Transfusion Services

Owing to the FDA "bar code readable" requirement when signing out blood products from the lab, how is everyone coping with a neonatologist who requires a 40% Hematocrit unit (for example) in an Exchange Transfusion? The usual course of events, for most I suspect, is an O Neg, Irradiated, CMV Neg, CPDA Packed Cell diluted to 40% Hct with a thawed AB FFP. If the lab transfers the FFP in to the red cell bag, I am assuming that is "making a product", and would require that the lab have an FDA facility code. It would also require a label printer able to output in both Codabar (for now) and ISBT (for now too?). Are most of you with NICU's just issuing the units in their orig…

We use ABD/Reverse gel cards to type in units that we recieve from ARC. Last week we started having a problem. On the wells that are negative, we see a group of cells that are negative and then about a 2+ reaction above them. We see it mostly in the B well and the control well. I've tried everything I can think of. Tried different centrifuge, different box of cards (same shipment), a new lot of cards seemed to be a little better until our last shipment. New MTS2 diluent, new bottle MTS2 diluent without using dispenser. I pulled units off the shelf that we had previously typed and 2 of the 3 had problems. Nothing we were using was new all had been open for 7-14 day…

Is it better to use aliquotes from the same RBC unit for neonates and peds to decrease donor exposure, or use new fresh units to assure a low K+ ? Moreover, what is your definition of fresh unit? Thank you. Liz

My laboratory Director is wanting me to cut way back on the anti-sera I keep on hand to antigen type. It just isn't cost effective for us to keep $1000 reagent on hand that we may only use one time, if at all before it expires. In the past, whenever we received an antigen-negative unit from our reference lab, we have always confirmed the unit is in fact antigen-negative upon receiving it. Generally we never ordered antigen negative units unless we were unable to find one in our inventory or it was someone with a combination that was going to make it extremely hard to find compatible units. Does other facilities confirm the antigen-negative units when they receive them? If…

I just received a look back notice for some platelets we transfused to an oncology patient back in january. The donor apprently donated the pheresis unit during the 12 month deferral period for tissue transplants. My question is, this unit was probably full of HLA antibodies. The recipient has had subsequent febrile non hemolytic reactions to platelets. I am thinking that the unit in January may have caused it due to the HLA thing. What is everyone's opinion? Thanks.

We've been having a long discussion on a number of threads about what we are doing about ABO confirmation prior to transfusion. I'm having that discussion with our lab manager and we have reached an impasse. He wants to know - in numbers - how the majority are dealing with this problem. I'd like to see a poll to determine what the prevalent method is: 1. Retype the same specimen (same or different tech)? 2. Retype a specimen drawn at a different time specifically for blood bank? 3. Retype a specimen from another lab section that was drawn at a different time - meets blood bank labeling requirements? 4. Retype a specimen from another lab section that was drawn at a …

Our blood supplier is now testing for Chagas and AABB recommends recipient notification. Living in an area with a high seropositive population, I have received my first batch of confirmed positives. Does anyone have a form letter or pamphlet for recipient's information? Any comments are welcomed....

I would like to know if many facilities are still routinely performing an ABORh and DAT on cord bloods for O positive moms in addition to the routine work-ups for all Rh Neg moms. Thanks

What are people's next step when Gel manual panels don't point you to an antibody? Send out, tube testing, something else? We had mysterious results in both Panel A and B. We were able to rule out all major antibodies. The techs then went on to perform tube testing which were completely negative. A fully compatible unit was transfused. I had my suspicions and repeated with a newer sample and found anti-Jka. I don't feel comfortable that we went from a sensitive method (gel) to a less sensitive tube test method with no real reasoning other than to try and get rid of the positive results. What are other people doing after strange gel results?

Does anyone out there state in their SOP's about an alternative to AB patients when giving FFP. This would be in an emergency situation when we are out of AB FFP and our supplier is also. Do you state the ability to give alternate types when you have started to switch the type for packed cells?

