Bob M

We also leave the syringe attached to the tubing, that is attached to the product bag (i.e. octoped, platelets, ffp). The entire unit, original bag and attached syringe, is issued to the nurses. The nurse removes the syringe and transfuses at patient bedside. We do not split or pool any products; but get them from our supplier if needed. How is everyone going to handle this situation (in particular the bar code readability requirement) with ISBT128? Will you have a barcode printer and put that label on the syringe?

Hi Everyone, It looks like Mabel is using the newly reformulated Gel reagent cells (the lot number prefix looks like the new ones that we have). I have not seen hemolysis with the gel. We use EDTA primarily, like Mabel does. We had another situation with one of the prior lots on a patient, and when we called OCD Tech Service, they recommended that we wash the cells and resuspend in Saline to the 0.8%, if we suspected a drug interference. Then, since there is no LISS in test system anymore, incubate for 30 minutes in the block (similar to a prewarm technic). Like donnellda, we also have seen patients that show a "bi-phasic" response with a 4+ band at the top and a small button of cells at the bottom (it looks like the mixed field results in the manual, but since there is only screening cells, there aren't 2 populations). In the current Interpretation Guide from OCD, there is a page devoted to these Positive results. See page 23. We too have primarily seen this phenomenon on Anti-E. It can be disconcerting, since the mixed field can indicate rouleaux or cold antibodies also.

Owing to the FDA "bar code readable" requirement when signing out blood products from the lab, how is everyone coping with a neonatologist who requires a 40% Hematocrit unit (for example) in an Exchange Transfusion? The usual course of events, for most I suspect, is an O Neg, Irradiated, CMV Neg, CPDA Packed Cell diluted to 40% Hct with a thawed AB FFP. If the lab transfers the FFP in to the red cell bag, I am assuming that is "making a product", and would require that the lab have an FDA facility code. It would also require a label printer able to output in both Codabar (for now) and ISBT (for now too?). Are most of you with NICU's just issuing the units in their original configurations, and letting the NICU combine the products? If so, who in the NICU is performing that task, the MD or the RN? Do you give them a third satellite bag (say 600ml) to combine for the Exchange unit? How does the "combiner" in NICU know how much FFP to add to the Red Cells, and how do they measure that (e.g. scale, syringe, moist finger held to the wind)? I was thinking that the 600ml Transfer Bag might be a messy proposition for the NICU folks, what with having to stab one unit, pull it out, and stab the second. So Baxter makes a plasma transfer set with a double spike that could cleanly go in to the FFP and the PRBC at the same time. Then, the FFP could be gravity fed to the PRBC unit to get the final Hematocrit. Is this viable, or is there some legal problem with doing this? Finally, how do you handle the expiration date conundrum? Do you label the units with a 4 hour outdate, knowing they are going to have to enter the bags? And on what unit(s) do you put this expiration information? There.........................I feel better just getting that off my mind. Thanks for any help (and by the length of this post, you can sure tell I need it!).

Hi Folks, I agree with the others here that you really cannot interpret a mixed field on the gel, and need to do the testing with a tube method. It could hint at Rouleaux (so be careful with immediate spin tests) or cold antibodies (you may need to go with a pre-warm technic). I have never seen it, but mixed field on an auto control in gel (we only run the auto when performing an antibody ID) could be due to a patient's antibody reacting to recently transfused cells.

Hello everyone. I have been lurking for some time in here, and have to say that the information from this community is extremely helpful. We recently had a CAP inspection, and were cited for TRM.41650. It reads: "Are criteria for the recognition of transfusion reactions documentented, and is there documentation of periodic in-service education on the recognition of such reactions? NOTE: These must be readily available to clinical personnel in areas where patients are transfused." I am unsure how to proceed here. Is this in reference to in-service training and yearly competency checks of the transfusionists (who are nurses in our hospital)? The lab personnel would not be the front line individuals who would need to "recognize" a transfusion reaction, so it must be some type of competency assessment of the nursing staff. If so, how are you doing this in your institutions? I am a clinical lab scientist, and I am not certain my skill set would recognize a reaction event at the patient's bedside. As such, I do not feel qualified to deliver an in-service of this nature. Are there on-line materials that might be used in these instances? Secondly, I am uncertain as to the definition of the word, "These", in the supplemental note. What materials are in reference here that "must be readily available where patients are transfused"? Again, this must be some type of information that the transfusionists/nurses would need access to. If so, do they need to be in the actual patient's room, or just available in the nursing stations. And what would it actually be? Hope I do not sound too clueless here. It's just that, well, I am. But I do thank you for any advice and pathways to information that you can provide. Bob