MaryPDX

I dont find any reason, to defer any Kell positive donor, and not eather refuse to use this blood, i think some population should be protected like children girls, women in pregnacy age, and multitransfused people like thalasemic or drepanositic ones. And of course, any person with anti Kell.
All other people can be transfused with Kell positive red blood cells.

We also would not consider discarding these products. We transfuse about 25,000 rbc's a years, with a guess of 9% pos, we'd need to discard 3,600 units of blood, and eliminate them as donors. I can't imagine that.
We do have certain groups of patients we give K neg to even if they don't have the antibody, but we still use the units for other patients.

We use the ALBA-Q-Check QC vials.  We add 40ul of ORTHO BioClone Anti-D to vial #4 to cause a positive DAT and a positive result in the Rh control test.  See attached document of our daily QC results from ProVue.  Our QC is designed to produce a positive and negative test result for each gel column in the A/B/D/R Monoclonal and Reverse Grouping card, the Anti-IgG Gel card, the A/B/D Monoclonal Grouping card, Buffered Gel card, SELECTOGEN, AFFIRMAGEN, MTS Diluent 2, and MTS Diluent 2+.
We do all our testing in ProVue including Type and Screen, Donor Unit Confirmations, Cord Blood testing, Weak D testing and both IgG and Buffered gel crossmatching and Antibody Identification.
ProVue Daily QC batch listing report.pdf

For red cells, we switch to ABO specific once we've processed a T&S (and a confirmation type on a second sample when not type O). We do that as long as we can (don't want to waste O cells on a non O if I don't have to). 
If the patient is Rh neg, and we had been using Rh pos during the massive, we don't switch back to Rh neg until the massive situation is over. 

For red cells, we switch to ABO specific once we've processed a T&S (and a confirmation type on a second sample when not type O). We do that as long as we can (don't want to waste O cells on a non O if I don't have to). 
If the patient is Rh neg, and we had been using Rh pos during the massive, we don't switch back to Rh neg until the massive situation is over. 

If the patient had a pre-delivery Type & Screen performed then we only do the fetal screen post delivery.

As far as I can remember, in a 46 year career, I never used anything but a two cell screen.

I have used two cell screen for 30 years

The sensitisation stage of antibody/antigen reactions follows the Law of Mass Action.  The rate constants for the forward and reverse reactions will change both with the temperature of incubation, and also with the concentration of the antibody and antigen (amongst other things) and this will, in turn, alter the equilibrium constant of the reaction (which, in the cross-match, you want to drive to the right, but not so much that you will get "false positive" reactions).  You would be ill advised, therefore, to carry on the tests at 37oc and AHG after saline replacement, as there is every chance that the equilibrium constant would be altered to such an extent that some antibodies would not be detected in vitro, that may be clinically significant in vivo.

We switched to 2 cell screens when we went to gel about 15 or so years ago. 

Do you perform all your antigen typing in tubes?  We validated our Fya and Fyb in gel, so that is what we use for antigen typing and QC'ing the 0.8% panel cells.

An interesting twist ! One could look at it that way.
Red cell products ultimately do deteriorate and that's why they must have an expiration date. Hemolysis is often the first visual clue. However, that doesn't mean that all of the antigens have suddenly become unrecognizable; it just means some of the older cells in the vial have popped. Studies have been published demonstrating that antigens remain stable many days/weeks after official expiration.
Manufacturers do have oodles of stability data - both static (in-house) and following shipping. Typically a unit of red cells that is turned into a red cell product has at least an eight-week expiration. This allows for manufacturing and shipping to the end users who then usually have five-weeks left on the expiration. In reality, those expiration dates could be longer, but the manufacturers deliberately give themselves a buffer period, just in case.
The wildcard in this whole process and issue upon which the regulatory agencies focus is shipping. How do the end users know that something horrible didn't happen to the material ? An unanswerable question. Even though the manufacturers have shipping stability data, they can't possibly foresee and test every odd, weird situation. One could argue that Ortho have less faith in their shipping process than other suppliers, hence the requirement for periodic QC.

