Ensis01

I like “Reactive”, though we use “least incompatible”. I think change is the issue as the the questions about meaning would last years!!

I would send out for molecular characterization of the D, and give O neg

I’m sorry but your post indicates that you are effectively going to make things way more complicated for the nurses. In my experience this will make the nurses extremely creative in negating the safety benefits you are trying to maintain or implement. I suggest discussing the flow with the nursing staff to figure out the most practical flow that will ensure safety. Talk to all the areas (especially the ER and L&D) as there can be large differences in requirements. Simplicity Reduces the potential for confusion, which minimizes errors and thereby increases safety. All that being said; keeping the option of armbands for down time and any glitches when you switch over sounds like a very good idea.

We were trained that you pipette the 0.8 RBC at about 45’ down the side (not hard) this ensures the RBC sit on top. The plasma gets pipetted straight down. Inspect and incubate. I was just told that the air space ensures a space for the plasma and RBC to mix. No air space and many RBC go down the tube reducing the number that incubate with the plasma.

If two of three screening cells positive at 2+ but panels are negative I would recheck everything

It seems a waste of time and resources as I cannot see how a lab could possibly QC a pannel even approaching what the manufacturer is required to do.

If I remember correctly (I worked with someone who used that route) you must have a bachelor's degree (or higher) to even be eligible to apply for the H1b visa. I also do not see how it is possible to be a qualified MLS/MT without a bachelor's degree.

Ah, inform them that by their logic; phlebotomist's should not use needles due to the many unintended sticks in hospitals each year

Who is telling you to switch? Are the plastic tubes transparent enough to see mixed field and weak reactivity clearly? As far as validating I would guess you could use the centrifuge calibration that determines correct spin times

Am I correct is saying that having the MLS ASCP certification and being an active member will allow you to be eligible for licensure (if appropriate) and work in all states in the USA? Blood-bankers from many countries contribute to the discussions on this site. I have always assumed, but am curious to know if every country has a certification requirement for working in a blood-bank or are there several different pathways available? Also how transferable are these different qualifications between countries, ignoring the visa requirements? I am guessing that at least some countries have agreements. Thanks for any input

As Malcolm posted if you don't believe the IRL results why send it. The IRL gave you a B pos result, which aligns with the other history you obtained. That being said your policy may need to be scrutinized to determine if the B pos result is valid for the entire admission or needs to be confirmed for each new sample. I would suggest getting this clarified for future admissions, get your pathologist involved as they may have strong opinions on this and once clarified document clearly in your LIS the process.

At the last hospital I worked, we only used BB armbands during downtime. Our downtime box contained all manual forms and the armbands. During downtime a tech went round and ensured departments like ER, ICU L&D had some (plus examples on how to use). The departments that were less likely to transfuse during downtime were informed to come to BB to collect if a transfusion needed. This process was repeated after shift changes and the RN first and last names were taken during these calls/visits (including spelling).

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.