lpregeno

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.

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.

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

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.

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

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.

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

In the circumstances (I don't live in the USA, so I would never be "In the circumstances"), I would be more keen to charge the MD who has changed his or her mind, rather than the patient!

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.

I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.

I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.

I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.

I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.

I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.

I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.

We discontinued doing titers in gel last year because we kept failing the CAP surveys (our results were always too high). After research, I found this in the Technical Manual:
"The AABB-recommended method is the use of saline antihuman globulin (AHG) incubated for 60-minutes at 370 C. Other methods, such as using albumin AHG or gel, may result in higher titers than the recommended method and should be validated with clinical findings and laboratory data to ensure appropriate interpretation by the obstetrician and avoid inappropriate referral of patients for high-risk obstetric care." We also retain the titered specimen and repeat it along with new titer requests to allow for possible operator differences.

We discontinued doing titers in gel last year because we kept failing the CAP surveys (our results were always too high). After research, I found this in the Technical Manual:
"The AABB-recommended method is the use of saline antihuman globulin (AHG) incubated for 60-minutes at 370 C. Other methods, such as using albumin AHG or gel, may result in higher titers than the recommended method and should be validated with clinical findings and laboratory data to ensure appropriate interpretation by the obstetrician and avoid inappropriate referral of patients for high-risk obstetric care." We also retain the titered specimen and repeat it along with new titer requests to allow for possible operator differences.

We discontinued doing titers in gel last year because we kept failing the CAP surveys (our results were always too high). After research, I found this in the Technical Manual:
"The AABB-recommended method is the use of saline antihuman globulin (AHG) incubated for 60-minutes at 370 C. Other methods, such as using albumin AHG or gel, may result in higher titers than the recommended method and should be validated with clinical findings and laboratory data to ensure appropriate interpretation by the obstetrician and avoid inappropriate referral of patients for high-risk obstetric care." We also retain the titered specimen and repeat it along with new titer requests to allow for possible operator differences.