Transfusion Services

We have a postpartum woman who we previously grouped as O Rh:positive (once by tube and once by gel). Both these historical results show negative with Anti-A and Anti-B, the reverse grouping is 2+ A cells and 4+ Bcells. Today one of our new grads noted weak 1+ reaction with the Anti-A, reverse again 2+ with Acells (weaker when warmed). We recollected the patient and got same results. Anti-A1 lectin is negative so we're thinking it is a A subgroup with an Anti-A1 ..... but gel doesn't pick up this subgroup at all!? We tried testing the patient plasma agianst two A units = one 1+ (weaker after warming) and the other negative. We tested the patient cells against group …

Hello All I've just had a patient undergoing an exchange transfusion for sickle cell anemia display symptoms of a transfusion reaction immediately post transfusion of a Diego a positive bag. The reference lab has confirmed the patients serum contains anti-Diego a antibodies. Clinically patients symptoms were of a hemolytic TR with tachycardia, back pain, dark urine, nausea and anxiety. LDH doubled post transfusion, haptoglobin was low but is low usually for this patient. DAT was negative in the post-transfusion sample. My questions are two please. 1. Has anyone ever seen an immediate HTR due to a anti-Diego a antibody? 2. Do sickle cell patients experience 'stronger' sym…

We've had to do some finagling in a couple cases (in light of the continuing blood shortage) and are also in the process of reviewing our SOPs, and we are curious about other folks' practices with the following setting: Mom has anti-D due to RhIg at the time of delivery. Baby is Rh-positive and needs product. Our current SOP is that we must give Rh-negative products to the baby, because of the mom's residual RhIg showing. I've had to override this a couple times recently in order to either comply with other maternal antibodies, or to get a young-enough unit on the fly. Am wondering if there is actually any utility in hewing to this in our SOP, since presumably baby…

Has anyone had problems with Anti-IgG gel cards lot # 121409001-31 exp 27OCT10? We had a problem a few lots ago and Ortho replaced our cards and the new lot was fine. Now we are having problems again with junky specks in both patients and QC. The cell button ins't disturbed, nor is it going up the side. Thanks.

Can anyone tell me if they require a patient to sign a Transfusion Consent for RH Immune Globulin and/or Albumin? We are trying to standardize our practice and I don't know of a regulation that requires a Transfusion Consent for these plasma derived products. Thanks, in advance, for your input.

We only test for a "Du" (weak D) on Rh negative babies of Rh negative moms. This is so we don't miss giving a needed Rhogam. We use to do any females of child bearing age or younger. We had a 13 year old come in yesterday with a Type and Screen order. She had a history of being B positive. This was done when she was born. The CLS yesterday got a B negative blood type. Since her history was B positive he did a Du. The Du was positive. I did here phenotype and she was r'r ( positive for C,c,e and negative E). Since almost all Rh negatives are rr( positive c,e and negative C,E) could the positve Du be a carry-over of the C being positive? Wouldn't it be safer to gi…

I have a pregnant patient that has had a Anti-E that isn't very strong. The last time we tested her she had a negative antibody screen. There is something in her history about a "cold autoantibody" but I'm not sure of the validity of that antibody. When I got a specimen on her today I decided to check everything at once. I did a modified cold panel which was negative. We use gel and have the "C" panels (panel A that has untreated and a ficin treated panel cells). The untreated results showed an Anti-E. The treated cells have an Anti-E with a posible Anti-c or an Anti-f. With the patient having an Anti-E, my only cell that differs a c from an f is that cell. It …

Hello everyone. I have been lurking for some time in here, and have to say that the information from this community is extremely helpful. We recently had a CAP inspection, and were cited for TRM.41650. It reads: "Are criteria for the recognition of transfusion reactions documentented, and is there documentation of periodic in-service education on the recognition of such reactions? NOTE: These must be readily available to clinical personnel in areas where patients are transfused." I am unsure how to proceed here. Is this in reference to in-service training and yearly competency checks of the transfusionists (who are nurses in our hospital)? The lab personnel would no…

Does any of the hospitals accept or use "Keep Ahead" Orders? My new medical director is trying to deactivate the "keep ahead" section on the prepare order because any physician can always place an order in EPIC. Most of the time our physicians do not know what "keep ahead" means, if a physician sees "keep ahead" section, the order gets placed. So, my C:T value has been high. Is it worth it to keep the "keep ahead" feature in EPIC? Please share your wisdoms. Thank you!

I know that when faced with patients with autoimmune hemolytic anemia, we should be doing absorptions (either auto or allo) to rule out underlying alloantibodies and/or antigen typing (preferrably by DNA analysis) and providing antigen matched units.... but what of the realities of incomplete/poor absorptions, time constraints, etc. for a patient who needs blood now? We can do absorptions (but they take hours). Autoabsorptions are 'easy', but alloaborptions are more difficult to interpret (and I don't really want off shifts doing them). Antigen typing with AHG antisera is of no help if the DAT is positive, and DNA antigen typing takes days. (Personally, I think the 'dil…

When you issue blood that is "least" incompatible for a patient with a warm auto antibody, is the ordering physician required to sign a release for that blood?

