Washed RBCs prevent recurrent acute hypotensive transfusion reactions.

OBJECTIVES: To examine whether a liver transplant patient, who was not taking an angiotensin-converting enzyme inhibitor and developed two episodes of hypotension with systolic pressure in the 50s within minutes of starting an RBC transfusion, may have had a disturbance in the production and metabolism of bradykinin and des-Arg(9)-BK. METHODS: All patient information was obtained by reviewing the electronic medical record, the transfusion service database, and transfusion reaction investigation records. RESULTS: The blood pressure returned to normal once the transfusions were discontinued. In an effort to mitigate the acute hypotension, the blood products were washed. Subsequently, the patient received three additional packed RBC transfusions without further incidents of hypotension. CONCLUSIONS: Our experience suggests that washing the products was an acceptable and effective preventative measure to avoid further acute hypotensive transfusion reactions in patients unable to metabolize these vasodilators present in the donor units.

Establishing an antigen-negative red blood cell inventory in a hospital-based blood bank.

BACKGROUND: Our blood bank is part of a large academic institution with an active sickle cell anemia program. We provide sickle patients with blood phenotypically matched for C/c, E/e, and K antigens. Since licensed reagents are available for phenotyping C/c, E/e, and K on an automated blood analyzer, we decided to evaluate whether establishing our own inventory of blood negative for those antigens would result in cost savings and decreased turnaround time (TAT). STUDY DESIGN AND METHODS: Antigen typing of blood units for C/c, E/e, and K was validated. From March 1, 2012, to August 31, 2012, a total of 1033 units from our own donor center and from our suppliers were phenotyped. We compared direct cost savings and TAT for blood availability with historical data before we began phenotyping. RESULTS: Thirty-eight percent of typed antigen-negative (AG-) units were transfused to sickle patients. An additional 35% were transfused to nonsickle patients needing AG- blood. Twenty-one percent were used by patients without antibodies to prevent outdating. The remaining 6% had not yet been transfused by the end of the study period. From March 1, 2011, to August 31, 2011, we spent almost $200,000 on obtaining AG- blood. In the 6 months since we started antigen typing, we have saved approximately $110,000, the majority of which resulted from AG- blood provided to sickle patients. In addition, TAT for AG- units from our inventory significantly improved to 1 to 2 hours versus approximately 6 hours when obtained from our suppliers. CONCLUSION: Establishing an AG- inventory in a hospital-based blood bank is cost-effective and time-efficient.