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We dropped when we switched to Epic Beaker for the LIS. It has the scanning capability for positive patient ID and bedside label printing. We also need two samples collected at separate times before giving type specific red cells, We were the last health system (out of a total of 5) in our area to stop using a separate Blood Bank band.
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Weak D testing in the presence of a positive DAT?
R1R2 replied to SusieQ132's topic in Transfusion Services
I have never seen an "extreme case" of antigen blocking resulting in a negative test and I would think that the baby would have a lot of other serological issues that might alert you that this might be going on. Our facility allows newborn weak D testing when the DAT is positive and most of the time the weak D is negative. If you have staff that can understand this process then it might be a good idea. -
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Weak D testing in the presence of a positive DAT?
BBgrl replied to SusieQ132's topic in Transfusion Services
Our facility treats the red cells with EGA then performs a weak D test if the DAT post treatment is negative. -
THERMOMETER FOR NEW ORTHO ID-MTS INCUBATOR
gene20354 replied to ANORRIS's topic in Transfusion Services
This is what I am using. Digi-Sense® Traceable® Remote-Monitoring Thermocouple Thermometers with Calibration -
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Please call Henry Cagadas at 847-613-2114 or his cell at 847-280-4931. He certainly can help you. Henry is our main technical support person for HemaTrax.
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Our policy is if the patient is transfused they get a new ABID every 3 days but if the patient is not transfused we will only do the ABID if they are going to be transfused or every 7 days which ever comes first. Being at a children's hospital we don't get a lot of antibodies and most of them are WAA from our oncology/hematology kids. Plus we don't have the staff to complete the WAA workups ourselves and they get sent to a reference lab. So if they are just keeping a current TSCR but are not planning on transfusing (usually they give medication instead of transfusing these WAA kids) we only send out the ABID if they want blood for a procedure or something. We also keep the kids on the same unit and/or donor as long as possible. That's the nice thing about kids. For those kids with other than WAA we do a new ABID with every sample. For neonates (passive antibodies) we do a new ABID when we run out of specimen to crossmatch new units which happens rarely.
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Charging for washed, irradiated, leuko-reduced platelets
Sonya Martinez replied to Lecia Guill's topic in Billing
No you charge for the product, then each process. So the HCPCS for leukoreduced platelets, washed is P9035 just like non-washed but you have 2 procedures codes in your CDM to include a larger charge for the washing then you add the irradiation using CPT 86945. For example a regular platelet unit is procedure code 63877 and is priced at $450 but when it's washed the procedure code is 68309 and you charge $611. We have our computer system built so that if the product code is washed then it charges the procedure code for the $611 but if it's not washed it charges $450. Unfortunately there's only a P code for washed RBCs. -
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THERMOMETER FOR NEW ORTHO ID-MTS INCUBATOR
ANORRIS replied to ANORRIS's topic in Transfusion Services
COME ON Y"ALL...ALL I WANT IS AN ANSWER... -
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Weak D testing in the presence of a positive DAT?
galvania replied to SusieQ132's topic in Transfusion Services
In my experience good monoclonal anti-D reagents will pick up all but the weakest of D antigen variants (by which I mean all normal D+ and all D variants with a reasonable number of D antigens on their surface). The positive DAT will not interfere with them unless it's caused by clinically significant cold haemagglutinin disease. So only the very very weak D variants will come up anyway with the weak D test in an IAT but not in direct testing. So if you did not do the weak D testing you might miss a few cases. Those few would have to nonetheless be able to stimulate mum into making an anti-D. I would be very interested to know exactly how many cases you see where the routine testing (using a sensitive method and good quality monoclonal anti-D reagents) is negative and the Weak D testing was positive (with a negative DAT). I wonder if it's more or less than the number of D variant mums you miss because they group as normal D+ ........... Also, for the anti-D to give you a false negative result because all the antigen binding sites are already loaded, your DAT would have to be VERY strong - and mum would have a known (hopefully), very high titre, antibody. So you would have to carry out an eluate anyway on baby's cells and find for example that mum has a high-titre anti-D and you can elute anti-D from the baby's apparently D-negative red cells. That's when you know that baby really is D+ and all the D sites are saturated. I've seen this twice in 'real life'.- 9 replies
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THERMOMETER FOR NEW ORTHO ID-MTS INCUBATOR
AMcCord replied to ANORRIS's topic in Transfusion Services
I'm sticking with you, Cliff. -
Physician Signature for Emergency Released Blood
AMcCord replied to applejw's topic in All other topics
