A FAIL-SAFE APPROACH TO INCOMPATIBLE BLOOD TRANSFUSIONS
ARMY MEDICAL RESEARCH LAB FORT KNOX KY
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The objective of the research was to develop a standard fail-safe system for managing incompatible blood transfusions. Minimum tests are specified for detection of incompatible blood transfusions. A salvage procedure is outlined and role-specific instructions are provided. A 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 elevated 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. 9 Thus, role-specific 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 immediately available to the pathologist who will adopt these forms and instructions in toto.
- Medicine and Medical Research