EAB81

So, we were inspected a couple of weeks ago, and I have some questions regarding a policy that I need to write and/or change. Standard 5.15.4 Selection of Compatible Blood and Blood Components for Transfusion The transfusion service shall have a policy in place concerning transfusion of significant volumes of plasma containing incompatible ABO antibodies or unexpected red cell antibodies. Question: What does everyone else's policy state for this? We did not have a policy that necessarily outlined all of this. I'm unsure where to start. Is this referring to emergency releases where we've discovered the patient had antibodies and the units were positive for the antigens? We wouldn't knowing do this, and we give ABO-compatible blood even during emergency releases. Thanks!

In the technical manual (pg 514, 19th Ed) it talks about Rh Negative women getting Rhig within 72 hours of being transfused with Rh positive platelets. I wonder if that would be the same for blood?

This is just my opinion, but I would imagine that since there isn't a standard that absolutely demands that antibody screens are to be performed for the Rhogam Workup, working up a positive would be at the discretion of your medical director. We've been looking @ eliminating the absc when working up postpartum samples from mothers who are Rh neg . We contacted the AABB, and they have stated that the standard 5.30.2 doesn't speak to it (requiring the antibody screen) because it's considered medical practice. I think what we're going to start doing is only performing abscs for those mamas who have had no prenatal care or no antenatal rhogam. Of course, if they have history of antibodies we'll still do it--just in case.

What didn't you like about it, if I may ask?

In the last few days, we have been talking about doing away with the AB Screen during the Rhig Workup. I've reached out to sister facilities who keep citing to me Standard 5.30.2 # 2 "The woman is not known to be actively immunized to the D antigen." My goal is to eliminate the unnecessary antibody panels and the anguish passive D can cause. But my justification will be this, and correct me if this is wrong: We can determine whether the patient has had Rhogam with one phone call to the floor. If so, then more than likely, she would have the passive D. It's not an active immunization. If she hasn't had any prenatal treatment, then, at that point, we'll do an antibody screen. We have docs that will give rhogam no matter what.

Looking closely at it, I do meet all the requirements. I don't think the commitment will be a problem at all. I haven't quite decided to do it for sure, but I so appreciate your input.

I do have a BS. This forum has already been tremendously helpful! Thanks!

I really enjoy blood bank and all the crazy stuff that goes along with it, but I want to learn more than just my scope of the BB Supervisor at the local hospital. Someone recommended to me that I should become an assessor. Does that sound like a good idea because they would train me? I'm not sure I meet all the qualifications from what I've looked at. For those who are assessors, former assessors, etc. , what can you tell me? TIA

9/10 times we don't perform the 1st ABSC. So, we spend a lot of time working up that ABID that is just remnants of antenatal RhIg.

We don't wait. If we waited, we would end up giving out our entire O Neg inventory, and the physicians would rather it be that way. Typically, we don't do massive transfusions. We do have a policy should the event arise. Our current policy states (for now) that we will give 2 O Negs, and then the patient would then either get type specific, providing the 2nd confirmatory sample has been collected and typed or they will get type O, but it doesn't specify Rh Pos or Neg. So, I'm revising.

Fortunately, we have phlebotomists that collect 99% of our samples. I can't get them to use the sticker that says " place patient information below...." either. So, I've just resolved myself to accept any of the barcoded stickers. We have bands that also have the BBID on little stickers on the tail that do not have a barcode. I haven't rejected it if that sticker is on it, but we do prefer a barcoded sticker. With the use of Bridge, nurses have to scan the patient's BB armband and then scan a 4D box the product tag, and the info has to match. We won't be going away from Typenex as long as we're using Bridge-- and that was implemented in October 2018. My issue does stem mostly from the nursing units (L&D mainly) who will armband their own patients and leave the date off the tube.....I could scream. I wish they would teach these nurses in orientation how to label bb tubes.

Same here. If the patient has a T&S upon admission, I will not perform the ABSC again for the RhIg workup. A couple of years back we tried to get the OB docs to all send their prenatal workups to us so that we could at least get baselines on their patients because every OB in town delivers at our hospital. Unfortunately, we have 2 groups in town--1 that is affiliated with the hospital system , and 1 that is not. Its really a struggle with these patients that you can guess had antenatal rhogam but their ABSC is all over the place. The blood banker in us wants to work it all up, but its so aggravating--esp if we have no history to compare to.

Honestly, I'm not sure how they get it accomplished, but the OR folks usually can produce a sticker from the patient's bb armband. We haven't had an issue where it didn't match.

We use the Typenex bands. I guess the scaredy-cat in me feels safer using the bands. Our current transfusion program, Bridge, requires the use of a barcoded band.

Well, that's what I originally called and asked them-- if I could have a copy of their policy. I've left an email again today because I've yet to receive anything from them. In the mean time, we are going to start taking temps of the coolers ourselves at random and documenting. We are within our inspection time for CAP and AABB. Hopefully, a last minute effort is better than none. I will, however, be contacting quality to see what standard they are concerned with. My money will be on probably Joint Commission.