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I think I will get away from the venting,(although venting can be very important to ones sanity at times) because although we have a few issues (generally minor, like not checking pending logs when they are supposed to and acting on them) for the most part my techs are very responsible and really take their jobs to heart. They all really care and I am so thankful to have worked with this group for the last 12+ years. I will be retiring Jan 3 and its been a great group to work with. I will still PRN a few shifts here and there but not as manager. I will still check in on BB Talk. Will have time to visit and spoil my little grandbaby. Hopefully get to move back to New England (New Hampshire or Maine), depends on the housing market. Anyway, Merry Christmas and Happy New Year to all of you. Thanks so much for this website, it is a great thing.

I agree too - Least incompatible is like saying someone is "a little pregnant"!

I agree wholeheartedly with Joanne Croke about the "least incompatible" issue. I'm not a fan and no longer use the term here. We either give compatible units, or make our physician sign for incompatible.

Problem is, giving 'least incompatible' just makes the tech feel better. Patient-wise, grade of compatibility doesn't always correspond to clinical significance (that's a whole 'nother conversation). Knowing that, if we have a patient whose auto antibody cannot be either removed (e.g. autoabsorption or differential absorption) or circumvented by other methods (e.g. less sensitive method, prewarming, etc.) so we can see 'what is under there', then we transfuse antigen-negative for the antigens that the patient does not possess. In other words, we avoid potential antibodies/antibody formation and we 'ignore' auto-antibodies. I say 'ignore' in semi-quote because if the patient is overtly hemolyzing (not all are fulminent), then it may be best to transfuse antigen-negative for the so named auto-antibody. If we had this patient ... if we can't clear away the auto-antibody, we'd give antigen 'identical'. (Noticing comments above, give E-neg only if he/she is E-neg.) If he/she is in an acute hemolysis situation (i.e. rapidly hemolyizing and dropping hct, severely low hct) then we'd consider giving e-neg RBCs.

Good idea - this way, you can get your QC done weeks ahead of time!

Many years ago on a day when I was in the middle of completing our MHRA return with no assistance from anyone and feeling very stressed I wandered from my office into the lab to discover about 10 such things in 30 seconds. I - very unprofessionally - had a rant which was soto voce but in a somewhat menacing tone and continued through the silence for what seemed like a very long time and ended with me shrugging my shoulders and - even more unprofessionally - walking out and going home. I am in no way proud of my behaviour nor commend such a course of action to anyone. And I did apologise profusely the next morning. BUT standards showed an instant, long-lasting and dramatic improvement. I suppose the answer is to use media like this to vent your frustrations and then finding an appropriate way to communicate that to your staff. Good luck.

What have I started? I may keep this thread going as a place to vent

Had a BMS put up a cold agglutinin screen last week (possibly a coroner's case, possibly going to court) by PBS and by DTT-treated plasma WITHOUT a control! I was livid!

I love this-----"Commonsense is not very common".... Yes this thread will reach 100, 1000 marks in no time....

Shortcuts! Don't forget the shortcuts some techs take to complete work - it's as if somebody has put a gun to their head and no one is going to come in next shift to continue further. They will shorten incubation time, not follow SOPs and give proper hand offs to incoming techs. I keep on streamlining work, make checklists and logs, but to no avail. I think with complete automation, technician errors will at least be taken care of with test procedures (hope???). I always tell everyone, at least use your basic commonsense, but then "commonsense is not very common".

Yes Dr. Pepper - Have seen all that too. Our pen was not calibrated properly on the refrigerator temperature module and it was adjusted several times but poorly. I found a week where it was reading 7C, but the techs kept reading it as 3-4. Another week and it was recording a temperature of 0. The techs that week recorded it as - you guessed it - 3-4!

