kate murphy

Clinical management of the patient can be tricky - and sometimes no matter what's done, there's not a good outcome. We advise following liver function and renal functions. Much depends on if the potential Ag/Ab reaction causes intravascular hemolysis. We'd particularly watch LDH and creat. We may recommend hydration/Lasix to keep those kidneys flushed. If hemolysis is severe, and LDH is high, we may recommend a red cell exchange. Which may or may not help. By the time you're seeing brisk hemolysis, most of the donor cells have been destroyed and there's little to exchange. Plasma exchange is also an option. But many times in an ABO mismatch, these things can happen quickly. The sooner the BB med director knows, the sooner he/she can help guide clinical management.

Not possible, Malcolm! You have the 'most liked content' here! Besides, you'll be speaking to all us blood bankers - kindred spirits, as it were.

In Massachusetts, it's the physicians. We audit a small percentage of transfusions every month, and consent in one of the things we look for. We've stopped "letters from the committee" as they are ignored. We report No Consent directly to Patient Safety/Risk Management. The hospital lawyers then contact individual MD and their chiefs. This is also reviewed at Medical Executive meetings. Very rarely now do we miss a consent. The higher up the food chain you report, the better the results.

I've put it on my schedule - and I will certainly be there this time! Providence is just a skip down the road from Boston...

I agree with you all - many things we do for no other reason than to be compliant with some rule somewhere. My advice for KB - talk to your Heme dept and see what they do for diffs. Or Micro for what they do for gram stains. Just similar subjective tests. Do the least amount to be compliant and maintain your sanity.

Hi Marianne, we don't have a hard/fast rule about using day 6/7 over "in-dated" - it really depends on inventory, what's expected to come in, and orders. The goal is to have 5 units ready to be transfused. We usually test at 10-12pm, adding 24 hrs each time. But if there are 4 on the shelf, no orders, and we're expecting a delivery of 3 more in a few hours...save the money, don't test, keep the platelets on the expired shelf available to be tested if needed. Definitely judgment calls ... and comfort levels. It's still a work in progress... BTW - I love your beach picture! Retiring there would be great!

Yes, I've seen similar - A pts rarely tolerate B cells. Oddly enough, I've seen a B pt tolerate 2 units of A just fine. I agree that for now support with O cells and AB plasma. And maybe a red cell exchange. 2 units are a lot to clear.

We started doing this in August. We are 500 bed, FDA registered, trauma center. We use the National Blood Exchange (AABB) for almost all our blood, everything is flown in and it's ours. We've been able to decrease our orders since we've extended some platelets. The cost savings is more than the cost of testing. We did have to amend our FDA registration, the Verax PGD test is licensed by the FDA and this is allowed. The test is very easy! The harder part is getting the workflow down and when to test. We don't test everything, we've set a minimum inventory and test accordingly. But we do hold onto expired 5 day plts to test if needed.

Welcome back to the neighborhood! - 1- 2 ft predicted for tonight.... I'm definitely retiring to the Caribbean!

We're not as big as Cliff's institution, but we keep an inventory of ~8. We do not titer, we'll wash for severe reactions.

Well, think about this... the indicator cells are rosetting any cell with IgM coating it - test uses a monoclonal IgM anti-D. But anything else that's IgM coating the cells may give you pos test. You cannot tell with certainty using this test the Rh of the baby. Certainly it's not the test of record. If you ever had to defend your result, you'd have difficulty. Picture this: you've presumed the baby is Rh neg based on the FMH screen. No RhIG for mom. Baby is really Rh pos (variant?), and mom goes on to develop an anti-D. Next baby is at risk. Mom sues. You have no defense, as this is not standard practice. In the case of a pos DAT with an inconclusive Du, we do a KB and presume the baby is Rh pos. RhIG dose based on the KB.

We label a seg with the DIN at receipt. All segs received TODAY are in a ziplock, we toss in 8 weeks. Bags are labeled "Rec'd Date Disc Date (+8wks)" That captures 1 week past the longest outdate of 7 weeks. Easier to pull original seg in a delayed - just look for the bag of that receipt date. I would be hesitant about taking a seg at issue - what happens in emergencies, even a small place can have a ruptured AAA? And if anyone forgets? You're pulling a seg at receipt anyway... but whatever works best for you...there is no ONE way to do this.

Our whole stem cell lab is moving next year to a new space (not a better space, mind you, just new to us!). We have 4 tanks full of stem cells. Any advice or suggestions on how to safely move full tanks with liquid nitrogen? I have a feeling most moving companies would balk at moving "dangerous chemicals". We can't be the only ones who've moved!

