BloodBanker80

We use Sunquest as well.  Our MTP does not drawn anything.  All it does is print the order in Blood Bank.  The BB Staff orders what is needed (Prepare Orders, etc.) and informs the provider IF a BB Sample is needed (often times we already have a sample).  I suggest you get the order for TS out of your MTP order.
We, too, put MTP on 'Downtime' protocol.  Our Unit Tags are 3 parts: White Top copy, Yellow middle copy and card stock back copy.  When issuing blood 'routine', the white top copy is discarded, yellow copy is kept in BB and card copy stays on the unit.  For 'Downtime', the white copy stays on the Unit Tag and they use this for their dual checks, etc.
Message me if you'd like more information.

No need to take a separate internal temperature providing your digital temp is accurate.  You will need to validate your digital readout to NIST and  then you are all set. 

CFR 606.60 has a listing for laboratory thermometers and electronic thermometers. Is it possible that the electronic therms refer to the ones used to check the donor's temp? This would be a good "Ask the FDA" question for the AABB annual meeting session.

We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow:
Transfuse order for RBCs is received in blood bank We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC." Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup) We look up the mom's record to see her antibody status If no antibodies, we result the "mom absc" as negative. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.) I hope this is helpful.

Yes, that helps!  Thank you  

We use a Fluke 561 IR thermometer for temps on our blood products.  We send it for calibration annually and test it monthly against a NIST thermometer at freezer temp (-28 to -30C), refrigerator temp (about 4C), room temp (21-22C), and thaw bath temp (35-37C) .  We wrap a unit at the specified temp around a NIST thermometer long enough for it to equillibrate, then hit it with the IR thermometer.  It always correlates within 1C of the NIST, except at freezer temps, which is a little further from 1C. We don't use it to take the temperature of anything in the freezer, but there may come a time where that is useful. I hope this helps

We diluted the antibody screen daily, panel cells as needed. QC antibody for the antibody screen was dilute anti-D and dilute anti-c. We wanted a 1-2+ reaction for QC, so diluted antisera accordingly. You could also use commercially available QC kits. For the panel cells, we selected a K+k+ cell for a positive control and a K-k+ cell for a negative control, testing with anti-K (polyclonal) diluted 1:20. In previous discussions about QC Malcolm suggested Fya or Fyb positive cells for a positive control since that antigen can deteriorate during storage. If you are using the diluted cells for select cells/rule outs, you could choose to use a cell positive for one of the antigens you are using the cell to rule out as your positive control with the appropriate antibody. A cell negative for that same antigen would be your negative control.

We are using Mediware's HCLL in the BB.  In general, ER will know through field triage what is coming so that they can use the registration system and give us a name/MR before the patient arrives.  It takes about 10  minutes to  order and print tags for a "initial resuscitation" cooler of 2 O neg RBCs and 2 AB FFPs. 
We are a level 2 trauma center so it is important that a patient can be registered before they arrive.  Like many facilities, we always have at least two AB thawed units of AB plasma on hand along with a 5-pack of plts, in addition to the O neg RBCs.
Scott

When I was diluting red cells to 0.8%, I ran QC straight from the bottle for tube (because we always do QC for tube), then repeated with the diluted cells for gel. The QC on the 0.8% dilution is going to cover the entire process, including the dilution step, and the reagents. We made up fresh cells every 24 hours, as required by the manufacturer.

Very interesting post - especially given that we are having current problems with Cell 2 also (R2R) with our Solid Phase RS3 strips on our ECHO.  We received a new lot# of strips last week and are doing better - just odd that it is cell 2 in both types of systems. 

this is what our vendors are recommending (Ortho).  I pretty much use my Ortho panel to deal with scenarios like the w+ cell2 and RhIg anti-Ds.  I use other vendors' panels, diluted to 0.8%, for most of my antibody ID's.

Excellent information!  We do try to use the product as soon as possible, but outdate at 24 hours.  You bring up an interesting point, when we combine a 'double bag' into one... the expiration has to be changed to 24 hours.  Although we don't routinely do that ahead of time, we wait until the nurse is here to pick it up. 

Check and see if your hospital uses a printing company so you can design your own forms. 

We are still on paper, so no computer fix. We also don't see Mass Transfusion/Emergency Release often enough to have a pack designated and ready to go. If we get advance notification from the ED/department, we will pull the appropriate units. If the patient is known, we can label tags (by hand) with patient name, blood type unknown if we don't have a current specimen. Once the patient is in the ED and we have a band on them, we use the band as the patient's ID - can use a sticker off of the armband tail as the patient name with male or female and location until we get more information.

We use the FinalCheck system in the same way as David uses BloodLoc, and before that, a Typenex band. I've never had a problem with inspections using this kind of process. We see JC, CAP and CLIA.

