donellda

I'm not quite sure what you are asking but I think you want to know if the clotting factors in a unit of FFP are measured before it released from the donor center. The only real QC that I know of is that the FFP must be frozen within 6-8 hours of collection, depending on the anticoagulant used, in order for the plasma to retain the level of reactivity of the coagulation factors. The FFP contains 1U/ml of the clotting factors. I believe that the only testing done is the testing for all of the disease markers. Sorry I can't be more helpful.

We get all of our blood products from ARC and Michigan Community Blood Centers but we do sponsor blood drives a couple of times a year with the Red Cross. Donor response to the blood drives has been very poor. The most successful one in the past few years was a success because the hospital offered free tickets to the hospital gala (fancy dinner) to the department that had the most donors. It sounds like you are going to the community for donors so that probably wouldn't work. My husband donated at the Canadian Blood Services a few months ago when his friend celebrated his 25th donation. He invited all of his friends to donate with him and the donor center supplied a cake for the donors he recruited. It was a nice gesture I thought.

We had our labels custom made by Centurian Label Systems in Howell, Michigan. There number is 1-800-248-4058 and web address is www.tshsc.com. Our quality specialist compared them with Shamrock and was happy with their product.

Hmmm. Interesting! We used to transfuse preterm pregnant women with CMV negative to avoid exposure to CMV for the baby. I don't remember giving irradiated units but it makes sense to avoid graft vs host for the baby also. The mom has sickle cell so the C, E and Kell negative units is a common practice with many transfusion services to help prevent formation of antibodies in multiple transfused African American individuals with sickle cell. I would also give Fya and Fyb negative if possible. I know our Childrens Hospital routinely uses this antigen profile for transfusing their sickle cell patients.

We have had some discussion with regards to prewarmed crossmatches. By prewarmed I mean the true prewarm where patient's serum and donor cells are warmed separately at 37 for 10 before adding the serum to the cells, with the subsequent 30 minute incubation without LISS and the 4 washes with prewarmed saline before anti-AHG addition. My question is, how many institutions do an immediate spin crossmatch in addition to the prewarmed? A former blood bank manager at a facility that I worked at several years ago maintained that you needed to have a compatible immediate spin crossmatch in order to call the units compatible even in the case of a cold antibody where a prewarmed crossmatch was performed. In order to do this we prewarmed an additional set of donor cells and then did an "immediate spin" with the prewarmed serum and cells. This was not used for the incubation of the actual prewarmed crossmatch. So it has been my impression that this was necessary. Any thoughts?

We have a code for anti-D due to Rhogam. We usually check our computer to see if the patient had a recent injection of Rhogam at our facility or we call the floor to check with the patient. The code is set up so that it does not go into the patients antigen/antibody file but it stays as a permanent comment in the patients blood bank administrative data file until we remove it.

That's very interesting. I have never seen that before but generally, we used all the wells in our gel cards so we never really had the opportunity to respin them. I do remember getting some weak to 1+ reactions, that when repeated, were negative on the repeat. I wonder if real small fibrin pieces could be responsible. I'm not using gel at my facility currently but we are discussing it's use so I will have to watch for this when we do get it.

Our SOP allows for ruleouts to be done on heterozygous cells but I am not comfortable with this either. I usually train new techs to rule out on homozygous wherever and whenever possible especially in the case of Kidds and Duffys. If we cannot find a homozygous cell to rule out then I will use heterozygous cells. Unfortunately, I am not the person responsible for writing SOPs so I just make sure that everyone realizes how important it is to use homozygous cells for ruleouts.

Our quality specialist is working with the LIS department on this issue. We do get a barcode label with the pool number for platelets and cryo, and aliquot number for aliquots but not for component codes. Those poor quality guys have the weight of the world on their shoulders.

I was interested in where the fresh frozen plasma returned after 30 minutes expiration of 6 hours came from too. This is something that we could use. Where did you get the reference from?

I think that most hospitals are going to single donor for babies rather than randoms. In our institution we try to limit the exposures for babies so using a pheresis for the 5 days works for us. Also I believe that part of the reasoning in doing this, is that the single donor platelets are aspirin whereas randoms may not always be. I don't have access to any literature for you right now. I'm on vacation:D

I used gel for several years when I worked at another location and it is very sensitive. Warm autos are often LISS sensitive so maybe the gel is just that sensitive to pick up a weak warm auto that will not react with a LISS tube method. We used to use a 30 minute incubation tube method without LISS for our warm autos and often times we were successful in getting negative reactions and finding compatible units with having to go to absorption techniques. I do remember trying our eluates with gel but if I remember correctly we abandoned the idea very quickly.

