bevydawn

I have a couple questions about how others handle their expired panels. First, how long do you keep the expired panels after expiration for rule-outs? And second, how do you differentiate between the expired panels and the in- date panels? Do you just mark them as expired or do you put them somewhere separate from the in-date panels? Just trying to organize so things run a little more efficiently and keep those inspectors happy!!

I'm just curious how others read their DAT's, microscopically or macroscopically?

Just curious if anyone out there has any information on a Hand Blood Pump by Pall? One of our open heart physicians is asking for them so nursing asked me if I could find any info. I've looked but keep coming up with the same, very limited facts about it.

We do not specify actual numbers in my facility either. Transfusion reactions and the signs of them are pretty much up to the physician to decide on (not that I necessarily always think that is a good thing!!).

My facility just finished validating electronic crossmatches recently and we actually just went live with them last week. Luckily for me, our Blood Bank LIS coordinator handled the computer validation part. We were being very careful to follow the AABB requirements for this, thinking these would be the most particular, but when we were almost finished, CAP gave us a snag. We use PPID devices alot of the time, however not ALL of the time due to nurse draws and problems with connectivity in some areas of the hospital. The CAP requirement as we understood it, said that we could not retype the same specimen twice in order to have the required 2nd type unless it was drawn using PPID. The only other options were the BloodLoc system (mechanical barrier system) which our higher ups didnt want to deal with or continuing to do initial spin crossmatches on those specimens with no previous type, which is what we opted for. I was afraid doing that would cause alot of confusion, but lucky for us, the computer is pretty smart and can tell us what kinda crossmatch we need to do (we use Cerner Millineum).

Can anyone give me your thoughts on running a cold panel? I am trying to get my procedure manual updated (and boy is it a mess!!) and I am debating the cold panel procedure that is in it. The main reason I am debating it, is because based on the other techs' that have been here much longer than I have, it has been at least 20 years since anyone has done a cold panel here. Any time we have any issues, the first thing anyone tries is to pre-warm. And the main time we are concerned is if it interferes with our screen in gel at which point we continue to identify the antibody through gel. We do electronic crossmatches so it doesnt interfere with IS crossmatches. The main interference we would see would be in our reverse types. But if we can warm it up and get our reverse types clear no one would bother even thinking of a cold panel, we would just do an AHG crossmatch. Is a cold panel something other facilities still do fairly routinely and we are just failing to recognize when it is needed?? Or is this something that other facilities have also slowly gotten away from due to things like gel and solid-phase testing? Thanks for your input!

Can anyone tell me if there is a recommended H&H standard for the administration of blood? This facility currently reviews everything with a hgb over 8 for non-surgical and over 10 for surgical. However, we now have a new pathologist who is thinking that these are too high. I know most facilities decide what works best for that particular facility but I didnt know if there was any recommended values out there? I've looked but have yet to come up with anything. Thanks for any help.

I have a question about how other people achieve consistency between techs when grading reactions. I realize that there is bound to be some variations when people read reactions, but I feel that they should generally come relatively close to one another. Yesterday I received a specimen on a patient who has for some time now expressed very weak reactions with her ABORh, usually a 1+ and very rarely making it to even a 2+. When I did her initial type, I received the usual weak reactions. However, when another tech followed behind me later to crossmatch units, he reported her reactions out as 3 and 4+! I realize that refrigerating a specimen could help enhance the reactions, but having done this particular patient several times prior, I feel confident that her reactions would not have reached this level of reactivity. And this is definitely not the first time something of this nature has occured. We have done competencies here before, but then it is just the usual "Well, maybe I dont shake my tubes off as hard as you do..." or these few techs read them consistently with everyone else for the competency. Any suggestions??

This is my first year for CAP inspection as a supervisor at the facility that I am currently working. Upon going through my checklist, I noticed that for this question, I don't have a solid answer. I can find documentation for when reagents have been switched, comparisons have been done between the old and new reagent prior to putting the new in to use. However, there is no written procedure as to how many specimens must be compared or what to do if some comparisons don't work. Can anyone tell me what guidelines they follow that pertain to this CAP question?!?! Any help would be greatly appreciated. **NEW** 12/29/2004 TRM.30882 Phase II N/A YES NO Does the transfusion service laboratory have an effective mechanism for evaluating and selecting suppliers of critical materials and monitoring suppliers’ ability to meet the laboratory’s needs?

At the facility I currently work, we were prepared to start utuilizing electronic crossmatches, the validation was complete and competencies were completed. Then I began reading CAP's guidelines more thoroughly, having relied mostly on AABB's guidelines to get us to this point. Here is the problem I am having: TRM.40670 Phase II N/A YES NO Has the recipient's ABO blood group been verified by repeat testing of the same sample, a different sample, or by performing a historical search of laboratory records? NOTE: Verification of the patient's ABO blood group must be performed by repeat testing of the same sample, a different sample, or a historical search of laboratory records for that patient. 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. This facility did away with BB armbands a while ago, before I was here so we strictly use the patients hospital armband. We do use a digital bedside patient id system, unfortunately it is not used 100% of the time. Can anyone give me some pointers as to products to utilize for the mechanical barrier system as our digital bedside system will never be 100% that can help us get this up and running??

