Ensis01

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?

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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.

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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.

Sunshine I am curious as if a patient has an anti-D result of 1+ or less you enter them as Rh negative, why do you then send out for RHD Molecular testing and what do you use the results for.

Agreed, though by clear I was trying to infer NOT a biohazard bag as that would, in my opinion, really send the wrong message about blood products about to be infused.

Makes sense to me that blood products are carried around the hospital in a clear sealed bag to keep tags, labels etc. attached, in good condition and contain the mess in case it is dropped and breaks. Because it is not regulated does not mean it is not a good idea, just my opinion.

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Yes. We use poly cards and IgG cards. Negative control can be one of the screen cells. We make the DAT Positive control by incubating 1ml of O Rh pos cells with one drop of anti-D, mix well and incubate for 10 min at room temp. Don’t wash and make a 0.8% solution and use. It should give about a 2+ reaction (the objective), though this probably depends on the anti-D so you may need to experiment. Hope this helps.

I understand the “system” in this contex is the hospital not the LIS. So if the hospital is a stand alone and is sold the information must be moved into the new hospital LIS system or be available as a clone of the original LIS (or be in an accessible form, eg excel, paper etc). If the hospital is part of a network and is sold or closes; the information remains with the original healthcare organization. If the hospital as a stand alone closes; the information must be held in an accessible format like excel or paper though I am not sure who would actually keep the records, probably the lawyers?

Confirmed typings printed on the label. An attached tag lists the unlicensed reagents (if antigen not on list it is licensed). Historical is listed on a separate sheet and included with the order. If historical typings were attached to the bag it would need to be clearly labeled tie tag. I can not see how historical typings could be printed on the label.

Sounds like a plan. I like the simple flow of decision making logic that can be followed consistently by all.

Sorry, my response was written with a combination of tongue in cheek and experience. When I worked in a transfusion service lab; the hospital policy was that RhIG was to be given within 72 hours, though we tried to get the RhIG to the RN ASAP. The reason was that patients would often discharge themselves, or occasionally boyfriends would insist on them being discharged before the RhIG could be administered. Many of these women would not see a doctor until their due date or there was a problem. At this point the patient would inevitably "clearly remember getting the injection", and as the order was in the system figuring out if the patient had actually received RhIG was difficult to determine satisfactory. In my opinion your 14 day policy is probably a practical timeline for your patient population based on hospital experience. I would however suggest following up on your eligible patients to see how many of them are (were) non-compliant in receiving RhIG and use that as a guide to determine if your policy needs reevaluating. Hope that helps.

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So they don’t forget?!