[2nd ABO]

We use a separate BB wristband, perform electronic crossmatch, and require a second draw on patients for whom we have no type history. (We may also use a separate draw, ie. CBC if available).  Last year, a patient was registered incorrectly (same name, different date of birth - so all bands, charts and labels were incorrect). It was caught by the phlebotomist performing that second draw. If I had ever questioned our process, I certainly did not look back after that near miss. We have to remember that patient identification IS the number one safety goal, because everything stems from that.

[ABO Retype]

On Thursday, July 19, 2018 at 7:58 AM, tcoyle said:

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.

 

 

I respectfully disagree. The CAP standard you cite is for the initial type. Any other time CAP mentions type confirmation (ie. TRM.30575, and TRM.4670) they state ABO only.

Jenny

[A2B pacient transfusion policy]

Thank you!

[A2B pacient transfusion policy]

We have a 19 yr. pregnant female, front type Apos, back type 1+ A1cells and 4+ Bcells. (in gel) No history available.

Tube test with A1 cellls=1+; A2 cells=0; two different O cells=0; and B cells=0.

Anti A1 Lectin = 1+

Antibody screen negative

Results the same with different lot A1 cells. Strength increases with cold incubation.

Crossmatch in IgG at 37 degrees with patient plasma and A1cells is 1+. (in gel)

We are having the patient re-drawn for confirmation, but do I call this weak A subgroup if all results confirm? Clinically significant? Transfuse O cells?

Or could this be pregnancy related?

[Return of used blood]

We save 2 segments and get bags returned only if transfusion reaction. We briefly discussed getting the bags back after a off-site clinic had a delayed reaction (patient reported to ER later), but logistically, seemed like a bit of a nightmare.

[Temperature Indicator for RBC Units]

1 hour ago, David Saikin said:

Where do you transport?

To the floors, units that are not in coolers. Also to our outpatient cancer center in another building, which do go in coolers, but are called for when they are ready to hang.

[Temperature Indicator for RBC Units]

We use the Blood Temp 10 for transport, not for storage. The standard for transport is 1-10.

 

[Temperature Indicator for RBC Units]

Check out Blood Temp 10, PDC Healthcare. We've been happy with them since switching over from HemoTemp. (No activation required)

[FDA AND TRANSFUSION FATALITIES]

Agree with AMcCord, we recently had this occur and FDA stated that unless the death can be directly linked to the transfusion, we do not need to report. We did investigate as a potential reaction, and our Medical Director reviewed the chart and wrote up a conclusion that indicated that the transfusion reaction was not likely. In case it's reviewed, we did our homework.

[Anticoagulant in Frozen Plasma affecting INR reversal?]

An MD at Trauma mtg stated that he understood that the anticoagulants used in Frozen Plasma collection were a reason that the INR reversal with FP is difficult to achieve. I had never heard this, just wondering if anyone else has?

[Transfusion reaction protocol]

We require BB notification, and after prelim investigation, the Lab Medical Director makes the call whether it's ok  to continue for hives/itching, and whether additional units may be given. Hives category gets a clerical check and all other "Transfusion Reaction Symptoms" (as defined by AABB) require disconnection of unit and are worked up as reactions. The patient's MD does not make the call. We have a separate transfusion reaction categories for: 1) hives, itching 2) potential bacterial contamination and 3) everything else.

[Antibody Panel QC]

We run the panel with diluted anti-sera (Currently Anti-Fya at 1:500 dilution). I am assuming that you are testing the cell viability, and that the panel will perform as expected. We test before the old lot expires. 

 

[Zika Virus Negative by NAT]

It's my understanding that the manufacturer of the unit must label the unit for Zika testing as long as it remains an investigational test. We collect donor units and must label each one with the Zika comment. If you are only the end user and the unit is already labeled with the Zika comment, I don't know that you have to log that comment into your system, unless you re-print the label. (as with thawed plasma).

[Cooler validation and QC]

email me at jcastle@ajh.org, I will share ours.

[QC procedure for donor units]

It's for WBC. We don't have flow cytometry so we are using the Hemacytometer method. Trying to get away from this if possible.

 

[QC procedure for donor units]

Currently we use the Nageotte Hemacytometer to screen donor units for WBC. I would like to switch over to running the samples on our Sysmex Hematology Analyzer, which is linear to zero in Body Fluid mode.  Has anyone done a switch like this that would be willing to share information?

[Draw and Band charges]

Yes, it's a tube drawn for Blood Bank that has no testing associated with it. It's simply ready for testing if needed. We hold them for three days.

[Draw and Band charges]

Hi,

I have a question from our IT person:
What/how are people charging for Draw and Band's? Is there a CPT code? And how are you tracking volume for this test in the lab?

Thanks,
Jenny

 

 

[Unit segments]

We keep for seven days post transfusion.

[Gel DAT QC]

Like ANORRIS, we use a 0.8% made of Check cells for pos control and one screen cell from Ortho screening cells (we make it up from the 3% to save our 0.8%) as the negative. Day of use. We also use these for the IgG-C3d cards, in addition to a C3d positive control.

 

[Continuing Issues with Ortho Gel Reagents and or Equipment]

We do manual and aliquot cells for the day. We have experienced very few problems, although I have noticed a slightly pink haze in the card toward the end of the cell expiration.

 

[Zika labeling with Hematrax and Meditech]

@amurphy We have the expanded field in test, we have entered the N0125 comment, have also entered this in our printer software. We can print a single label for a single unit, but do not know how to make this a permanent change.

Thanks, Jenny

[Zika labeling with Hematrax and Meditech]

Our problem is that both Digi-Trax and Meditech are claiming to have solved the problem, but the "fixes" are not communicating. We have yet to see any solution that gets us to the final outcome, which is printing the read-only comment on our donor units entered into Meditech onto labels from the Hematrax printer.  If someone has gotten that far, I'd love to hear from them.

[Zika labeling with Hematrax and Meditech]

Has anyone been able to implement the required Zika comment on their donor unit labels with the combination of Hematrax and Meditech?

[Reporting prophylactic anti-D]

We report as positive for Anti-D with a notation in history of the last date Rhig given. We do full workup and report as Anti-D if we cannot determine this information.

Jenny