lpregeno

Send me your e-mail and I will send you my paperwork on MTPs.

This is something I found on the CAP website: (For some stupid reason I did not copy the URL.) From the CAP website: Optimum timing of post-transfusion phlebotomy is critical for ensuring meaningful laboratory testing results, and medical judgment is required in making this determination. Several factors must be considered, including the type and amount of blood product given, purpose of the test (that is, the question it is intended to answer), and clinical setting. In general, it is best to perform phlebotomy when the patient’s circulatory system is in homeostasis. A patient who is bleeding or undergoing blood product transfusion, or both, is not in a steady state. Whenever possible, samples for laboratory testing should be postponed until bleeding has stopped and transfusion is complete. One obvious exception to this rule, however, would be the setting of massive transfusion, during which monitoring certain laboratory values, such as cell counts and coagulation parameters, is essential to guide ongoing therapy. Variables such as patient blood volume, cardiac output, renal function, and volume of blood products transfused affect how quickly homeostasis is achieved following transfusion. For the evaluation of post-transfusion increments in hemoglobin, hematocrit, and platelet counts, a practical approach is to draw blood samples within 10 to 60 minutes after completing transfusion, as this time interval is aimed at measuring peak recovery.1 Results determined from blood samples drawn later than 60 minutes post-transfusion are increasingly affected by confounding conditions, such as splenic sequestration, sepsis, and consumption.1,2 If the intent is to determine the extent of such confounding processes on red cell and platelet counts, one should combine a 10-minute post-transfusion sample with sequential samples drawn at one hour and 24 hours post-transfusion. Alterations in chemistry test results following transfusion are not usually a concern in the low-volume transfusion setting. However, assay results may be affected for varying periods following transfusion of large amounts of blood products, as seen in massive transfusion, red cell, or plasma exchange—particularly if the recipient has impaired hepatic or renal function. Banked storage of red cells results in elevated plasma levels of hemoglobin, potassium, LDH, and iron in the blood unit that may, particularly in the metabolically impaired patient, be reflected in the post-transfusion laboratory values. In addition, citrate anticoagulant present in blood products may result in transient hypocalcemia in the recipient.3 Therefore, following large-volume transfusions or exchanges, waiting 12 to 24 hours before drawing samples for chemistry assays will provide results that are more reflective of the patient’s underlying metabolic state.

limper55 - Just out of curiosity, why was the Poly considered unacceptable? What manufacturer were you using?

Our Blood Bank has always performed the DAT by tube method (the exception being cord bloods). We do the Poly and if it is positive, then we do the IgG and complement. Recently a patient presented in the ER 5 days post-transfusion with a 4.2 HGB and a positive antibody screen. His autocontrol was positive as were most of the panel cells. His Poly DAT was negative. Due to the patient's symptoms I still highly suspected a delayed transfusion reaction. Our reference lab agreed to see what they could figure out. They only perform the IgG DAT and they perform it in gel. They got a strong 1+ and their eluate showed an Anti-e. Needless to say, this caused me to doubt our previous method of performing these tests. I was able to validate performing non-cord blood samples on our Erytra and would prefer for this to be our main method for doing these. I previously was looking into getting rid of the complement portion by default (i.e. Poly - Pos, IgG - Neg) because we use so little of it that it is a big waste of money. We often throw out complement check cells that have never been opened. However, now I am looking at getting rid of the Poly and just doing the automated (gel) IgG and tube complement. I see my choices could be the following: 1. Eliminate the Poly and perform the automated IgG and tube complement on all DAT samples 2. Perform the automated IgG and, if positive, perform the tube Poly and default the complement I want to be sure that my decision is acceptable to the AABB and CAP, hopefully save some money for our department, and still maintain proper patient care that the physicians will be happy with. Any thoughts and/or suggestions on this would be greatly appreciated!

At the risk of sounding redundant----me too!!

I agree with cswickard

I will attempt to attach my form I made. Lot to Lot Verification of FMH Screen.docx

Does anyone here use the SoftBank program? We are having a lot of problems with a lot of the nurses not wanting to pickup the blood utilizing SoftID.TX. They say it is too complicated. I think they just need more education on it since they get very little. They go out of their way to attempt to get us to issue it to them using the old paper method. If anyone deals with education, do you have a format or any suggestions on presentation to make it simpler?

I was told I could only charge for the units they receive. Do you have the CMS code for that charge by any chance?

We have a "pick-up" slip for any time the anesthesiologist is monitoring the blood. This slip must have a chart label attached (name, dob, mr#), the BBID wrist band number, and how many units are requested. We NEVER, EVER give out blood, even emergency release, without them bringing some type of patient identification with them. What if there were 2 patients needing blood? We use SoftBank and we print out a transfusion slip for the anesthesiologist who scribbles "see anesth. report on it rather than filling it in and we issue it from our side into SoftBank as issued. My feeling is that the fewer "exemptions" the safer the process is. I also suspect that some physicians would capitalize on the "exemption" and push it past the limit.

I've never heard of any. However, I'll be watching this to see if anybody has. We have the same situation at my hospital. Most after-hour phone calls I get and problems I have to deal with are because of this. (Even though they could look in the procedure manual, it's quicker to get an answer from me than looking it up in the manual.) I would love to have at least one other designated blood banker at least on days and one on evenings. This is hard to do right now with them cutting staff and expecting twice the work out of the rest of us.

Try CSL.

