EAB81

That follows our policy then. Thanks a bunch!

So, when releasing units for emergency release, we have always followed the policy that you give O Neg until an armbanded sample can be collected and typed regardless if the patient has history or not. I have 2 questions: 1: Is there an AABB or CAP standard to support this? If so, I cannot find it. 2: If the patient doesn’t have a historical ABORh, and the type is completed on the armbanded sample, can we give type specific even if the 2nd confirmatory type hasn’t been collected yet? I’m trying to update our emergency release policy, and I need some clarity. Thanks, friends!

I am going back through the AABB/CAP checklist, and I have a couple of questions. Do you find that inspectors tend to look at certain things moreso than others? If so, what are they? Regarding TRM.32250 Record Retention (Revised 8/22/18), under QC records it lists "irradiation dose delivery." Now, we do not irradiate units here. We get them from our local blood supplier, and they send sheets with the invoices that has this information on it. Am I suppose to keep these if the blood supplier keeps this information and can send it to me, if needed? It does not appear that we have kept these in previous years, but this is my first inspection solo, and mama wants to nail it. If anyone has any words of wisdom, advice, or good jokes-- I'm all ears! Thanks!

Hi Friends, Quarterly, I go up and watch a nurse start a unit of blood and document that each criteria is met, a self-assessment if you will. I know that this satisfies a standard with AABB or CAP, but I cant seem to figure out which one. I've gone back through my checklist, but maybe I'm over-looking it. Can anyone help a sister out? Thanks in advance!

When reviewing transfusions (documentation, etc), how many is required by AABB, CAP? Do you just review a percentage a month or so many a year? I ask because I took over blood bank late 2016. All of 2017 I reviewed every backcopy for completion. This year I'm kinda starting new, and its inspection year. Can anyone help? Thanks in advance!

So, I was reviewing completed antibody panels and discovered that some techs are having trouble ruling out Kell. I was taught that Kell had the potential to show dosage but often did not. So, to be safe, you wouldn't rule Kell out on a heterozygous cell. Personally, I always try to use cell 22 on Panel B from Ortho. It's homozygous. I can lay my head down at night. However, the newer techs are being taught ( or at least the ones I seem to work with) that Kell doesn't show dosage and can be ruled out on 1 heterozygous cell. I called our local Blood Bank Reference lab. They try to rule out Kell on the homozygous cell as long as anti-E and anti-D are not a factor, but if they cannot, they use 2 or 3 heterozygous cells. So, my question is: How can I instruct my BB techs to do this? What's really right? I'll take whatever you got! Thanks in advance!

Is anyone certified as a BB (ASCP)? I've been looking at it for a while, but can't decide if I should or not. Also, if there is someone out there, did you struggle with what reading resources to use. The reading list is a ton of journal articles and such. Anyone have better recommendations?

wow. Thanks for that!

Okay... my question is this: In order to do a low alarm check on your freezer, how would you go about getting the temp low enough to do the testing? Like most BB refrigerators, for example, ours has the wands that we can "trick" the fridge into triggering the low and high alarms. How would you trick the fridge? Currently, our plasma fridge is at -60. How could you fake the temp lower than that or am I thinking about this wrong? We've never been cited here for alarms on the freezer as long as I've been a tech.

WOW@ this feed So, we've decided that we will start labeling them even if they are Jane/John Doe along with our "uncrossmatched" conspicuous sticker. Name, DOB, and MRN should suffice, correct? Also, there has been discussion of what type to give patients.... I know what you're thinking, but hear me out. Normally, we give O-Neg no matter what. That's never been an issue, but a tech asked me if we could give type specific if it was a patient we had a confirmed history on. Another tech says that at her previous hospital they had to either give O Neg or they could give whatever type the patient was typing at that time. The AABB Technical Manual states " issue uncrossmatched blood if the patient's ABO group is unknown. Issue blood that is ABO and Rh compatible if there has been time to test a current spec." Well, if it's a person we've had before and there's no time to test a current specimen, and we have a confirmed type--can we technically issue whatever their historic type is? The manual doesn't speak to those we would know the type just from history.

