Ensis01

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.

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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