Transfusion Services

Hello everyone.................. I hate anti-a1 to be honest with you... I never liked it.. Patient's history blood type: A pos. no discrepancy noted on the other hospital.. One hospital reported inconclusive antibody result. Received 2 prbc within 30 days. Patient is at my facility. Now has back type discrepancy. ABID- Anti-M and inconclusive. Before getting the absc result.. my tech decided to work on the extra reaction backtype discrepancy thinking that it's a subgroup.. anti-A1 lectin was negative and RT tube screen was positive at IS. A2 cell was negative at IS, but when I let it sit for 15 min.. it was 1+w positive. So…

Hello everyone, We will be moving to a new manufacturer for daily QC to be run on the blood bank gel analyzer. I need help on what the validation plan should include in order to establish the new QC works as expected. Any advice, details or examples would be very helpful. Thank you.

Patient is identified as having “warmautoantibodies” in our lab with transfusion instruction to give C, E, K neg units. Patient was phentotyped for RH and Kell on the first work-up. When patient came back for a type and screen, 2 cell screen were 2+, ABID were all 1+ except for one cell being 3+. DAT was negative and when I performed tube screen and autocontrol, they’re both negative. When I looked at the previous work-up, no transfusion has been done since 2018, screen and ABID also have panagglutination reactions. DAT and Tube screen were also negative. My supervisor asked me to do an elution and it came out with panagglutination reaction (3+ and 4+)…

this is a donor blood grouping also with tube tech anti A given Neg reaction !!! what could be the reason?

Current workflow: The first Type and Screen ordered/resulted has an outdate of expiring on the 3rd day (after collection) at midnight. All product orders will net to this Type and Screen order. A new Type and Screen order is allowed in on the 3rd day after 12pm. Duplicate Type and Screen ordered in Epic 'net' into the same Soft order, but label does not print for a new collection. This keeps any product orders on the active T&S sample. New Epic/Soft Bank workflow: Epic displays a warning for duplicate Type and Screen. Providers/nurses may disregard warning and enter a new T&S for collection. These duplicate tests will no longer ‘net’ to th…

We have a 71 yo male patient who has had a week of horrid nosebleeds requiring emergency transfusion of 2 units and later crossmatched units, They eventually fixed the nosebleeds via Interventional Radiology after nothing else worked. INR never above 1.4; Plt count always >100. Then he was found to have "coincidental diverticulitis complicated by perforation, ileus, and shock". They did a colectomy 18 hours ago, during which he was transfused 4 units RBCs. The op note includes, "A large volume of purulent fluid was evacuated from the abdomen.". That's 12 RBC units over 8 days, never more than 3 per day except during this surgery. No plasma and never a massive transfu…

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 need help with determining what steps can be taken to alleviate manual processes to get orders and results from the Grifols blood bank analyzers into SoftBank/Epic after an extended downtime. How does downtime retransmit instrument results work after downtime for blood bank w Epic? Do any of you have a good downtime procedure to facilitate the transmission of results from the instrument into SoftBank to eliminate the necessary manual entry process?

I have an older tech when performing an acid elution will use the same pipette for washes 1-3 to remove supernatant. The tech uses a new pipette for wash #4. I have never seen this before. I don't believe this is correct, but I am unable to find any reference material. Do any of you have an opinion or possible reference?

Good afternoon everyone, I have a question. We just had our unannounced JCAHO inspection today in the blood bank. The surveyor asked us why we use clear plastic ziplog bag when issuing blood products when blood products are considered biohazard. Why not use the biohazard bag. What kind of plastic bag does everyone use in the blood bank when issuing blood products to floor? Help~ Thank you!

Is an ABO retype required if the specimen will NOT be used for transfusion purposes? For example, when an ABO is ordered for prenatal testing, outpatients who just want to know their type, and newborn cord blood testing (we do not transfuse newborns at our hospital)? AABB standards refer to "pretransfusion testing" but if the sample would never be used for transfusion purposes does it need to be confirmed?

Good morning, Blood Bankers. I work at a Level 1 Trauma center and we just purchased 4 of these coolers. Has anyone had a successful validation plan? If so do you mind sharing. TIA. I am trying to find the most efficient way to validate and make sure we are covering every extreme possible.

