Carrie Easley

I'm not sure I understand the question...
In order to perform a fetal screen (rosette test), you must know the infant's Rh type as it is not valid on a weak D infant.  This is rarely known in an early loss.  For a loss/bleeding up to 20 weeks gestation, we do an antibody screen to make certain that the mother is not previously sensitized to D, and give one full dose.  After 20 weeks, we would perform a Kleihauer-Betke for a loss/bleed if the infant's type is unknown to determine if > one vial is needed.
 

I am insanely jealous - I keep trying to get one of those but it is futile.  That is the way fetal bleed calculations should be done.

We also enter it as an event wasting blood/blood components so it can be reviewed by the appropriate people.

In addition to being a financial and quality issue, I've tried using the ethical approach (donors giving up their blood as well as time, etc.) I can't say it's been successful but I suppose it can't hurt to throw that in to the discussion at each facility.

Excellent point! We also make that point in some discussions and it does seem to have at least a little impact. My hospital prides itself on hosting successful blood drives, so seeing the problem from a donor perspective can hit home with some staff.

We always place temp indicators on blood products placed in a cooler just in case they are not transfused and returned to us.

Yes, we charge the floor/unit responsible for the waste.

We report it as a quality issue - which gets the attention of people who can sink some teeth into the problems on the other end. As a result, we have very few cases of these kinds of issues over the course of a year.
We don't charge patient care units for the wasted/destroyed products - my lab director points out that the money all comes from the same pot in the end, i.e. the hospital budget, so he's not interested in taking that route. From a practical standpoint, the person who did something dumb to waste the product or the doctor who cancelled the order would never know about or care about the charge, so it doesn't address cause and prevention. The money is small in the overall scheme of things, so pushing a charge through does not provide much of motivator for nursing management to fix problems or educate staff. (If you need to bill for enough wasted products that it IS a financial issue, you've got major problems.) That's why we choose to use the quality route. That's something that management notices here.
 

No,  I wish we did.  

Yes and we charge for autologous no used too.

Personally, I would not worry too much about a donor who has a positive DAT.
We know that a certain percentage of fit, healthy individuals have a positive DAT for no apparent reason, but the fact that they are fit and healthy, and have a high enough haemoglobin and haematocrit to be able to donate blood, and not keel over themselves, means that their red blood cells are almost certainly surviving normally in their own circulation (or, at the very least, the red blood cells are surviving long enough not to compromise the donors health), and they will almost certainly survive long enough in the recipient's circulation to be efficacious, even if they do not survive quite as long as would be expected.  Such red blood cells are most unlikely to be the cause of some form of haemolytic crisis, just because they are DAT positive.
In fact, the NHSBT no longer routinely test their donors for a positive or negative DAT, and we have seen no incidents as a result.

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.

The following are our criteria for performing a KBT:
Order a KBT on an Rh-negative obstetrical patient for any of the following:
post-delivery Fetal Screen test is positive,
trauma during pregnancy (ordered by the physician),
mother had a vaginal bleed, fetal death, terminated pregnancy, amniocentesis or CVS at > 20 weeks gestation,
mother had a version procedure, and/or
neonate is Rh-negative with a positive or invalid Weak D test, or Rh cannot be determined.
At less than 20 weeks we issue one dose of RhIg without further testing, other than the type and screen.
 
CarrieM has nicely summarized the use of the Immucor FMH RapidScreen if that is the kit you are using.
 
Additionally at delivery, we use an on-line calculator recommended by the AABB to determine the amount of RhIg to be given based on the mothers height/weight:
W:\AB\Bloodbank2\CAP AABB RhIG calculation\RHIGCALe.zip\

I'm not sure I understand the question...
In order to perform a fetal screen (rosette test), you must know the infant's Rh type as it is not valid on a weak D infant.  This is rarely known in an early loss.  For a loss/bleeding up to 20 weeks gestation, we do an antibody screen to make certain that the mother is not previously sensitized to D, and give one full dose.  After 20 weeks, we would perform a Kleihauer-Betke for a loss/bleed if the infant's type is unknown to determine if > one vial is needed.
 

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). 

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.

We're a pretty big hospital and provide products for a pretty big cancer center.  I know you excluded babies, but we also have a NICU.
We do not have CMV sero-tested products, only leukoreduced.

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 are trying to move away from CMV seronegative products, except for neonates. Our Pediatric Hematology physicians - about a year and a half ago - stopped ordering seronegative products for their patients following a literature search for current best practices. They found that leukoreduction was at least of equivalent risk of CMV transmission. We are encouraging our adult hematology oncologists to do the same or at least test patients for CMV before ordering.

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.

This is one technique that I would not want to validate in gel.   Gel will enhance reactions and will pick up strong, direct agglutinins.  A microscopic reaction (negative) in tube could be a 1-2+ (positive) in gel.   I don't want to take the chance of enhancing unwanted reactions and would opt tube testing in this case.  I am interested if others have done this and their success or failure.  

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

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

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