That should work manually as well, correct? We are not automated here in our BB.

Thank you, sir

Currently, our blood bank system does not allow us to have labels printed as we dispense units. So, everything has to be handwritten. We will be getting Cerner sometime in late 2018, and that will change, but we have to do something before then. Another facility just has labels printed up that they write the info on and place on the unit along with another brightly colored sticker that says "Uncrossmatched." I'm not sure if that's the route we wanna go here. I'm definitely open to suggestions.

Since we're on the topic of DATs performed on cord bloods, does anyone have a procedure I might look at for doing the DAT in gel? The previous BB Super had begun the task of researching but didn't get far. Thought maybe I'd pick up the torch.

We use the A1 in our eluate. That's what I was thinking. Yes, I mean anti-A

This may be a no brainer, but I'm just gonna put the feelers out there Our risk management came to me a week ago and inquired about the specific labeling we use for emergency release units. She happens to be the risk manager for 2 facilities, including mine, and there was an issue at the sister facility regarding labeling. Apparently, there was no time to get an armbanded sample in surgery, and the patient had no previous history. So, the BB sent out a unit of AB FFP but did not put any labels on the product indicating whom it was for. The nurses were baffled and didn't know what to do about it. Well, this has sparked conversation regarding labeling of any emergency released products. If we are giving universally compatible blood or products in an emergent situation, do we need to put labels on it indicating to which patient it goes to as long as we have an Emergency Release form that the physician will sign indicating who and what unit? I ask this because the majority of our ER occurs in the emergency room where we might not know what the patient's name is right away but can't keep them from transfusing the blood til we get that info. Would you just label it as Jane Doe or John Doe? I personally, have always just filled out the ER form, had the physician sign it, and use bright colored stickers that say "UNCROSSMATCHED BLOOD." There's not been any issue til now.

We do the Lui Freeze eluate on all cord bloods with positive DATs. These mostly come back being a maternal-A1, B, or both when mom is an O and the baby is an A or B.

So when you guys say for each method-- your techs are actually doing the physical work up? I'm asking because before I took over as BB Super, we were just getting panels already filled out with reactions, and we ID'd the AB. I'd like for all of us BB techs to be proficient as possible, but I don't think the previous method worked out real well. Any suggestions are much appreciated.

How often is everyone doing antibody ID competencies with their blood bank techs? One a year? Two?

We keep 3% screening cells as well as our 0.8% screening cells. Most of the time our 3% screening cells suffice; however, on occasion, we find a cell negative for the anti-sera we're using on one of our panels or expired panels. Hope that helps!

Oh, our phlebs are too. However, I think if the tube is already drawn, they are more apt to use it rather than have a little integrity and restick the patient while there are 2 people to positively ID the patient. Unfortunately, I can't prove that with physical proof. Although, our phlebs are also very good at ratting out each other . lol.

Unfortunately, that policy is here to stay until we switch to cerner and the phlebs can scan an armband as another positive patient identifier.

So, at my facility, we have phlebotomists who collect about 98% of our samples. On occasion, a nurse will be generous and help them out. Our BB policy for armbands states that 2 members of the staff have to be present to positively identify a patient before the sample is collected. Both initials must be on the tube and armband. We always seem to have issues with nurses drawing pink top tubes in L&D and the ER for BB testing, but they don't follow procedure. They leave the tubes for our phlebotomists to use. And I'm betting 9/10, they do and put their initials with the nurse that drew it...but not at the correct time and 2 people not being there. My questions are: Does anyone else have this issue? and What do you do to resolve it?

I'm sorry to be so green, but where can I find this communication?

I have emailed CAP for clarity, but I haven't received a response. I may give them a call on Tuesday when I'm back in the lab to get a quicker response.