Wondering what everyone's Blood Bank procedures are for when a Trauma rolls in, what is current standard practice. We are a level 2 trauma center. We currently emergency release two units on every Trauma Priority 1 and 2 that comes in the door. This has proven to be a huge waste of time and resources, (we need a T&S and usually a retype on these folks so that we can perform the XM in Safetrace) but our ER and/or Trauma docs (not sure which ones) insist on this. We have been collecting data to show that only a fraction of these patients receive blood, (usually the trauma 1's or a patient who progressed to and MTP ANYways) to hopefully move to only emergency issuin…

Hi all, This is my very first post in this forum. Nice to meet you all. We had a patient today with anti-Lea previously identifed. I'd like to know what your policy of selecting units for patients with anti-Lea is -- do you use phenotyped units or not at all. I did a little bit research today and found that some says anti-Lea rarely causes Hemolytic Transfusion reaction, and some says there are examples that it causes HTR. Does your blood supplier (e.g. donor centre) phenotype units for Lea Ag or not at all? One of my colleagues said today if we order Lea neg. units from our blood supplier, they are going to laugh at us (-- sounds like they don't care about anti-Lea at al…

Hi I have a question about strong cold antibodies. Does anyone here, recommend blood warmer for transfusion on the floor, not OR? I understand in OR it is recommended because of the low temperature in OR setting, but a patient room is warmer. If you do not recommend, do you have any research on the topic, either for it or against it. Thank You

I have a site where the lab is not staffed 24/7 but they do retain emergency units in the blood bank fridge. The units have a red tag and are stored on a shelf labelled "emergency units". We have provided training for nurses on how to access and sign out the units but it is becoming a challenge to maintain this due to staffing (clinical and lab). We need to allow nursing to come in and retrieve emergency units after hours. Does anyone else have this type of situation? Our current training is proving to be unmanageable due to the change over in nursing staff and Agency nurses. Sometimes I think we make it harder than it has to be - thoughts?

Hello all, Any truth to the maxim which I've inherited in my training which is that anti-Jka can do funny things on the panel? e.g. react with heterozygous donors and then not react with homozygous donors? React inconsistently? Not sure if this lore can be confirmed by others ... Thanks!

Yes, this again. OR wants to use it; the circular still says not to. Does anyone have any definitive data that allows the use of Lactated Ringers solution in blood infusions? I see one small study out of Canada in 2009. I'm not sure how it could be allowed when the Circular of Information specifically says never to use it.

What's a high frequency antigen that might be weakened on expired reagent cells, reacts in Ortho MTS gel testing (about 1+), including when 3% cells are converted to 0.8% to run in gel but not in PEG? It does not react in MTS gel on 2 expired 3% reagent cells converted and run in gel but did react with 3 in-date cells converted to 0.8%. It does not react using 30-minute PEG with any cells in a 16-cell panel. DAT is neg. No recent transfusions; 51 y.o. fe with a lacerated spleen from being thrown from a white-water raft onto a rock. Hgb staying stable enough. O pos. "Race: Other White" and she is from Arizona. I would think it was antibody to the gel diluent in predilute…

Some of you more "experienced" people will remember the little saws that we used to score the microhematocrit tubes so we could break off the part with the immature red cells for antigen typing someone who had been recently transfused. What the heck were those saws meant for originally? I feel like they came with something else in the lab. Were they for general chemistry glass tubing? Also, what tool works well now for scoring the plastic-coated glass microhematocrit tubes since those little saws aren't available? I found a few centimeters of staples (ready to be put in a stapler) could work. Hack saw blade?

Someone online said that anything not in an FDA-approved kit or reagent system purchased from a vendor is a lab developed test and thus subject to the new FDA rules, including all those ancient procedures that are in the methods section of the Technical Manual. I could argue that the titer procedure is really just specimen treatment, not a test different from any other tube AHG test. Generally, the tube AHG tests are defined in the manufacturer's instructions. Is saline replacement a test? I wonder what the Lab regulatory bodies will say about the new rule in regard to BB tests. Anyone have any extra knowledge about this for BB?

Hi all, just wanted to get some advice from more seasoned techs. Is it wrong to let tubes sit before looking at them under the microscope to catch rouleaux and cold? I feel like they don't always clump up immediately. And regarding tech to tech variation, do you just ignore it if you are able to shake out small clumps in the back type? I usually work it up and make sure there isn't rouleaux or cold but some techs think that's too much work. Thanks.

Is it acceptable by both CAP and AABB standards, to use FFP after thawing without changing the product code on the label to "Thawed FFP", only updating the expiry? (Up to 24 hours post thaw) TIA

Hello, We are making the switch from gel DAT back to tube method due to supply issues. The package insert is not specific on what to use as a negative control for daily QC. Looking to see what everyone else is using? Thanks!

If the Kleihauer calculations are for seven (or more) 300 mcg vials of RhIG (assuming persistent fetal Hgb and weak D have been ruled out), are there precautions for giving that much? Is it effective? Is there a number of vials that is just too many? I have heard of concerns for hemolysis, which are sometimes mitigated by spreading out the IV doses and by giving steroids. I vaguely remember the idea that over a certain number of doses it may be hopeless. Is the approach different if due to transfusion rather than a FMH? Does anyone have any actual guidelines or evidence?