chart) to donor."

3. An experienced medical technologist who supervises a busy transfusion service laboratory reports that when their computer system was 'built' for her laboratory, the blood product codes were created such that they could be easily converted for use with ISBT 128 labeling. That means each product has a unique description which includes the anticoagulant, as well as other attributes. For example, RBC AS5 = 'Red blood cells in AS5 anticoagulant', DRLI AS3 CMV = 'Directed red cells, leukoreduced, irradiated, CMV negative, in AS3 anticoagulant', etc. The transfusion form contains the product code and the product description. The compatibility tag that attaches to the unit has just the product code (in addition to patient information and unit blood type).

She concludes saying that in her previous jobs, all that they ever used on the compatibility tag with regards to the product's description was 'RBC' or 'WB', etc. If the anticoagulant used ever became an issue, that information could always be determined by looking at shipping invoices.

ADDENDA Feb. 27, 2007

4. A blood bank supervisor in Los Angeles reports that their computer system distinguishes between RBCs collected in different anticoagulants when printing product descriptions and product abbreviations on transfusion records and transfusion tags. However, for plasma, the computer distinguishes between Thawed Fresh Frozen Plasma, Thawed Frozen Plasma 24 hour, Thawed Cryo-Poor Plasma and Thawed Plasma. Plateletpheresis products are designated as being leukoreduced and/or irradiated, and if collected from the same donor they show the same donor unit number. The anticoagulant designation does not print on the transfusion record or tag for plasma, platelets or cryoprecipitate. The responding colleague is of the opinion that unless there is a "clinical reason" to know the anticoagulant used, this information may appear on the product label, but should not be required for the transfusion record.

ADDENDA March 6, 2007

5. At the Editor's institution (LAC+USC Medical Center), all blood products received from suppliers are pre-labeled with the appropriate anticoagulation formulation information as well as if the product is leukocyte reduced and/or irradiated. RBC and plateletpheresis products used at this institution are all pre-storage leukocyte reduced. Neither the compatibility tag nor the chartable transfusion paperwork distinguishes between the various anticoagulation or Additive Solution formulations that are used in the manufacturing of the RBCs, Pheresis, Platelets or FFP. However, the chartable transfusion paperwork states if the product has been leukocyte reduced and/or irradiated. Should it become necessary to determine the anticoagulant formulation used, we would go back to the packing slip/invoice to determine the product code.

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Ira A. Shulman, MD
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W. Tait Stevens, MD
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