rmblack

Hopefully I've added the poll correctly. But I'm curious to know, upon activation of MTP do you set up O Positive PRBC's or O Negative? These are uncrossed without knowing the patient blood type. We would move to type specific as soon as possible. Thanks, Michael

Hi Scott, We report directly into our LIS from the gel card. We label our Gel cards with barcode specimen labels. When the tech results at the terminal, he/she scans the barcode and enters results directly from the gel card. We also have a system in place to verify blood type on patients without a history in our system. Those patients require a second type either from the same tube or a completely separate draw. The following morning, myself or a designee reviews an automated report that contains all the patients tested the previous day. That report is compared patient for patient to the actual gel cards tested the previous day. Like David mentioned, your system should have rules or truth tables built into it. For instance, ours is set up so that you can't crossmatch a unit on a patient until a second type has been done or a tech acknowledges a results field indicating a historical blood type is on file. I hope this helps a little. Michael

Excellent post!! I do the same as everyone else. Especially Id the antibody in the system to the proper checks are made. I follow up with a historical comment documenting what facility and the individual I spoke with.

It sounds like we do the same as everyone else. We accept verbal orders for emergent needs. We also accept a verbal order, but document what physician activates the MTP. With just Emergency Uncrossed (initially two units), we get physician signature on the "Emergency Release" form. I don't require an additional signature for activation of the MTP. I just document the physician and time of activation. Our Policy states that we have one pack ready once activated and keep doing so until deactivation of the MTP. Sometimes the ED nurses will call out of the blue and activate the MTP. We begin preparing two "packs" (6 PRBC's, 6FFP and Plt Pher. q every other pack). This has been problematic because the nurse just wanted uncrossed and not necessarily a MTP activation. Then I'm stuck with 12 thawed plasma and no orders. There's obviously and education issue there. But that's a whole other topic. They fly by the seat of the their pants sometimes- often times and it really concerns me. There must be a balance between patient safety and providing the necessary blood products in a timely manner to save lives. That is an ongoing struggle and may not ever be fully accomplished. Also, our Transfusion Committee reviews all MTP activations and emergency releases. You may be able to get some help there. Risk Management is a great resource for this type of issue.

I know...I struggle with that argument. I don't know if I should make them come to blood bank each time or if I should let them have a freezer in their respective area. I could put a portable graph recorder in it but then some alarm would have to be tied into the switch board or the units would have to be returned to the BB while the department was left empty. The data logger is a great idea. I can validate a separate cooler for "transportation" while in flight but I can't validate it for every season/weather change. I don't believe the inside of the helicopter is a temperature controlled environment but I could be wrong. Just looked at the Credo cooler. That may be the ticket. Who gives the order to transfuse? Do you have trouble with wastage? I like the idea of billing medflight if they are wasted or the patient is taken to another facility. What about competency of transfusing staff? I believe CAP requires competency documentation of transfusing staff at least yearly. Thanks for all the ideas and input.

Our MedFlight team has approached me with possibility of carrying O Neg cells on their helicopter. Does anyone have any expierence in dealing with this situation? I have a hundred questions. Thanks Michael Joplin, MO

I was thinking the exact same thing. Very well done. I hope her pregnancy goes well.

Anti-E (in low titers) is notorius for not showing up on Panel A from the Ortho MTS products. I have our techs perform panel B when Panel A is negative. I can't explain it but Panel B seems to be a little more sensitive for Anti-E. Just something to think about. If Panel B is negative I would repeat the screen in gel with either a new lot (be cognizant of the possibility of rare antibodies and the antigen pattern) or try fresh screening cells of the same lot. I would be careful of running an antibody screen in tube then calling the antibody screen negative. In my comparison studies tube is 1+ to 2+ less sensitive than the Gel methodology, which is why you sometimes pick up stuff that seems impossible to identify. When that happens, we call it a "Miscellaneous Antibody" and make an external comment to the effect that "All clinically significant allo-antibodies have been ruled out. Units are crossmatch compatible at AHG and Immediate Spin phases". I've never had a physician call me yet reporting it like this. They ultimately want to know if they can have compatible blood if they need it.

We perform a thermal amplitude on all patients going to CVOR that have a cold antibody identified in PRE-OP testing.

