Dear Center for Phlebotomy Education:

I have a question about drawing chemistries during a transfusion. Our lab policy has always been to wait 30 minutes post transfusion for ALL blood collections. A former pathologist once said that if the patient is having chest pains or a suspected transfusion reaction, we can draw stats. But lately we've been challenged to draw TDMs during a transfusion as well. As the collection expert, we wanted to get your thoughts and opinion. The Lab Draw Answer Book doesn't really say whether it is okay or not. What should we do?

My response:

This is a great question. You rightly observed the Lab Draw Answer Book exercises an abundance of caution in the response to that question, splitting the hair so to speak, by not saying it's okay and not saying it isn't.

Here's why: It's understandable why physicians need information on their patient's status without waiting for a transfusion to complete. We never want to put the patient at risk in that regard. So, while it is best to wait so that we may obtain more accurate test results, it's not always in the patient's best interest. In other words, we don't want the perfect to be the enemy of the good.

Therefore, if your current policy states not to draw blood during a transfusion, we would recommend a modification such as "...unless the ordering provider accepts the results may be compromised by the transfusion" or words to that affect. Whatever phrasing makes it possible only on a case-by-case basis. We would also strongly recommend the results obtained by any specimen drawn during a transfusion have the circumstances be documented along with the results and identify the physician who okay'd it. The more information that accompanies the result the more likely it will be interpreted properly.

Got a challenging phlebotomy situation or work-related question? Email us your submission at [email protected] and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)