We would recommend giving e+, E- units. The thing is that the "anti-e" is almost certainly a mimicking specificity (the actual specificity being something like an anti-Rh17 or anti-Rh18). The "auto-anti-e" can probably be adsorbed out to extinction with e-, E+ red cells (although it will take more adsorptions than doing it with e+, E- red cells), but this will prove that it is quite okay to give e+, E- blood, and you will not run the risk of sensitising the patient to make a genuine allo-anti-E. There will be very rare cases when e+ transfusions will not give some form of sustainable increase in Hb (i.e. less than a week, or the patient actually has a reaction to the transfusion), when you just have to give e-, E+ units, but these cases are very, very few and far between.

whenever I have an "auto" anything I transfuse Rh phenotype specific rbcs (or recommend this when it is a referral). Anytime I have NOT done this, I invariably see the Rh abs that the pt would develop. I don't know how valid this is but it seems that once a pt is in the autoab mode, they tend to be more inclined to be sensitized.

We had this situation just last week. We recommend that these patients not be transfused unless life-threatening. Our patient had an 8 g/dL hemoglobin, so no way. If there is clinical evidence of active hemolysis in the patient, most recommend giving the Anti-e neg blood, knowing that you will probably encourage a new Anti-E. If no clinical evidence of hemolysis, you are better off giving E neg units. Read below for explanation. https://www.cbbsweb.org/enf/2006/auto_e_bloodselect.html

Auntie and others, we share your pain. If I may add to the list of pet peeves: 1. Starting weekly temperature discs on fridge/freezers on the wrong day and/or time. Then 5 days in a row 5 different techs document that the scribe is OK. 2. Not recording medical record numbers and dates on panel scoresheets. Record keeping in general. 3. Not printing copies of panel scoresheets on both sides so you get the extended antigen typings on the the back. Not changing the scoresheets when you open a new panel lot. 4. Filing QC records etc. with bloodstains (hopefully reagent but you never know) all over them. 5. First cousin to the above: finding blood all over the counter, centrifuges, agglutination viewer, outside of the biohazard bin, drawers or cabinets, making you wonder if a worker had been shot or merely had sneezed violently during a torrential nosebleed. 6. Discarding packing lists from the blood center so I have to get copies to check the bimonthly bill. Happens pretty much each cycle. 7. Finding obviously broken thermometers, pipettors etc. in place. Whoever broke them knew they had done so but decided to keep it secret.. 8. Not telling you when the last kit, vial, package, bulb or box was opened so you might have a ghost of a chance to order more before you run out. 9. I put out a half dozen pens and markers a week. Where do they go? Even if we supply the whole lab we should have reached the saturation point decades ago. 10. A tech asked me if it was OK in a pinch to just use one drop of plasma/serum per tube for an antibody screen; another tech had told him that was fine if you didn't have much sample. This was right before last year's competency eval, so I included that as a question. 5 people said it was OK. So we had a little inservice on the value of following the manufacturer's directions, our own P&P, and the need to validate any variations in protocols etc before you do so. I heard a great line a few years ago that went something like "Ignorance ain't what you don't know; it's knowing too many things that ain't so!" Thank you, I feel better.

it seems to me that there is a trend in healthcare in general, ofr less and less appriopriate oversight. In the Lab, we have here a few managers, but there time is spent with HR duties and other administrative tasks, such as attending meetings. They do not have time for major oversight of day-to-day activity. We have coordinators for keeping track of technical issues in various areas, but no supervisors to ensure that bench techs do waht need to be done every day (techs are supposed to be independently motivated anyway - right?). Other than continuing education for all for problems that keep popping up (time consuming for someone!), it seems like you need to fall back on discipline. If a job description says a BB tech needs to file paperwork, and they do not do it, that is a deficiency and should be reflected in thier appraisals. But keeping track of all this stuff takes time, which management does not have. It seems to be a visious circle. Remmeber to not sweat the smaller stuff. One has to depend on those techs that will go the extra mile, and sometimes they are few and far between. The ones looking at retirement often do not seem to care much about anything, and too many fresh techs just don't have the experience or mature attitude to do what needs to be done. All it seems we can do is try to set a good example. This is especially important for management; who are after all, primarily responsible for the morale of the people who they are responsible for. Scott