[Transporting staff to mobile drives]

My small staff (usually 4 in all) would ride together in the bus . . . they prepared for the drive and went together. If they decided to take their own vehicle, for whatever reason, I did not reimburse.

[TRM.30882 Evaluating Suppliers]

Assuming you have defined your critical materials . . . what I do is record how many times things I order are backordered/delivered on time/not available. I found this particularly effective in evaluating my blood supplier. As an example, if I ordered 4 O= rbcs, but they could only supply 1, I would document this. They would put down that they fulfilled my order because I accepted the 1 unit. However, at the end of the year I forwarded them my qualtiy review of their service . . . they were not happy since I showed that they fulfilled <50% of my O= requests (vs their documentation of 100%).

Hope this helps.

[ABO Records OK From Other Institutions?]

Would you accept the "donor" card as a type to issue uncrossmatched blood? I think not . . .

[Up to date QC testing for all blood components]

Check in the AABB Standards and/or Technical Manual. Also, the CFR 600. These will have defined the QC necessary for acceptable components.

[How to deal with AIHA transfusion]

Thanks for your posts. For this kind of patients we usually give the least incompatible units to them. The first unit is the least incompatible one, but the result is not good; the second one is a random one, the Hb is risen. So I think the most important is not the crossmatch but the steroids her been used. The Hb risen is the result of weakened hemolysis.

Just a comment on least incompatible . . . that's like saying someone is a little pregnant.

[Up to date QC testing for all blood components]

If you are not a manufacturer of blood components you do not have to do QC testing on them (except for bacterial growth in random plt concentrates and appearance at defined intervals). Reagents are all tested on day-of-use.

[How to deal with AIHA transfusion]

As long as there are no alloabs, like Linda has stated, your transfusions should be "safe". I like to give Rh phenotype specific blood to these pts so that they won't make any Rh system abs. I have found that these autoimmune pts are prone to sensitization so I try not to give them a good reason.

[Centrifuge calibration]

If you are talking about serofuges, you really only need to calibrate them upon receipt and after repairs. Otherwise . . . enjoy. If they have analog timers, those will need to be checked. You do need to do rpms but my biomed team does that.

[Calibration of Blood Pressure cuffs and Vital Signs Monitors]

It's catch 22 . . . the standard is the mercury manometer - we are not allowed liquid mercury in our hospital. The FDA had no problems with this scenario (as a licensed operation): 1) verify that the gauge is "zeroed"; 2)verify that there are no cracks in the tubing; and 3) pump the gauge up to 40-50 mm and verify that it maintains pressure. I do believe that BioMed can validate your anaeroid cuffs (at some places anyway) . . . some device can do it, I do not have that info.

[solid phase associated antibodies/ Jka antibodies]

I have noticed a similar phenomenon in gel. Homozygous jka cells react 1+. However, enzyme pretreatment has removed this reactivity leading me to believe I am seeing complement activity or HLA antibodies that are denatured by the pretreatment. I have seen this in the past with tubes also . . . looks like Jka but enzyme does not enhance.

[CMV- charge]

you can only bill for it if the MD orders it for a specific patient. If you end up giving it to someone else you may have to eat the charge. I use an additional charge bundled with my rbc charge for the specific patient. I bill that patient for the cmv regardless of transfusion (or not).

[MTS-Gel Back-Up methods]

Labking - there are more issues than cost when doing your own Abid - like decreased length of stay for your patients. For the main question - I use Peg/tube as backup for unresolved gel id's. We recently had a pt with a 4+ anti-c and a Jka that was only 1+ with homozygous cells (could only find the anti-c with tubes). I have found more Kidds recently that I would not have found using tubes with peg (reactions in gel 1-2+). My experience is that gel reactions of 2+ or less are not discoverable using Peg or even enzyme pretreated with peg.

[Patient/Blood component verfication prior to surgery]

John - at a previous institution we attached HemoTempIIs to the units (stored in a refr in the OR). They ALWAYS came back converted. Inquiries were met with a response of "your tags must be defective". We paralleled them with units in the blood bank (the tags never converted). It became a hot political issue and tagging the units sent to the OR was discontinued . . . interesting and enough said.

[Testing Standards (Pt. Retypes and DATs)]

Because we have 2 types on all patients who are transfusion candidates it is not mandatory to repeat such, but I never stop a tech from doing it if it makes them feel more comfortable. We do document these retypes. We stopped performing an auto ct when we switched to gel antibody screens but we do run an auto if and when we perform an antibody id. We do not do DATs with xms. We are a 40 bed facility with an active transfusion and reference service.

[DAT's]

We use the buffered gel card to do the anti-complement testing . . . the immucor complement check cells are always 4+.

[Daily QC for tube & gel type cards]

I use the Immucor CorQC system for my + qc. For negative I use an 3% O neg suspension and the MTS 2+ diluent for both cells and antibodies - I can find out if my cells and/or diluent are contaminated.

[Mixed fields]

I grade mf reactions when they are noticed.

[Medion Reagents]

I have been using their panel for about 3 years . . . it is a backup for my 0.8% panels, but it always has a Kpa+ cell and usually a Jsa+. What I don't like - Sometimes it will have up to 5 K+ cells and the antigram paper is 1/2" wider than the usual antigrams (if you put them in a binder they are a bit out of place). I can live with these idiosyncrasies (sp?).

[Second Tube to confirm ABO/Rh on New Patients]

I cannot find that standard in the new CAP checklist TRM 035150. I think they have discarded it in favor of a question asking if 2 qualified individuals id the pat and unit at the bedside.

[Price Increases]

The price increases by both vendors (Immucor and Ortho) should have been predictable by all of us. Granted, not to the extent that they were, but . . . both these companies are on record to increase "classic" reagent prices until there is no difference between the classic and the "noveau" technologies. The 100% by Ortho and the 50% by Immucor do seem a bit steep for a one time increase.

[Faster Methods of Thawing Plasma]

I use a Helmer Plasma thawing bath - 2 units in 14 minutes.

[Gel Antibody Titers]

We use tubes for titers. Too much work to validate for gel and provide meaningful data to the docs. Unless there are more documented studies I can't see a conversion.

[Rh Control and other QC questions]

I don't think the 1-3+ rule applies for CAP anymore. I was concerned with that when I switched to gel but the standard now only calls for reactivity to be verified; reactivity must be 1+ or greater.

[Antibody Titration]

We use 6-8% albumin as diluent (but otherwise no enhancements) with anti-IgG after 60 minutes.

[DATs]

Good Question . . . why do I run the check cell? They let me know that my reagent is working. I run them in parallel with my test. On my gel card I run the patient twice and the ct twice. One set with reagent and one with diluent. Why? It makes me feel better about the anti-C reactivity/non-reactivity.