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We performed the tests with serum, everything negative. The most likely suspicion is passive anti-B

Just as a matter of interest, were the samples tested by the Blood Bank for compatibility EDTA samples? If so, it might be worthwhile testing a clotted sample (i.e., using serum in the tests, rather than plasma) and using broad spectrum AHG. It would be highly unusual, but it could be an antibody specificity (such as an anti-Vel) that requires active complement to be detected.

Our facility uses MobiLab. This system prints labels after scanning the patient identification band. The specimens are then labeled at the patient bedside when collected. We have Meditech that uses Bar-coded Transfusion Administration. Nurses scan the patient ID band and unit identifiers (DIN, Product, and Blood Type barcode labels). If something doesn't match, an error message pops up to return the product to the blood bank. This system is used for all transfusions except some emergencies (i.e., Massive Transfusion Protocols). It works very well. In the past, we used Biologics wristband label with patient ID. These worked like a credit card -- labels were made from embossed plates and attached to specimens -- so I've never used the Typenex bands. With the Biologics and now our current wristbands, we are able to use the blood specimens that were collected previously for CBCs, etc., for our blood bank work if the specimens were labeled with MobiLab. There was no reason to have to stick the patient again for a blood bank specimen. This system works.

I too am the only dedicated Blood Banker . I have found it more and more challenging as staff is quickly retiring and being replaced with young grad generalists. I try to reinforce the theory behind all of the blood bank tests in order for them to grasp the whole picture for trouble shooting those patient's that are the exceptions to the rules but there is only so much new grads can absorb during training. They are learning our processes, a new computer system, and often have not been in Blood Bank for over a year and that was only for a rotation during school. It takes years to become a seasoned tech. Between training new techs, 6 month competencies, annual competencies, meeting changing standards, and dealing with shortages I find it a little overwhelming. Unfortunately I believe this is the new Norm and agree we are in a staffing crisis which needs addressed now.

I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes. You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation. BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!