Below are the relevant CAP checklist items for emergency release of blood products. My viewpoint is that the emergency release is a 'deviation from SOP' and that is what the blood bank medical director must review. What I regard as a deviation is: our policies require us to perform compatibility testing for RBCs or perform a blood type for plasma (platelets) prior to providing them for transfusion. If we 'emergency release' blood, it is released uncrossmatched, and plasma (platelets) is/are released w/o a patient blood type. We are thus deviating from this policy. Our medical director is also looking for evidence that we followed the SOP for our emergency release process. We have an ongoing quality project to monitor documentation, how long it takes to provide product after request, and compliance with SOP. Quality improvement projects/processes are also part of regulatory compliance. For us the reviews are not a major problem because we don't have that many emergency releases. Our problem is maintaining staff competency to make sure that everything goes quickly and smoothly This is where the quality improvement part of the equation comes in and we've made some major improvements there. No inspection problems w/ Joint Commission, CAP or CLIA and we've been doing this way for years. I don't know if it's overkill, but it works, and it's good for our patients. TRM.40770 Life-Threatening Situations Phase II Adequate policies and procedures have been established for the investigation and handling of life-threatening situations (such as the use of uncrossmatched blood or abbreviation of testing) that include the written authorization of a qualified physician. NOTE: Written policies and procedures must be available to expedite testing for transfusion in a life-threatening situation. If an institution's procedure allows abbreviated testing in massive transfusion situations, records should indicate that the procedure was followed. Records must include the authorization by a qualified physician. (If approved by the institution and recorded in the laboratory's procedures, the physician responsible for the transfusion service laboratory may accept this responsibility.) If an incompatibility is discovered on completion of an incomplete crossmatch, the responsible physician must be notified in a timely manner and this notification recorded. 29 of 85 Transfusion Medicine Checklist 08.21.2017 Red blood cells released before testing has been completed must be conspicuously labeled as uncrossmatched on the tag or label. Records of completion of compatibility testing for units released uncrossmatched must be maintained. Evidence of Compliance: ✓ Records of emergency release authorization by a qualified physician REFERENCES 1) Food and Drug Administration. Current good manufacturing practice for blood and blood components. Laboratory controls. Compatibility testing. Washington, DC: US Government Printing Office, 1999(Apr 1):[21CFR606.151] 2) ibid. Records and reports. Records. Washington, DC: US Government Printing Office, 1999(Apr 1):[21CFR606.160] AND TRM.30900 Records of Deviation From SOP Phase II The transfusion service medical director or designee provides written authorization for deviations from the standard operating procedures. NOTE: The standard operating procedures constitute the approved procedures of the laboratory and are to be followed at all times. Any deviations from these procedures must either be authorized by the responsible transfusion medicine medical director or designee prior to their performance or, if detected only after the event, must be investigated through the laboratory's quality assurance process. A wide variety of routine procedures may, from time to time, require the transfusion service medical director or designee to authorize an alternative approach because of specific clinical situations. Among these, for example, might be the need to give Rh positive red cells to an Rh negative recipient because of inventory shortages, or to provide a unit of platelets that was not HLA-matched (or “crossmatch compatible” or “antigen-negative,” depending on the laboratory's routine approach) to an alloimmunized patient in an attempt to control hemorrhage. REFERENCES 1) Lam H-TC, et al. Are retrospective peer-review transfusion monitoring systems effective in reducing red blood cell utilization? Arch Pathol Lab Med. 1996;120:810-816 2) Shulman G, et al. Creating useful statistics to audit transfusion services. Lab Med. 1998;29:371-374 -
And most of the titres quoted on this thread (if not all) are dilutions and NOT titres. A titre is the reciprocal of the dilution - not the dilution itself.
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the trouble with titres is that the result is method dependent - so unless the methods are identical, comparing across labs is not much use
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Weak D testing in the presence of a positive DAT?
Malcolm Needs replied to SusieQ132's topic in Transfusion Services
No Mabel. I wouldn't have any concerns whatsoever.- 9 replies
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The WRP Check from Sysmex extends beyond the stated "linearity" for most parameters. I recommend that you stop doing periodic reportable range checks--it's not required by CAP anymore unless the analyzer is moved or you are reporting beyond the manufacturer's stated ranges.
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I always want testing of patients with antibodies to be as sensitive to detect new antibodies as the screen is for patients with no antibodies. That means, for all usual specificities, I want to run a double-dose cell (from homozygous donor) that is negative for the antigens that known antibodies are directed toward whenever possible. I am comfortable mimicking the screen cells (single dose K cell, but double for the other "usual suspects"). In the face of multiple antibodies, it is not always possible to test all of the desired specificities with double-dose cells, but I want to come as close as I can. We just had an O neg "frequent flier" (with prior anti-C) transfused on 7/26 make a new anti-E found on 8/14. Auto control negative (so it either was not very avid or already destroyed the E+ unit). That's 18 days, Had it been covered up by an antibody that reacted strongly with both screen cells, we might not have found it without the panel cells if the antigen on the crossmatched cells was not particularly strong and the antibody was pretty weak (like Malcolm said).
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Weak D testing in the presence of a positive DAT?
