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MS-26
(2)
(b)
(c)
(4)
Every indication for the use of blood products cannot be anticipated. These
guidelines will not override physician judgment and the blood products will
be released in response to physician orders. However, transfusion outside
these guidelines shall be carefully peer reviewed to assure appropriate use.
(2)
(6)
Washed Red Blood Cells- requests for washed red blood cells must be
initiated by the ordering physician
(a)
(b)
Must meet established criteria for red blood cells, and one of the
following:
(1)
(2)
(7) CMV Negative Red Blood Cells- requests for CMV negative red blood cells
must be initiated by the ordering physician.
(a)
(2)
Infant less than 4 mos. old and/or infant with birth weight
<1500gms and mother is CMV neg.
(3)
(b)
(8)
Irradiated Red Blood Cells- requests for irrradiated red blood cells must be
initiated by the ordering physician.
(a) Must meet established criteria for red blood cells, and
(1) Suspected or established DiGeorges syndrome.
(2) Infants with birth weight <1500 grams.
(3) Intrauterine transfusion or neonatal exchange transfusion.
(4) HLA-matched products and crossmatched platelets for
designated recipient.
(5) Recipients of donor units known to be from a blood relative.
(6) Patients who have undergone bone marrow transplantation or
peripheral blood progenitor cell transplantation.
(b) Transfusion Service physicians will prospectively review all requests
for irradiated red blood cells if the request does not meet the
established criteria.
(9)
(b)
Elective surgeries, the post-op value is not higher than preoperative (excludes preoperative anemic patients);
(c)
(a)
(b)
(c)
(d) After massive transfusion (10 or more RBC including autologous RBC
salvaged intraoperatively).
(e) Open heart surgery with bleeding episode.
(f) Dysfunctional platelets.
(g)
To treat acquired coagulation problems including, but not limited to, liver disease,
vitamin K deficiency, or warfarin (coumadin, coumarin) effect as mentioned in the
physician progress notes written within 24 hrs of the transfusion in question, in the
physician admitting note at the beginning of the current hospitalization, or in physician
progress notes written at the beginning of a series of plasma infusions.
Patients with these conditions should exhibit prolonged partial thromboplastin time
and/or prothrombin time using current normals PLUS either the presence of overt
hemorrhage or mention of plans to perform an invasive procedure within 12 hrs. The
interval of > 12 hrs would permit an attempt to correct the clotting abnormalities with
vitamin K therapy, so that plasma may not be needed.
Protime, PTT or factor assay done before and within 24 hours after
transfusion.
(3) To treat active bleeding in a patient with the diagnosis of uremia, renal failure or
with a blood urea nitrogen (BUN) > 50 mg/dl or serum Creatinine > 4.0 mg/dl
(measured within 24 hours before the transfusion). A trial of DDAVP therapy is
preferred prior to cryoprecipitate.
(4) Fibrin glue.
(5)
(B)
No evidence of bleeding
10
11
Date, 200_
RE:
Dear ___:
Following an investigation conducted by our blood source provider, it has come to our
attention that at the time of donation, the blood product(s) you received on (date) was/were tested
and found to be negative, or not tested due to lack of test procedure, for HIV-1, HIV-2 and
HTLV-I or HTLV-II. However the donor of that/those components) now has developed a
positive test result for
________________.________ _________
Because it is our duty to inform anyone who may have been infected in order to prevent the
spread of such infection, we urge you to do the following:
1)
Arrange immediately to have a screening test for
. At our request, we
can perform this test for you and your spouse/partner at no charge. Contact our
staff (334) 793-8705 and we will arrange the screening test at our facility or assist
you in making arrangements to have the test performed at no charge at the nearest
healthcare facility.
2)
Contact your physician for counseling, or we can, at your request arrange for
counseling at an outreach program through our Social Services Department.
We realize that this information is unsettling and we apologize for its necessity. Please be assured
that this matter will be treated in a confidential manner by our facility; however, we are obligated
to communicate with your attending physician. We urge you to contact us if you have any
questions or need assistance.
Sincerely,
Dr.
12
Date, 200_
RE: CONFIDENTIAL NOTIFICATION OF POTENTIAL BLOOD PRODUCT
CONTAMINATION FOR HEPATITIS C RECIPIENTS LETTER
Dear
A nationwide effort is underway to identify people who may have been infected with the
hepatitis C virus (HCV). One of the ways that HCV has been transmitted is through a blood
transfusion. Our records show that you received blood that may have been infectious for HCV.
This is not HIV, the virus that causes AIDS. HCV causes a liver disease called Hepatitis C.
You should get tested for hepatitis C. Most persons who get hepatitis C carry the virus for the
rest of their lives. Most of these persons have some liver damage but many do not yet feel sick
from the disease. Of every 100 persons infected with HCV, about 15 persons will develop
cirrhosis (scarring) of the liver which can lead to liver failure. This can take many years to
develop. It is important that you get tested for hepatitis C so you can be checked for liver disease
and get treatment, if indicated, and in addition, learn how to help protect your liver by avoiding
substances that can further cause harm, such as alcohol and certain medicines. If you have
hepatitis C, it is important that you learn what actions you can take to avoid spreading this
disease to others. We can provide testing for you at no charge. To arrange for testing, contact
our staff at (334) 793-8705 and we can arrange the screening test at our facility or assist you in
making arrangements to have the test performed at the nearest healthcare facility. We can also
arrange for any counseling, as indicated, after testing. You may desire to contact your
personal physician for this testing and any subsequent counseling.
Please contact us if you have any questions or need assistance.
Sincerely,
C. Wayne Hannah, M.D., J.D.
Risk Manager
Mark E. Shertzer, M.D.
Medical Director, Laboratory Medicine
Date, 200_
13
Dear
The Food and Drug Administration (FDA) is requiring the notification of persons who received
blood or blood products that were potentially contaminated with hepatitis C virus (HCV). Our
records show that the above listed patient was in your care recently (may not have been at the
time of the transfusion.)
We are in the process of notifying this patient, so he/she can obtain testing, counseling, and if
indicated, possible treatment. Should the patient contact you, please provide this care for
him/her or refer him/her to another physician that you may feel will be appropriate.
The donor at the time of this donation tested negative for hepatitis C virus (HCV).
However at a subsequent donation the donor tested positive for hepatitis C virus (HCV).
HCV testing for this patient can be performed at no cost by our facility. Contact our staff at
334-793-8705 to arrange for testing.
Please call if you have any questions or need assistance.
Sincerely,
C. Wayne Hannah, M.D., J.D.
Risk Manager
Mark E. Shertzer, M.D.
Medical Director, Laboratory Medicine