Carrie Easley

We validated Quotient  panel cells for use in Grifols DG gel.  It’s nice to get more rule-out’s/in’s while still using the same method.

That's an awful situation!  I have had to retrain several techs who made mistakes.  How long do you usually train them?  I would document everything he does wrong.  Does your procedure state that you have to put your results in immediately?  Ours does, since that is what CAP requires.  What's worse is that your higher ups aren't alarmed by your observations.  If he is not following procedure, or changing his actions based on what you have communicated to him, I would not sign him off as being competent.

I would agree with mollyredone, but would go further,
Not only do you need to record everything you say to him (and get him to counter-sign the record), you need to record everything you tell your own seniors, and get THEM to counter-sign what you have told them.  THIS PERSON IS DANGEROUS.  You, as a conscientious employee, should not have to take responsibility for this person, but, if the worst happens (and it well could), you want to make certain that you are not held responsible in law, but that the finger is pointed in the right direction.  If you get your own seniors to counter-sign your written concerns, you will, not only be protecting your own future, but will also cause them sleepless nights until they do something about the situation.

This actually has helped. I have been trying to implement Liquid Plasma and this may help.

Did they happen to cite a specific standard?  Just curious.
Thanks, Scott

Absolutely the advice given to you was correct.
For a start off, as you say yourself, 80% of A2B individuals do NOT make an anti-A1, but of those 20% who DO make an anti-A1, how many will make that anti-A1 as a result of immunisation as a result of transfusion or pregnancy?  The answer to that, if you read any book concerning blood group serology (and that is NOT a criticism of you - we all started somewhere, including the very best, such as Herr Dr Willy Flegel, and others - and I have HUGE respect for Willy), you will see that a clinically significant anti-A1 is amazingly rare.
For an anti-A1 to be clinically significant, it has to react strictly at 37oC, and that is a VERY rare "animal", and no example of anti-A1 has EVER been implicated in a case of HDFN, so, PLEASE, do not worry about giving A1B (or even A1) blood to an A2B individual, even if they have an anti-A1 in their circulation, UNLESS they have an anti-A1 that is actually active at strictly 37oC.

Went live with our Erytra in February (used to have a ProVue).  The staff has been extremely happy with the switch...especially our 2nd and 3rd shifters who are covering more than one department.  True random access, great traceability, & responsive company who are already implementing our suggestions.  

How do you handle those that you don't have antisera for - like Vel for example?

Our policy as well.  

Our policy as well.  

We do not notify our medical director.  We alert the nurse taking care of the patient that more than 1 vial of Rh Immune Globulin is needed due to a positive FMH.  The KB results are on the chart also.  The nurses inform the patient's physicians.
 

This is correct...two different products.  The liquid plasma we use has a 26-day outdate, and was never frozen.

I like that ! None of this wishy-washy, barely reactive stuff.

In my opinion (and that of the BCSH Guidelines) you do not need a K+k- red cell to rule out anti-K.
If you look at the antigen profile of the red cells you use every day as screening cells, they will not have a K+k- cell, and yet you are ruling out the presence of anti-K (and any other antibodies directed against the major blood group antigens) with each sample that gives negative reactions with these red cells.  In addition, if you look at the screening cell profile that the BCSH Guidelines recommend, they say that the K antigen MUST be represented, but NOT that these cells must be K+k-.

Soft Bank is by far the best BB LIS I've worked with. 

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

We use Hemo-Temp II on our blood issued in coolers (Trauma, MTP, OR).  Additionally, the cooler temp is recorded every 4 hours.  Nurses are instructed to request a new cooler if the temp reaches 6°C.  The coolers that we use, however, validated to hold 1-6°C for ~24 hours.  For blood that comes back from a nursing unit (no Hemo-Temp), we wrap the unit around an NIST probe thermometer.  If it exceeds 10°C, we adjust the expiration to 4 hours from issue stipulating that it has to go to the original patient.

Congratulations on your retirement!  

Retesting of the same sample will not catch a wrong-blood-in-tube.  If performing a computer crossmatch, CAP states that you can only use same specimen if specimen was drawn using a mechanical barrier system or digital bedside ID system.  I believe there was an other thread regarding Typenex/Hollister no longer meeting the requirements of a barrier system.
We will use a hematology specimen for our verification if it was drawn on a separate phlebotomy event.  The blood bank can order the verification per protocol if another specimen isn't available.  If blood is needed in the interim, we issue type O.  It's a hard stop in our BB system.

I've had a look at my books, and I can't see any references that say you should NOT phenotype during pregnancy.
This strongly suggests to me that there is no reason why a phenotype should not be performed during pregnancy (otherwise I am certain that it would have been mentioned, and that a reference would have been given).  Therefore, I go back to what I said earlier, that the phenotype is okay, unless there is a mixed-field reaction seen.  If a mixed-field reaction is seen, I would worry more about the health of the foetus than I would about the maternal typing, as, for a mixed-field to be seen, either the foetus has had a massive bleed, or has had a chronic bleed over a long period of the pregnancy.

30 minutes derived from when blood was in glass bottles.  Currently CAP Std TRM.42470 requires each facility to validate the time allowed for red cells to be returned for reissue.  It does not take too long for the rbcs to reach a temperature >6C.

We either get a sample from Hematology or have a second sample drawn.  Retesting the same sample twice does not rule out pre-analytical errors.

I have had physicians tell me that patients can't have transfusion reactions to autologous blood and that hypotension is not a sign of a transfusion reaction (even though there is a type named that).  I've seen them order irradiated blood because they think it is less likely to transmit infections.  If the patient has been spiking a temp for another reason and they write off this temp which is actually due to TRALI or a hemolytic reaction and keep giving more of the unit, they have done the patient harm.  If you can tell whether there is a reaction going on by playing the odds based on the patient's history and condition then why do we ever do the testing?  I've never had to let a heavily bleeding patient wait for a transfusion reaction workup.  If their life was in danger from bleeding the medical director would override the usual policy if needed.  I'm afraid, in my experience, the pathologists are more knowledgeable than the bedside physicians in may cases.

The laboratory medical director has the final responsibility for these protocols.  Your medical staff should review the policy and discuss it with him/her.  We have emphasized that a fever can be the first indication of a hemolytic reactions and the transfusion must be discontinued and a workup performed.

Retesting of the same sample will not catch a wrong-blood-in-tube.  If performing a computer crossmatch, CAP states that you can only use same specimen if specimen was drawn using a mechanical barrier system or digital bedside ID system.  I believe there was an other thread regarding Typenex/Hollister no longer meeting the requirements of a barrier system.
We will use a hematology specimen for our verification if it was drawn on a separate phlebotomy event.  The blood bank can order the verification per protocol if another specimen isn't available.  If blood is needed in the interim, we issue type O.  It's a hard stop in our BB system.