Carrie Easley

Another one for hospital transfusion services: For those of you in complex blood banks (multiple ABID's, adsorptions, elutions, irradiation, neonatal aliquots, titers, student interns, Trauma, etc...), do you maintain a dedicated blood bank staff or are they all cross-trained in other areas of the laboratory? Thanks!

Thanks for your responses! We have a similar process for MTP. Patient care staff place an initial order set (they have to order as medications are included), and BB issues product per the prescribed ratio until the event is over. We have this routine down. It's the occasional orders for two uncrossed that nurses are having a tougher time getting in the system. I like the idea of the verbal order log. It would make retrospective review easy!

For those in a hospital transfusion service... Do you accept verbal orders for blood products? I'm particularly interested in urgent/uncrossed blood. Are your blood bank staff permitted to place the order in the hospital/lab order system? Thanks! Carrie

We use RadSure. Recently did a brief trial with RadTag....the techs preferred RadSure. They like the clear yes/no.

We sent two of our Clinical Engineers to the training. It is supposed to help with initial troubleshooting and basic tweaks. Can also help Rad Source determine the source of the problem and parts that should be brought. The Rad Sure engineer performs our annual PM. Dosimetry is incredibly easy...stick the canister they send in and run a cycle. At the risk of jinxing myself...we went live last April, and haven't had a downtime. It will also do 35mL syringes (in addition to the 60mL).

We are currently working on this as well. Our supplier has recently made type A liquid (never frozen) plasma available. We have built a new main product code, and utilized the ABO override Em_Issue set to Y in the 25.3 upgrade in the Alternate ABO/Rh Table. We tried it in the TEST system yesterday, and it worked well. It does create an exception @ emergency issue. At this point, we are only planning to permit the exchange for Trauma & MTP, so have not made the same override with other plasma products. That could change, though!

We've been extremely happy with the Rad Source. Service and extended downtimes on the Raycell were an issue since parts had to make it through Customs from Canada. Rad Source offers 24/7 phone support, if needed. We have had minimal problems. They are based in Georgia, and respond quickly if there is a issue. There is also a syringe adapter for neo aliquots. I don't know anything about disposal of a cesium device, but Rad Source did take care of of Raycell.

The T&S is included in our MTP and full trauma activation order sets. Both phlebotomy and blood bank are included in the page for both scenarios. Unless a patient expires immediately after arrival, it is very unusual for us not to get a specimen within 10-15 minutes.

We switched from a Raycell to a Rad Source 3400 X-ray irradiator about a year ago. We're very happy with it as it does not require plumbing...it has an internal water tank for cooling. The company is based in Georgia, USA and is very responsive.

Our compatibility tag is a 4X4 label (we don't take backing off) that we attach with a tag gun (like price tags on clothing). It's slipped through existing holes on front of the unit allowing comparison of the patient/unit info during read-off.

We are in an almost identical position as you....Level II, stat order takes 2 hours, minimum level is 3 apheresis platelets. We order additional if we have a daily user or multiple complex CV cases going on at the same time. One of our first steps when an MTP is activated is to increase inventory to 6. To make things more interesting, our supplier charges $100 to restock each unit we return.

We were using BCW, but now we have a genomics lab about 2 hours from our hospital. http://nybloodcenter.org/about-us/press-room/new-innovative-national-center-blood-group-genomics-created-nybc/ Both facilities provide transfusion/RhIg recommendations in the report. We send women who are pregnant or have potential to be.

We send ours out for molecular if </= 2+ in gel and no increase in incubated tube. The vast majority do come back as being eligible to receive Rh+ blood and not RhIg candidates.

We also outdate our aliquots 4 hours from prep and use a sterile weld. This allows us to dedicate a unit to a couple of babies. Our irradiator has a syringe adaptor that lets us irradiate exactly the amount they request.

The other issue is wastage. We routinely have product returned at the conclusion of adult MTP's. As long as the units were stored correctly, we are usually able to use them for other patients. I doubt the same would be true of divided units...

We are also revising our MTP procedure to include peds. Although we routinely divide units for neonates and pediatric patients, we will issue full units during an MTP. The clinicians do not want to wait while we physically and electronically divide the units. The # of packed cell and plasma units issued per MTP "round" will be based on patient weight. Once they hit 45-50 kilos (still under discussion), we will use full adult rounds ( 6prbc/6plasma).

So sorry to hear.

We are a little over a year out with our SoftBank upgrade to 25.3 and integration to Epic/Beaker. I'll send you my info!

Not sure about Meditech, but SoftBank requires it on all types. It reflexes the ISXM if needed. We have a hard stop that will only allow issue of O packed cells if only one type one record.

We perform a gentle heat elution. If we successfully attain a negative DAT after the elution, we test baby for weak D.

Currently validating our new Erytra, and am really pleased. All of the techs who have used it so far love it. Incredibly simple to use and very intuitive. Grifols is working on liquid antisera that can be used on the analyzer for both patients and units. Really looking forward to that as well as a short panel to rule-out passive RhIg. When you consider the number of cards that can be stored on-board, it's not leaving any bigger footprint than our ProVue. 28 minute STAT T&S (2cell) from the time we put the specimen on!

Our primary method is gel. If we get =/< 2+ reactivity (on someone pregnant or with childbearing potential), we repeat with tube reagents to see if it reacts at IS. If not, we incubate @ RT for 15minutes. If tube reactivity is not 2+ or more, we tentatively call the patient Rh- and request an order for Rh genotyping from the physician. The vast majority do come back as being a variant that can be treated as Rh+ for transfusion/RhIg purposes. There have been a couple that we were told have the potential to make an anti-D. I uploaded one reference to the library under Educational Materials. There was also a good article in Transfusion Volume 55, March 2015

I will say that the only reason we have such compliance on antibody moms is due to the blood banker calling L&D and telling the nurse that a cord needs to be collected. If they fail to, we ask for a heel stick.

I assume the clinical pathologist has been notified of this sentinel event? They should be involved in the management of the patient and subsequent reporting to appropriate agencies.