Basic question about intraop blood transfusions

maeyken · Mar 31, 2009

"type and screen" is just that... they test blood type and screen for antibodies. Some people have different antibodies that make it hard to match their blood (crossmatch takes longer... good to know!)

"type and cross" includes the "type and screen", but also crossmatches a certain number of units. Those units are held for that specific patient until either the blood is used, or sample expires or is canceled (releasing that unit to be used for someone else.

Plasma (FFP) is used for volume expansion and to help with clotting. Just like when FFP is given pre-op for a high INR... I don't know a whole lot about it though...

core0 · Apr 1, 2009

Hey-
Newbie RN trying to understand everything there is to know about the CTOR. Our anesthesia docs often ask for us to order 4 RBCs 4FFP and possibly one platelet. If the RBCs are for low crit and the platelets are for low platelets then what is the FFP given for? Volume expansion? Coagulopathies not involving platelets? Are there different reasons for giving plasma or albumin for volume expansion?
And while we're at it, what's the diff between type and screen and type and crossmatch?
Thanks,
L

FFP is the fluid portion of whole blood. It contains the factors, as well as compliment and proteins. So if you have a patient that is bleeding some surgeons feel that after a certain blood loss the factors are depleted and need to be replaced. There is a lot of controversy if this is the case. It is also used to reverse Coumadin and correct INR. To make clot you have to have an active factor cascade as well as proteins for lattice and platelets.

Type and screen means that they have a clot in the blood bank and they have checked the blood type and screened for atypical antibodies. Type and cross means that you have typed the blood and crossmatched it. That is you have checked the clot against a specific unit of blood. Even when a unit of blood has been screened there still may be antibody reactions. Sometimes you get have to decide to use the unit despite the antibodies. It depends on the blood type and the reaction.

David Carpenter, PA-C

linda2097 · Apr 1, 2009

For circulating purposes, type and screen takes time. If you are doing a case that MIGHT need blood, always make sure there is a type and screen. If not, tell anesthesia that there is no type and screen. He will probably draw up a blood sample so lab and type and screen.

If you are doing a case that might need blood, also ask anesthesia if they want blood available. This way, blood bank can type and cross right away before anyone asks for blood. Just tell blood bank to type and cross and hold the blood (don't send it to the O.R. unless you ask).

If the patient needs blood, and there is no type and screen, it will take a lot of time to process the blood. If the patient needs blood and there is a type and screen but no type and cross yet, it will still take some time, but not as long as if there were no type and screen. If the patient needs blood NOW, and there was no type and cross already, the blood bank can send uncrossmatched blood, which is much riskier.

Also, find out your facility's policy about type and screen expiration. Even if the patient has had a type and screen, it might be expired which mean a new type and screen is required.

To summarize:

If there might be a lot of blood loss during the case, make sure there is a type an screen, and ask anesthesia if they want blood available.