We use the BloodLoc system.  Anyone admitted as a patient gets one.  In a pinch we will transfuse based on the bloodloc code.  It only exists on the patient's arm band and blood bank tube.
When they can't wait, they a unit labeled as uncrossmatched - group O (Rh depends on gender and age).  As Cliff has reported out, if you are giving group O . . . Sometimes we never get a specimen.  In these cases, the BB Medical Director signs off on the request sheet  from the ordering MD.
During out trauma certification the inspector had no problem that there wasn't a patient designated label on the product.  When someone is bleeding out the paperwork has to become a secondary issue. I tell my staff - "give them the blood, bring the paperwork when it calms down (including the MD request for unxm rbcs.

We have been using LF1 form (FORM WITH LABEL) for over 10yrs and they are awesome. We use them for all of our products. We get them from Standard Reg. company.  CT/1000ea.

A list of possible label vendors can be found here: https://www.iccbba.org/subject-area/vendors/labeling-blood 

Shamrock

When we were bringing up a platelet collection system I asked the manufacturer some questions about the bag volume limits (100-400mL) and time spent where the volume was greater than 400mL. This scenario occurs for example when a 500mL intended-double is collected, but stored in one bag until counting/processing begins after the collection. That manufacturer said you could go up to 24 hours "out of range" before you compromised the product. Similar concerns about the storage concentration, the manufacturer has validated an acceptable platelet concentration range, odds are your volume reduction process results in a concentration greater than their validated upper limit.
With your closed system scenario I'd be uncomfortable giving the volume reduced product more than 24 hours without having validation data showing viability past that point. Due to container, volume and [PLT] concerns.

At a previous employer we volume reduced platelets and they were pretty ugly products, my current employer no longer volume reduces platelets, we give multiple divided aliquots instead.
[sorry for reiterating some of the points made earlier. they're good points ]

Each manufacturer of platelet bags has validated conditions that must be met for 5 day storage.  The AABB/ FDA cannot give you a standard because each bag is slightly different.  Talk to your supplier to find out the storage requirements for the bag you are using.  (I know Terumo is validated up to a concentration of 2,100,000 and Fenwal has a minimum volume requirement for a range of concentration).  If you're outside of that storage recommendation... you probably will need to short-date those products, or at least test the pH prior to issue to ensure a quality product.

There are no data.  When we wash platelets or red cells, the outdate is 24 hours because of the open system (ancient COBE/Terumo type 2991s).  Patients do better in terms of key clinical outcomes (mortality, infection, thrombosis) with washed platelets so I'm not concerned about the container, length of storage, etc.  Ultimately clinical outcomes are more important than any of those surrogate in vitro markers.  We routinely wash to remove incompatible ABO antibody and soluble antigen, FYI.  We do not wash red cells more than 21 days of storage due to increased hemolysis, and poorer clinical outcomes with these components (washed >21 days). We currently wash with normal saline, but Plasma-Lyte A (AJCP in press) causes less hemolysis and we will be moving away from normal saline. Hopefully we remove normal saline from use for all transfusion service and clinical uses, due to recent data that normal saline causes increased mortality and renal failure in ICU patients (in NEJM).  See references below.
 
A randomized trial of washed red blood cell and platelet transfusions in adult acute leukemia [ISRCTN76536440].
Blumberg N, Heal JM, Rowe JM.
BMC Blood Disord. 2004 Dec 10;4(1):6.
 
Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence.
Henrichs KF, Howk N, Masel DS, Thayer M, Refaai MA, Kirkley SA, Heal JM, Blumberg N.
Transfusion. 2012 Mar;52(3):635-40. doi: 10.1111/j.1537-2995.2011.03329.x. Epub 2011 Sep 2.
 
Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions: results of a prospective, randomized, controlled clinical trial.
Cholette JM, Henrichs KF, Alfieris GM, Powers KS, Phipps R, Spinelli SL, Swartz M, Gensini F, Daugherty LE, Nazarian E, Rubenstein JS, Sweeney D, Eaton M, Lerner NB, Blumberg N.
Pediatr Crit Care Med. 2012 May;13(3):290-9. doi: 10.1097/PCC.0b013e31822f173c.
 
ABO identical and washed blood transfusions as candidate strategies to reduce early mortality in acute promyelocytic leukemia.
Sahai T, Henrichs K, Refaai M, Heal JM, Kirkley SA, Schmidt AE, Mendler JH, Masel D, Liesveld J, Aquina C, Blumberg N.
Leuk Res. 2017 Nov;62:1-3. doi: 10.1016/j.leukres.2017.09.011. Epub 2017 Sep 23.
 
