Carrie Easley

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

Well- sounds like I have TWO issues to address.  The age that we perform the rosette test AND that we are not using the rosette test correctly.  We currently perform the test on infants/fetus of unknown type.  I don't think the core lab is going to be happy to hear that they may be doing more KBs!

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 also listened to the Immucor webinar. What I got out of it was BB does not have to do lot to lot for our reagents, rare or otherwise. We do daily QC and the reagents must pass before use. We do have to compare current FMH kits to incoming FMH kits. You must make sure the controls on the current kit work on the new kit and vise-versa. This is to make sure the controls on the new kit work as expected and that the shipping conditions did not cause the cells to deteriorate. We had also been comparing Elu-Kits but someone specifically asked if those needed to be compared and they do not. I think I heard that it is because there are not any controls in the kit. I am grateful for small favors so I am getting rid of the Elu-kit comparison portion of my procedure.
When it comes to comparison of panel cells, look carefully at the package insert instructions. Does it say you HAVE to QC? Then you must. Does it say you MAY test, then it is up to the facility if testing is done. I personnally take that as a legal loop-hole and will run with it. Besides how could you ever compare one panel to another since you would be comparing different donors?
I had talked to CAP in the past about this subject. They said you must check all incoming shipments for proper shipping conditions AND must be checked prior to use and these checks must be documented. I made up a form that reagents are listed as they come in (date arrived, #, lot number,etc.) and I added a column for checking the shipping container. Acceptable Yes or No. At the bottom of the page in small writing I listed what was acceptable and what was not so there was not question.  All of this checking must be documented. We all know if it is not written down, it hasn't been done.
Below is the next slide from the Immucor presentation:
TRM.31241 All new lots of reagents and critical materials (e.g. blood collection sets) are inspected and tested, as applicable, before use with records of acceptance.
- If manufacturer’s instructions require testing prior to use (e.g. panel cells, antisera) then lab is expected to test
-If manufacturer’s instructions recommend testing prior to use, it is up to the discretion of the laboratory to test
-Once reagents are put into use, TRM.31400 applies

In the UK, EVERY unit is typed for C, c, E, e and K (as well as ABO and D of course!), so it would be no problem for us.  It may be the same in Finland?????????????????

Yes, we have SoftBank and we got rid of our bands because of the reason you mention and many others.  It became more trouble than it was worth.  When we got SoftBank, we went to electronic crossmatching, which requires two separately drawn blood types before non-type O blood can be issued.  We also implemented barcode scanning at bedside for patient ID when drawing samples.  So we felt that those two additional safety measures were enough reason to feel comfortable about removing the bands.  Our error rates are lower than ever and we'll never look back.

We perform a Kleihauer and, at 20 weeks of gestation, we presume the foetus is D Positive, just to be on the safe side.

The QC always works...that's what was frustrating.  We did note on our response the mixed information that seems to be circulating from CAP regarding this topic.  Hopefully they can all get on the same page, and alleviate some confusion!

The QC always works...that's what was frustrating.  We did note on our response the mixed information that seems to be circulating from CAP regarding this topic.  Hopefully they can all get on the same page, and alleviate some confusion!