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All this just reinforces my opinion that one should never, never, ever get sick, because then you can get treated and all sorts of bad things can happen!

You did bloody good anyway! It's awful isn't it? If it makes you feel any better my first night was a favour I had offered to do as I was due to go on but hadn't yet shadowed anyone. They promised me as it was a Tuesday it would be quiet - it wasn't! I had a 4 unit crossmatch on a patient in A&E who had been in a car accident (plus all the samples on everyone else who had been involved - 4 cars and 9 people), a 6 unit obstetric haemorrhage, a 10 unit AAA crossmatch and a CSF on a kiddy for microbiology and chemistry (I was everyone!). I cried... I phoned my supervisor and he helpfully said 'prioritise who will die first'. So I did (whilst crying) thinking they were all going to bloody die! My supervisor did come in but by the time he had, everything was cleared and everyone survived. I told him if this was what nights were like I didn't think I could cope and didn't want to do them. He told me it would be a once in a lifetime type shift and said I did brilliantly - he also apologised for his flippancy as he had assumed it was first night nerves and not a real crisis like it was.

There's not much I can add to what has already been stated ... a learning experience, talk about it so you can be better prepared next time, etc. Except ... 1. Your supervisor dropped the ball here. As 'Quality Guy' quoted CLIA (and it should be a 'rule' regardless of who requires it), your supervisor should have a 'call me anytime and if you can't get me, call ____' with the phone numbers perpetually posted at every BB phone.As far as the policy about 'the patient has not been transfused so you do not need to repeat the workup' - yes, it may be a rational thing to do, but unless this exception is written in your policies, you are not free to skip the testing. That exception should be written in your procedures and you should have been informed of it during your training. Sounds like you were not trained to deal with 'unusual crisis' cases. Were you trained in what antibodies are truly 'clinically signficant'? Were you trained what to do if you have a crisis patient who has 'clinically significant antibodies'? ... or other issues like IgA Deficiency, Sickle Cell Protocol, etc.?2. "Remember exanguination is a lot harder to treat than a transfusion reaction." Keep in mind that it's up to the attending MD to decide if the patient can wait until all the required testing is done or not ... it's not the Blood Bank's responsibility. All the demands, threatening statements, and loud voices are not going to change that fact. The responsibilities of the BB Tech are: to inform the requesting MD of any additional risks (e.g. clinically signficant antibody, IgA Deficiency)to convey to the requesting MD the TIMING for filling the order (very important, they will change care plans based on what is said) and not burdening them with the details about 'how'.to do whatever tasks are necessary to get the safest blood out the door in a timely manner in accordance to whatever can be done in the given period of time, e.g. Group O RBCs vs Type Compatible RBCs vs crossmatched RBCs.to focus on those tasks, not worrying about what's happening in the ED or who's screaming on the phone or what MAY happen 'if'.Yes, it's all these things that help techs get through these tougher situations. You lucked out with this crisis, but as you are feeling, you need more support and more information ... get those things before this happens again.

You can have it from me- You did a great and thorough job from what you are telling us! Good for you! I don't think the pit in the stomach ever really goes away and I think having that keeps you on your toes, keeps you from getting complacent and potentially miss something. So you had a rotten situation, did all the right things, and it worked out- again good on 'ya!! I can't think of an antibody situation offhand that I was witness to, but I have "fond" memories of working alone overnight when a newborn was in crisis and the MD came flying into the Blood Bank begging me for blood, no time for any paperwork, just PLEASE let him have one of the Oneg Pedi units off the shelf. He grabbed one as I opened the frig and out the door he flew. That one has stayed with me for 40 years. Oh yeah, about 15 years ago there was the actively gushing patient on the OR table with 5 antibodies and the surgeon came rushing in begging for "ONeg blood, that's all we need" and I had to 1) try to explain to him (calmly so he wouldn't hear my heart beating very loudly) that ONeg wasn't the solution to multiple antibodies 2) make the BB tech who was screaming at him "you're gonna kill the patient" sit down and shut up and 3) pray as we waited for delivery of several screened units from the Blood Center next door. We got the units, out he went and the patient did well. So your future events will likely happen. Try to read up on problem situations when you can to keep fresh, including any online teaching tools you can use from your vendor or here in the wonderful PathlabTalk. We are here for you!

I call that the "baptism of fire". Just remember that experience is the best teacher. If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to? As a newbie there really should be some kind of support for you in these situations. Just a battle story to share.... we are not a trauma center either and a while ago when I was new, we had a patient that came in as a trauma and they wanted emergency release. Blood was issued and then we found out the patient had multiple antibodies. I believe that one was a Kidd. Of course, the units that the patient was given were incompatible. Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this. I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction. They just need the oxygen. Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore. Don't be discouraged, you will gain the knowledge over time to be confident in your decisions!

We were JC inspected this past fall and the inspector asked me to pull the package insert for our Ortho Panel A 0.8%. He pointed out that it stated that the panel should be tested periodically with weak antibodies. We do QC our panels whenever we receive a new lot # and I was able to pull the folder to show the inspector we were in compliance. We use Ortho Confidence Antisera 1:40 dilution for the positive control and Bio-Rad Solidscreen II Negative control. We perform QC using these controls for both our gel panels and our 3% panels QC'd on the TANGO for all new lots received.

Done that many times Terri!

Worst thing is answering the phone "Blood Bank" when you're home.

I think Parafilm should be available for home use.