Carrie Easley

We only routinely get cords on Rh negative moms & moms w/ a clinically significant antibodies. Occasionally a physician will request one on an O mom who has had a previously affected infant, but it’s not very common. If a baby didn’t have a cord performed, and there are concerns of jaundice later, we have a separate test order for the ABO/Rh/DAT drawn via venipuncture or heel stick.

Our Erytra was delivered on Monday!!! So excited as our ProVue is on its last leg. So far, I have also found Grifols to be open to suggestions from the end-users. Brenda~ I may be peppering you with questions as I move through this process. Thanks for posting.

Agreed! If anything it would shorten expiration, but certainly would not extend.

We are also analyzer shopping, and I found that the data provided by the company should only be taken w/ a grain of salt. Some companies start the timer when the tube leaves the tech's hand, while others start at the beginning of pipetting (negating all of the sample & reagent identification steps). Most of the ones we have looked at are within a few minutes of one another. Some of my biggest motivators were a manual back-up method using same methodology, random access, the ability to run infant specimens, phenotyping capabilities, on-board reagent storage, and quality reagent cells. We are moving forward with the Erytra by Grifols (currently have a ProVue).

Unless a physician requests otherwise, we reconstitute to a 50-55% HCT. The average crit of our CPDA units is ~75%, and the approximate volume is ~270mL. By sterile welding about 100 mL of plasma, we get the desired HCT. All packed cell units used are LR, HGB-S neg, <7 days old, and irradiated. They would also be negative for offending antigen in cases of HDN. If a physician requests a different HCT, we use the formula:. x= DTV X DH/ OH x= mL packed cells DTV= desired total volume DH= desired % HCT OH= original HCT The plasma needed would= total volume desired - x I'm sure the Technical Manual can fill-in some of the blanks. Our LIS does all of the labeling and tracking work for us.

They are for exchanges, and the NICU tells us the desired volume. We reconstitute to a standard HCT, and issue in a transfer bag. We use SoftBank, and it basically allows us to create a pooled product so all the components are included on the label.

We use SoftBank. Does anyone know if you can use the Haemonetics remote storage if you aren't using their BBIS?

We use CPDA O neg packed cell units and AB plasma. It is a rare occurrence, and usually involves middle-of-the-night phone calls when it comes up!

Currently, our blood bank responds to all full team/class I trauma activations with O units (Rh dependent on age/sex). The units are delivered in validated coolers that remain w/ the patient until the clinician feels they are not needed. There has been a recent request that I evaluate remote storage in the trauma room. Could those of you who store or have stored blood outside of the Blood Bank share experiences? Thanks!

We currently use the Ortho ProVe, but are looking at the Erytra by Grifols. I really wanted to maintain the ability to have manual back-up with the same method. We only use tube for trouble shooting (warms/colds/etc...). Even heelsticks can be put on the Erytra. With their phenotyping cards, I'm hoping to automate a lot more than we currently do. Honestly, I've been disappointed in Ortho's reagent cells. We often have HLA+ cells on our RhIg short panel. It creates extented work-ups for something that should be easy. I also like that the Erytra is random access with two pipetting systems & two centrifuges that can work independently if one is down...kind-of like a back up analyzer built in. Grifols is the company that manufactured the ProVue for Ortho.

We also use SoftBank with Epic/Beaker....love SoftBank!

We don't get a cord unless there is an order (typically only Rh neg moms or moms w/ clinically significant antibodies). Occasionally a pediatrician will order on an O mom if she's had a previously affected infant. If they are concerned with an increased bili later, and we didn't perform a cord, they just do a heel stick ABO/Rh/DAT.

We are actually looking at the feasibility right now. Did you see the article in the most recent Transfusion? Great info! We are a trauma center that is about two hour STAT delivery time from our supplier. Additionally, our supplier charges $100 restocking fee when we rotate plts....

Do any of your facilities transfer charges for improper handling of blood products (not following storage guidelines, spiking through side of bag, taking to floor and not transfusing, etc...) to nursing units or services such as Surgery/Trauma? Does the Lab/Blood Bank just continue to educate and see it as a cost of doing business?

Our neonates and peds patients get CMV safe/LR reduced. We only have the rare, transplant patient where the doctor is adamant that the units be serologically tested.

