Baby Banker

We antigen match our sickle cell patients who are on chronic transfusion therapy for the five major Rh antigens, Kell, Fya, and Jkb.  At least that is what we started with; it has grown from there.  One of the issues we see in our area is that most of the units are from white donors.
Most if not all of the new patients are typed and matched for V/VS and Jsa.  These antigens are rare to non-existent in whites, but are found in a sizable percentage of blacks.  So when you target black donors to be able to match the Duffy and Kidd antigens, you may be setting your patients up to make anti-V/VS and or anti-Jsa.

I disagree with this statement unless pathogen reduction will prevent lymphocyte activation. 

In the UK, we have this (relatively new) saying, "Why give two, when one will do?"  This is NOT for someone who is bleeding out, of course, but for your "Average Joe" who needs a transfusion.
It is predetermined what Hb level the patient needs, and a second (or subsequent) unit will not be released unless the patient's Hb has been checked.  If the Hb has reached the predetermined level, the unit will not be released.  This is not something that is decided by the Consultants at the Hospital; this is something that is decided by the Chief Medical Officer (nobody above him/her except the Minister for Health)!

We have been doing second ABO/Rh types on transfusion candidates with no previous history since 2002! We use previously drawn hematology specimens whenever possible.  Since nursing does some of our draws, we send a small pink top tube to the floor to be used (we are the only department allowed to order and use these tubes) for the "confirm type".  We use parafilm around the cap so we can make it "tamper proof" to some extent.  Before we did this step, industrious people would draw two tubes at the same time and save one, waiting for our request of a second draw.  They would pour over the saved tube into our special tube....now they can't.  We do second types on all ABO types, we don't exclude type O.....they too can be WBIT.....which could affect other lab departments.....we let them know if we find mistypes.   We also don't exclude emergency transfusion......that is when the most errors happen because people seem to lose their minds in high stress situations.  We stick with type O until the confirm type has been drawn. 
We tried the two signatures on the tube route, but found they were just grabbing anyone and having them sign the tube whether they witnessed the draw or not.
Fun times in the blood bank! :)
 

Something that most people don't think about is the size of the unit.  I am in a pediatric facility and we have units of all sizes.  The smaller the unit, the more vulnerable it will be to temperature change.  There is also the issue of the time the unit is out being made into an aliquot, and the fact that, in most institutions, the processing into an aliquot will be done close to the time of issue.  So if you have an aliquot that is close to RT when it is issued, and then it comes back, what do you do?  I think the only way to adhere to the spirit of the regulation is to measure the temperature directly.  However, in that case, you are going to see your rate of expired units go up. 
There are no easy answers here, and in my experience, most inspectors know this, and many of them do not pursue it too vigourously. 

Something that most people don't think about is the size of the unit.  I am in a pediatric facility and we have units of all sizes.  The smaller the unit, the more vulnerable it will be to temperature change.  There is also the issue of the time the unit is out being made into an aliquot, and the fact that, in most institutions, the processing into an aliquot will be done close to the time of issue.  So if you have an aliquot that is close to RT when it is issued, and then it comes back, what do you do?  I think the only way to adhere to the spirit of the regulation is to measure the temperature directly.  However, in that case, you are going to see your rate of expired units go up. 
There are no easy answers here, and in my experience, most inspectors know this, and many of them do not pursue it too vigourously. 

We had a patient with an antibody to one of the Bg antigens.  I remember that dealing with it was not straightforward.  They are (I think) HLA antigens.  Issitt says that the antigen expression is variable even in the same donor or patient.  I didn't see anything about sample age, but I just glanced over the entry.  It is in Chapter 19 of the third edition of Applied Blood Group Serology.  Be aware that this was published in 1985, and so relies on serology alone.  

We had a patient with an antibody to one of the Bg antigens.  I remember that dealing with it was not straightforward.  They are (I think) HLA antigens.  Issitt says that the antigen expression is variable even in the same donor or patient.  I didn't see anything about sample age, but I just glanced over the entry.  It is in Chapter 19 of the third edition of Applied Blood Group Serology.  Be aware that this was published in 1985, and so relies on serology alone.  

There is some truth in that, and especially from his perspective.  However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

The size of the patient can be a factor in how much incompatible plasma you can safely give, but in an MTP you are poring the blood products in, and often it is poring right back out.
The comment on giving platelets is well founded.

