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We are the same. We get a fresh <7 day old unit shipped in weekly from our blood supplier, so there is always an option for a fresh unit. We don't transfuse a ton of neonates, but our policy is to provide freshest possible, CMV safe/leukoreduced and HgbS neg to all babies. Those who have a very low birthweight or other indications for irradiated products will also require irradiated. Since the unit we get weekly is irradiated, pretty much all babies get irradiated because it's the freshest we have. We aliquot units to a syringe or bag, but in emergencies we will send the whole unit to the NICU if they can't wait. Same for platelet units.

In New York State, we also are inspected by the state. FDA, NY State, AABB, CAP. You can make a sound argument that this is wasteful and duplicative. Obviously we don't have any choice about FDA and NY State. CAP and AABB, as accreditation organizations, will accept the results of each other's inspections, which is a plus, but you are still dealing with two sets of requirements. My advice to smaller facilities is to pick one if you can do so, and not duplicate your efforts and expense. Both organizations are essentially trade organizations, not scholarly/research societies. They both provide important educational opportunities, but you don't need both to keep your staff current, in my view. With the shortage of medical technologists, reducing non-productive non-clinical effort is a priority to prevent staff burnout and keep everyone focused on the main mission, patient care.

Malcolm, my very 1st AABB inspection came about 2 months after taking the Blood Bank supervisor job. After it was over I contacted AABB and told them that I would never let that inspector in my facility again and if they tried to send her I would drop our AABB membership. YES, the inspection/inspector was really that bad and luckily I never had to carry through with my threats/promises.

I agree, except for the first time Red Cell Immunohaematology at NHSBT-Tooting Centre were inspected by the Medicines and Healthcare products Regulatory Authority (MHRA), who had previously only inspected the donor side of things. We (RCI) were "inspected" by the top inspector (no name, no pack drill), who knew s*d all about blood group serology, but who was determined to make his mark by finding anything he could (however minor) and making it a major. As a result, we lost six months of screening for rare donors (it's a long story). Since then, I agree with you that more inspections actually help (and the MHRA inspectors now seem to have done their homework - although most of them would still not pass a reasonably difficult examination in blood group serology - but at least they now realise that).

Personally, I never minded inspections/assessments. My blood bank and transfusion service were "visited" no less than twice every year by inspectors. Either FDA (we were licensed to ship blood interstate at one facility I supervised), AABB, CAP or JCHO. Being inspected that often meant we never had the opportunity to let things slip unlike other areas of the lab that were inspected less frequently. On the other hand it did become very expensive paying memberships as well as buying materials required to stay current on the requirements of each agency. When cost cutting measures were called for reducing in this area was always discussed but for some reason was never acted upon.

We do provide the units to the air ambulance. Patients transfused with those units can either get transferred to our facility, or another trauma center in the area. We keep segments aside of the units we give out and if they come to us we crossmatch but there is talk of removing that from the SOP. We feel uncomfortable with that because we cant find much information other than the FDA wants traceability and trackability of the unit. I feel like this situation is a black hole for units, not much information in the regulations/standards.

My current hospital lab is JC and FDA inspected. My prior lab was CAP, with the hospital being JC. I honestly don't see a difference without the CAP inspection here, as we follow all AABB standards anyway. We used to be AABB inspected in BB, but dropped it in 2004 or 2005, before I got here, due to costs and not much gain for a hospital transfusion service that doesn't irradiate, wash or pool. My two cents: you don't need inspections by 4 organizations, just pick one.

@AuntiS - as far as running the last wash with A1 and B cells - my thought is that it serves as a negative control for your possible (although VERY unlikely) ABO specific antibodies that may be left. We run a panel and A1, B cells with ALL our eluates except cord blood eluates. For them we run screening cells and x3 A1 or B cells depending on mom/baby ABO incompatibility (we prefer rapid acid over LuiFreeze for cord bloods) For our last washes we run screening cells and A1,B cells In the end it comes down to how the protocols are written for each facility.

A number of years ago in a meeting of the corporate transfusion service supervisors we discussed the possibility of dropping our AABB membership. After much discussion the corporate transfusion service medical director decided that we would not be dropping the AABB membership. Her reasoning, the prestige of being in charge of a group of facilities fully accredited by AABB was very important to her. She actually told us that!