Baby Banker

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.

I was wondering if Amy is a blood banker.

Never mind. I just read it again.

Unless I'm missing something, the first case could be caused by maternal anti-B.

I think Johns Hopkins does titres in gel. We looked at it a few years ago for our isohemagglutinin titres, but decided to stay with tubes.

We don't titre because we don't have anything to do with the mother's care, but I know the hospital down the street tracks the titre. As for the panel/screen, I take the antigen profile and circle all the required antigens. Then I select a cell that is homozygous for each one. I sometimes have to use cells from other panels or screens. I know the rule is that you can substitute two heterozygous cells for one homozygous cell, but I never do that if I can help it.

If you know she has anti-E, you can probably put together a custom screen of E negative cells. That screen would only be positive if she developed another antibody. Be careful that you cover all the antigens that the FDA requires. That list used to be in the Technical Manual. I think it is D, C, E, c, e, M, N, S, s, P1, Lea, Leb, K, k, Fya, Fyb, Jka, Jkb.

I should have mentioned that we have X-ray irradiators.

We have used both. They both perform well. We are currently using Rad-Sure.

The Blood Bank Manager and someone from Biomed have trained to be able to do some repairs. There is not a recurring cause of downtime.

We have one of each. The Rad Source is much more reliable. Also, it has it's own water supply which is recycled, so you don't need a water hook up, and it requires only a 220 power connection. Another plus is that it can irradiate 60 mL syringes. We're a pediatric hospital, so that is important for us. The company has been very responsive to the few issues that have come up. Having said that, no x-ray irradiator is as reliable as a cesium irradiator. They have a lot more working parts, so there is a lot more that can go wrong with them. Even though we have two x-ray irradiators, we have had them both down at one time.

positive: small dead space, very little wastage negative: can cause hemolysis if used with red cells

Thawing in cold water would probably cause the cryo to precipitate.

Who titres and who washes out of group platelets?

They will need a sterile connection device. We have two. We filter the platelets when we draw them up. A tube sealer would be handy too.

We used to reduce volume platelets here, but haven't done in years. It produced a substandard product. We use aliquots of apheresis platelets. They are usually in syringes. We have a neonatal ICU that stays full.

We tube units of blood only to our CV Lab, and we transfer them in the computer, so our documentation is the packing slip generated by the computer. It includes a statement: 'Acceptability confirmed and packed by: tech's user id.'

We have had a terrible time with the DI product, Instrument Manager. The Lantronix box has failed twice (the network guy didn't plug it into a surge protector), and the mapping is a pain, even with direct help from DI.

Most CAP and AABB inspectors know how ridiculous the differentiation between storage and transport is without a time limit for transport.

We have an SOP for when our system is down. The staff are trained on the other various scenarios, but there is no SOP. For example if the HIS is down we get paper orders. If the registration system is down, we can still use SafeTrace for any patient that was registered before the system went down. Any new patients have to be done on our down time records. If both the HIS and registration systems are down, we can still use SafeTrace for any patients registered before the down time began, AND we get paper orders.