Ensis01

Sunshine I am curious as if a patient has an anti-D result of 1+ or less you enter them as Rh negative, why do you then send out for RHD Molecular testing and what do you use the results for.

Agreed, though by clear I was trying to infer NOT a biohazard bag as that would, in my opinion, really send the wrong message about blood products about to be infused.

Makes sense to me that blood products are carried around the hospital in a clear sealed bag to keep tags, labels etc. attached, in good condition and contain the mess in case it is dropped and breaks. Because it is not regulated does not mean it is not a good idea, just my opinion.

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Yes. We use poly cards and IgG cards. Negative control can be one of the screen cells. We make the DAT Positive control by incubating 1ml of O Rh pos cells with one drop of anti-D, mix well and incubate for 10 min at room temp. Don’t wash and make a 0.8% solution and use. It should give about a 2+ reaction (the objective), though this probably depends on the anti-D so you may need to experiment. Hope this helps.

I understand the “system” in this contex is the hospital not the LIS. So if the hospital is a stand alone and is sold the information must be moved into the new hospital LIS system or be available as a clone of the original LIS (or be in an accessible form, eg excel, paper etc). If the hospital is part of a network and is sold or closes; the information remains with the original healthcare organization. If the hospital as a stand alone closes; the information must be held in an accessible format like excel or paper though I am not sure who would actually keep the records, probably the lawyers?

Confirmed typings printed on the label. An attached tag lists the unlicensed reagents (if antigen not on list it is licensed). Historical is listed on a separate sheet and included with the order. If historical typings were attached to the bag it would need to be clearly labeled tie tag. I can not see how historical typings could be printed on the label.

Sounds like a plan. I like the simple flow of decision making logic that can be followed consistently by all.

Sorry, my response was written with a combination of tongue in cheek and experience. When I worked in a transfusion service lab; the hospital policy was that RhIG was to be given within 72 hours, though we tried to get the RhIG to the RN ASAP. The reason was that patients would often discharge themselves, or occasionally boyfriends would insist on them being discharged before the RhIG could be administered. Many of these women would not see a doctor until their due date or there was a problem. At this point the patient would inevitably "clearly remember getting the injection", and as the order was in the system figuring out if the patient had actually received RhIG was difficult to determine satisfactory. In my opinion your 14 day policy is probably a practical timeline for your patient population based on hospital experience. I would however suggest following up on your eligible patients to see how many of them are (were) non-compliant in receiving RhIG and use that as a guide to determine if your policy needs reevaluating. Hope that helps.

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So they don’t forget?!

For donors; molecular testing provides a full predicted phenotype which becomes their historical phenotype. To send out labelled antigen negative units they need to be serologically confirmed. If there is no anti sera it will be labelled to that effect I.e. “historically negative by molecular methods”. This will efficiently provide the supplier more combinations of antigen negative units. Though they will proberbly still screen for the Rh and only send out if good. Another very important and useful part of the information molecular testing provides is the antigen variant information for both donor and patient (several other threads on this!). Also If the volume sent out is high enough it may be less expensive and provide more information than the usual full serological phenotype.

For those that do elutions; do you use the cord blood or get a new specimen?

If Panel A has one cell with a 1+ reaction and all other cells are negative, I would call it positive. The iffy/suspicious screen cell that may or may not be an artifact becomes irrelevant. The patient would remain on full cross match forever due to the positive panel A cell. Trying to prove the reactions to be artifact at this stage may be very time consuming and still not resolve the issue. It seems more efficient to just do the full cross matches while the screen is being run.

Forever.

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I agree with Cliff and AMcCord. I suggest to first determine if your lab can afford the time, i.e. do you have enough techs to work-up warm autos that require allo adsorptions in addition to your current work load. If you can and do then look for the answers to your list.

Any comparable unit.

Agreed

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