bevydawn

We do the same as the others and have never had any probelms with inspectors.

During my last CAP inspection, this was the only thing I was cited on, and unfortunately it's not the first time, but no one besides us lowly lab people seem to care. However, they are now supposed to be checking them every January and July per the manufacturer's recommendation. They did do it in January...we'll just see if it continues on.

We don't do adsorptions at my facility so we send our WAA's to our reference lab. They call them incompatible, but compatible using adsorbed serum. We then crossmatch them in gel and call them least incompatible (we have the same issue with calling them incompatible) and footnote that they were compatible using adsorbed serum per our reference lab.

I am just curious how other facilities would have handled this situation which we had just a couple days ago... A patient presented with what was an apparant cold auto-agglutinin. No matter what we tried we could not get anything to work, including his type. His DAT was also 4+ positive with poly and C3. We finally sent his specimen to our reference lab. They worked him up and were finally able to get a type (B pos) and determine that he had a probable auto anti-I with no underlying alloantibodies. Initially the physician requested 2 units to be transfused so the reference lab crossmatched 2 units of B pos to him and found them compatible using allogenic adsorbed serum. My concern came with our laboratory policy that states if WE are unable to obtain a valid type on a patient we are only to transfuse type O units. When I said this to the tech at the reference lab after learning she had crossmatched B units, she stated that one of the reasons we sent this specimen was to resolve the type issues we were having. I understood what she was saying, but posed the question to our medical director who agreed with me. Luckily the physician decided transfusion was not in this patient's best interest so we never had to go any further with finding compatible units. Would you rely on your reference lab's type? I realize we rely on them for antibody issues, but for me, a type just seems different.

Well, I must say you're preaching to the choir on this topic...I argued with my "people" for months on their so-called logic and according to our current practices, you can see who won that battle. They just cite TRM.40670 as their case for having us do it that way, no matter how pointless it is.

I agree that doing an IS crossmatch is of no more benefit than the same tech retyping the same tube of blood, but because of the verbage in TRM.40670 "Repeat testing of the same sample may be inadequate unless the sample has been drawn using a mechanical barrier system or digital bedside patient identification system" we require that if there is no previous type, then the patient must have an IS crossmatch until a second specimen can be obtained. We do use a digital bedside patient ID system, but unfortunately, right now, it is impossible to use it 100% of the time. If a second specimen is drawn, then we have a test order code for an additoanl type that won't charge the patient so we do not have to worry about crediting.

I keep between 2-3 years worth and the only reason I keep them that long is because the previous supervisor told me she has had issues in the past when they were needed, although I'm not sure what exactly those issues were. It's probably overkill, because they are maintained in the LIS, and I know of no certain requirement for them to retained.

We often times do selected cell panels when we know what the patient has or can rule out a bunch from the antibody screen so I don't think that would be any different. As long as they are following the 10 cell panel with the appropriate rule-outs if needed there shouldn't be a problem.

We had this happen just recently and we reported out the patients type as Rh pos, left the demographic type as Rh neg, and footnoted like crazy to explain the reasoning behind all the madness.

To monitor the >4 hour infusion times, do you just go to the patients' charts to see the start and stop time?

We don't offer an Rh only type, it's all or nothing. I can understand why they would only need the Rh type, but it's never been offered that way here and so far, there have not been any compliance issues.

If any of our DATs are positive with only anti-C3 then we do not perform elutions

I interpreted it the same way that you did, and we made it safely through our inspection in October. I am curious how the person in your position prior to you interpreted it to make them think that your facility was not in compliance?

When someone comes to get a unit of blood or blood product, we require they bring us a "pink card" that has the patient's name and MR# (usually has the patient's sticker on it), vitals, and ordering physician's name on it, plus what product they want. We then either write the unit # on the "pink card" or put a sticker from the unit on it. We are supposed to dispense the unit in the computer at that time and then use the "pink card" to do the verbal check against the crossmatch tag with whoever has come to get the blood. We then save the card until the computer prints a batch transfusion report which happens twice a day at 06:30 and 18:30. Then we just use these cards to make sure everyone did in fact dispense the unit in the computer and they are then thrown away. However we then maintain the batch transfusion report for one month which has all the important info on it that the "pink card" had.

