Ensis01

It is all over the place, to be honest.

It is Caucasian, rather than caucasian,  It is group O, D Positive, and group A, D Positive, rather than either group O Positive or group A Positive (see the early editions of Peter Issitt's book).
It is Oh (with a subscript "h"), and not "Bombay".  The FUT1 gene, or, rather, the lack of a functional gene through various different genetic mutations, leads to the "Oh" phenotype, but this should NOT be called the "Bombay phenotype".  Although this phenotype was first described by Bhende YM, Deshpande CK, Bhatia HM, Sanger R, Race RR, Morgan WTJ, Watkins WM.  A “new” blood-group character related to the ABO system.  Lancet 1952; i: 903-904.  DOI:  10.1016/S0140-6736(52)92356-8, Another example of the Oh phenotype can be seen in the rare recessive condition, Leukocyte Adhesion Deficiency Type II where, to all intents and purposes, the patient will have a normal H gene, and yet the red cells are of the Oh phenotype, and anti-H can be found in the plasma. the phenotype has been identified in many different parts of the world (and is not just confined to mutations in India or even Asia (Hidalgo A, Ma S, Peired AJ, Weiss LA, Cunningham-Rundles C, Frenette PS.  Insights into leukocyte adhesion deficiency type 2 from a novel mutation in the GDP-fucose transporter gene.  Blood 2003; 101: 1705-1712.  DOI: 10.1182/blood-2002-09-2840).

The other thing is, of course, that "Bombay" no longer exists - it is now Mumbai!
I APOLOGISE FOR BEING A COMPLETE PEDANT!

Does acquiring more good blood banking staff count?

Does acquiring more good blood banking staff count?

Does acquiring more good blood banking staff count?

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

I just answered this question.


My Score PASS  

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

I believe our middleware does the conversion.. We're on an older safetrace version.  The only issue we have with donor confirmations is when you get multiple containers per unit #.  They have to be manually programmed or done by hand and entered into BBLIS.

At our facility (MEDITECH User), when we bring units into inventory, the LIS automatically orders a retype test (front type only) and generates a specimen barcode label. That is matched up to the unit and is placed on the specimen tube that is loaded on the analyzer (we use IMMUCOR ECHO Lumena). The LIS programs the analyzer just like any other patient specimen and results are transmitted back to the LIS when complete. This is a very efficient system. Have you considered that route?

@jayinsat makes a great point about quickness. 
If we had a current TYSC on a patient, we would prefer to give XM'd products, type specific, if able to be done quickly. If not, we would go for quickness with our pre-made trauma packs of O pos or O neg RBCs and A or AB liquid plasma, depending on the patient. 
We only do WB as part of the MTP for our trauma patients, which is upon arrival usually, so there isn't a known blood type, and if they were to stabilize and need MTP again later in their admission, we would do component therapy as described above. We've only been live with WB as part of our MTP for a year and half, so other centers doing this longer may have more input!

I must be getting old and slow because I really don't understand the question!!

I wish.  Unfortunately the grant can't be used to supplement wages or add FTE.

Not only is it quicker to issue 2-4 LTOWB, it is also easier for rapid infusion. The products are supposed to be infused through blood warmers rapidly. This is important to avoid that "lethal triad" of hypothermia, coagulopathy, and acidosis in traumatic bleeds. Whole blood has been shown in studies to be more effective than components in these cases as they can be given quicker and through only one iv access. With 4/4/1, you need at least two lines and possibly more than one rapid infusion pump.  

There is an AABB standard that your facility has to have a policy on how many out of group PLASMA transfusions are allowed. This very broadly encompasses LTOWB. It's 5.15.4. 
That said, our level 1 adult center will give 4u of LTOWB once MTP is activated, then switch to component therapy, of which our packs consist of 4 reds and 4 type A liquid plasma. Obviously, we end up transfusing incompatible plasma on occasion to B and AB patients with our normal process. Once we have a patient type we switch to type compatible plasma of course. Our policies state this, but there is no maximum number  we have defined of how many units we'll give, as sometimes we don't ever get a sample until much later than we'd like, which means we're giving A plasma for a bit. 
We capped our LTOWB at 4 units, mostly due to inventory constraint when we started this program, but also to ensure we weren't overloading patients with too much O plasma if they weren't type O! Our supplier has a low titer cut off of 256. I track all of the patients who have gotten our WB, including their native blood type, and we are monitoring for issues, but have had none yet. I have heard of programs that will give up to 8 units of LTOWB per patient. 

With respect to RBCs. If the patient has unidentified antibodies (as the title states) then NO. 
If you have identified the antibodies but can not confirm the patient’s antigens (as your question states) and the AHG crossmatch is compatible with units negative for the antigens that the patient has antibodies to then yes, though there are some/many possible caveats. Hope that is not too convoluted. It would help us if you give more details. 
Can you please explain what you mean by filters as in this context it is a little concerning to me. 

With respect to RBCs. If the patient has unidentified antibodies (as the title states) then NO. 
If you have identified the antibodies but can not confirm the patient’s antigens (as your question states) and the AHG crossmatch is compatible with units negative for the antigens that the patient has antibodies to then yes, though there are some/many possible caveats. Hope that is not too convoluted. It would help us if you give more details. 
Can you please explain what you mean by filters as in this context it is a little concerning to me. 

Does acquiring more good blood banking staff count?

We would rarely perform an eluate on the baby's red cells unless there are clinical (as opposed to laboratory) signs of HDFN.  In other words, an elution is not considered to be a "reflex test", just because the baby has a positive DAT.

If you have any, you could try D Negative Cord or Neonatal red cells, which express the LW antigen comparatively strongly (certainly compared with adult D Negative red cells).

Does acquiring more good blood banking staff count?

How is the tap water? You could get a water filter to remove any/most of the mineral content