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It is the policy at our facility to give E=c= RBCs when patient has anti-E and types also as c= or if c pheno is unknown or cannot be done due to very recent transfusion, but we do not type the units for E when patient has anti-c only. In this case, we only give c= units.

Sorry sweetie! I thought you were already in consulting mode I never thought you'd abandon us. I certainly won't. I'm not sure about assessing but I'll keep up the lecturing, editing, meetings and fun stuff. I've not set a date yet but it will definitely be in the next 5 yrs. Sooner if health limits me but I 'm working on that.

We give all patients with Anti-E, blood that is c antigen negative. Until a few months ago, we had several patients who were chronically transfused that required both E, c negative units so we stocked two at all times. The 18th Edition of the AABB Technical Manual, p. 331 states: "When seemingly compatible E negative blood is transfused, (to a patient with anti-E who most certainly has been exposed to the c antigen as well), it is most likely to be c positive and may elicit an immediate or delayed transfusion reaction. Therefore, some experts advocate for avoiding the transfusion of c-positive blood in this situation."

And labeled with Rh/K typing, right? Very jealous!

I have the advantage in that I work in a Reference Laboratory in London with an enormous stock of units. That having been said, we would give c Negative E Negative blood to all R1R1 patients with a haemoglobinopathy, or an auto-antibody (or any other condition that means they are likely to become transfusion dependent) and to females of child-bearing potential, even if they have not made an anti-c or an anti-E, as a sort of prophylaxis to stop them making these specificities (although of course, "naturally occurring" anti-E-like mimicking specificities still occur). Any patient that falls outside this, we just give the cognate antigen negative. Remember, the vast majority of patients who receive a transfusion either die within 12 months,or never require further transfusions throughout their lives, and so it really isn't worth giving R1R1 blood to these others.

I'm jealous. You two know all the rock stars.

We have a Sanyo, now Panasonic and have been very pleased with it.

We've been happy with our Panasonic freezers. Ours happen to be ultra-lows, but I suspect their regular freezers would be good as well. Their pricing is good.

A few comments: first, I really like what was said above about this being a pubic forum. You don't want your employees seeing comments like that. Second: if you are in charge then YOU are in charge. Set the ground rules and enforce them. You will need your Medical Director to back you up. Blood Bankers are notorious for not letting go, esp the older ones (like me). If you feel your techs are not able to perform up to their performance programs document, retrain, document - once they see you documenting things they will get the hint. Don't let them boss you around. Ask them what the procedure says. That's why there are manuals. If you think they are busting your chops, keep a record and then you can "retrain" as indicated but you also have a record for competencies at evaluation time - but you must make the effort to provide retraining. If they balk, document . . . It's a fine line to walk. When you have more management experience you will understand. In many instances we were promoted to management because we were good serologists . . . suddenly we had to learn to handle people - a whole different ball game. To the person that started this post: getting calls at all hours is part of being in charge of the BB. On the off shifts, I have found that a bit of extra time for training goes a long way in reducing the calls. No matter how simple the procedure seems to you, esp if you are dealing with generalists, and it is something that occurs infrequently. Don't make it so they don't call when they really should. If you have a dedicated BB staff it might be a different story.

I'd say the fact that you are getting so many calls means that either training/competencies aren't up to scratch, or the SOP is lacking. You say that the tech had signed to say they were competent in the task - who had verified this? It sounds like you need to look at your own management, rather than blaming the techs. I've been in the situation you are in as a young supervisor with people who are older (and more experienced in terms of years) below me and it is a hard place to be. Ironing out the issues with poor performers is the hardest thing to do and the only way to do it is with good competency-based assessments. Another thing to consider is including a list of changes when putting a new SOP out - you will find that 'old-timers' think they know the SOP so won't bother to read it (I've been guilty of that myself). Another thing I did was introduced an hour a day for each section where one person (on rotation) could spend the quietest time of the day (usually 11-12 or 2-3) getting up to date with any outstanding training. It meant that everyone (in theory) got an hour a fortnight. Do keep in mind that how they perform, and your response to it, will reflect directly on you - it's a good idea to keep them on side and make sure competencies are absolutely spot on. Anything that isn't can be brought up at their appraisal as a goal for the next year (not a stick to beat them with). Help your staff, keep them happy, and they will start having the confidence to trouble shoot themselves without fear of reprisals or looking stupid. You could really make something positive out of this situation and get brownie points for it in your own appraisal.

I'm on call 24/7. I tell them to consult the policy first. If you try and can't find it anywhere in a policy, ask your coworkers to show you where to find the answer. If nobody else on your shift can point you to it, THEN you call me. Do not guess! I get a lot more text messages than I do phone calls. Usually they already know the answer, they are just wanting me to confirm their answer. We have quite a few generalists on my eve and night shifts that are not very experienced with difficult BB issues, so I have no problem with them calling me. I would much rather that than a patient gets hurt. I feel like it's part of my job as BB Manager to support them and have them feel confident in asking for help when they need it. I think the key to "weaning" them from calling too much is giving them really great policies (written very simply so anyone can follow them, even if they have not done the test for a while) and some good flowsheets (which I am still working on) for antibody workups, RhIg workups, etc.

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done. I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.

Have seen this many times with cancer patients. They are probably immunosuppressed and not making a lot of antibodies including isoagglutinins. I would try room temp incubation first. Make sure you run an autocontrol.