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If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation. If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing. The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened" Good luck

I would advise people to look at RH/index.htm. There are now WELL over 100 (almost 200) different weak D types, not to mention the number of Partial D types. Unless you have access to ALL of these red cells, AND use them as a control EVERY time you perform this test, you cannot QA/QC this test. There are times, even in the world of blood transfusion/blood group serology, you just have to admit defeat and keep your fingers crossed! Even if you were using molecular, rather than serological techniques, you would have to perform complete RHD sequencing each time to ensure you would detect all known mutations AND any novel mutations.

I am retired but volunteered several years as an AABB assessor. Both CAP and AABB send the deficiencies from the previous assessment to the assigned assessor with the submitted plan of action to correct the previous deficiency. Most plan of actions have a time frame documented to correct the issue. We were supposed to make checking completion of the plan of action a priority. My first question would be if this individual had completed any work before his training records were completed. Then, I would ask for his competencies that were completed during the allowed time frames. If I performed a tracer on your FDA reportable, could you provide completed training and competency records for all the employees who worked on that patient? Your pathologist may be young, but he does not want repeat deficiencies. Document everything!

This is a scan taken from Petz LD, Garratty G. Immune Hemolytic Anemias. 2nd edition 2004, Churchill-Livingstone. George may not have been medically qualified, but Lawrie Petz most certainly is, but the two of them were regarded as the world authorities in this kind of thing. The chapter on HDFN was added to the second edition. It was not in the first. It shows what a waste of time, money and reagents it is to perform a DAT on all babies born to group O mothers. This has not changed within the last 15 years.

You are not overreacting. You are being responsible, which is what all healthcare workers need to be. Other than discussing all of this with your department administrative director (your manager's manager -- maybe you have done this already -- at our hospital, this is at the department director level), I am not sure there is much else you can do within your department. You mentioned talking to the FDA and your risk management department. Your hospital should also have a corporate compliance fallback for things like this (that cannot be resolved through management -- you can report anonymously if you desire) For corporate compliance issues, the business must respond to your concerns and report back to you within a limited amount of time. Good luck. Scott

Are your techs generalists or dedicated blood bankers? If they are generalists, chances are they are not going 2nd guess BB Mgr. If they are dedicated blood bank techs they should know better. Unfortunately I have known SBBs who would give inappropriate plasmas (gr O to gr A) just because they were thawed. Laziness. Do you have a BBIS? It should have required an override to give the O plasma. Having been an inspector/assessor for AABB and still a CAP team leader I would think these issues should have been flagged in your quality plan and subsequently made their way to lab management and hospital quality folks. Don't be derelict in your duty to your performance program AND your patients. I'm certain your Medical Director should be in the know as he/she is ultimately responsible. I would not bring up this individual's past history (though how you discovered this would be an interesting aside). Don't let your lab's quality suffer because of an individual's poor performance, both the manager and the tech involved. The transfusion of inappropriate plasma should have resulted in a Biological Product Deviation to the FDA. Is this in your purview? I would recommend jumping immediately on errors of this type as soon as they are found. I also would recommend going directly to the Medical Director as it seems your manager has some serious BB judgement issues. In the past I have commented to a Medical Director that one would not want to practice Laboratory Medicine in jail. The Feds can take you out in handcuffs if they think you are culpable (rare but they do have an enforcement arm). I'm being kind of verbose here but the bottom line is as the quality person for your BB, don't hesitate to call a spade a spade. Inform lab upper management with your concerns, especially your Medical Director.

I think what you are doing is acceptable. I am in the same boat. I had a procedure for splitting units but can no longer comply w the labeling regulations. I've never had an order and would recommend transfusing rbcs the same way you do.

If we only do D typing on babies from D negative mothers and a weak D or Du test needs to be performed, the results of the weak D is only valid if the DAT is negative, so a DAT would need to be performed. Therefore, an ABO and DAT would be a good place to start. Just my thought.

We had to use tube lifters in some of our centrifuges to prevent the tubes from sinking down into the holders. If we didn't use the tube lifters, the cap of the tube would hit the lip of the holder and pop the cap off. Once we used the lifters, we stopped having caps pop off.

We use the Hettich and have separate programs set up so only the wash program has the longer break time included. We also have a site that set two wash programs (one for larger cell suspensions and one for cell button only) allowing only one program to be affected by the increased break time.

We had stopped doing cord blood panels on O Pos moms for several years. Then a Family Practice physician took over as chair of OB/Peds and insisted that we resume cord blood testing on all O Pos moms. Why? ... because his children were born with elevated bili levels and his spouse is O Pos. Was there a difference in the treatment of these infants because their DAT was positive? ... probably not. We need to revisit this issue because we do a lot of cord blood panels on O Pos moms and it adds to their bill w/o adding much, if any, benefit to the infants care.

I would think that a 4th option in the poll should be: Routinely perform only D typing on babies from D negative mothers. Why do ABO and DAT routinely on these babies?

To the elution question: if the results of the test will never alter the patient's treatment, it is hard to justify having the policy to always do the test, even if the results are academically interesting to understand causes and what is really going on.

Are you asking about which labels can be placed on the bag and which have to be on the base label?? Some irradiation indicator tags - both Rad-Sure and Rad-Control - have a type of adhesive that can touch the actual bag. Both can go above or below the base label (or at least that is what I have always been told). Most little labels/stickers, like the original Irradiation label in this thread, do not have this type of approved adhesive and are not allowed to be placed directly on the bag. You have to find somewhere to stick it on the base label without covering anything else up.

Question. If the patient is registered, why can't you use the SoftBank emergency issue function prior to the Type and Screen being completed?

NO! I am a professional blood group sereologist!

You can use either. For products with an expiration of less than or equal to 72 hours, you must use the exact time. For products with an expiration of more than 72 hours, you can use the number of days @2359 (Technical Manual, 16th ed, pg 219). We have been using the 120 hrs but are in the process of changing to the 5 days @2359.

An EXCELLENT question Darren ! I look forward to some interesting debate.