Transfusion Services

I am ready to change our policy to do an immediate spin crossmatch along with each Gel IgG crossmatch so satisify "to detect ABO incompatibality". Although we have not been doing it for about 10 years, now I see no alternative. Any suggestions?

I think it could be a great help if we were to share experiences with disasters so we could all learn from each others' successes and failures. I think really big disasters make the journals, but what if we had a sort of database of them as well as smaller events on BBtalk? Whether it is an influx of patients, an internal system failure, weather or other natural issues, a transportation stoppage, an act of violence or some combination of these, it could provide helpful ideas. One obstetric patient in DIC is a disaster if you are 100 miles from the next closest hospital and you only stock 4 units of FFP and 16 units of blood. If you post an experience it would be good to…

I was looking for any guidelines(with references, if possible) as to how fast a bag of platelets can be safely transfused. Thanks!

What is your protocol for when the floor wants to return a unit of RBCs that have been dispensed for transfusion?

How does everyone handle retyping of patients with no previous blood type history? I've heard of doing two separate blood draws, two techs doing typing from the same tube, two aliqouts from the same draw, and others, but I'm just trying to get a overall idea of what is the easiest way to do this.

I would like to get this forum's opinion regarding autocontrols and/or DAT. Currently, when we get a positive antibody screen, we then run a panel with an autocontrol. If the autocontrol is then positive, we then do a full DAT (poly, IgG and Comp). If the IgG portion of the DAT is positive, we then perform an eluate if the patient has been transfused in the past 30 days. We just obtained the Immucor Echo analyzer. We were told the Echo does not do an autocontrol and we would have to do a DAT. We have determined that we could still do the autocontrol and run in as a XM with the patient's cells and plasma or do the DAT as recommended by Immucor. So, my question to you …

1 homozygous 1 homozygous and 1heterozygous 2 homozygous anything goes

Hello,I am a new tech in training in a Reference Lab in a Blood Center.I would like to know more about absorptions.If anyone is good about explaining this process so that I could understand it.I know that if I think my patient has an autoantibody and an alloantibody that I am supposed to adsorb it with an allogenic specimen.Any opinions on this subject would be appreciated.Thanks,Bertie:confused:

I need your help! I had a distributor call me a couple months ago offering Rhophylac at a much cheaper price (than Ortho Rhogam) and a promise of better insurance reimbursement. From what I can tell it looks like exactly the same as Orhto's Rhogam. I had never heard of Rhophylac so I started calling around (actually I delegated that part) and found only one area hospital using it. Can you let me know what you use and where you are from? Happy with it or not or no feeling one way or the other?? I want to present something to my medical director. Thanks for being there. Melissa McHenry, Il

Have you seen the price increases from Immucor effective 7/1/08? Wow!!!!!!! I think they are selling "liquid gold"!!

Hi, I have worked in several other hospitals that did MTS gel Antibody Screens and panels, but did ABO/Rh testing by tube. It was because the tube testing is cheaper (and of course faster). We only have one MTS centrifuge. What are your opinions on the comparisons of the gel and tube methods for ABO/Rh testing on patients and retypes on units?

Last night I had an ER physician insist on O negative RBC to give uncrossmatched to a 59yo male. Even though my tech explained our protocol for O pos, he still insisted on O neg. For the patient's sake, she released the O negs(what a pity, the patient turned out to be O pos). Can someone please give me a reference that discusses emergency transfusions using O pos for males? I have reviewed an article from Transfusion vol 43, issue 7 that was mentioned in another thread. Thanks for the help. :disbelief:disbelief:disbelief

Any advice on how often transfusion audits should be performed? I try to do as many observations as possible, but being the only person in my department I find very little free time to actually stand over nurses while they administer a blood product. I also think that if they know I'm watching, compliance will be artificially high. Should I involve nursing in the process or just keep it to myself here in the blood bank?

AABB and FDA clearly define the storage (1-6 C) and transport (1-10 C) temperatures for blood products. We have many (30+) coolers that we have validated can hold a temperature between 1-10 C. Most of them will not reach a temperature below 6, and those that do usually only hold it for a couple of hours. Previously we had considered these products to be in transport; however, I will agree it is more appropriate to consider them often being used for storage, especially in the OR when they may remain there for many hours. Does anyone have a cooler they have been able to validate that maintains a temperature of 1-6 C?

this is the reason for my question! in case you have a patient with an antibody identificated, and need a transfusion today. But later on (a week or a month later) he or she needs another transfusion: Do you performe the antibody screening and full identification again, then give blood antigen negative, cross match negative or performe the antibody screening and cross match and just if the cross match appears positive, you do the antibody identification again? or do you do something else????

