BSIPHERD

Joint Commission has published its new Performance Measures for Transfusion. Here is a link to their Implement Guide (OMG - It's 180 pages long). What does it mean for each of us? I guess we have to read it first! What have others done (or will do) to implement this? http://www.jointcommission.org/assets/1/6/PBM_Implementation_Guide_20110624.pdf

We did 31 KB for Fetal Bleed last year. We have more techs than that who perform blood banking. Performing less than one a year of any manual test does not keep you competent. Plus I'm sure man of the techs who perform it would disagree with you about it being an easy test to master. We would love to pass it on to Hemo, but can't get anyone else to love (or at least not hate) the test either!

Our medical center has both trauma and OB patients. The KB's we do because of a positive Fetalscreen (rosette test) are not stat. However, all the ones ordered to determine possible fetal bleed are STAT. Most of these are traumas or OB patients when doctors are worried about a fetal bleed in a high risk OB patient. We would prefer not to do them - it's not a great test, but don't have a choice. We do testing for other hospitals - except we will NOT do KB's stat for anyone other than patient's registered at our medical center. We only have a limited number of techs trained in this (Consultation Techs who do Blood Bank problem workups), and if one is not working (middle of the night, weekend evenings), they would have to be called in.

I have to admit I've just recently had to think about LW. We had a patient (Rh positive) with a warm autoantibody that reacted stronger with Rh Pos cells than Rh Neg cells. The DAT was strongly pos and there was Warm Auto in the eluate. However, two adsorptions with ZZAP treated cells had the antibody getting a little stronger rather than weaker. The warm auto being stronger with Rh Pos cells made me consider LW specificity and I knew that LW was destroyed by DTT, and ZZAP cells are of course treated with Papain and DTT. So we did some enzyme only coated autologous cells and were able to do the adsorptions and remove the autoantibody. It was kind of a fun case.

The antibody could have LW specificity. If so, it should react with Rh Negative cord cells.

[ATTACH]410[/ATTACH]We call ours Tasklists as opposed to checklists. I tried to attach one as an example, but think I failed! bb ROUTINE Tasklist Daily.doc

The only reason that we occasionally run cells to determine if the antibody is still reacting is to determine if we can use the patient's plasma to screen units, then only antigen type the units that don't react. Particularly these days with the high cost of reagent typing serum.

Blood bankers might not find us if they do a search if the name changes. I really like it the way it is now.

Most patient with anti-f that we see are CcDEe and they would be CDe/cDE so that c and e are not together. While CCDee and ccDEE patients can form anti-f, most also have anti-c and/or anti-e and that masks the anti-f. But that's not important since patients with anti-c will get c negative blood which is also f negative and patients with anti-e will get e negative blood which is also f negative.

We do a DAT with a panel rather than an auto control. If all cells are positive on the panel and the DAT is negative, then we do an auto control, but this is very rare. Belva in Lincoln

Yes, we perform KB testing in place of the rosette test if the baby is weak D and the mother is Rh neg. And I agree with you - I really dislike the KB test! Belva in Lincoln

I assumed the Enzyme panel was Coombs phase. Since that may not be true, I would take the enzyme panel through the IgG phase.

I suggest you go back and review the enzyme panel. Remember all of the cells run by enzyme technique were negative. So you can use them to rule out antibodies to antigens that are not destroyed by enzymes (many of those are actually enhanced by enzyme treatment).

I think this would be "post manufacturing" and not part of the process overseen by the FDA. I don't think anyone disagrees that this is bad and adversely affects the safety and purity of the blood - but it happened after the process controlled by the FDA is complete, so unless it kills the patient, it would not be FDA reportable. The incident certainly deserves follow up and root cause analysis, but as part of the "practice of medicine error" rather than as an FDA Reportable event.

This is FDA Reportable. It fits into the category RT6-61-03. You can also contact the FDA and they will tell you if it is reportable or not. It is mandatory that you report - they don't give you a choice. (Although your chances of any bad thing happening to you if you don't report are low.) " RT-60-01 OtherRT-61-** Testing performed, interpreted, or documented incorrectly for: {use RT61** only if testing was performed, interpreted or documented incorrectly; use QC92** if testing positive or use QC93** if testing is not performed incompletely performed or not documented} RT-61-01 Other {includes: DAT; Hemoglobin S testing} RT-61-02 ABO RT-61-03 Rh RT-61-04 ABO & Rh