[Why irradiate liquid plasma when RBCs for trauma patients aren't irradiated?]

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

[Temp of units while receiving to inventory]

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.

[Daily QC for ABO Reagents]

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. 

[Blood Bank automation vs Manual]

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. 

[Antibody Screen Tube method]

3 hours ago, Mabel Adams said:

Also, why do all of the methods I can find still include the 37C reading?  AABB Tech Manual, John Judd's book, Harmening, Blaney & Howard all reflect this (some may be older editions).  Even Immucor's instructions for their screen cells include it.  Quotient/Alba screen cell instructions list it as optional.  

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.  

[Alternative to DTT treating cells for ABSc when patients are treated with anti-CD38]

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

[RHIG Dispense from Pharmacy]

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.  

[Pre-Transfusion Two-Blood Group Policy]

Charge for ABO, not sure the codes

[BB Validation/New Server]

On 11/11/2021 at 8:06 AM, Baby Banker said:

I mean what's next?  Validating the change is the oxygen/CO2 ratio due to staff breathing?

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 ...

[Time from Issue to start of transfusion]

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.  

[No Patient Registration]

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. 

[No Patient Registration]

On 10/23/2021 at 9:24 AM, John C. Staley said:

I hate to be the mercenary here but who's going to pay for it??  Probably going to be one of those "cost of doing business" things.  

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. 

[Professor David Anstee.]

Sorry to hear this. My condolences. 

[No Patient Registration]

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.

[BloodBankTalk: Clinical Aspects of Transfusion Reactions]

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[Pre-Transfusion Two-Blood Group Policy]

Ok, two-Blood group policy is same principle as US second check; GET THE ABO RIGHT!! Does Australia follow the UK standards? 

[Calculating the Frequency for finding antigen negative unit]

19 hours ago, Malcolm Needs said:

Not so in the UK.  ALL of our units are typed for the D, C, c, E, e and K antigens, as well as (obviously) ABO and mandatory viral markers.  However, those that are intended for patients with atypical antibodies will come from a store of units that are further "fully typed" (usually from the MNS to the Kidd BGS) and these tend to be all K Negative, as they are intended for individuals who have already shown themselves to be "responders", most of whom will be K Negative, and K is a highly immunogenic antigen (although, of course, those intended for individuals with anti-k will be K Positive and k Negative!).  The number of these typed units is not, however, immense, and so does not really "skew" the overall antigen frequency in the normal stock.

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!!

 

[Pre-Transfusion Two-Blood Group Policy]

What is the two-Blood group policy?

[Calculating the Frequency for finding antigen negative unit]

11 hours ago, David Saikin said:

All the talk about statistics is great but in the real world you never know:  I once screened over 30 units for K.  All were positive.  As I was the night guy, the day folks were laughing until they got the same results.  All we could figure is the blood center was screening for K and shunted all the +s to  a shelf which we received in bulk.  I've also screened for Fya in past.  Once i screened 4 units and found 2.  The next time I had to screen 16 and the last 2 were  negative.  As I said, the stats look good but reality is sometimes a bit different.

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.  

[Mixed Field Testing Interpretation]

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.   

[Blood on Helicopter]

19 hours ago, RKB1988 said:

Can anyone share their logistics to storing blood at the launch pads for the choppers?  We are getting a requests to store whole blood at each chopper launch site so the flight team can grab a cooler and take it with them out to the field.  I am wondering about storage, coolers, freezing of ice packs for the coolers, swapping out the shortdated WB, documentation of storage temps, documentation of transfusion etc.  Has anyone else already figured these pieces out? Love to see a policy or procedure for this...Thanks!

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.  

[Last Wash run in parallel with Eluate]

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.

[Balance Acceptability Range]

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. 

[BloodBankTalk: Clinical Aspects of Transfusion Reactions]

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[Anti-CD38 therapy discontinued]

On 8/19/2021 at 3:44 AM, jojo808 said:

I need clarification. I once asked on this site that if you could not rule out an antibody could you 'ignore' it once your screen is negative and I believe the answer was no. If in these cases with Patient's going off Daratumumab, if you could not rule out Kell (due to DTT treatment of cells), even once, don't you have to consider that a permanent problem even though  we know that the probability that an allo anti-K developed is probably null? 

There is a difference, I believe,  between not being able to rule out an antibody in the context that it may be there, the answer no you state above, and not being able to rule out due to the method limitations (DTT). The DTT method  limitations result in K neg units being given but once the DARA effects wears off a different, more appropriate (and better) method is used so anti-K can be ruled out and the K neg requirement dropped.