Recently, we switched to a different blood bank ID band and found out that surgery was routinely cutting off the blood bank ID bands that we had and reapplying them after surgery. The bands that we switched to cannot be reattached without taping. My question is how do other transfusion services deal with this problem? (Loss in the chain of identification) As a blood banker, I was shocked when I found out that this was so routine. Any anwers that you may have will be much appreciated.

What department at your hospital manages each of these products? 1. Albumin 2. Clotting Factor concentrates 3. Rh Immune Globulin-intramusular 4. Rh Immube Globulin-intravenous (WinRho) 5. IVIg

I'm in the process of updating my panel procedure (we use Ortho 0.8% panel A and B, with Immucor Panocell 10 as a backup) and I want to do rule outs on homozygous cells. I wan to use the following rules: rule out on 2 homozygous cells (preferred), 3 heterozygous cells, or a combination of 3 cells of the above. I need to tap into your collective wisdom and knowledge. Where are the holes in this thinking and what do I need to fix or re-think?

I'm getting conflicting info from two sources. Our trauma service is asking us to update our massive transfusion protocol and to consider adding in guidelines for when physicians should start adding in components like thawed plasma and platelets, i.e. when X number of red cells are issued give Y units of thawed plasma and Z number of platelets. One of our Blood Bank physicians is reluctant to do this saying the trend is to get away from specific numbers. As far as the trauma service is concerned their patients are usually not in the ED for very long so for the most part they just transfuse red cells to keep the patient alive till he/she reaches the OR. Then the surgical …

Hi, I have been a blood banker for over 6 years and have been very fortunate to have worked in a trauma setting at the start of my career and then as a Blood Center reference lab blood banker for the remainder of my career. I moved to CA 2.5 years ago and have found the blood banking practices to be slightly alarming in many ways. I recently was informed that one of the trauma centers here has a policy to give O Pos blood to all male and female trauma patients regardless of their Rh status. Does anyone else besides me find this to be a very poor blood transfusion practice? I can’t imagine why anyone would want to give an Rh negative individual the opportunity to make …

In general, what is a good amount of time to wait to check a hemoglobin after a RBC transfusion? I realize that the term "general" may be a bit too broad here considering all of the different conditions a patient getting transfusions may be in. What we are looking at is newer policy here at our hospital requiring a H&H for most RBC post-transfusion patients before an order is processed for any further transfusions. We are anticipating questions on this. If anyone has a definitive reference regarding a study on this or whatnot that would be nice to have also. Thanks, Scott

Who performs this test? Hematology or Blood Bank? Is it done on all shifts as a STAT test? If so how do you maintain tech competency if your 2nd & 3rd shift techs are generalists? What is your turnaround time? The majority of the KBs that we do are ordered by physicians on antepartum patients who have fallen or have been in a car accident. Our current policy is that this test is done on day shift only since that is the only shift that does evaluations on Rh neg moms post partum. We have a physician who wants us to change our policy to to the test stat on all shifts. Obviously our generalists are having a fit. Any information that you can offer would be appreciated.

I'm a little worried.....we had an esophogeal varacies patient bleeding out this afternoon....he has an anti-c so of course it was tough to keep up. After the initial 10 units given before a sample was obtained (these units c negative) we thought all our hard work is just being bled out, we would wait until bleeding was controlled and give antigen negative for the units that would remain in him. Last request for 4 (still uncrossed - but we finally have a sample) we called once again to ask how the bleeding was - still profuse - so no phenotyped blood issued. I left after an hour overtime leaving staff with 8 compatible units, FFP, cryo and platelet pools just issued …

We use the gel system for most all of our testing. Occassionally we have problem false positives that occur with the gel. When sending out "positive" antibody screens for identification the reference lab blood bank will recommend we re-screen the patient using tubes since they got negative reactions using tubes. Our problem is that we only have the 0.8% cells. We don't do a high volume of blood banking at our hospital and it would not be economical to keep the 3% cells on hand. Does anyone convert their 0.8% cells to 3%? If so, how? and is this acceptable?

I debated which category to post this; but decided to do so here. One of my Techs. left the panels and GEL cards last night on a patient she could not figure out. I always review panels the same way to prevent biased blood banking (rule-outs on all negative reactions first; then look at what is left; my first step is never to look at the positive cells and see what Antibody pattern they match). Anyway, after ruling out on negative reactions from 2 Ortho Panels as well as the Surgiscreen, everytthing was clearly ruled out; except, anti-f. It is the perfect pattern for f. When I first came here, no one knew what an anti-f was (and I don't even want to think about what…