Eagle Eye reacted to Malcolm Needs in 2nd ABO
As the vast majority of hospitals (and Reference Laboratories) in the UK use column agglutination technology and automation, it is almost impossible to perform a second ABO without either a second D type or wasting a column or more than one column. But, my point was that, if a patient groups as O the first time, and A, B or AB the second time, then, it is obvious that either the first bleed or the second bleed was WBIT. Why should it be assumed that, if the person types as group O the first time, that is both correct and that it is automatically safe to give group O blood? If anyone does, I advise them to read the posts of Dr Neil Blumberg on ABO mismatched, but apparently compatible transfusions.
Eagle Eye reacted to Malcolm Needs in 2nd ABO
Sorry, but to my mind, these patients should also be typed twice. Yes, they can be given group O blood (almost always safely), but what if it is a WBIT, and the D typing is wrong because of it, or an antibody is missed because the "real" patient is group O with, say, an anti-K, while the other patient bled is group O, with no antibodies present. In addition, and incredibly rarely, what if the "real" patient is an Oh, while the patient bled is an ordinary group O.
Eagle Eye reacted to Cliff in AABB 5.14.5
We allow specimens collected through SunQuest Collection Manager to be used as the single specimen, which we will then type two times.
Of course there can be many workarounds for other techniques. Double signatures - just collect the specimen and ask a friend to sign it. Specimens collected at different times - collect two at the same time - put different times on them.
I heard of a local facility that the second tube was coded and provided by the blood bank. That sounded fairly fool proof.
Eagle Eye reacted to tsanders0703 in Low Titer Group O Whole Blood
Is anyone out there using low titer group O Whole blood for patients? We are on track to use it for trauma patients in the near future. Any information you can share about your process would be extremely helpful.
A couple questions I have right now:
Can you run Whole blood through a blood warmer/rapid infuser? Seems like a no-brainer since it will be used for trauma patients, but you don't run platelets through a blood warmer, and that's one of the pluses of Whole blood is that there are activated platelets present.
How do you cross match Whole blood? I vaguely remember learning about Whole blood crossmatches in school, but we were told we would never use Whole blood in real life do you XM the patient's plasma with the donor cells, the the donor plasma with the patient cells? Since it will all be group O blood, wouldn't we expect the plasma to be incompatible with out of group RBCs, even I found it is low titer? Is there any benefit to the crossmatch if we know it will be incompatible, and we know low titer group O is safe for non-group O patients?
Can we expect discrepancies in the reverse blood type of non-group O patients if blood is collected after Whole blood has been given? How much Whole blood before we can expect a discrepancy?
Can you switch to type specific packed RBCs after giving Whole blood? I understand that bleeding patient will be bleeding out the anti-A and Anti-B from the group O plasma, but what happens Hohenzollern the patient stops bleeding, still has Whole blood in circulation Andy then you give type specific blood that will be hanging out with those antibodies for the next few weeks/months? Should we expect hemolysis?
What limits did you set on the use of Whole blood? Only for certain diagnoses (just trauma? What about other massive bleeding like GI bleed, ruptured/perforated AAAs, post partum hemorrhage?)? Only in certain areas of hospital (just in ED/OR)? Is there an age limit/range? Is there a weight/size range/limit (specifically is it ok for smaller people)? Not available for people with specific conditions (CHF)?
How did you educate medical/clinical staff? Any good resources you are willing to share?
Any issues encountered in Transfusion Services (BECS? Tech training/understanding? Things you wished you'd have known when you started using Whole blood or lessons learned along the way?)
What is the max number of low titer group O whole blood units you will give a patient?
How much do you maintain in inventory? How much is used vs. wasted?
If you are willing to share any processes or procedures, it would be greatly appreciated! Thank you!
Eagle Eye reacted to John C. Staley in AABB 5.15.4 (European input welcome)
I've put off weighing in on this topic for as long as I can. I really hate impossible "shall have" rules and regulations. First you would need to know/calculate the body mass/blood volume of the patient. Then you would need know the level of activity of the incompatible ABO antibodies in each unit of plasma going into that patient. Then you would need to know the volume they are bleeding it back out. All this to give you an accurate estimate of the volume of incompatible plasma you could "safely" give one specific patient. I'm sure I've left out a factor or two but you get the gist of what I'm saying. My minor level of OCD really whats me to do it right if I'm going to do it at all. I had a non-technical lab director (BA in business) throw me out of his office for trying to explain why the request for certain data by a VP was not only impossible to accurately provide but was a stupid, worthless waste of time.
This is one of those times where you and your lab director will have to make something up based on your best guess and basic instincts because there is no one size fits all answer to this.
Eagle Eye reacted to galvania in Questionable blood types
and you would - I hope - transfuse with group A, so if you wrongly called it a group A, rather than an AB, it would actually be better for the patient. I know of at least one case where an ABel was transfused with group AB blood and died as a result of a transfusion reaction.
