Baby Banker

We use fresh (less than seven days old) irradiated RBCs. We wash the units only if they are not fresh.

We used to get them back from OR. What with bags returned with needles attached, and units clotting to the counter, it became a biohazardous nightmare. Now we only get back bags associated with transfusion reactions.

Both of these are good examples. We do our validation in three parts: Installation Qualification, Operational Qualification, and Production Qualification. The IQ just shows how it was installed. For a piece of equipment it could be the installation checklist. For a test it could be screen shots of whatever was changed in the computer to create the test. Operational Qualification shows that a piece of equipment does what the manufacturer says it will do. What I do for a test is build it in my Validation Environment and test it there. If that passes, I build it in the Production Environment and test it again. I can't move a computer build from one environment to another. So the testing method for OQ and PQ for a test is usually the same. However you validate, be sure to get your Medical Director to sign off on it.

Send him on his way now, while he is in his six month probationary period. It will be much harder to do later. You cannot manage an employee whom you cannot trust.

The Technical Manual used to have a list of antigens that must be represented in screening cells. I haven't checked the newest edition. I circle the required antigens at the top of a panel antigen profile, and then circle the cell number of each cell selected for the screen on the left of the profile. Remember to take zygosity into count. It almost always requires more than three cells. I usually do this when a patient has a known antibody. I omit that specificity, and what I am left with is a screen/short panel that will only be positive if the patient has developed a new antibody.

Since I work in a pediatric hospital, our patients are minors. We will approach the parents for consent. If they will not, we get a court order and proceed. I'm told the parents usually consent.

We test if the patient already has the antibody. We've had units come in that were marked one thing but were actually the opposite.

I remember from somewhere that Kell doesn't or is least likely to show dosage.

Going into the bag with a needle would make it an open system. Does the bag not have segments attached?

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 remember that too, but this was a gas I think. It left a residue in the disposables that caused some patients to go into anaphylactic shock. It was in the Technical Manual a few versions back.

I vaguely remember hearing that patients may react to the chemical used to sterilize plastics. I think it's a bigger problem with patients on dialysis.

Children frequently make anti-M that reacts at Coombs phase. This is usually without known sensitization. I saw this in a text book years ago, but have seen it in real life many times during my 36 years of pediatric blood banking.

We use API. It is cheaper but you don't have as much time to do them.

In pediatrics we often struggle to get an adequate sample, so most of the time we go directly to the panel.