I agree, Mabel. A handoff is a handoff. We document inspection upon release in the BB. We validated the system, all stations, then started using it. We do not use secure send - it slows the whole system down and led to many complaints. We use Epic for med record, and it auto prints in the BB when they nurse is ready to transfuse. We put a sticker on that print out to document who in the BB is sending, date/time. RN documents receipt with initials/date/time and sends it back. If we don't get it within 10 minutes, we call and track it. I've attached our downtime request slip. This is simple - patient name/MRN and the product requested. Same documentation of send/receipt. Works for either a person picking up or sending through the p-tube. I'm a big believer in the KISS principle - Keep It Simple, Stupid! Blood Request slip.pdf

If you split the unit using a sterile connecting device, the E code does not change. Divisions are created. The original unit becomes E####VA0 and the other half becomes E####VB0.

Both MT and MLT students do clinical rotations with us. They are allowed 14 days total for the BB rotation! I agree with all the above concerning attitude - both for MT and MLT. The difference I see is background. The MLTs are at a disadvantage because they don't get all the theory and most don't have well-equiped student labs. But some of the worst students were MT - they made it clear they were immediately going on to graduate school and had set their sights on big pharma, so they really only needed to know enough to 'pass'. I also agree with David - many more BS/BA/PhD students in MLT programs - many from foreign countries. They cannot find a job in their field and this is a fill-in for them. They are not invested, and may do well in gen'l lab, but I would hire very few for the BB. But I also would hire very few of the MT students as well. I want someone who thinks like a blood banker. As we all know, we do think and operate differently than the rest of the labs. I do have both MT and MLT in my lab - they all do the same thing (even eluates and adsoptions!)

We do not, but I think it depends on your institiution. We have a very involved med director and path residents. They communicate well with the ordering doc in these instances and our med director approves these transfusions. If you don't have this luxury, I would advocate some documentation that the additional risks have been explained and understood by the ordering doc. An emergency release would work if you added that the patient has hyperhemolysis.

oh, I see - same as transfusing in an ambulance.

We have a Galileo, in process of moving to Neo, and a Bio Rad Tango. We use PEG as our backup method. We do have LISS for those pesky WAA and colds.

I'm not exactly sure what you're asking. From the term "LifeFlight" I'm assuming moving blood around the country? Blood is flown around on commercial aircraft all the time. I don't think FedEx or Delta Dash is FDA registered. As far as FDA registration/license - nobody will do business with you if you as a blood center are not licensed. So what exactly do you want to know?

If the paperwork/unit tag that was attached to the unit, the one the nurses double-check before they transfuse it (usually) did not match the actually unit, then yes, it is reportable. Switched tags, even if it's the correct patient, but the wrong unit, is a reportable event. And everyone else is correct - the FDA doesn't swoop in! But when/if they do come, they will want to see your corrective actions, if needed. Last FDA inspector here (2014) informed me that they are looking at computer systems, since most places bypass their computers for emergencies.

Thank you all! There are several system out there that could be used. We have selected PaperVision. It's pdf's by MRN then date. Secure, accessible only by blood bank staff. All the data lives on our servers, but there is a optical disc backup. And it's already in use by our HR and Finance department. Relatively cost effective. I have 60,000 files to convert, and they will scan for me. We are moving into smaller quarters and there is just no room for our files. again, my thanks for all your suggestions!

I think you've interpreted it correctly - antigen neg OR XM'd. Our practice is antigen neg XM'd with mom's sample. Since we dedicate a red cell unit to one infant, the single XM is valid for all aliquots from that unit. We are definitely a belt AND suspenders kind of place!

We do screening the same - only group O or Rh neg moms. i guess I'm the youngster here with 37 yrs...yahoo!! I never get to say that anymore. That said, we do save the cords and mom's specimen in case the clinical symptoms warrant further testing.

We have a Galileo, a Tango, had an Echo, and do PeG manual. The thing with solid phase is that it is extremely sensitive - to real antibodies and "not real" antibodies. There are many times that a weak Galileo/Tango screen/panel (2+ or less) will not replicate in PeG. No specificity, a few random cells. We do a PeG screen and if that's neg, we're done. If it's a patient with previous antibodies, we might look very closely and avoid an antigen based on the assumption that a responder will usually make more. You might check and see what validation they've done when the instruments came in.