I found this number on their website (202) 354-1000 for general inquiries. The experience that I have had trying to call US customs is that you get transferred through the automated phone system several times and can wait anywhere up to an hour. If you can find an email address somewhere you might be that much further ahead.

I cross the border every day but I'm on vacation this week otherwise I could have asked one of the customs officers. I know they give us a difficult time with our lunches especially with chicken, beef and fresh fruit so my guess is you will probably have to something prearranged with US customs.

I have never read that it has to be a separate fridge or freezer. We have a box in our walkin fridge that we put quarantined units in with a sign that says "Quarantined".

We don't wash our cell suspensions before crossmatching. If there is a problem with the crossmatch, washing the cells could be done to trouble shoot in case there are some irregular proteins coating the cells causing interference. If the cells had to be washed for whatever reason, I do not see how this would be considered a variance though. In our department, we no longer wash our cell suspensions for cord bloods although there is one tech who still washes her suspensions. I think this is just a personal choice and I would not consider this a variance. Maybe your boss's concern is in the reference to the other procedure for preparing a cell suspension. If you are going to wash the cells in one procedure then you would need to do it in the other to avoid confusion. What if you left the washing of the cells out of the procedure and put a comment in the notes to wash the cells if there is a problem with the crossmatch. I think that most institutions do not wash the cells first anymore but at least you would have it in the procedure notes as an option for problem solving.

I just took over my new position a few months ago and our utilization review meeting is scheduled in a few weeks. My part in the committee is to go through our utilization reports and submit patients who do not meet our transfusion criteria. From what I understand is that not too much gets accomplished at our meeting either. Our meetings are done quarterly though as opposed to monthly. I will soon find out how it is run and what is put on the agenda. I can let you know.

We don't use the word trauma pack but we have a "red chest" policy for trauma patients who are going to be massively transfused. The "red chest" is a red cooler and when ER calls for a red chest we get 6 prelabelled O neg packed RBCs ready for them to pick up. They bring an emergency release form with patient labels and we attach a label to each unit and to each unit tag. We ice pillows to place in the cooler with blood. As part of our protocol, we thaw 4 units of AB FFP and make sure that we have 5 random donor platelets available (not pooled). ER is too supply us with a specimen as soon as possible so that we can switch the patient to type specific.

I usually open my tubes with a piece of gauze in case of aerosols. The one time I did use my shield, the whole counter fell down so I haven't use it since.

We have been coverting our FFP that has expired from the 24 hour expiration time to thawed plasma. Our expiration time for the thawed plasma is 5 days from the time it is thawed. When I change the expiration date on the plasma I add 4 days to the expiration of the expired FFP. We have found this to a huge savings in costs because we use the thawed plasma for traumas and for some of our open hearts that use a lot of plasma. I think last month we only 4 thawed plasmas that had to be discarded because of outdate.

We usually get our low incidence antigen typed units from ARC. They have a better supply of antisera and cells than we do. For patients with Anti-Cw, we have been giving AHG compatible C negative units. The Cw antigen is usually present when the C antigen is present so if you give C negative units you are pretty safe that Cw is not there.

We don't do our own absorptions . We send them to ARC reference lab. I worked for a facility that did there own using ZZAP. It took forever just to wash the absorbing cells . I have heard that absorptions with PEG goes much smoother. Maybe someday I'll get to try it. I believe that SE Michigan ARC reference uses PEG for their absorptions. I remember some discussion about PEG when I attended the MABB lecture series but my notes are buried deep in my basement. I'll check some of my references at work tomorrow.

I'm not advocating totally banning microscopes in the blood bank. They can be very useful in investigating rouleaux and other special cases which would definately not be considered "old school". I am referring to individuals who have a hard time letting go of the practice of reading all screens microscopically. We all check that "scratchy" reaction every once in a while under the scope but we don't read every reaction.

I agree with you. We only use the microscope to read our fetal screens although I have noticed some of the old school techs sneaking a peak once in a while. My former supervisor always said if you can't see it with the viewing mirror then it's not there (or at least not worth working up).

My former employer was not 100% irradiated for all blood products but we irradiated all platelets. It made life a bit difficult because we had to pool them first then irradiate them which subtracted from 4 hour expiration time.