We are a small hospital of @300 beds. I do all the auditing, statistics, writing of policies and procedures, etc. as well as being on the bench most of the time. There is no way I will ever "catch up" to where I would like to be under these circumstances. I say all that to let you know how lucky you are to have all of those people being part of the Transfusion Services to take care of those aspects of the job. We have a quarterly meeting that includes 2-3 RNs that cover safety, compliance, and monitoring of the hospital, not just us. Also my lab director and assistant, Pathologist, one MD from the birthing center (even though any of them are welcome). This Blood Utlization meeting seems to satisy the AABB as they have never questioned in depth. My problem is the RN who is in charge of the meetings and takes my statistics to review random cases. I know she is spread thin but when I question any RN or physician practices in transfusion, she ALWAYS sides with the RN or physician with no proof only that she is convinced it was correct. It shouldn't be like that. I'm not trying to get people in trouble, I just feel that the process should be a collaborative process, not an "us against them" process and the way she handles it I feel contributes to the environment of an internal conflict. Just sayin'!

I am trying to find someone who has been through connecting the Grifols Erytra to the SoftBank software. We were supposed to go live on Oct. 31st but due to interface problems were unable to. We have completed all of our other validations except for the Software validations. We are having issues with querying, particularly that it won't query more than one sample which is not practical. I'm not involved as much in this part of the validation. We have an LIS person who is just learning SoftBank and a person from Grifols working with us and we are on the phone a lot with SoftBank but nobody seems to have an answer! We are using TCP/IP connection. Has anyone already been through this? If so, is it working? Could you give me any information that would be helpful? Or a contact number would be great! (as well as probably faster and more productive!) Thanks for any help!! We are getting desperate!!!

Thank you all for your input!

We perform therapeutic phlebotomy by appointment only. Occasionally a patient will come in and have his/her H and H drawn to see if he/she needs to have it performed and then schedule the phlebotomy for another day. Does anyone have any information on what the length of time this H and H is considered "good" for performing the procedure? Two days later? A week? Are there any rules about this? What is your facility doing if this occurs? Thank you all for your help!

Same as above. Here is the form I made in case you need it. l to l to send.docx

Wow! I'm thinking that, even though this happens rarely, that this has been handled incorrectly here. Whenever we send blood with a patient, we issue it in our LIS and we're done. The patient gets charged whether they receive the blood or not. The LIS also changes them to "transfused" after 48 hours. I assumed (which I'm always told "makes an ### out of you and me") that it was up to the receiving end to document anything further. So I will be keeping up with this post to see what I need to do differently. Any and all suggestions are welcome!

I was told that unless a time out of the Blood Bank has been validated, we can't use time as an indicator of whether or not a unit is acceptable for re-issue. Only temperature can be used. If the unit is being transported within the facility, this is still considered "storage" and the upper level allowable would be 6 degrees, not 10 degrees. We attach Hemo-temps (switching to Safe-T-Vue 6 once validated) to the units as well as checking the temp when it returns. The indicator is necessary because if the transfusionist left the blood sitting out, it could have reached an acceptable temperature again once it has been on the cold pack a while. For units not sent on cold packs, we use a Traceable Mini IR Thermometer by MarketLab that is ISO calibrated that has been really reliable. I don't recall them being super expensive either. How on earth did they condone returning units to inventory when the indicator had turned red!?! Inspectors haven't noticed this? My question would be: to what use is the indicator being used if it is being ignored?

Is this a typo or do you seriously have that many FDA reportables per year!?! From ONE transfusion service?!?

You took the words right out of my typing fingers Malcolm!

mollyredone stated: Yes, we charge for all units, positive or negative, we type looking for antigen negative units. Obviously we don't type 10 units to find 1 K-negative unit, but base the number typed on the compatibility percentage. We are lucky to have a historical antigen database from our blood supplier, but sometimes we have to "wing" it and just grab a bunch from the shelf and type away! I want to discuss this with the person that does my billing. She led me to believe that unless the patient received the blood, we couldn't charge for any antigen typing on other units. Is there a way to charge for all the units screened that will be accepted by insurance? This would be great for when we order special blood from our supplier and then the MD changes his/her mind. We could charge the patient for the special blood but not the transfusion. (Yes? No?) Obviously I'm new at this charging stuff!

Question: We charge for the antigen typing in 3 groups and we only charge for the ones that the patient actually receives the blood for. Does anyone add on a cost that includes the number of units that have to be antigen typed to find antigen negative units? Seems like we waste a lot of money looking for them and that it is often cheaper to just order the antigen negative units from our supplier. Any thoughts on this?

We were doing titers in the gel and kept failing our CAP surveys for titers. They were always one titer too high (CAP gives you a 3 titer range the results can be within to pass). After investigation (I was new at this job at the time) I found where the Technical Manual says that they shouldn't be performed in gel. (Like SMILLER says above). It goes on to state that there is a danger with interpretation by the physician and the higher results of unnecessary invasive procedures performed due to that combination. They, strangely, do not tell what studies they base that comment on. We switched to the tube method and haven't failed a survey since. We are in the process of deciding on new Blood Bank automation. When we saw the Vision, that seemed to be one of the "hot" selling points - the ability to perform titers. We questioned them about how they felt about it being contrary to AABB recommendations to do titers in the gel. The response was something like, "Do you want it to be faster and more hands-off or more exact? We would rather see it be more hands-off." (Not a direct quote, but you get the picture.) Personally, I would prefer the "exact" results to one that may or may not be too high. I would also prefer to pass my CAP competency surveys! Just saying.

We get a sample that is good for 3 days following the draw. If the account number changes, as long as the patient still has the armband on, we use that sample. We just transfer the results to the new account number and credit one of them. It's a pain, but better than redoing all the testing. We require a current sample for platelets and FFP also. I think the chances of someone using someone else's name/insurance are too high to take a chance not to do this, not necessarily for the platelets but for the FFP.