Hemolysis levels vary among different cell washers. Decreasing the expiration time of units after washing may be warranted.

Objectives To determine the concentrations of nicotine and nicotine metabolites in RBC units as a means to estimate the point prevalence of exposure within the healthy donor pool. Methods Segments from 105 RBC units were tested for the presence of nicotine, cotinine, or trans-3ʹ-hydroxycotinine by liquid chromatography–tandem mass spectrometry. Results Of the 20 (19%) units that contained detectable concentrations of nicotine, cotinine, or trans-3ʹ-hydroxycotinine, 19 (18.1%) contained concentrations consistent with the use of a nicotine-containing product within 48 hours of specimen collection. One RBC unit contained nicotine concentrations consistent with passive exposure. Conclusions Chemicals from nicotine-containing products are detectable within the US RBC supply. Further investigation is needed to determine the risks of transfusion-associated exposure to nicotine and other tobacco-associated chemicals among vulnerable patient populations such as neonates.

Overutilization of CA testing could be reduced by establishing laboratory acceptance criteria based on a positive DAT using anti-C3. Such acceptance criteria would have reduced CA testing by 68% for those with an available DAT result.

A 16-year-old female presented to the emergency department after a motor vehicle collision. Upon arrival, the patient was receiving group O D-red blood cells (RBCs) through intravenous lines inserted into the dorsal venous system of each hand. Retrospective analysis revealed trauma team personnel obtaining a blood sample for a type and cross from the cephalic vein of the patient during active transfusion (see figure). The table shows the forward blood type to be O Dwith a significantly weak reverse blood type.The forward and reverse type discordance was the result of obtaining blood downstream from the transfusion site with the blood sample consisting predominantly of donor RBCs with minimal plasma. A repeat sample from the patient was requested and additional group O D-RBC units and group AB freshfrozen plasma units were released for ongoing resuscitative efforts. The repeat sample from the femoral vein of the patient revealed a mixed field (MF) consistent with the blood group A D+. The patient was subsequently transitioned to blood type-specific products for additional transfusions and thus any potential ABO-incompatible plasma transfusion was successfully avoided. The hospital's phlebotomy standard operating procedure prohibits blood draws for ABO typing downstream from the transfusion site. This policy was reviewed with trauma team personnel and a teaching module is being prepared for further education.Our case illustrates the potential for erroneous ABO typing secondary to blood sampling error. Such miscues can theoretically result in the release of ABO-incompatible blood products, which have the potential to cause hemolytic transfusion reactions. Hemolytic transfusion reactions are a source of morbidity and are the second leading cause of Articles can be submitted directly online at: http://transfusion.manuscriptcentral.com Volume 52, September 2012 TRANSFUSION 1855 transfusion-related fatalities, accounting for 25% of transfusion-related deaths since 2005. 1 Preanalytical errors, such as blood sampling and tube labeling, are well-documented sources for the mistransfusion of ABO-incompatible blood products. [2][3][4] Ideally, a sample should be obtained before the initiation of transfusion to optimize both blood group identification and utilization of valuable products (group O D-RBCs). To ensure ABO typing accuracy in patients actively receiving blood products, one must obtain the blood sample from a venous site that is not directly downstream from the site of infusion. Education, communication between medical staff and laboratory personnel, and specimen acceptance policies are all important components in reducing preanalytical errors to further prevent ABO-related hemolytic transfusion reactions.

- Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.