And if this is a donor, the amount of B antigen present MIGHT cause a minor reaction if transfused to a group A patient but would not do any serious harm. An what percentage of those weak reactions with B cells will actually be caused by this phenotype anyway? Probably less than patients having antibodies against LFAs that are not picked up in the antibody screen and who have a minor reaction due to the incredible bad luck of receiving a unit of blood that just happens to have the antigen
Eagle Eye reacted to AMcCord in Questionable blood types
I can relate to that! I can log in to my work desktop from home, so sometimes I ask them to fax a copy of what they are doing to my work email (secure!) and I can see what they've documented. Once we're up with our new blood bank system, I'll be able to access that as well. That can be an enormous help sometimes with the ones who don't communicate well.
Eagle Eye reacted to galvania in Questionable blood types
Yes, that's true, Malcolm. On the other hand, if you test with 2 different monoclonal anti-A reagents (and an anti-AB for good measure - a real one not an A+B) and they all come up 4+, I think it's fairly safe to say that the patient is a group A. I think that giving group O blood in this case is both wasteful of group O blood (unless you are swimming in it) and overkill
Eagle Eye reacted to John C. Staley in Freezer -30C Thermometer uses sand instead of glyerol in bottle
I had never heard of it but it sounds like a great idea to me. Wish I had thought of it!
Eagle Eye reacted to Malcolm Needs in Gold Medal.
I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year. It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK. Sorry if this sounds egocentric, but I am very excited.
Eagle Eye reacted to tcoyle in ABO Retype
Agreed! From the 31st Edition of the BBTS Standards:
Standard 5.14.5 Pretransfusion Testing requires two ABO group determinations and cites Standard 5.14.1 as the precursor. 5.14.1 states the ABO group shall be determined by testing the red cells with Anti-A and Anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent red cells....
TRM.40550 Forward/Reverse Typing Phase II
For each patient, red blood cells are tested with anti-A, anti-B, anti-D, and serum/plasma is tested using A1 and B reagent red cells.
NOTE: The ABO/Rh type of the patient's red blood cells must be determined by an appropriate test procedure. Tests on each sample must include forward and reverse grouping.
CAP and AABB are in agreement.
Eagle Eye reacted to Ehowell66 in ABO Retype
Currently when a patient does not have a prior blood type on file, we will collect a second specimen (drawn at different time, different person). The forward type is repeated and resulted as the second type. This was set up before I became supervisor. Recently a CAP inspector told me she thought all ABO/Rh typing's needed a forward and reverse done. How do you do your retypes? Based on TRM 40550 it seems the retype would need a reverse typing as well, thoughts?
Eagle Eye reacted to AMcCord in MTP with EPIC
How do we survive without a BBIS? Well, it takes a boatload of paperwork and even more time to deal with the paperwork. We've never had a BBIS, so we don't truly know what we're missing (though I have a vivid imagination, did work with a BBIS validation years ago, and I am soooo looking forward to getting SafeTrace Tx up and going - I have been the squeaky wheel for years pushing for a system and they finally said YES ).
We've given as many as a thousand units of red cells a year with paper records, though we are currently down to 700ish with patient blood management taking effect. I track products with an Access data base and we had a DOS data base before that . We use report forms built into our LIS - the LIS we are using now and what we were previously using. These are strictly reports, nothing more. All other documentation of testing, etc. is on paper. Prior to that (and not so many years ago) we typed our reports on a typewriter - I kid you not! Our entries in the LIS are made manually from drop down boxes, a minimal number of free text boxes and using barcode scanners for DINs and product codes. We have rules in the LIS to remind staff about required testing. All entries are verified by a second tech and are further reviewed at a later point by myself or a designee. Old school, but it works. The pertinent information passes from our LIS to EPIC, so BPAM works. I wish we were going to use the SafeTrace blood admin module, but that decision was made for us.
I stress to every nurse that I talk with about patient ID that the information that BPAM is checking is a manual entry, so is not a guarantee of anything. If something doesn't look right, they are instructed to stop instantly and contact us. The 2 person bedside check of armband and unit tag/bag information that we were doing prior to BPAM is still critical. And our medical director and I meet every new nursing hire for a pep talk in Blood Bank about patient ID, transfusion safety and MTP/emergency release.
We pass Joint Commission, CLIA and CAP inspections w/o issue and transfuse our patients safely because I am a well known, absolute DRAGON about following procedures and doing things right! (Did I mention that I can't wait to get SafeTrace up and running ??? )
Eagle Eye reacted to David Saikin in Complement QC with Poly IgG
I have never seen that interp for polyahg requiring IgG and C3 sensitized cells. It seems to me that the final sentence of referring to TRM.40200 allows the use of the IgG sensitized cells to document the reactivity of your poly reagent. I know I am not the only one who interprets this. I will f/u w CAP on this.
Eagle Eye got a reaction from AMcCord in At my hospital we manually enter Type and Screen results....
NO. Too many issues here.
If i am supervisor i would not be able to sleep at night.
1) why are you entering results manually? If vision is interfaced and someone is entering results manually, there should be a check pr report for you to see all manual entries.
2) also er check all manual entries by second tech. (As some one stated this is CAP and may be your STATE requirement.
3) Every WBIT must be investigated with RCA to fix the problem.
4) If you are in US some of these are report able errors to FDA and may be STATE.
5) Start documenting every issue immediately.