Opposites attract, according to an old saying. Janet Cass-Baxter, MT(ASCP)SBB, and Roger Baxter, CRNA, can certainly attest to that. The couple, who have been married for more than 30 years, are both health care providers but are on very different sides of the patient care continuum. Cass-Baxter is a blood banker at Anne Arundel Medical Center in Annapolis, Md., while her better half is a nurse anesthetist with the U.S. Army Medical Command. Baxter understands from first-hand experience the panic clinicians feel when they see a patient suddenly in desperate need for a blood transfusion, but only when he started talking to Cass-Baxter about some patient cases did he begin to see the other side of transfusions.

“Nurse anesthetists have very little training in blood banking services and what they do. It’s not very technical; it really skims the surface,” he said. “After a day at work, I often go to my wife asking her, ‘How does this work? How does that happen?’”

Of course, not all clinicians have a blood banker spouse available to field questions. To help the others, some blood banking experts came up with a “top 10” list of things clinicians should know about transfusion services.

10. Know Which Products Are Refrigerated and Which Are Not

“Sometimes clinicians or hospital staff store cryoprecipitate in the same cooler we had sent them previously with red cells, not realizing it should stay at room temperature,” said Linda Fatolitis, MT(ASCP)SBB, director of the compatibility laboratory at Florida Blood Services. “Clinicians should know that some components — such as cryo and platelets — should not be refrigerated and are optimally stored at room temperature.”

Using components that have been improperly stored, such as refrigerated cryo, can create problems. For one, the products may not work as well as they should. After infusing a component and not observing an optimal reaction, a clinician might believe there is a problem with the patient when, in reality, the improperly stored component is not working appropriately. Fatolitis employs a low-tech strategy to try to avoid this situation.

“We use a red stamp that says ‘DO NOT REFRIGERATE’ on the transfusion record that is enclosed with the product,” she said. “Nonetheless, products that are not supposed to be refrigerated occasionally end up in the cooler. We need to increase awareness on this issue. The blood bank in particular should be involved in clearly letting both clinicians and hospital staff know which products do and do not need refrigeration.”

9. Realize Why Blood Bankers Operate in a Highly Regulated Environment

Anyone who has experienced an FDA inspection will realize how rigorously the industry is regulated. This type of inspection is a good thing because it creates uniformity in quality and safety, said Gregory Wright, MT(ASCP)SBB, blood bank manager at the NorthShore University HealthSystem in Evanston, Ill.

“If a clinician came down to the lab, they would probably be surprised to learn about all the particular steps, rules and procedures we need to follow,” he said. “The reason we do this is because we want to keep patients safe and provide clinicians with the most effective products to treat their patients.”

“Clinicians need to realize that it’s not that we’re trying to be difficult, but that in some areas we just don’t have the latitude to compromise. Hospitals do have processes in place to provide uncrossmatched blood in cases where time is of the essence. Clinicians need to weigh the patient’s best interests, and, if necessary, order the appropriate products emergently,” Wright said.