My biggest fear is that the staff at bedside may give you the incorrect name or DOB or whatever then a tech looks into the computer system and hopefully finds the right patient. Too many chances for error. I have told my techs that if we do not have a current type (within 72) to give type O in these situations. I think the potential is too great that either nursing could give us incorrect information or the tech looks up the wrong patient. I see way to many patient ID errors to trust that they are giving me the right patient name. Most of the time it is a room number and they don't remember the name. They actually think that's acceptable. I will often follow the units up to the areas to obtain the physician signature and the nurses are not performing patient ID checks. I had a patient yesterday that has a history of anti-Fya and Kell and came in as a trauma. The surgeon wanted two units uncrossed after I told him the odds and chances. Luckily I already had 4 units typed negative for Fya and Kell. The patient has a history of A pos. But I still performed a quick tube type just to make sure they ID'd the patient correctly in the ER. When I took the units up the nurses grabbed them and ran them in without any checks at all. Something to think about. Happy New Year Everyone!!

I noticed on my validation samples (that I prepared from the guide) that the reactions were somewhat weaker on the new kit. But technically correlated with the previous test kit.

I had just taken over BB a few months prior to the May 22nd tornado that went through the middle of Joplin, MO. The other major hospital one block away from us took a direct hit and cut a path a mile wide through a very densely populated area. I had just left work as the storm was about 30 minutes out. The weather team had indicated at that time that it was going to go north of the city. Well it didn't. I made it home just in time to take cover myself... Patients were being brought in by pick up truck, ambulance and every other way you could possibly think of. We also took in numerous patients from the hospital across the street that was destroyed. I think our emergency team did a great job all things considered. Our system practiced many disaster drills but they never thought of practicing a disaster that directly affected our community. They seemed so unrealistic... Most of the time they were practicing for a disaster in a different community and we take on patients that were transferred in. Anyway, several areas failed in my opinion. The lines of communication were absolutely non-existent. Phones lines were not working, cell phones were not working, the radios were the only thing. And our entire lab had one. They paged the blood bank over the intercom system which we couldn't hear in the blood bank. One of our pathologists immediately recognized the need to get more inventory in. You think duh...But amidst of this mess the obvious gets overlooked. We were able to get 250 units from the hospital that took a direct a hit. Our supplier is 85 miles away. But our pathologist had to drive out of the city to get cell service and place that call. The only line I had to communicate was texting to an employee at our distribution center. It wasn't pretty but it worked. The second failure was that the patient's were not properly identified when they arrived to the hospital. We have the wristband available exactly for this reason but the ED services did not utilize them. I spent weeks in ICU going through charts trying to figure who patients were. There were three Jane and John does for example. Patient's were given ID's based of their clinical presentation, I.E. sex, approximate age range and their clinical impression or situation...You wouldn't believe what they came up with. And a lot of them were the same as well. I still have a basket of transfusion copies of about 50 units that I have no clue to whom they went to. I presume most of those did not even make it beyond triage. Another failure in my opinion was the system never activated the disaster plan. You think well duh a tornado just went through town. Luckily most people ignored what they were trained to do, which was stay put until called or notified, and came to help anyway. So again the issue of a disaster occurring within the community was never seriously addressed. The other problem was the distance of the laboratory to the actual ED. Through several renovations the lab just kept getting pushed further and further away from the main "Tower". Nurses kept showing up for blood with no name, sex or anything. We immediately stopped releasing O- unless they could tell us it was a female under 50 or a child. I'm sorry if it seems like I am venting. I probably am a bit. But it seems like a consistent theme when disaster strikes. Communication failure... The whole thing has given me an eye twitch I still can't get rid of... I hope somebody fines the info useful. Thank you everyone else for sharing. An I appreciate anyone's imput.

Our blood product supplier is going to start using more variable content platelet apheresis units. My medical director has asked me to think about guidelines and a proposal to take to the transfusion committee advising when it is appropriate and not appropriate to use variable content products. My question is do any of you have it outlined in your procedures. I don't feel the blood bank techs should be making the decision. Thanks for your help. Michael Black, MT(ASCP) Freeman Health System, Joplin, MO