Ensis01

If the candidate has commercial lab experience running HPLC or LC/MS/MS they will have direct transferable skills and experience with following SOPs/procedures, running QC and tight deadlines. So they would definitely be trainable. However you would have to teach them everything BB as BetnaSBB described above. Do you have the time for that commitment?

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

Have you ever found anything unexpected and clinically significant?

With respect to RBCs. If the patient has unidentified antibodies (as the title states) then NO. If you have identified the antibodies but can not confirm the patient’s antigens (as your question states) and the AHG crossmatch is compatible with units negative for the antigens that the patient has antibodies to then yes, though there are some/many possible caveats. Hope that is not too convoluted. It would help us if you give more details. Can you please explain what you mean by filters as in this context it is a little concerning to me.

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Does acquiring more good blood banking staff count?

How is the tap water? You could get a water filter to remove any/most of the mineral content

What is your pathologist’s opinion? I mean there is a point where a unit’s volume is unlikely to achieve the desired effect. Nurses are also going to raise concern with your physicians if the volume differences are large.

It maybe that you need to ask the flip side of the question; at what volume will the hospitals you supply no longer accept the unit (or at least begin to express concerns)?

It sounds like you are giving emergent uncrossmatched units, with an extra layer. So I would keep your current process. The only thing I would check that may be relevant is the point the patients get registered to your hospital. If they are on route to your hospital before the blood is given I would regard them as your patient, like a GSW walk in to the ER.

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With staff shortages there is, or at least seems to be, a push to hurry and skimp on training. This usually results in huge amounts of stress due to feeling (and appearing) ignorant, slow, unprepared etc., which in turn causes them to quit. If trained correctly, the stress moves to the existing staff, who may be better able to deal with it as they can see the medium and long term benefits. Or not! A difficult cycle to break. Sorry for the side bar / rant. To the OP; as jayinsat said; if you auto print, call the station where the label prints to provide an explanation.

Why Lewis?

Agree with Malcolm. Our policy is antigen to any antibodies and the corresponding antithetical antigens plus C, c, E, e, K (and k if K pos). The full phenotype if we expect it to be useful.

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Talk to your IT people and get them to talk to the SoftBank people to determine exactly what they need and in what format and file type.

Those 25% that appear order abuse or CYA could just be physicians erring on the side of caution. Alternatively many ER departments have check-list protocols; when curtain symptom boxes are ticked orders are automatically generated (or required). It may be worth while seeing if this is the case.

In my opinion while this sounds convenient there may be a potential issue with the labels getting lost or forgotten especially if the situation is emergent and nurses are therefore busy.

If you can electronically issue blood I suggest just ensuring the patient has a current T&S. If you need to do serologic cross matches then as David said above; you decide. It may just depend on why they want blood on hold.

I would wash the red cells in saline and test the DAT (I have occasionally found stronger reactions). You can also try washing the red cells using cold Elu-Wash as that can help bind any weak antibodies to the red cells. In this case I would do an eluate including A1, A2 and B cells irrespective of the DAT results. Lastly I assume you can call the transfusion reaction irrespective of DAT results if hemolysis is evident in the post sample? The only hemolytic transfusion reaction I worked-up was clear cut and involved uncrossmatched blood given to a patient with history of an anti-Jk(a), against the BB tech’s advice. As Malcom stated above not many red cells were left, including the patient’s as the hemoglobin went from a 6 to a 3! I could not tell where the plasma ended and red cells begun.

28% sounds good to me, allows units to be blood type specific and gives time for antibody identification. I remember the frustration waiting for samples. I suggest asking the Dr how/if the question incorporates risk assessment for patient care and/or is it just financial.

The front and back label bar codes are identical. It maybe that when you bring the unit into your LIS system the double zeros and check digit at the end of the unit number are not used but when the vision scans the label for ABO conformation they are, thereby creating this discrepancy.

If you incorporate the main exceptions to policy into your SOP; it gives techs a clear path to follow if / when time is short or it is 3am. As you indicated it is hard to get O neg little c neg units (fresh or frozen).

We rarely had 10 O beg in inventory