There is some truth in that, and especially from his perspective.  However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

The size of the patient can be a factor in how much incompatible plasma you can safely give, but in an MTP you are poring the blood products in, and often it is poring right back out.
The comment on giving platelets is well founded.

There is some truth in that, and especially from his perspective.  However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

The size of the patient can be a factor in how much incompatible plasma you can safely give, but in an MTP you are poring the blood products in, and often it is poring right back out.
The comment on giving platelets is well founded.

There is some truth in that, and especially from his perspective.  However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

There is some truth in that, and especially from his perspective.  However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

There is some truth in that, and especially from his perspective.  However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

I have seen many examples of anti-M that only reacted with M+N= cells.  

I have a lot of experience with SafeTrace, and some with Cerner.  I much prefer SafeTrace.  I did like the Cerner reports better than SafeTrace.  When I was at a Cerner facility the staff used to issue expired blood all the time.  Right before I left Cerner removed the label confirmation after modification requirement.  I will say that I was told that the facility I was in used Cerner differently than other facilities.
I think the best blood bank software is Mediware's HCLL.  They are now Wellsky, I think.
 
The more complex the service you provide, the less I would trust Cerner.  Having said that, a great deal of how useful a system is depends on decisions the user makes when setting it up.
SafeTrace does take both parts of its name seriously, and because of that it has a lot of hard stops.  Many times this can frustrate staff level users.

Most transfusion practices in neonatalogy, including this one, are not evidence based, but rather empirical expert opinion.  The use of reconstituted whole blood is more historical than anything else.  A unit or two of recently collected (perhaps 7-14 days) whole blood would probably be as rational.  One might check the potassium before using to make sure it isn't super high.  That is the rationale for washing a red cell.  It removes potassium from hemolysis during collection and storage, and makes the red cells more likely to absorb potassium once transfused.  It's definitely more useful if the baby is hyperkalemic to begin with.  Otherwise, whole blood would be fine.  The reason for using plasma is fear of hypocoagulability, which is probably mostly mumbo jumbo for small exchanges, but might be more of an issue for larger exchanges (2 or more blood volumes).  There is no real proof that any of these approaches is superior or inferior.
Calculating the hematocrit is a case of weighing the red cells and measuring their hematocrit and then diluting accordingly with plasma or albumin solution (5%).  You don't want a hematocrit higher than 40 in the exchange as normal neonates do not have high hematocrits and oxygen delivery is actually worse at hematocrits much above 30 in experimental models.  In this case, more is not better as far as anyone knows.  Once again, this is expert opinion not evidence based.

There is no such thing as never in science and medicine.  But while leukoreduced transfusions may on rare occasions be associated with a CMV seroconversion, the same is true of CMV seronegative, since it is possible to have a donor who is viremic but not yet seropositive.  There are those who believe CMV is almost never transmitted by transfusion, but that these seroconversions are by the usual route of individual to individual environmental transmission.  I am close to that point of view.  We have not used CMV seronegative, as pointed out above, for the last 20 years plus.  We have a 70 bed+ neonatal intensive care unit, do about 80-100 allogeneic transplants of stem cells, heart transplants, etc.  CMV seronegative is totally unnecessary and provides little or no benefit to patients.  Leukoreduction is much more important overall and provides enough CMV safety on its own, in my view, to beat a dead horse here :).

https://www.nacblood.ca/resources/guidelines/CMV.html
These are the Canadian National Advisory Committee Guidelines for use of CMV Negative Blood Products.
 

We are CAP, AABB, Joint Commission, and FDA inspected.  I feel that AABB prepares you for FDA better than the others.  I'm not talking about only the assessment process, but the total package of AABB membership.  

We use CMV seronegative blood for stem cell transplant patients who are CMV neg  their donor is CMV negative.  Other than that we use CMV safe.  We are a pediatric facility with heart, liver, renal,  stem cell, transplants.  The services that use the most blood here are CV, Heme/Onc, and neonates.
We used to insist on CMV negative components, but we found that doing so delayed transfusions while we were trying to find seronegative unis.

We don't give blood from sickle trait donors to sickle cell patients.  We are usually trying to bring the patient's % of HbS down, and using sickle trait blood will not do that as efficiently as sickle negative.  We do a lot of these transfusions, and have done for many years.
So, requirement?  Not of which I am aware.
Our workflow?  definitely.