Ensis01

I just answered this question. My Score FAIL

Did you test the eluate against DAT negative patient cells?

They should have, or create a policy to replace/reattach the armband. Get your pathologist and QA involved.

My main concern would be the cold ambient temp in the OR.

I would say it depends; if you need to do extra testing to resolve a discrepancy that is billable. if the instrument did not give a result due to QC failure (due to a hemolized sample for example) and you used tube then not billable. It should however be noted that I do not do billing.

My experience is that When a patient is being transferred from another facility with cross matched RBC or other products; infusion should have started by the time they leave the ambulance. Products not being infused are discarded unless they have correct transfer paperwork, I.e. for antigen neg units. Crossmatching process begins again. To put it another way if you know the patient is coming; the other facility Dr. Orders enough products to cover the journey. If the patient is a hard work-up get all information and transfer antigen negative units. If worked up at a reference lab: Reference labs have a form that will allow transfer of results though receiving facility do not always accept these results.

Try 4 drops plasma and incubate for 30 min at RT, include an auto control.

That seems wrong on several levels, or is it me?

So when you find the discrepancy, do you test for weak D and if that resolves the discrepancy add a comment and move on?

Get the lab director to talk to the pathologist to determine if the photos are to help techs identify a skiptocite or if the photos are for review.

Either CAP or AABB provide a Titer for intra (and inter) lab comparisons.

Do you get many inquirys about about discrepant results from hospitals/Dr offices that only do IS?

If your patient is negative at IS and positive using IAT what is recorded in the LIS and how do you deal with resulting questions?

You could try 56'C heat elution method. Though this is better for IgM antibodies it usually works with IgG, but does take longer. See AABB Technical Manual Method 4.3

At the risk of opening a can of worms; who does accredit the accrediting agencies WRT blood bank? It seems the higher up the government system you go the less serology they know (let alone the growing molecular implications) but they must ratify/audit each agency?! If the agencies are therefore effectively self regulatory how do they form agreements within itself, other agencies, define who the experts are, come to agreements and then implement the results? I am familiar with the AABB technical manual revisions but have never thought through the process let alone the ramifications of integration with all the different agencies. Is there a pecking order? The ISBT meetings must be a whole other level of frustration! From reading several threads it seems a hospital blood bank chooses (and pays for) the accrediting agency according to it’s requirements based on work volume and/or the complexity of testing done? Who within the hospital makes that decision? I am trying to get an overview so I understand the process by which the OPs question could be resolved by each agency and how inspectors will audit individual hospital policy. Thanks in advance for some enlightenment!

I liked the first vitals being taken just before the blood was picked up. This prevented many a wasted unit. Not sure if this policy was regulatory or if common sense had broken out.

Did you try saline replacement at IS and 37?

I just answered this question. My Score PASS

My understanding is: If you are irradiating then Yes. It is a new product. there are also licensing requirements that may be relevant.

Centrifuge your final eluate for 60 seconds and pipette it to a new tube. Check the old tube for fine red particulate matter adhered to the tubes sides, and if present repeat the process.

I just answered this question. My Score PASS

A policy of nurses doing an ABO test at the bedside prior to transfusion makes me uneasy and it has taken a while to figure out and try to articulate why. Fundamentally it seems to me that if this policy is needed then the hospitals system of blood collection needs a total overhaul. To put it another way having nurses do an ABO test at the bedside prior to transfusion creates an extra layer in the transfusion process that will inevitably (in my opinion) cause delays, create confusion and problems that will need to be resolved by the bloodbank. Plus there is the need for training, validating the kit, monitoring etc. There are several threads (and lots of discussion) on this site expanding on different and effective ways to implement the second ABO check. There are also several treads on efficiently, and safely getting blood to patients emergently in different and difficult situations. Designing a robust process from the ground up would, in my opinion, be more efficient, safer and easier to control, audit and hold those that make errors accountable. So am I being paranoid, short sighted or just do not like change. Thoughts anyone

We once had a mismatch due to a correctly labeled but Incorrectly drawn cord blood? To be honest I did not understand the explanation on how it was, or could be drawn incorrectly?!

As ABO typing is so important I think you will have difficulty justifying to your regulatory bodies this test done at the bedside by nursing professionals. Who or which department are you researching this for?

My understanding is that leukocyte reduction in a hospital setting is not possible as firstly the filters function is based on differences in deformability and adhesiveness between different cells; this decreases with time so the filtration must be done within a specific time after collection, probably before the platelet can be released. Secondly I think leukocyte reduction is a manufacturing process and would therefore require an FDA licence and a lot of QC to prove you have achieved leukocyte reduction to a certain standard.