David Saikin

For you folks who use a second specimen - if you are unable to obtain one (and I am assuming from a separate phlebotomy event), are you only distributing group O red cells? Seems this would be the case for the majority of traumas (esp after you've transfused 8-20+ rbcs)? Just seems like a waste of valuable group Os. Where I come from it is hard enough getting O+ let alone O=. I have run across situations where they ask you to type the blood on the floor in the ED . . .

I have an incompatible form. It states the nature of the incompatibility and documents the incompatibility and also that the Medical Director or designee has discussed the case with the attending. It is based on my uncrossmatched form's format. Don't have access to it right here and now but should be easy to make one up. Run it by your risk management folks after your Medical Director approves.

WE found bloodloc to be an acceptable alternative to typenex. I have seen typenex fail. BloodLoc requires a code attached to the pt sample. The only place the code exists is on a separate bracelet attached at admission. The blood is released with a combination lock. The combination is the code. IF the lock doesn't open either the xm is not on the correct patient sample or the tech entered the code incorrectly. This is considered a barrier protection device. Only requires one type. Never had a problem. Nursing has to buy into it and not cut open the bag if the lock doesn't open.

My opinion: Why are we recording vital signs? The person recording them has to be able to interpret them in regards to the transfusion taking place. They must be trained to recognize changes that are indicative of a reaction regardless if they are an RN or not.

have always used 4 hrs from release from Blood Bank. It seems that is the consensus. In lieu of a succinctly defined criteria I think you have to go with the standard of care in your area.

It seems more prudent to purchase already prepared. Not overly expensive. Unless of course you are doing a tremendous volume.

I've had up to 12 John/Jane Does in the ER at one time. We require patient identifiers. We updated our MTP protocol to release 2 group O's; while these are delivered we get our MTP package together and it allows the p/u person to return with the patient ids.

My feeling on this matter is: would you reconstitute with thawed plasma rather than thawed FFP? I think that if you are using FFP that 24 hrs should be the exp date. I've never heard that anyone has used thawed plasma, so . . .

So how do you know if the antibody you are detecting is antenatal RhIg or active sensitization? Just because it reacts weakly doesn't seem to me to be a valid criteria. We do not do absc to release RhIg post partum.

If I have no history I get an ABORh. I also prefer one if a new admission even if I have a history. It just helps to verify the patient. I am not averse to transfusing either based on a historical type in my file.

Better make certain you validate the heck out of Epic, esp if you are using Beaker. My most recent experience with Epic/Beaker and HCLL made me want to call the FDA. I'd run my own validation protocols rather than the Epic ones. Not enough training for staff , though this could have been a vagary of the institution rather than the system.

We use the birthdate and mr# in order to check patient history. We also use the BloodLoc code (have also used Typenex) for transfusion safety, though I have seen Typenex fail. You've got to be able to trust your end users when using any of these extra safety systems.

I cannot tell you where to get a program. As I recall, you will need to enter your antigram into that program. Some panels may come with downloadable antigrams. JUst thought you should be aware of this.

Dosage addresses the expression of ag on the red cell.and its reactivity with antibody. Homozygous intimates a single expression of the gene. Let's say we/re talkijng about the K ag. KK is homozygous for K, Kk is heterozygous for both K and k , kk ia homozygous for k. Dosage occurs when the antibody reacts less strong when the gene products are heterozygous, i.e, the homozygous expression will display stronger reactions. The systems which express dosage are the Rh, MNSs, Kidd, and Duffy. The texts tell you the Kell system ags do not express dosage but I have found the reality is that they do. When ruling out antibodies it is generally considered good practice to not rule out based on a negative result with a heterozygous cell. There are modalities of testing which enable the use of heterozygous cells for rule outs: enzyme pretreatment (not for Duffy or MNSs); I've also considered PeG to be valid for this. Hope this helps

I've had these at 2 institutions: at one place, we used plasma constantly - we cleaned the bath weekly. However it did pick up mineral stains on the inside of the bath. Could not remove these with usual cleaners. At the other place, plasma was ordered infrequently. We would leave the bath empty and only fill it when there were orders. We also immediately drained it. Did not have to clean weekly.