Our basic post-transfusion work up includes clerical check, hemolysis check (pre & post), icterus check (pre & post), post ABO/Rh, post DAT, pre DAT if post was +, elution if the post DAT is stronger than pre. Additional testing is ordered if any of these results dictate. A blood culture of the bag is requested if there is unexplained hemolysis in the recipient, or when a fever greater than or equal to 39 degrees C. or an increase in temperature of at least 2 degrees C over pre-transfusion temperature is reported. We encourage and constantly educate nurses to identify and call transfusion reactions. We have found that physicians tend to be dismissive, and want the unit continued. An area hospital actually transfused the entirety of a contaminated platelet because the physician paused, gave Tylenol, and continued the unit. The patient died. Hives/urticarial only requires clerical check. We require pathologist OK prior to issuing another unit. The only time we will allow a transfusion to continue is if hive/urticaria are the only symptoms. We continue using the original specimen for crossmatch.

Unless your kit specifies it can be performed with an unknown fetal Rh type.... Ours (Immucor FMH RapidScreen) states that it can only be performed after delivery of all products of conception (so not after an obstetrical event mid pregnancy) and only on a known D negative mother and recently delivered known D positive child (but not a weak D infant).

Did you mean four single donor apheresis platelets (equivalent to an old "six pack")? Most of our peds oncologists dose apheresis SDP in kids @ 10-15 mL/kilo. At 24 kilos, your patient would get one irradiated apheresis SDP at our institution (most of ours are around 270mL with a plt count of at least 3.0). If volume really isn't an issue for your patient, that would be fairly simple. If they really plan to use four single donor apheresis platelets, I would agree that they would need to reduce the volume. That would really be a big dose, though. Our adult oncology patients typically only get one with a plt<10,000

We use Rhophylac so that it can be given IV on inpatients. You have to use an adapter or the syringe jams, but they are provided free of charge. Nursing (and I'm sure patients) loves the IV option.

Our supplier suggests putting refrigerated plasma with questionable globs (for lack of better term) in the water bath. If it goes away in the warm water, it was cryo and is fine to use. If it remains, we consider it clotted, discard, and ask for supplier credit. Thoroughly thawing the plasma before sticking in fridge greatly reduces formation of cryo.

All of our patients admitted with an alias (Trauma, Jane/John Doe) are drawn with a blood bank band (Typenex). The billing/stay number is used as the second identifier on the band since this will not change for the duration of the admission. When the patient's identity is updated, the demographic changes print in Blood Bank. When the nurse replaces the patient's hospital band with their real identity, the Typenex remains until the T&S outdates. All packed cells have the BBID printed on the compatibility label and transfusion record. When sending for the units, the nurse must include BBID on request. If the band is accidentally removed, we do require a redraw. We have an alert message built in Softbank to remind techs that the Typenex is in use.

We have SoftBank and Epic. Prior to November, we had SoftLab as well, but went live with Beaker November 1st in conjunction w/ upgrading SoftBank. I'm very pleased with SoftBank and the support we received during the upgrade implementation. We also utilized an outside validation company to help with the process (it was that or hire another FTE). I would also offer that it is no surprise Epic does not have a BB product. I was less than thrilled with their process and validation. I'd be glad to offer more details if needed!

For what it's worth...we really don't do that many. We are a large hospital (450+beds) w/ trauma center, and we average maybe 1 per week. We don't even have our 3rd shifters maintain competency. Most of the miscarriages are early enough that they don't need quantitated so we just give one vial. We just get the occasional amniocentesis or late loss on an Rh negative mom & trauma/fell down and bumped belly to perform the K-B's. It is on our fetal demise & pregnant trauma order set, but it's just not that common. Take care

Liz & David~ Will the fetal screen kit you use detect the cells of a weak D+ fetus? Ours (Immucor FMH RapidScreen) doesn't, so we can't do it until after delivery & Rh is known (or we would risk a potential sensitization on the off chance the fetus was weak D+ and a large bleed was missed). If your kits do detect them, I'd love to hear about it so we could reduce the K-B we perform. Thanks!

I'm wondering if you use a different kit than us (Immucor FMH RapidScreen)? Our package insert states that it can only be performed after delivery of all products of conception (so not after an obstetrical event mid pregnancy) and only on a known D negative mother and recently delivered known D positive child (but not a weak D infant). In the event of an event <20 weeks, we give one vial. If >20 weeks w/ unknown infant type (so most amnios), we have to do Kliehauer to quantitate a potential bleed. We routinely have student interns and our mantra w/ them is "if you don't have a baby, you can't do the rosette test". If there is another kit option that permits it, I'd love to hear about it!