Hello all - Currently when we perform an adult DAT, we start with Poly-specific IgG, C3d. If that is positive, we perform both anti-IgG and anti-C3d,C3b. Are there regulations that say I HAVE to perform the anti-complement portion? I'd like to discontinue the anti-complement reagents to save costs. Thanks! Heather

I am curious as to what other facilities are doing, especially since the COI is a bit ambiguous in its wording. How many of you our there are adding sterile saline as an aid to pooling cryo units? We have had a long standing practice of using 50cc's as an adjunct when pooling cryo and I haven't seen any other facility to that. It adds one more item to the documentation on manufacture and increases the cost. So, do ya'll pool cryo au naturale or do you add saline?

whats the official guideline on this do most people use homozygous or heterozygous to titer say a known antenatal E?

We have had more than a few instances in which the fetal screen is obviously positive on a maternal post delivery sample (NOT weak D), but the KB is reported as completely negative. Has anyone else seen this? What could cause this? I have worked with this Fetal Screen kit for about 6 years and I have only seen this in the last 2 years or so.

:)I was browsing the internet and I came across this site. I browsed through it found a lot of great information. I recently acquired the blood bank lead tech position and I am looking forward to bringing it up to date. It is going to be a great challenge for me. The hospital I work for is 180 bed, so the blood bank procedures performed there a minimal. I am glad I found this site. Question 1: Does anyone have any information regarding competencies for new employes it could use. We use Tube and MTS. Thanks

Where can I find info on blood product infusion sets, specifically what micron sizes are acceptable for different products? Is a 170-260 micron filter universally acceptable for blood, FFP, platelets and cryo? We had been using an 80 micron filter for blood and FFP and a 170-260 micron for platelets. Now the hospital has recently (unknown to us in the lab) discontinued stocking the 80 micron size and apparently the floors are using the 170-260 for everything.

Does anyone have a policy that sets a time limit for issue of a blood product for a non-stat blood administration - i.e. a routine order to give (no specific time stated by physician)? Nursing is looking for a benchmark.

Has anyone had experience transfusing an IgA deficient patient with anti-IgA antibodies >1000U (and anti-c) with RBCs? I understand deglycerolized rbcs are first choice and then second choice is washed (X2) RBCs. Is deglycerolizing really necessary?

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When you have a cold agglutinin present that will not go away until the crossmatch is performed by IAT prewarm method do you inform the nursing unit to use a warming coil? What about those crossmatches that interfere at immediate spin but will go away if put in the warmer for 5 minutes?

This has probably been discussed before, but once again... Transfusion of a blood product must be completed before the expiration time of that product. Agreed? Do you have policies about how close to the expiration time blood products can be issued from the transfusion service? Plasma can usually be infused within 30-45 minutes. Would you issue a unit of thawed plasma 25 minutes before expiration? RBC's one hour before expiration? Do you instruct nursing staff to infuse until the expiration time, then stop the transfusion whether the unit is completed or not? Just seeking ideas...

Would anyone be willing to share an example of an Emergency Release Record that contains multiple units of blood for a massive hemorrhage and that contains all the required transfusion information? Thanks, MWL

Maybe it is too easy, I need some help.

Am I thinking correctly -- or just tired from working extra covering for vacations? An associate -- gotta love students and new employees! -- remembers being cited at a past facility for not collecting a Fetal Screen shortly after delivery, immediately after Stat cord blood testing confirms baby is Rh positive. Those of us reading product inserts know the wording is close to "at least 1 hr after delivery, but as soon as possible thereafter". I've always defined that as "with the next AM CBC." Injections are always given within 24 hrs. A quick google search for something later than 1990 and rereading Bowman's more recent talks yielded nothing. So, other than a fading…

Need to pruchase a new plasma thawer that will accomodate from 10-20 units of cryoprecipitate. Would appreciate advice on what plasma thawer to purchase and manufacturer of same. Also if you have had any good or bad experience with any particular brand/device Thanks