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My best guess and it is nothing more than a guess, is that if these patient's require any support from the transfusion service it will be due to a preexisting condition and not the direct result of the corona virus. I don't recall in all my years, of any patients with pneumonia requiring a transfusion due to having pneumonia and I understand that pneumonia is the primary reason for hospitalization here. Now I may be way out there on this but only time and experience will tell.

From the management side; involve the tech. Meet with them and have a conversation about how/why the think the error occurred.. Make them feel involved in QA and PI by asking if they have any suggestions that may prevent a recurrence. Front line staff often have great PI ideas, but won't speak up. During the conversation you will also be able to get a good feel for whether the tech knows the procedure and is committed to following processes as written, needs some re-training or whether they purposely deviated because the had "a better way".

Platelets are in adequate supply largely due to hospitals (in my service area) enforcing restrictive transfusion measures and postponing elective surgeries. Most blood centers except in New York, Washington state, and California are treading water with respect to RBCs. As usual Rh neg units are in short supply. Most of the hospitals in my service area are also freeing up beds to treat respiratory infections. These will require fewer transfusions, although patients needing ECMO are of concern. Looking ahead, it is difficult to predict what will happen. This is a long term event. My current concern is that blood donors will be fatigued 3 weeks from now and avoid giving blood. That is what happened after 9/11. It could be that you might need that unit of O neg on your shelf 42 days from now. In my opinion the goal is to provide blood for everyone who needs blood. Measures to restrict are prudent (and the literature indicates this is good medicine). After this is all over and we are criticized for being too conservative, but no one died for lack of blood, I can live with that.

When the reason for a deviation is determined we can decide how it needs to be addressed. In some cases, the deviation was an acceptable response to a given situation. No follow up required. If education or training is required, that is provided and documented on the same form. If the deviation is the result of continued 'bad behavior', training/education issues, or egregious disregard for policy, then our next step is an 'Opportunity for Improvement'. This is something we use throughout our lab. The tech and a lead sit down together to discuss the deviations and the problems identified to determine what the tech needs to do to remedy the problem. The tech is also asked what he/she feels is needed to help him/her resolve the problem. Once the lead and the tech have come to an agreement, the resolution to the problem is spelled out, including any education/training the lead will provide and the expectations for the tech's future performance. An end date for the required improvement is also determined. When that date is reached, the lead evaluates the tech's progress. If all is well, that is documented. The End. If there are still issues, the lead can re-evalute the situation. Additional training or education can be provided, with another periord of evaluation. If need be, the problem can be referred to the lab manager for possible disciplinary action.

The DAT is easily explained, with an anti-D level that high! Even after a double exchange transfusion, there will still be approximately 5% of foetal/neonatal red cells in the circulation, which is quite sufficient to give a positive DAT, but with an IUT, you are not removing an foetal red cells from the circulation (or minimal amounts) and should be considered more as a simple top-up transfusion (with profuse apologies to people who work in the Fetal Medicine Units, as I fully realise that there is nothing remotely "simple" about an IUT). As far as the reactions with the anti-A,B, the anti-D and the control is concerned, while the anti-A and anti-B are negative, it must be remembered that there are potentiators in monoclonal antibodies, such as albumin, that will possibly lead to them giving "false positive" reactions (although, I would suggest, that the reaction with the anti-D is anything but false - unless the anti-D is blocking the D antigen sites, which, with an anti-D level of 847IUmL-1 [it is NOT 847IU, which is an amount, rather than a concentration] would not be in the realms of impossibility). The amount of potentiator in each specificity will be different, depending upon what the antibodies are designed to detect (for example, what A and B subgroups, if any). However, the anti-D will most certainly contain potentiators, to ensure that most weak, and some partial D types are detected. This means that the control, which will have the same make up as the anti-D reagent - but without the anti-D, in other words, it would contain potentiators that would detect "false positives", which is the whole point of the control.