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Hi tsanders0703, yes, this phenomenon is actually not that unusual. The anti-D immunoglobulin in the maternal circulation will have a lower concentration than that in the foetal circulation because the IgG immunoglobulins are actively transported across the placenta. However, because the maternal red cells do not express the D antigen, it will appear that the concentration of the anti-D immunoglobulin in the maternal circulation is higher than that in the foetal circulation, as that transported to the foetal circulation will be adsorbed onto the D antigen expressed on the foetal red cells; hence, there is detectable anti-D in the maternal plasma, but not necessarily in the foetal plasma, but the foetal red cells are DAT Positive. As long as the mother has been shown not to have any atypical alloantibodies in her plasma during the pregnancy, then there really is no need to perform a DAT on the cord sample. In the UK, this is actively discouraged by our Guidelines, if the mother is definitely known to have been given prophylactic anti-D immunoglobulin during her pregnancy. Although the baby's red cells may well be DAT Positive, there really is no need to perform an elution, as the amount of anti-D adsorbed onto their red cells will be insufficient (by a considerable amount) to cause any clinically significant haemolysis (and, remember, there is always quite a drop in haemoglobin concentration anyway soon after birth). If, however, the baby shows any CLINICAL SYMPTOMS of HDFN, then all tests should be performed, as the mother may have made an antibody against a low prevalence antigen that is expressed on both the paternal and baby's red cells that is not necessarily expressed on any of your screening or panel cells.

We are a small blood bank in New York that is looking to implement the electronic Transfusion Administration Record (TAR) software in an older version of Meditech. We (Nursing and Blood Bank) reviewed the system and like the software for issuing and transfusion of the blood products. But to review patient’s transfusion information in Meditech after the transfusion is horrible. The reports/forms are not formatted and appear mashed together. This is not acceptable Blood Bank practice. I contacted Meditech to give me suggestions or allow me to contact any blood bank that uses the Meditech systems so they can give me suggestions. But it has been over a month and Meditech still have not contacted me. If I do not get this issue resolved, we will have to continue documenting transfusions on paper. So, this is my last hope... Is there anyone that uses the electronic TAR feature of Meditech? If so, how are you auditing the transfusions and showing inspectors the transfusion information during inspection?

We are version 6.15 in Meditech and currently use TAR for almost all transfusion documentation. I find review fairly easy, but we have a real bull dog of an RN in our IS dept who did a great job building it, and assumes total ownership of it. Documentation outside of TAR (in nurses' notes, in "vitals" section, etc.) is not considered compliant for non-emergent transfusions. (Vitals entered in TAR do flow to the "Vitals" section of the EMR however). Nurses are prompted at the correct times and each timed entry includes a section asking if s/s of transfusion reaction are observed. She has included a 30 min post transfusion vitals check within the TAR record. I review a sampling throughout each month and forward minor exceptions to dept nursing leadership; I submit Report of Events for significant exceptions. Aside from checking for transfusion orders and labs, most everything else I need is included in the TAR documentation. How TAR is built in OM determines how much info is available in it. Don't get me wrong, I spend a considerable amount of time in the EMR sleuthing out why we transfused someone who didn't appear on the surface to meet criteria, but that is not the fault of the TAR documentation.

We have Meditech and TAR and it is a problem. The transfusion report gives minimal information. My staff spends hours on auditing for compliance. TAR was suppose to eliminate incomplete transfusion charts, consent, vitals ,outcome. The implementation of TAR requires checking in EMR for transfusion data . IF the data is not present we have to search for documentation in the nursing notes. I would like a NPR report specific for TAR documentation. IF the information is not documented then it is an incomplete document. Unfortunately we do not have access to a NPR writer and Meditech has limited options. If you manage to get a transfusion report to please can you share it.