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This came up at our facilities during the Covid-19 pandemic. Infection control advice was to handle blood units as per usual precautions, given that PPE would be worn by anyone handling the blood units and hand hygiene performed before initiating transfusion. All coolers returned to the blood bank are disinfected at our facilities regardless of patient isolation status.

The amount of times that I have encountered a doctor that refused to transcribe critical information to a Blood Bank paper record is astronomical. We usually send a form with the emergency pack and if it's not signed when its returned, we send it back to them and someone signs it. It would be easier to get rid of the whole paper signing business, but it serves as a downtime record in and of itself if you cannot issue the units or cannot pull the care team that ordered the emergency. Just a thought.

I just answered this question. My Score PASS

The antibodies used for routine ABO and D typing these days are almost universally blended monoclonal antibodies. They are incredibly strong, but they are also highly specific. An individual with a particularly weak expression of either the A or the B antigen may not express all of the epitopes on all of the various "backbone" carbohydrate molecules that express the A or B antigen, Because the monoclonal antibodies are so specific, they may not contain the "correct" specificities to sensitise some of the weaker antigens. Anti-A and anti-B derived from a human will be polyclonal, and, because of this, these antibodies may not be as strong as the monoclonal antibodies, but they will also be less specific (they are likely to be a whole "soup" of either anti-A or anti-B specificities), and are, therefore, much more likely to sensitise most, or all of the various epitopes. Because of this, if only a few epitopes are expressed, they are much more likely to be sensitised by polyclonal antibodies than monoclonal antibodies. Obtaining human-derived anti-A and anti-B from a commercial company these days has become very difficult, to say the least. Many people are using either patient-derived plasma, or donor-derived plasma, but, if you are going to use these sources, it would probably be a good idea to perform a quick titration to ensure that they are of a reasonable strength (128 as a minimum), but they should be thoroughly tested to ensure that there no other specificities "hiding" under the desired ABO specificities. As for the method, the optimum temperature for IgM is about 4oC, and so the tests should be incubated in the cold, and quite possibly the red cells should be treated with a proteolytic enzyme, such as papain or ficin. As for the elution method, the Lui method is very good for ABO elutions, but, equally, the old-fashioned method of elution at 56oC also works well, but needs to be constantly shaken until the eluate is separated from the red cells. I hope that is of some value to you.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record. Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.