Improved outcomes in acute myeloid leukemia patients treated with washed transfusions.
Greener D, Henrichs KF, Liesveld JL, Heal JM, Aquina CT, Phillips GL 2nd, Kirkley SA, Milner LA, Refaai MA, Mendler JH, Szydlowski J, Masel D, Schmidt A, Boscoe FP, Schymura MJ, Blumberg N.
Am J Hematol. 2017 Jan;92(1):E8-E9. doi: 10.1002/ajh.24585.
 
Longer RBC storage duration is associated with increased postoperative infections in pediatric cardiac surgery.
Cholette JM, Pietropaoli AP, Henrichs KF, Alfieris GM, Powers KS, Phipps R, Spinelli SL, Swartz M, Gensini F, Daugherty LE, Nazarian E, Rubenstein JS, Sweeney D, Eaton M, Blumberg N.
Pediatr Crit Care Med. 2015 Mar;16(3):227-35. doi: 10.1097/PCC.0000000000000320.
 
Transfus Apher Sci. 2018 Feb;57(1):127-131. doi: 10.1016/j.transci.2018.02.021. Epub 2018 Feb 21. 0.9% NaCl (Normal Saline) - Perhaps not so normal after all?
Blumberg N1, Cholette JM2, Pietropaoli AP3, Phipps R4, Spinelli SL5, Eaton MP6, Noronha SA7, Seghatchian J8, Heal JM9, Refaai MA9. Crystalloid infusion is widely employed in patient care for volume replacement and resuscitation. In the United States the crystalloid of choice is often normal saline. Surgeons and anesthesiologists have long preferred buffered solutions such as Ringer's Lactate and Plasma-Lyte A. Normal saline is the solution most widely employed in medical and pediatric care, as well as in hematology and transfusion medicine. However, there is growing concern that normal saline is more toxic than balanced, buffered crystalloids such as Plasma-Lyte and Lactated Ringer's. Normal saline is the only solution recommended for red cell washing, administration and salvage in the USA, but Plasma-Lyte A is also FDA approved for these purposes. Lactated Ringer's has been traditionally avoided in these applications due to concerns over clotting, but existing research suggests this is not likely a problem. In animal models and clinical studies in various settings, normal saline can cause metabolic acidosis, vascular and renal function changes, as well as abdominal pain in comparison with balanced crystalloids. The one extant randomized trial suggests that in very small volumes (2 l or less) normal saline is not more toxic than other crystalloids. Recent evidence suggests that normal saline causes substantially more in vitro hemolysis than Plasma-Lyte A and similar solutions during short term storage (24 hours) after washing or intraoperative salvage. There are now abundant data to raise concerns as to whether normal saline is the safest replacement solution in infusion therapy, red cell washing and salvage, apheresis and similar uses. In the USA, Plasma-Lyte A is also FDA approved for use with blood components and is likely a safer solution for these purposes. Its only disadvantage is a higher cost. Additional studies of the safety of normal saline for virtually all current clinical uses are needed. It seems likely that normal saline will eventually be abandoned in favor of safer, more physiologic crystalloid solutions in the coming years.
 
N Engl J Med. 2018 Mar 1;378(9):829-839. doi: 10.1056/NEJMoa1711584. Epub 2018 Feb 27. Balanced Crystalloids versus Saline in Critically Ill Adults.
Semler MW1, Self WH1, Wanderer JP1, Ehrenfeld JM1, Wang L1, Byrne DW1, Stollings JL1, Kumar AB1, Hughes CG1, Hernandez A1, Guillamondegui OD1, May AK1, Weavind L1, Casey JD1, Siew ED1, Shaw AD1, Bernard GR1, Rice TW1; SMART Investigators and the Pragmatic Critical Care Research Group. BACKGROUND:
Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes.
METHODS:
In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first.
RESULTS:
Among the 7942 patients in the balanced-crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04). In-hospital mortality at 30 days was 10.3% in the balanced-crystalloids group and 11.1% in the saline group (P=0.06). The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P=0.60).
CONCLUSIONS:
Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779 .).
 

sounds neat and tidy.   No handwriting anything!
 

Our traumas are assigned MR#s before they are arrived and given a doe name, it is usually a name of a car (Mercedes, Doe). The sex  is usually  known and the dob is the same for all patients (100 yrs old). The computer system we use (Cerner Millennium) allows us the dispense the units with a exception flag telling us the unit isn't crossmatched ,do we want to override and why (we pick emergency). A transfusion tag is generated but the area which usually states compatible says uncrossmatched and across the blank area of the tag which usually has special attributes(irradiated) there is a statement saying "emergency dispensed, uncrossmatched.  

If you have access to the 31st edition of the AABB Standards for Blood Banks and Transfusion Services handbook, Reference Standard 5.1.8A is a table that provides the expiration times for a number of blood components (e.g., platelets, RBCs, plasma). This should provide some guidance for the expiration of your volume reduced platelets. Hope this helps!
Kaytee