DPruden

thanks, Sheri!

The Bone Marrow Transplant unit orders them post transplant, not anything to do with newborn/fetus

I was looking for a standard method for IgM titers of anti-A and anti-B. Our BMT floor requests both IgG and IgM titers often. The only methods I can find are for the IgG anti-A and anti-B primarily for pregnancy which is not concerned about IgM.

Unfortunately, there are only 3 HCPCS codes that deal with washed RBCs. P9022--Red blood cells, washed, each unit, P9054--Whole blood or red blood cells, leukocytes reduced, frozen, deglycerolized, washed, each unit, and P9057--Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit. So, for a unit that hasn't been frozen and deglyced, you have to use P9022 and add the Irradiation charge code separately, if you have one built.

Does anyone have a reference for manual isohemagglutinin titers? I can't find one on the AABB website or in the technical manual

UNOS has guidelines on off-type kidney transplants. We were using the UNOS protocol for DTT treated iso-titers, but have transitioned to running IgG and IgM iso-titers on our NEO Iris. https://community.asn-online.org/blogs/mark-lerman/2018/07/09/weekly-rewind-abo-incompatible-kidney-transplant-r https://optn.transplant.hrsa.gov/media/2347/mac_guidance_201712.pdf

Most of our MDs order the MTP in Epic fairly real time, and if they don't the Blood Bankers enter the order with a required co-sign.

I would say have compassion and flexibility, but don't let people walk all over you. Don't be afraid to ask for what you need, like 5 minutes to finish a task before addressing their issue. If people are complaining, I will often ask them to come up with a solution. I definitely agree that stepping into a leadership position internally is more difficult than starting as a leader in a new facility. One of the most helpful things that I was told early in my career was to vent up, personnel management can be frustrating, but go vent to a supervisor or manager away from the lab, this can often help bring perspective to the situation. Good luck!

Technically, it is only indicated for treatment of patients who are undergoing massive transfusion. because of life-threatening trauma/hemorrhages. We use it for MTPs in our OR as well as trauma patients coming into the ER.

We have a BloodTrack in our ER, we have it built only for MTP packs. The interface is problematic with SafeTrace Tx, mostly due to the time it takes for the admissions info to cross into BloodTrack and Tx. We have also had some challenges with training the nursing staff in the ER, but we monitor the errors and follow up with the ED educators

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units. this was during a time when many people were donating autologous units and having them frozen (early 1990s). There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS. To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it! So, he got an entire BPOS unit and he was OPOS. The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences. I will never forget that one!

My argument would be that blood bank testing is qualitative and not quantitative. We have run into this a little bit in the US as well, they re-organized the federal regulations and starting using chemistry and hematology requirements for blood banking. Our method comparison requirement in particular has never made sense to me. Of course LISS, PEG, solid phase, and gel methods give different results, they are designed to!

21CFR606.151(e) states "Standard operating procedures for compatibility testing shall include the following: Procedures to expedite transfusion in life-threatening emergencies. Records of all such incidents shall be maintained, including complete documentation justifying the emergency action, which shall be signed by a physician." We keep them regardless of whether or not the units are transfused.

https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173

We are not currently billing for convalescent plasma, we built them in SafeTrace Tx will a billing holder code so that all of these products end up in a, Epic billing workqueue. I'm not sure that you should be billing the patients for these anyway seeing as the products are investigational products for research use only.