We do. We also have Erytra and wadiana. 
Our cord blood samples are collected in either purple or pink edta tubes. All specimens get spun when received. If a cord sample needs to have testing performed, any clots are removed with applicator sticks and respun prior to testing. 

Malcolm, you are SOOOOO naughty !

Which, of course, gives her an extra day to get pregnant if it is a leap year!!!!!!!!!!    (but I do agree)!

We have implemented Verax testing - only used for 6 and 7-day extension at present.  If/when we are required, we can expand to 4 and 6-day platelets. 

When your lab goes to Beaker your BB system will be interfaced, regardless of which system you decide to go with.  My organization has 16 labs on Beaker with HCLL Blood Bank.  We sunsetted Meditech, Cerner, McKesson and Sunquest lab/BB systems and all of the labs are on Beaker and HCLL.
Being downstream from Beaker you will want to become best friends with your Epic interface analyst as there is always some gymnastics that need to occur with any BB system to get it to talk to Epic and Beaker.
After bringing up these 16 sites we learned quite a bit and with our last Epic 2015 upgrade and HCLL Maestro interface upgrade we are at a very steady state.
Don't forget you will want to look at the Blood Product Administration workflow, again, regardless of the BB vendor you choose.
If you have more specific questions PM or email me, Mary.Mendel@Mercy.Net
  

Dan87 do you get reimbursed for all of this "extra work"?  
I haven't done complete XMs since the early 1990s and have worked in a variety of places, large, small, adult, pediatric.
Change is hard but it really is time to drop the "unnecessary" testing, imho! 
 

Good Lord!!!!!!!!!

If you wind up sticking with paper - it might be faster if you use tagger guns to attach your paperwork..  These are the same type of tagging guns that are used for clothing labeling.  You can get both the guns and the tagger tails from a place like Staples (Monarch SG Tag Attacher).
Hold up and punch through the paper 1st and then go through one of the little holes on the unit (or very carefully, through some of the outside edge on the unit above the interior area) and then press the trigger.  Works fine for us and stays with the unit.
One word of caution; the needles - when new - are extremely sharp.  I always take a new needle outside and dull it down by swiping it back and forth over some concrete walkway first, prevents finger sticks.  Sounds gruesome, I know, but we have no troubles with the needles (after dulling) and have never harmed a unit.

Our BB system, HCLL, prints a single sheet, 8.5 x 11 transfusion slip which has a sticky label as part of the slip.
We remove the sticky label, place it on a "toe tag" and use the plastic loop-tee-loo things to attach to the blood bag.
The paper does not accompany the unit most of the time, we are on Epic and tx documentation occurs there.
We only use the paper if we are in a downtime situation, or blood is going to an offsite location or the transfusionist is not able to document in Epic.  

I'm not sure what IT has to do with it. They usually balk at versions for PCs that are used for normal PC use. That's because they are required to support those PCs when there are issues. Since the ECHO PC is only used to interface with the ECHO and the IT is not who has to provide technical support for the PC they shouldn't even be involved other than providing access for an interface and to an internet connection for the cisco box. Any problems with the ECHO PC will be handled by Immucor, not IT.
I think they've overstepped their bounds on PC requirements.
 

seems like a great deal of expense for what end?  To determine if a patient is a RhIg candidate? OR WHAT.
I was a member of  a TAC for one of the BB vendors last summer.  We discussed Rh molecular testing.  The company thought it was  valuable, the committee members thought it was not worth the bang for the buck.  Unless the price has come down significantly.

Digi-Trax offers blood compatibility labels with FDA approved adhesive that will not leach into the bag.  The adhesive is quite durable and labels will not fall off the bag.  For more information, please visit our web site at www.digi-trax.com or contact us at 847-613-2100. We’re happy to provide you with the right solution.

As far as I know, Verax is the only FDA approved test for this.  FDA is not mandating (yet) that we test on day 4 & 5.  Though I do think that's coming.  Currently, we're using Verax to extend the platelets to day 6 & 7.