We had this very situation not long ago. Our computer will allow us to issue out Rh positive blood to an Rh negative patient irregardless of gender and age but it always gives a warning. It gives us a warning when we issue any blood that is not ABORh specific to the recipient, even if it is ABORh compatible. We then have to select a reason to override this warning, which is good, because it makes us double check ourselves and each other. And yes, it did allow us to do an electronic crossmatch...that is until the anti-D showed up!

Ours is currently set at 55, but I personally think 50 should be sufficient; I have only seen one person over 50 ever come in to L&D. If it happened more frequently then I could understand the reasoning for setting it higher.

I just wonder if anyone else out there using the Clay Adams Sero-Fuge 2000 series has trouble with the lids breaking off? It's actually the black plastic part that holds the lid to the centrifuge that breaks. We have had 2 break in the past 1 1/2 yrs and the 2 we are currently using are both on the verge. Are we just that rough on them?? It's very frustrating especially when we are down to one and everyone is trying to share the same cetrifuge. Just thought maybe someone knew some way to baby them so they won't break so easily.

We test each platelet concentrate's pH individually using a Multistix strip. Anything less than 7.0 is quarantined. However, because of time and staff shortages we seldom ever use platelet concentrates, we just go the easy way with platelet pheresis. Concentrates are more or less a back up for us.

I am curious as to how other facilities handle crossmatches on women who have had a previous "anti-D possibly due to Rhogam". Do you do full AHG crossmatches from that point on or do you do IS crossmatches after the anti-D is no longer demonstrating, and for those facilities that do electronic crossmatches, would you do an electronic crossmatch on these women or are they forever marked as having a clinically significant antibody? Thanks for any input.

We have issues with this a lot with our heart patients that need rushed to open heart surgery. To my knowledge there is no written procedure, it is up to the physician's discretion as to how many pheresis he thinks is necessary. But it generally ranges from 1-3. As for general, scheduled surgery, they seem to try to keep the patient off plavix prior to the surgery.

We will give whatever the physician asks for, if they feel 5 is sufficient then we would pool 5, but generally speaking all of our physicians just automatically order a pool of 10 for everyone. Of course, this is strictly for adult patients.

I am just curious how often other Blood Banks weigh their pipettes? CAP just says they should be checked periodically depending on the laboratory's intensity of usage so when I came here, BB was only checking quarterly, but all other departments were doing it monthly. When I questioned this, they stated that the other departments used their pipettes frequently...well we use gel so we use ours frequently, also. So I have been working towards weighing them monthly, but everyone thinks I am crazy to make more work for us when "quarterly has always worked before". Anyone have an opinion on this based on your facilities procedures?

We only keep 20 units of cryo on our shelf, but they are a mixture of all types. And when cryo is ordered, if we can, we pool 10 of the same type (although it is rarely ever type specific for that particular patient) but that rarely ever happens. And if by some miracle we are able to get 10 of the same type, the patient gets it no matter what type they are or the products are. They have done it that way here since way before I was here and as far as I know they have never had any issues creep up.

we would do an electronic crossmatch also

I am trying to come up with some new things for QA for this coming year and wondered if anyone had any ideas? Currently we monitor all of our mislabeled specimens, our TAT on stat and ER specimens, our crossmatch to transfusion ratio, etc. We've tried monitoring transfusion tags to make sure they were properly filled out by nursing but when we were getting less than 50% nursing decided they would monitor that themselves and now it is miraclously 95-100%, imagine that! I am most interested in adding things we the techs can improve on ourselves for now, that way I know I will get compliance! Can anyone share what different things you monitor? Thanks!