[Rhogam]

Antenatal RhIg gets an antibody screen. One doc wants it done before it is given, the other wants it released at the time of phlebotomy. Post delivery, there is no standard demanding absc, but our docs want it, so we do it before release.

[Unusual antibody?]

I think PeG definitely has its place. I wouldn't use it routinely and do not let my techs use it unless it seems prudent. However, I have seen those weak, junky reactions in LISS become C's and Kidds in PeG.

[Proficiency testing for autoadsorption]

Once again the spectre of ignorance appears to rear its ugly head. Come on, all you are doing is an antibody id. I agree with you . . . there is no call to over bleed someone in with a hemolytic anemia. Some inspectors just can't see the forest for the trees . . . I would challenge it, in fact, I would have called the inspecting agency while the inspector was there and got some clarification if they felt this was worth the effort of a response.

[Physician Office Lab]

YOu should contact the state Public Health Lab in Concord. They can point you in the right direction.

[Leukoreducing Whole Blood]

It seems like an IV pole should suffice. You could always get a footstool to put the bag on at the lower end . . . or put the bottom bag in a transport bag so it can't "touch the floor". Why can't it touch the floor (or am Ijust being ignorant?).

[CAP Inspection Question TRM.30550]

I am curious - if half your error rates are due to nursing, who is responsible for the other half? And more importantly what have you done about it? I find it almost incomprehensible that samples are mislabeled by lab personnel. My personal feelings are that drawing the incorrect patient is grounds for dismissal (but I seem to be a dying breed in that respect).

[Hemocare Upgrade]

Are you talkiing about HCLL?

[QC for disposable Donor Physical thermometers]

I check them upon receipt, comparing the tempadot with my certified thermometer using the 37C water bath.

[MLT in the Transfusion Sevice]

I have been in places where only MTs or baccalaureate (sp) degreed individuals were allowed to work in blood bank. Most insititutions I have been in are not so restrictive.

[Sickle Cell testing of donor units]

I assume you are doing testing on the segments from the unit. Usually (I think) the segment is made prior to the additive solution being added, so the segment is probably just CPD blood. If your segments are made after the additive is added, you would have to consult with the kit manufacturer, or, more exciting - YOU would have to validate that it works on such a specimen.

[Blood Warmers]

It is not mandated to monitor the warmers if they have a validated alarm system and are maintained according to manufacturer's recommendation. I never have a problem with folks doing more than is necessary. If there is no alarm, then I think recording the temps is prudent, but ALL user's should follow the same directive.

[Screening for U antigen using glycine soja]

Chown tubes are capillary tubes with an internal diameter of 0.4mm. The technical manual used to have a procedure for using them. Basically, you load antisera and then a cell suspension. The tube is inverted so the cells have to fall through the antisera. The tube may be flipped so the cells fall through again. Reading is done with a hand lens. You can screen about 100 suspensions with 1 drop of antisera; or do panels on babies and convert it to AHG if necessary.

[Screening for U antigen using glycine soja]

We had a tech in SBB school who studied the U antigen. She used Chown tubes and a commercial anti-U to screen patients and then formally tested those which were negative using the Chown tubes.

[Weak D testing on donors]

I think you should pose that question to the FDA, as their rule states Weak D testing must be done. Of course, if you can substantiate that claim by validation studies, they may let you off, but I don't think you can or that they will let you.

[Quality Representative Poll]

I'm seeing the same thing as John, QA dept is getting more staff. Unfortunately, I don't think they really know what quality is . . . from my perspective they seem to exist for compliance purposes. I have not seen one quality initiative that improves any process in the hospital. Of course, I am persona non grata . . . esp since I refuse to implement things and then fix them after the fact.

[100% leukoreduced]

Our Medical staff voted unanimously to go 100% LR years ago . . . and we did.

[D Typing Dilemma]

I am assuming you are talking about historicac weak D pts, as you state that you only do weak D on babies and donors (usually). Our protocol matches yours for weak D, however, I am certain that the volume of pts I test pales next to yours (we do about 350 tx/yr), and we have yet to see any anti-D's, except for one historical pt (type VI). I do not have any solution to your problem but do commiserate with you. I do not like calling those 1+ D's Rh neg, after all they obviously have the D antigen. They can always be give Rh neg red cells.

[New System Implementation]

It hasa been my experience that most folks go overboard with validation. Some feel that you must validate everything a system does, or can possibly do. I feel that you only have to validate the aspects of a system that you are going to utiliize. I look at what my facility does and how my system is going to perform those things. So far, I have validated 3 systems, including a donor module, with no problems from the FDA regarding my implementation.

[autologus blood donations]

It seems you all are having an opposite spectrum of events than I am . . . My Docs don't order any autologous, in fact, we draw for a few other area hospitals. So far this year I have drawn 2 units . . . last year 10. We would prefer having autologous, as this would allow our very small blood supply to go farther. I guess it's all a matter of perspective.

[100% leukoreduced]

I understand and agree with 100% leuko reduction, cliff, but why 100% irradiation? And are you billing for irradiated products to everyone who gets them regardless of the medical necessity?

[Recertify Weights]

I did not care to purchase weights for my phlebotomy area . . . too expensive. What I did was go to the maintenance department and get a heavy chunk of metal. I weighed it 20X and used the average for my standard weight to validate my volume of blood collected. The FDA does not have any problems with this; their only recommendation was that I revalidate the weight of the weight annually. I do this by weighing it 20X with documentation.

[To prewarm or not prewarm, that is the question!]

Though used rarely, we still rely on PW technique when it is indicated. Using EDTA specimens has cut down the number of cold agglutinins we encounter, however, in Northern NH, where we are located, most of the small hospitals still use serum. As their local reference lab, it is important for us to realize this . . . and we have found more often than not a negative absc using plasma but significant reactivity with serum. The BIGGEST problem I have encountered is that the small places have a PW technique procedure but their staff modifies" it to the extent that it is useless. And you know, those demigods of blood bank poo-poo it, but I feel it is still a valuable assay when used correctly.

[Survey for Transfusion Services – What computer system?]

While I personally like Hemocare, it is being sunsetted next year, as I expect you know. I am marginally familiar with softbank but know a few users who really like it. You probably won' t go wrong going with it . . . it will just be different. Good luck.

[A hard day's ID!]

What is the patient's original dx? and current dx? DON'T say "anemia". Would it be safe to "assume" that the current need for transfusion is related to destruction of the transfused cells or is there some other process occurring along with the +DAT? By-the-by, how strong is the original DAT and why did the patient need to be transfused in the first place?

Tell me more . . .

[Blood Bank or Pharmacy?]

Albumin and IM RhIg from blood bank. The others from pharmacy.