David Saikin

Are your techs generalists or dedicated blood bankers? If they are generalists, chances are they are not going 2nd guess BB Mgr. If they are dedicated blood bank techs they should know better. Unfortunately I have known SBBs who would give inappropriate plasmas (gr O to gr A) just because they were thawed. Laziness. Do you have a BBIS? It should have required an override to give the O plasma. Having been an inspector/assessor for AABB and still a CAP team leader I would think these issues should have been flagged in your quality plan and subsequently made their way to lab management and hospital quality folks. Don't be derelict in your duty to your performance program AND your patients. I'm certain your Medical Director should be in the know as he/she is ultimately responsible. I would not bring up this individual's past history (though how you discovered this would be an interesting aside). Don't let your lab's quality suffer because of an individual's poor performance, both the manager and the tech involved. The transfusion of inappropriate plasma should have resulted in a Biological Product Deviation to the FDA. Is this in your purview? I would recommend jumping immediately on errors of this type as soon as they are found. I also would recommend going directly to the Medical Director as it seems your manager has some serious BB judgement issues. In the past I have commented to a Medical Director that one would not want to practice Laboratory Medicine in jail. The Feds can take you out in handcuffs if they think you are culpable (rare but they do have an enforcement arm). I'm being kind of verbose here but the bottom line is as the quality person for your BB, don't hesitate to call a spade a spade. Inform lab upper management with your concerns, especially your Medical Director.

Malcolm - I have a patient at my small hospital here: O POS w anti-D. Sent her specimen to Ms Moulds at Gamma (circa 1992). Mom came back as DVI. Besides anti-D she also has Jka. Nice letter from MM but still needed to provide some input to the OB guys.

AABB Technical Manual also

John - had an O Neg guy. Negative ab screen as I recall. He rec'd an O+ random plt concentrate (early 80s). I don't remember the circumstances but the next day he had anti-C,-D.-E. The next day a Kidd. We didn't think it was the anamnestic response. Too long ago but I believe he ended with 5 or 6 allos. My boss was familiar w these types of individuals. New specimen for every transfusion, even if the same day.

you really need to do the test on O Neg cord bloods unless your gel Anti-D detects the DVI. Of course, if you do donors, it is required to call a unit Rh Neg.

I am looking at that but have not made a decision yet. Do you have one or considering it?

I have to agree w John on this based on results you state. It seems she should have received at least 3 RhIg doses after that delivery. RhIg dose covers 30mL whole blood bleed, so there is the need for 2 doses. In my experience we always give +1. Doesn't sound like very good prenatal care especially if you have documented anti-D in the past (and not due to RhIg).

New sample pretty much gets the whole nine yards. Only exception for me is a pt w an antibody. We'd repeat the screen, If it was consistent w the previous testing we would abrogate another abid. Unless of course we were dealing w a super responder, in which case we would get a new specimen every day the patient was going to be transfused - not even if done the day before.

SCARY. I've seen pts expire due to scenarios like this.

Why is the blood getting warm a problem (how warm is too warm)? It's signed out; it's going to get warm. The tube is not storage. Don't need to maintain storage temp.

Haven't used one of those in decades; what does the manufacturer recommend?

TS: an hour from receipt in the lab Cord Type & Coombs: an hour.

Have never had to do that (from 24 bed to 700+ hospitals)

How do you know it was alloanti-D if it was not ruled out? If she had a history of alloanti-D why did she receive RhIg? Anti-D tends to stay around for quite a while, in my experience. Are you sure you weren't detecting residual RhIg initially? To do or not do elution - you should follow your policy.

Stop using paper once you have your BBIS validated. It is just as easy to type 4 as to write 4+. The system shouldn't let you make interpretation errors. Trust it. I know I've been turned down for positions because I told the technical staff that their papers would be history from my day 1. I also have inspected places that did the paper first. Went to watch a transfusion and had to return because the patient needed irradiated products - only found in the computer. It was a good lesson that you don't want repeated when you get inspected.