Ensis01

My understanding is there are no WBC in plasma

I can see that irradiating plasma for reconstituted whole blood makes sense if the LIS needs both the RBC and plasma to be irradiated for consistency. I see no other reason to irradiate plasma due to the manufacturing process

If the blood center packs per their SOP there should not be an issue. That being said I once opened a box of RBC and was surprised to find no ice, units were very warm. Units were immediately replaced, follow up was taken out of my hands but did involve photos and many phone calls over the next week.

I have very limited experience with using XLS spreadsheets set up for this. Advantage you can get the expiry date to highlight when close. You will have to consult with QA first to ensure they are happy. Be warned though, clerical errors will still occur and will potentially remain undetected for long periods. Thorough checking means little saved time overall.

I know of one hospital that switched to total automation (can’t remember the method or lab size). They had major issues and ended up having to send way too much to their reference lab (think anti-A1, IgM, rouleaux etc.) After a few months they changed back. As Cliff indicated above using automation as the primary method is sensible, just keep your manual methods as backup. Else expect a big increase in send out costs and time delays.

My understanding is that when BB primarily used serum some antibodies like anti-Jka would show at 37 but not at AHG (this may also have something to do with albumin being the primary enhancement media at that time). Now as BB use plasma and better enhancement media this is not an issue. I would however appreciate someone correcting or expanding on this.

News to me and sounds like great idea; cost and time depending

I do not know what the "best practice" is but my experience is that unless the BB makes the (documented) phone calls to both RN and pharmacy the BB will be blamed when a dose is missed, whatever the reason.

Charge for ABO, not sure the codes

Random extrapolation: I always ponder the change in BB tech heart rate when an Massive Transfusion Protocol is called, the differences between techs, and how much, if any average variation between hospitals ...

I think the nursing policy determines the time from issue to transfusion start. That time is (or was) often coordinated between nursing and BB as to be acceptable to return the unit within temp. With the advent and common use of temperature indicators attached to the unit, returning these units within temp seems harder. There may be a case for just saying complete transfusion within 4 hours from issue, and no return of units. Most returns seem to be due to the patient's temp not being taken prior to issue or no consent form. The 4 hours from issue also gives auditors an accurate and easy to find start point.

While I am not an auditor; I would assume that from an auditor's perspective a hospital not being able to show the tracking of how, where, when and why a unit of blood disappeared from the BB inventory would be a bigger problem than verbally taking registration for a patient in transit to a different hospital or trapped in a car.

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.