Ensis01

In the case I described above; the patient was retrospectively registered and the units issued and billed to them. My understanding was the hospitals, ambulance and police all had good communication, cooperation and shared all the information to treat the patient efficiently in unusual circumstances.

Sorry to hear this. My condolences.

I have seen something similar once; if I remember correctly the BB kept track of the patient to confirm which hospital they went to, ensured the paperwork went to to our registration, who registered the patient and the BB then issued the uncrossmatched RBCs in the LIS. I do not believe there was a deviation as you have documented orders from an ER doc for uncrossmatched RBCs.

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Ok, two-Blood group policy is same principle as US second check; GET THE ABO RIGHT!! Does Australia follow the UK standards?

The US has many different organizational blood suppliers. While some organizations are national like the American Rec Cross (ARC) there are many regional and even local organizations. In my experience, each center has their own screening policy, which is determined by their hospitals requirements. A region with a high sickle cell population may send all (or most) new African American donors for molecular testing, while other regions may only screen units when specificities are needed. So, when a blood center has an aggressive screening policy, or when they are looking for specific phenotype may affect the frequencies hospitals encounter. This explains Cliff’s and my experience described above. Also, the local donor population, and/or if (and when) the blood center imports units from a different region may impact the antigen frequencies hospitals encounter . As described by other posters above, I use the antigen frequencies to primarily determine the order in which to screen antigens and to manage expectations. For example, when I need to screen for R2R2 K- units there is an approximate expectation of 2%. I would therefore screen batches of 100 units; on one occasion I found zero units, on another 9 units with the norm being between 1 and 3 units. I am jealous screening for R2R2 K- units (or any Rh combo) would not be needed in the UK!!

What is the two-Blood group policy?

I learnt that when screening to take units distributed evenly throughout our inventory to prevent the situation David found himself in, after I screened the first 15 units on the self (shortest dates) for E, which were all positive! The units after were conformed to the expected frequency. This situation occurs because reference labs will routinely batch screen for single antigen or basic combination requests from the blood center's general inventory to prevent or at least minimize use of the reference lab's rarer units.

ABO mixed field must be explained; find out patient transfusion history. If it is not clear what their blood type is, or if the mixed field cannot be explained (patient intubated, confused etc.) document and give type O. Interpretation of mixed field in gel is easy, harder in tube but I would expect it to be there. I would therefore suggest checking very carefully for mixed field by tube (this may be an occasion to use a microscope to confirm mixed field if needed). Sounds like this is a good sample to use for mixed field training in your lab.

That sounds like an absolute logistical nightmare. Maybe I have missed something but I have visions of coolers being left in the helicopter, on the helipad (winter and summer), in bathrooms and forgotten in corridors etc.

Run side by side. Does your SOP, or manager (or anybody for that matter) give a reason why it is eluate first then Last wash? It would make more sense for a policy to state run the last wash prior to the eluate (especially if there are few red cells) to ensure sufficient washing.

I assume that as there are no decimal points involved there is little, if any, variability on day to day readings. Remember the purpose of daily checking the scale is to ensure it is fit for YOUR purpose at the max acceptable ranges in variability, which is why information is harder to find, each lab has to determine what is appropriate for them. Therefore if your inspectors have no problem with the range why would you. An additional advantage of the wide range is that you will/may see a drift in readings if the scale starts to malfunction and so have time to call someone in to fix it before you can no longer use it. I personally see no reason to make things harder without good reason or just because you can.

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There is a difference, I believe, between not being able to rule out an antibody in the context that it may be there, the answer no you state above, and not being able to rule out due to the method limitations (DTT). The DTT method limitations result in K neg units being given but once the DARA effects wears off a different, more appropriate (and better) method is used so anti-K can be ruled out and the K neg requirement dropped.

My two penneth for what it's worth; when the patient is in the OR the anesthesiologist determines blood product requirements (often by verbal order) so all an OR runner needs is name and MR#. It seems your, very valid, concern is avoiding WBIT from the outset due to the issues you outlined above. I suggest the solution is that the OR processes need to be cleaned up (literally). Therefore get QA involved. I am not a manager so others here will be way better at giving suggestions on how to proceed down that path and ensure changes are made, and just as importantly maintained.