Ensis01

Question to those wiser than I. Is the primary reason for these required validation comparisons to ensure we in the lab know how to follow the package inserts and so use the reagents correctly? I ask because I can't imagine any lab will be able to test the reagents to the level the manufacturer can with respect to numbers and variants (see package insert).

I do not see how a genuine massive protocol can be supported with irradiated products. This is based on experience supporting patients during many massive transfusion protocol in a level 1 hospital, and also working in/with two facilities with three different types of irradiator. The irradiating process is just not that fast. I imagine the practical solution would be to give irradiated blood once the patient's bleeding is getting under control. I wonder if the patients stressed systems would prevent GVHD response?

There are many drugs legally prescribed in Europe but not in USA, and vise versa. I therefore suggest you go through the list and find out which drugs can be prescribed and what can't to make your list.

I just answered this question. My Score FAIL  

My experience with DARA patients is panagglutination with tube testing, both in LISS and PEG. This may be manufacturer dependent. For a first time patient we need to serologically explain the gel reactivity even if the tube was negative. For subsequent visits negative reactivity in tube would be sufficient. I suggest you discuss with your pathologist to see what they are willing to accept. Other BB have different policies with regards to DARA patients, which I hope will be described.

On a basic level: someone from the floor needs to collect the product from the BB and check it is correct. Someone from the BB needs to check and issue the correct product. It is a terrifying thought they object to that! You could try and use the same principle as preventing wrong blood in tube!

In this context two people means that one person is from the floor or OR (an RN for example) who brings a transfuse order, a physical piece of paper, for a specific patient to the lab. One person in the lab issues the relevant product to the RN. This issuing process therefore involves two people representing the two involved departments comparing the name, MR#, product type and product # and any other requirements (Irr, antigens etc.) prior to formal issue. This theoretically ensures no errors. That being said I have had an RN bring a valid transfuse order for a different patient to the one she wished to transfuse.

reactivity "all over the place" describes my experience of anti-P1. I have seen negative reactions from cells labelled as strong and cells labelled as weak have been positive. P1 substance (if you have it) to neutralize the anti-P1 provides an elegant resolution.

Just a suggestion; see if your pathologist can find something that would/could be part of a physician's continuing education. The doctor's equivalent of our ASCP credits.

Agreed, we also send blood all over the USA with no thought of time zones, however not when product is close to or day of expiry

Product date and time expiry is determined by the local time and location of manufacturer and displayed on the unit and in the computer system. Manufacturer's location is defined in the product DIN (Donation Identification Number). I expect/hope that products getting close enough to expiry for different time zones to matter would not be shipped that far.

My understanding was availability and cost. Probably due to FDA and European drug administrations having very different opinions (that list is long).

For consistency you should probably have guidelines about the cells you select; i.e. stipulate for anti-D titers use R1R1 cells (or R2R2 or...), and for other antibodies stipulate the use of either heterozygous or homozygous expression of the antigen.

Main practical issue from a transfusion perspective is a positive IAT XM. If RBC given via electronic issue you would be unlikely to ever know the unit was DAT positive.

I once got a pre-surgery form where the patient initialed “never been transfused”. Our facility had given 5 RBC (over a two week period) three months previously.