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The Standard from AABB was 2.1.3. The CAP was Gen 555.00. The CAP deficiency I am going to argue, since that is testing personnel only.

They are very busy you know..................guess we're not.

Hi, Yes I did mean panels, the interpretation would be manual, As aposed to screening. Gagpinks, great thank you, those are the kind of things I’m thinking about. I suppose I’m wondering if we’re only keeping reagents on board for 48 hours, as with the ABO and Screening cells, we would then increase the number of panels we require per delivery and as such increase the costs. Or only put the reagents on at the time of need but as a busy laboratory this seems a bit impractical as you’d have to QC every time.

There are lots of mutations now known which cause weak expression of the D antigen. Patients who have been found to be weak D, which traditionally wasn't associated with the production of alloanti-D have gone on to make alloanti-D, so the old adage of "weak D's don't make anti-D and partial D's do" does not hold water any more. As Malcolm states, Geoff Daniels' paper above describes the situation perfectly. Current BSH guidelines state that if the patient is found to be a weak D type 1,2 or 3 then they are to treated as D positive, as the evidence behind alloanti-D production in these weak D phenotypes is limited, and flawed in many cases. Therefore ANY OTHER WEAK/PARTIAL D should be called a D variant, and treated as D negative.

I was advised by one assessor to have an information sheet like the one mentioned above for the couriers (nurses, patient care techs, anyone who pick up blood) to read and sign. We gave them a sticky dot for the name badge and if they didn't have that, they had to read and sign the form. We required the form to be read yearly and they got a different colored sticky dot each time. It would be difficult to perform true competencies without following the courier to the floor to make sure they delivered the blood properly.

That is almost exactly what I meant exlimey. One or other should take FULL responsibility, and given that it is blood, it should be the Blood Bank.

We have Meditech, and I have built charge only tests for all of the reference lab charges. I manually add these once the workup comes back. There are some that aren't billable, like the after hours charge, so we absorb that cost.

Over the years I came to realize that a lot of what we did was geared toward simply passing inspections and meeting requirement that, in reality, did little or nothing to aid the patients. Smoke and mirrors to confound the masses. I've said this multiple time on this site and still believe it strongly; "Complicating a process never made it better!" yet every time something happened everyone's first response was to add more layers to the process in a effort to make it fool proof until some new fool came along. Human error will occur as long as humans are involved. All we can hope for is minimizing the impact. This statement used to make our corporate transfusion QA folks lose their minds. I've kinda taken a tangent for a moment. Getting back on track, Cliff and Malcolm I agree with you completely.

I wouldn't mind betting that, either your anti-D reagent has changed, or the technology used has changed, or both. The monoclonal anti-D reagents are blended so that certain epitopes of the D antigen are detected, and some are not. These blends may change over time, even from the same supplier, but, if you have changed supplier, you may have a different blend altogether. Then the technology could have changed from tube (or whatever) to, perhaps, CAT - there are different sensitivities with each technology. Has the woman got the R2 haplotype? By that, I mean is she an R2r with a weak D? The reason I ask this is because Weak D Type 2, which is associated with the R2 haplotype can be expressed really, really weakly sometimes, and this may explain why the woman has been classified as D Negative in the past. Just a bit of Sunday afternoon musing on my part!

Agreed Malcolm. With Meditech, there is a BIG red warning when the transfusion time parameters are exceeded, and some of the nurses following the offender will end the transfusion, while some won't. Some enter a nursing note, and some ignore it. Most of these happen in our outpatient infusion area where the patient is dismissed before those transfusion time parameters are exceeded and they don't have the chart open anymore, but some still occur on the other nursing units. Our outpatient nurse manager will always take care of it when I notify her, but the other units do not.