There is another current Thread regarding problems with the GEL Cards themselves. And I know there are other Threads regarding problems with false positive reactions from Surgiscreen (with the instrucions from Ortho to "keep them in the dark;" but now I am thinking perhaps WE are the ones being kept in the dark.... So another recent problem I have experienced are "additional"Antigens on the Donor Cells that cause positive reactions that you might not care about so much. Recently there were 2 Lot Numbers in a row with Lua. Now you wouldn't think that should cause a lot of problems, but we actually ended up having quite a few patients with anti-Lua!! Now we are havin…

Hi, Disregarding the concern about an official order, Medicare issues, and the billing aspects, what are your thoughts on issuing products without a formal pick-up slip (or whatever your organization calls it) being presented? For instance, if you had products crossmatched and received a phone request to issue the products through a pneumatic tube and were provided the patients full name and medical record number (and you verified this in your computer and documented the request), would you issue the requested products? Thanks for your replies

I know this topic has been discussed before (see thread below) but I wondered if anyone in the current crowd had a literature reference, standard, documented recommendation or anything concerning 'resting' platelets for a short period of time before issuing them for transfusion, if they just arrived in a platelet shipment. http://www.pathlabtalk.com/forum/index.php?/topic/6060-issuing-platelets/ This resting period is taking place for platelets that were packed the night before and arrived that morning with the standing order and for platelets that are packed shortly beforehand and picked up ad hoc for emergency transfusions. I'm trying to break the technologists of…

I would like to find out how other facilities handle orders for CMV neg and/or Irradiated products. Currently, we just have 'one' option for ordering RBCs, and they must add a comment that CMV neg/Irrad is needed. Once we get an order like this, we add a patient marker, so that we provide all future products CMV neg/Irradiated. Do you have a computer code for Irrad/CMV neg RBC (PLT, etc.) for the nursing units or physician to order? If you do, how do you handle it when you have an history of special needs and they don't order it the next time? I want to keep this as simple as possible, and not replace one potential problem with another. Thanks! Linda Frederick

The term "Trauma Pack" has been used by physicians and nurses in one of our ICUs and in some ORs when there is a STAT need for blood products. This is term is not in our SOPs and has not been used, until recently, in this hospital. When asked to define "Trauma Pack", the RN calling the blood bank has no idea what she is asking for and tells us that's what the order says. Does anyone use the term "Trauma Pack"? If so, how do you define it, when is it used, what turn around time is expected, etc?

We are a 400 bed hospital level 1 Trauma Hospital and occasionally have patients that require "massive transfusions" We have a massive transfusion protocol that seems to be working BUT.... The nursing staff now wants us to send all blood products (RBCs, FFP, cryo, and platelets) together in some type of transportation "system". We of course put RBCs in a cooler 1-6 and send the FFP, cryo and platelets seperately. My question is.... DOES ANYONE HAVE ANY IDEA AS TO HOW I CAN CREATE A TRANSPORTATION "SYSTEM" THAT SOMEHOW WOULD HAVE ALL PRODUCTS, KEPT AT DIFFERENT TEMPS. IN ONE CARRIER. My thought was to have plastic carrier bags to attach to the outside of the cooler for th…

I'm curious what others out there think of this: We have a hematologist/oncologist who has given "trial" platelet transfusions (two separate occasions to two seperate patients with ?ITP "to see if they will respond if platelets were needed during a planned surgery"). Both patients had platelet counts in the 80's but the surgeons did not want to perform the procedure before consulting a hematologist. I questioned him before the first "trial" happened and he was quite irrate to be questioned. Needless to say I just gave out the second "trial" set since my lab director didn't really back me in the first case. Platelet counts did not go up in the first case (actually drop…

We have a Mother with a "weak D". Her baby's cord blood also looks like a "weak D" . What to do at this time?? Do they cancel out the need for Rhogam? I thought it safer to give Rhogam for Weak D with RH pos baby , but haven't had this problem before. Any suggestions! Thanks, Jan and Rosanne

Hello there, It has been some while since last time I was here. We're planning to validate a new Kleihauer Betke staining method as our current one does not work well (especially with CAP samples) and trying to determine # of samples required for this validation. We couldn't find any requirement/standard to specify the # sample needed to fulfill the purpose of validation. Could anyone please provide some related information? Thank you for your help. Clarest

I hate to post this question but its bugging me for the last 2 weeks In my monthly usage report, I have to calculate % RBC utilization. I look at our existing policy which was originally written in 1992 and was revised in 2004. According to the policy; % utilization of RBC is calculated by dividing the number of RBC transfused for the month by the number of RBC transfused. The total should be 100%. That don't make any sense to me. If we transfused 263 and wasted 6 for the month, I guess my calculation should be 263/269 X100=97.77%. The policy should say; % utilization of RBC is calculated by dividing the total number of RBC transfused for the month by the number of RBC t…

At my facility, we've had two cases recently where an eluate was positive with specificity to an alloantibody even where the DAT (poly) was negative. My facility performs the tube DAT but we can perform a gel (MTS) DAT to back up what we do in tube since the gel is often more sensitive, at least where IgG is concerned. Sure, in most cases, we'd never perform an elution if the DAT was negative to begin with, but occasionally a doc will request an elution if the DAT is negative, or we in the lab will take the initiative on a suspected hemolytic episode to perform an elution anyway, since as you know, coated cells can quickly be vamoosed from the peripheral circulation rende…

Sorry if this the wrong Thread. Also, I apologize for this dumb question. What does +s in the ortho Panel mean? Thank you

I am trying to find a current reference for completing a red cell transfusion within 4 hours of the time of issue. I could not find it in the current CAP Standards and was wondering if this is still a requirement. Does anyone monitor Blood Administration for this?

I would like feedback for the following: Unit is issued and NOT spiked. 30 min have elapsed & something happens that causes the transfusion to be stopped/ delayed but it is possible the situation will be fixed so that the unit can be transfused within 4 hrs from issue. ( ie. IV infiltrates) We would like for the BB and Nursing to have some discretion on these cases so that units aren't summarily discarded. I have researched & read feeds on here that give us some grounds for altering our policy. I would like to know if anyone else does this and any problems or unanticipated consequences. Please state the size of your facility and if you are not in the US, pl…