Lookback

A multistep process a blood establishment must complete as a response to a donor who is newly reactive for an infectious disease test. The whole idea behind lookback is to (guess what?) “look back” to find previously collected blood products from a donor who is now reactive for a particular infectious disease marker (in particular, HIV and Hepatitis C). The previous units within a particular time frame (which varies by infectious marker) should be destroyed if not already transfused. If a previous product within the lookback period for HIV or HCV was already transfused, federal guidelines mandate notification of the recipient (or next of kin) and the physician of record.

The whole idea with lookback is to prevent a recipient from being infected by products that may have been collected after infection but before the infection could be detected. The rules for lookback are complicated and vary from infectious test to infectious test, so I will steer clear of substantial detail here. In general, though, the lookback process includes the following, begun at the time of notification of a reactive result (but not necessarily before the confirmatory results are available):

• Quarantine of previously donated products still in inventory (either at a blood center or on the shelf of a blood center client (“consignee”)
• Additional testing of the donor
• Destruction of previously donated units, if confirmatory testing is positive
• Notification of recipients of previously donated units, if applicable (it isn’t in all cases)

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