Does anyone using gel have any thoughts about doing IAT antigen typing using gel over tube?

Does anyone know if there is a required validation for tubing blood through a pneumatic tube system? Our doctors would like us to tube blood, especially for our open heart patients, but it seems to me that there should be more to it than just deciding we will do it and doing it.

Could anyone tell me what guidelines you follow for doing a culture/gram stain when performing a transfusion reaction workup? At a previous facility I worked, it was a temp spike of greater than 1 degree. However, at my current facility, doctors call transfusion reactions and list fever as the cause when the temp spikes less than a half a degree. We also currently do a culture on ALL transfusion reaction workups which I feel is a big waste of time and $$! Any input would be greatly appreciated!

I am just curious as to what rules other facilities follow to do antibody rule-outs. For instance, I worked at one hopsital that required everything be ruled out homozygously except Kell, and C and E when anti-D was present. In those instances we could use three negative heterzygous cells to consider it ruled out. At the hospital that I am currently working, they allow anything and everything to be ruled out if there are 3 negative heterzygous cells and I just do not feel that this is the best practice to follow. Whenever I am performing an antibody ID, I always make sure everything is ruled out homozygously except for Kell (we are a small facility and dont have many panels so homozygous Kell cells are few and far between) and the C and E when anti-D is present. I would like to have this "rule of 3" changed but would first like to see what other facilities are doing.

We do an inventory reconciliation every day on our red cells. We have a smaller sister hospital which we supply with blood products so this is very important to make sure that units weren't transferred to them without actually being transferred in the computer. We do FFP on Mondays and Fridays, and we do Cryo and Rhogam on Mondays.

My facility is the same, I review all of the transfusion committee reports to find any transfusions that don't meet criteria and then submit those to the BB Medical Director. He then reviews them and 99.9999% of the time he ok's them. (He is very non-confrontational!!) On the rare occasion one gets past him, it goes to the committee, but there they have thus far been 100% ok'd by the committee. I feel that the committee is more for show than to actually accomplish anything. At the meetings, they just review the crossmatch/transfusion ratio, how much blood we have utilized over the past quarter (ours are done quarterly), any wastage of products, stuff like that, just throw numbers around but never get anything real done.

Our facility is relatively small so we dont keep platelets on hand. Therefore whenever we need some we just take whatever our supplier has available regardless of type. It usually ends up being more by expiration than anything.

We too, would record the temp every four hours until it was fixed.

I am just curious as to what type of screens other facilities are using, 3 cell or 2 cell screens.

We switched from classic to Millineum, but when we used classic, I was told Classic wasnt capable of doing a computer crossmatch. Of course they may have just told me that because the anxiety some feel about switching to computer crossmatches...

At one facility that I worked, we were required to pool FFP if it was for a plasma exchange. That was new for me too, everywhere else I worked just sent the individual units, even for an exchange. Seemed like a big waste of our time.

We keep ours indefinitely. I keep the last couple of years in a filing cabinet in the Blood Bank and when I clean them out, the older ones go in files in the basement of our hospital. I dont know if I could handle the dust to ever clean those in the basement out!

At the facility that I work, we have no procedure or policy regarding re-typing new patients to confirm the ABO. Yet, whenever I receive a specimen on a patient with no history that is for crossmatch, I ALWAYS retype the patient. Once I am finished with the initial type, I throw everything away except my pink top and order a type at no charge and start from scratch. If we receive a specimen merely for a type and screen and the patient has no history, I don't bother retyping because if an order for crossmatch is received at a later time, it is our policy to retype the initial specimen before performing the initial spin crossmatches so I can rest assured that there will be 2 types performed. I have also managed to convert a few other techs to performing an 'addtype' on any new patients they receive, because I feel whether it is policy or not, it is a good practice to follow.

I currently have a student in my blood bank and I am busy trying to make sure I cover all the bases with her. My problem is, I have never had to prepare specimens for students before and I am having a hard time coming up with a positive DAT for her to work up. I have made coombs control before but it has been too long for me to remember the correct way to do it and I havent been able to locate a procedure for it yet. If I simply heat a specimen with antisera to an antigen the cells are known to have, is that enough to cause the antisera to absorb onto the cells? Any help would be greatly appreciated!

I am just curious as to what other blood banks require for transfusing FFP and platelets. For instance, if a patient has a type from a year ago and FFP or platelets are ordered today, does your facility require that a new specimen be drawn and typed before giving the products or does the type from a year ago suffice? Thanks for any input!!