Mabel Adams replied to SusieQ132's topic in Transfusion Services
I have seen weakly positive DAT cells taken through AHG for a weak D test end up negative in both the D test and the control. I have always thought that this was due to a mild heat elution during the incubation removing the coating antibody (which we have usually expected was ABO antibody, not anti-D, because mom and baby are ABO incompatible and mom is not known to be sensitized to D). Would anyone be concerned that this is a false negative weak D test as defined in the insert mentioned initially? -
I'm seeking help with setting up Meditech and HemaTrax. We have been having issues printing on the 2x2 labels (product and expiration) - it has never worked correctly. HemaTrax told us it's a known problem with Meditech and Meditech doesn't seem to know the ins and outs of the printer setup. If anyone has any suggestions or contacts from either company I would greatly appreciate the help!
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Physician Signature for Emergency Released Blood
Mabel Adams replied to applejw's topic in All other topics
We require a signature be in the record because it is a requirement of standards. We don't require it to be completed before we will issue uncrossmatched blood so there should be no delay in care. We will issue uncrossmatched on a simple verbal request or the order (it is built into our trauma order set). Our uncrossmatched order in Epic does not send product orders to the Lab; it is a communication order that gives us permission to create the supporting product orders in the BBIS. Our process is partly for the above situation and also because they sometimes decide they need uncrossmatched units before the antibody screen is complete even though they have already ordered RBCs. We do request that either the computer order be placed or a paper be signed so we can have that in the record, but it can be done after the patient is cared for. It seems like just asking if they need uncrossmatched blood will halt the ones who just think that calling the lab repeatedly will speed up the process but remind those who really need it that it is an option. I am inclined to agree that getting the order/signature doesn't really accomplish much. I've never even heard of any litigation arising from a case where a patient was harmed from an emergency issued unit. I've seen a few antigen positive units issued to patients with antibodies who still didn't show evidence of harm so maybe the lack of litigation is because I've never seen harm. I have seen harm from not transfusing a patient with a strong anti-D during an O neg shortage where they attempted to avoid giving Rh pos blood by just using blood salvage during his emergency aortic aneurysmectomy and he ended up needing dialysis. I think this is what ended up being our final wording in Epic: The question “This patient’s clinical situation is sufficiently urgent to require release of uncrossmatched blood.” – must select YES. Where is the requirement that the medical director review them? Is that CAP? -
XM for a newborn with mom's specimen
Malcolm Needs replied to cheru26's topic in Transfusion Services
We would report them as "maternal", on the grounds that babies with even the most "mature" immune system at birth will only produce IgM immunoglobulins (and these do not "fit" the cognate antigens very well), but would not,under any normal circumstances produce IgG blood group specific immunoglobulins, and so these would disappear from the foetal circulation pretty quickly. -
Weak D testing in the presence of a positive DAT?
Malcolm Needs replied to SusieQ132's topic in Transfusion Services
No, it all makes perfect sense, but, if you don't have access to CDP yourself (and are used to using it, as it can, in itself, weaken the expression of Rh antigens), I would send samples to the Reference Laboratory, and if their TRT is too long, give the anti-D immunogobulin anyway, on the grounds that, even though it is a human-derived blood product, it is still probably safer (even if not required) than the risk of the mother making an immune anti-D.- 9 replies
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XM for a newborn with mom's specimen
BloodBanker80 replied to cheru26's topic in Transfusion Services
Thank you for sharing! I was wondering if anyone can help with this situation: Mom: Anti-D and Anti-c Neonate: Positive DAT - Eluate Anti-D and Anti-c If we result the Eluate as anti-D and anti-c on baby, this will require AHG XM/ honoring of antibodies (Dneg/cneg transfusions) well passed neonatal time period. How does anyone else result this to reflect these antibodies as 'passive' or temporary? Thank you for any feedback! -
Weak D testing in the presence of a positive DAT?
SusieQ132 replied to SusieQ132's topic in Transfusion Services
Yes. I should be more specific in that the main patient population where this is an issue is for neonatal patients where the mother needs to be evaluated for Rhogam eligibility. Where treating the neonate as D negative is not enough. My question for this is when would I know to do this treatment? (Or send it out to have this performed, since we wouldn't have the resources to perform it in-house. ) Do you think I would know the Weak D was falsely negative due to other odd reactivity in the ABO/Rh typing, etc.? Or would I unknowingly result a neonate as Rh negative, and say that the mother is not eligible for Rhogam, only to later find out the mother developed Anti-D? Just trying to think about the risk of performing the Weak D in the presence of a positive DAT. I know it's more likely to cause a false positive, which is why we were thinking about performing it even if the DAT is positive, and only cancelling it as invalid if the Weak D is positive. But I don't want to cause patient harm by reporting it if it could be a false negative reaction. Hope this all makes sense. Trying to get all my thoughts into words is hard today! -
Weak D testing in the presence of a positive DAT?
galvania replied to SusieQ132's topic in Transfusion Services
You are talking about patients? The biggest problem as I see it is that you will get a false positive result due to the positive DAT and then transfuse with D+ blood. Either you go to a lot of time and effort and strip off the antibodies from the red cells as Malcolm said - or, probably a lot easier - and safer - treat them as D-negative- 9 replies
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Weak D testing in the presence of a positive DAT?
Malcolm Needs replied to SusieQ132's topic in Transfusion Services
We would treat the red cells with chloroquine diphosphate.
