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July 2016

The Lifesaving Work of the Blood Bank and Transfusion Medicine Unit

















Have you ever wondered what happens to blood donations when they are taken to a hospital?     

According to the American Red Cross, 6.8 million Americans give blood each year. The Blood Bank and Transfusion Medicine Unit at Strong Memorial Hospital receives and stores these blood products to be ready for patients around the clock. 

We spoke with Debra Masel, Blood Bank chief supervisor, and Aimee Kievitt, lab supervisor, to learn more.

Where do blood products stored in the Blood Bank come from?

The vast majority of our blood comes directly from the American Red Cross located on John Street in Henrietta.

There is also a small donor room located off the main lobby at SMH where patients scheduled for surgery, and who qualify to donate their own blood, can have a unit of blood collected. This blood is then stored in the Blood Bank specifically for them if a transfusion is needed during their surgery.

What are the main functions of the Blood Bank?

We do testing to make sure that the blood received from the American Red Cross is compatible with patients who need it. If a patient has any type of transfusion issue, we need to identify and resolve the problem to ensure that the blood is truly compatible and that we’re not causing more harm by transfusing them.

Our attending physicians, nurses, residents and fellow provide clinical consultation on effective and safe use of blood transfusions, and evaluate transfusion reactions.

How much blood does the Blood Bank receive each day?

We transfuse about 100 units a day. During the blood collection process, approximately 500 milliliters of whole blood is collected which is then separated into red cell, plasma and platelet products. A unit of red cells has a volume of approximately 400 milliliters, which includes a preservative solution to increase the shelf life of the product.

What’s the difference between a blood sample and a blood product?

A blood sample is drawn directly from the patient and is used to complete pretransfusion testing to ensure compatibility with the intended blood product. Blood products are collected from volunteer donors.

A donation is separated into its component parts – plasma (55%), red blood cells (45%), and white blood cells and platelets (less than 1%) – which are each stored and used separately to help multiple patients.

What happens when there’s a trauma patient in the Emergency Department who needs blood products?

The Blood Bank has a trauma pager so when a Level 1 trauma patient is being transported to the hospital, the technologists are notified. They then prepare the trauma cooler with four units of O Negative (O-) uncrossmatched red blood cells, commonly known as the “universal donor.” When a staff member from the ED comes to pick up the blood, he or she will bring a patient blood sample for testing to be performed.

It is important to switch the patient to blood products identically matched to their own blood type as soon as possible, since our research at SMH shows that ABO identical transfusions are safer than use of “universal donor” red cells or plasma.

BloodbanktestWhat kind of testing does Blood Bank perform?

The Blood Bank processes about 120 patient samples a day, many of which are outpatient samples for pre-operative and prenatal testing. About 90 percent of our transfusions are given to inpatients and the remaining 10 percent are transfusions received by outpatients.

What happens if a patient with very rare blood type needs a transfusion?

Sometimes there are other complications besides a patient’s blood type. If a patient has multiple antibodies, for example, finding compatible donors in the available blood inventory may not be possible.

In that case, we contact the Rare Donor Registry via the American Red Cross and a national search is initiated to identify a compatible donor. If we request something that’s available in the registry, they send it to us. We have gotten products from Florida, California, and other states.

What if the Red Cross can’t find what you’re looking for?

If we have a need for a rare unit and the American Red Cross has nothing in inventory, they can search their database to find a donor who matches the patient’s needs. They contact the donor and let them know that they are a rare match for a patient in need and request that they come to a center to donate.

How does a critical shortage in blood donations affect the work of the Blood Bank and Transfusion Medicine Unit?

In the event of a critical shortage (and it would have to be very dramatic) hospital administration and our attending physician and resident on call are notified. Our physicians and technologists will triage requests so that only clinically urgent transfusions are performed during the shortage.

The hospital chief medical officer may ask surgeons to reschedule elective surgeries so that the available blood supply can be conserved for urgent needs.

Thankfully, the community response to blood shortages has been good in bolstering the blood supply so that the drastic measure of rescheduling surgeries hasn’t happened in many years.

What’s a more common type of shortage you encounter?

When there’s a shortage of O- blood and the Red Cross can’t provide our normal inventory levels, we may need to evaluate every requested transfusion for clinical necessity and urgency.

It’s very important to obtain a patient sample as quickly as possible so that trauma patients receive products identical to their blood type instead of group O- blood. In those cases, it requires a higher level of communication and coordination between Blood Bank and the ED or Operating Room so we can appropriately supply their needs.

The same is true for platelet shortages. Our physicians, nurse and technologists evaluate each request for necessity and urgency. We discuss orders with providers to hold off on transfusion or reevaluate whether a transfusion is absolutely necessary when the necessity or urgency are not clear from the order.

Bloodbank3When do you have the greatest need for blood donations?

Summers (around the Fourth of July) and December tend to be the two times when supplies are running lowest. Schools, which hold many blood drives, are closed, and people are on vacation so they are not available to donate blood.

What have been the biggest changes in blood banking within the last decade?

There has been a national push for restrictive transfusion practices, and this is a good thing. Blood transfusion can be lifesaving in certain situations but it’s not the cure-all. A transfusion is like a liquid transplant. If a patient doesn’t have a specific need to be transfused, they shouldn’t be.

Research performed here has led to substantial changes in transfusion practices to render them safer for the recipient, such as use of ABO identical transfusions, leukoreduced transfusions for all patients and washed transfusions for select patient groups. This has led to many fewer complications of blood transfusion and increased survival in some instances.

How has your role in patient care changed over time? 

In the last decade, our staff has started to interact more directly with nurses and ordering providers to discuss patient cases; their underlying diagnosis, signs, symptoms, and whether transfusion is the most appropriate course of action. There have been more of those types of collaborative and educational discussions. 

In photos: 

Top: The Blood Bank at URMC stores all blood products in a cooler where staff can pull units needed for patients. 

Middle: Lisa Hughes, a medical technologist, performs a test to determine the blood type of a patient who has received a bone marrow transplant.

Bottom: Medical technologist, Kim Bastian, releases a blood product to a patient for a transfusion. In this case, the patient has had transfusion reactions, so the product has been "washed" with saline to help prevent further reactions from occurring.

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