Baby Banker

Since I personally retyped a unit that was labeled wrong I would be very uncomfortable with not retyping. 

Absolutely!

Just to add a bit to what David has already explained.  I tend to think of dosage as relating to the amount of antigens present on the RBCs that you are using to ID the patient's antibody, and if the reagent RBC has lots of antigens of the type in question, then the reaction will be stronger.  This is really important for a patient whose antibodies are just developing--you want to use a reagent RBC with the strongest expression possible, and these are the homozygous cells.
For example, at our hospital, we use the 3 by 3 method for antibody ID (for each type of significant antibody, if the antibody is present, we want to rule in with 3 positive RBCs, and to rule out all the other antibodies, we want to have 3 negative reactions for those.)  So for antigens that "show dosage", we want at least one of those three rule out RBCs to be homozygous.
Scott

I might add that the patient was Filipino. 

This is a long shot, but if your patient is black and transfused often, it could be ant-Jsa or anti-V/VS.  We see that not infrequently with our sickle cell patients who are on a chronic transfusion protocol. 

It does occur, but what we see more often is a negative screen and about a quarter to a third of the units incompatable by Coombs crossmatch.  These patients get transfused about once a month, so we still do AHG crossmatches on them.
 

there are three main reasons why this can happen:
1.  antibody against a low frequency antigen present on the screening cell but not on the panel
2.  Temperature difference between the screen and the panel.  Main culprit here is anti-M
3.  contamination
 
Are there lots of screens positive with this cell?  Yes, all in a batch - cell contaminated
                                                                             No, only this one, but neg on repeat - either 2 or 3
                                                                             Some - either 1 or 2
You can repeat the panel in IAT (I presume we are talking about an IAT technique here) at RT.  If it's an anti-M it will come out more strongly
If it's an anti-LFA then finding blood that is XM-compatible won't be a problem

I think ICCBBA may release some information on 1 April.  They are, of course, operating under the same sort of constraints as the rest of us.

I asked the blood bank manager and director if I need to put these codes in our computer system; I have not heard back from them.
 

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

We keep the signed form regardless of transfusion.

if I sign out emergency release, I am keeping the request regardless if rbcs are used or not.

This is where having a transfusion service director who knows something about clinical medicine and hematology comes in very handy.  It shouldn't be the medical technologists' job to triage requests.  Many transfusions do more harm than good, so it's not that difficult to figure out which patients urgently need transfusion and which can wait, but this requires a knowledgeable and tenacious physician to handle the individual requests and screen them.  As a field, pathology has paid little attention to the need for those who can do such tasks, as compared with surgical pathology skills, cytopathology, etc.  You may need to involve your institution's hematologist(s), intensivist(s), surgeons and anesthesiologists to help make these decisions if your lab physician(s) aren't up to the task.

I believe the topic -- QC for panel cells -- has been discussed a few times here on Pathlabtalk.  As far as "validation", not sure you need anything beyond what the manufacturer suggests.  And I think Ortho only mentions QC.
Scott

I wondered if you were testing fecal occult blood.

I wondered if you were testing fecal occult blood.

Ah...but you have to carefully calibrate the use of that finger or fingers. And bare fingers worked better than gloved fingers. Of course, that was before we really had gloves.

Depends on a lot of factors.
As for the assessors, you need to approve them to ensure there is not a conflict of interest, so you'll know exactly how many are coming.  
How big are you, what are you seeking accreditation for?  If you have a donor center, and IRL, or another accreditation, it's likely you'll get an AABB staff member, otherwise, you'll get all peer assessors.  While they are all trained to assess to the Standards, there is a lot if subjectivity.
How many days also depends on your size. 

Pneumatic tube systems generally have a way to set a priority based on location.  You should check to make sure carriers coming from the Blood Bank have the highest priority available.

Pneumatic tube systems generally have a way to set a priority based on location.  You should check to make sure carriers coming from the Blood Bank have the highest priority available.

We do.  We use plain clear zip lock bags.  We have used biohazard bags in the past.  We stopped because there was a concern that the patients might think we were giving them biohazardous units.  

Looking back over, I realized that I did not specify that the patients I am talking about are the ones on chronic transfusion therapy and are transfused about every three to five weeks.  They have all either had a stroke or have been identified as being at high risk for stroke.

We limit our matching to a group that is generally manageable. It has been some time ago since I looked at their recommendation, but the Sickle Cell Foundation was recommending matching further than we do.  We do find that these patients develop 'warm autoantibodies' which I think are or may be a reflection of the myriad other antigens that we do not match.  That being said, our practice has been successful in preventing stroke overall in a disadvantaged and usually overlooked (in my area) group of children. We have done a pretty good job of indoctrinating the patients and their families to get in touch with us when our patients go to another facility.  

They may indeed "cause very mild delayed transfusion reactions", but to a multi-transfused (Sickle Cell Disease, SCD) patient, with often a multitude of other alloantibodies, what would be a typically mild reaction in a "normal" patient can be serious, even fatal in SCD patients, especially if it induces a hyperhemolysis event. SCD patients understandably have very fragile immune systems. It doesn't take much to upset the apple cart.
They sure do, especially since many laboratories routinely use the super-sensitive assays like PEG-IAT or CAT (gel/bead technology) for crossmatches.