L.C.H.

We tell our clinicians to do exactly that, yes. Likely it won't turn into an anaphylactic event, but it could, so STOP and initiate a transfusion workup. Give benadryl and watch the patient.
For future transfusions, pre-treat with benadryl - even though it's likely a response to that one specific donor's plasma proteins, and a bag from a different donor may not provoke a reaction.

We tell our clinicians to do exactly that, yes. Likely it won't turn into an anaphylactic event, but it could, so STOP and initiate a transfusion workup. Give benadryl and watch the patient.
For future transfusions, pre-treat with benadryl - even though it's likely a response to that one specific donor's plasma proteins, and a bag from a different donor may not provoke a reaction.

We tell our clinicians to do exactly that, yes. Likely it won't turn into an anaphylactic event, but it could, so STOP and initiate a transfusion workup. Give benadryl and watch the patient.
For future transfusions, pre-treat with benadryl - even though it's likely a response to that one specific donor's plasma proteins, and a bag from a different donor may not provoke a reaction.

We tell our clinicians to do exactly that, yes. Likely it won't turn into an anaphylactic event, but it could, so STOP and initiate a transfusion workup. Give benadryl and watch the patient.
For future transfusions, pre-treat with benadryl - even though it's likely a response to that one specific donor's plasma proteins, and a bag from a different donor may not provoke a reaction.

For open heart surgery our perfusion team washes the red cells in the OR (faster than we can) and uses those with a small amount of FFP (for babies usually < 1 year especially those < 4kg).  Our policy is to provide 1 fresh, <6 day old, irradiated (<24 hours) AS3, CPD, CPDA-1 or CP2D packed red cell for post CPB but we give then two <= 10 day old unit (irradiated, AS3, CPD, CPDA-1 or CP2D) and mark them "To Be Washed" for priming the CPB.  For non-pump cardiac surgeries we wash if the patient is <4kg.  I would love to get away from washing RBCs for surgeries (we also wash for major open belly procedures on <4kg infants) but over 20 years ago a patient died because of a K+ overload from a RBC that was irradiated 3 days prior to surgery even thought the unit was still <6 days old.  Now I can't even get our Transfusion Committee to even discuss the topic.  Guess I just wait until more surgeons retire.

In terms of hacking- we have two offline PCs, one here and one at our sister hospital, that contain backups of BB data for both hospitals (dont know how often we back it up though). we were hit by ransomware last June (downtime for a week in the middle of COVID, yay)and then found out IT had connected one of those two "offlines" to the network, and it was gone.
We still had one lonely functioning PC, tho, with the entire systems' BB data, adn it got us through what was otherwise a very, very dicey time.  

In terms of hacking- we have two offline PCs, one here and one at our sister hospital, that contain backups of BB data for both hospitals (dont know how often we back it up though). we were hit by ransomware last June (downtime for a week in the middle of COVID, yay)and then found out IT had connected one of those two "offlines" to the network, and it was gone.
We still had one lonely functioning PC, tho, with the entire systems' BB data, adn it got us through what was otherwise a very, very dicey time.  

thanks for all the responses! looks like most folks, like us, have the KBs read in hematology. And the inspector was OK with it; i think he'd just been looking at our BB personnel competency forms, but when he asked for the KB staff competencies he didnt like the (slightly different) format that our heme dept uses. He was a very seasoned inspector, so when he said BB, not heme, most often reads KBs, I just got curious if our institution is really an outlier in that respect. Seems not!! thanks!

thanks for all the responses! looks like most folks, like us, have the KBs read in hematology. And the inspector was OK with it; i think he'd just been looking at our BB personnel competency forms, but when he asked for the KB staff competencies he didnt like the (slightly different) format that our heme dept uses. He was a very seasoned inspector, so when he said BB, not heme, most often reads KBs, I just got curious if our institution is really an outlier in that respect. Seems not!! thanks!

The hematology department does the KB. There is a built in table when the KB is resulted that states how many vials of rhogam is indicated, which is doted out by pharmacy. Only BB involvement is if they did a fetal screen which turns out positive they give hematology the sample, the KB is automatically reflexed based on a positive result.
Hem and BB share the PT testing. The leads work together on who is assign the samples , review the results and submit to CAP. The only "trouble" we ever got in was on what medical director signed the attestation form. The site medical director was signing it but according to CAP it should of been the BB medical director.  Not an issue anymore as now it is the same person.

Wow, just wow.  I can't even imagine a blood banker in the US considering this as acceptable.  Our usual assumption has always been, if we didn't do it then it's probably wrong.  Our paranoia runs deep and swift.  Now, before anyone gets too upset with me please know that I was one of you for 35 years so I can play the what if game with the best of you.  I'm just noting what I observed over many years.  If anyone in the US is actually accepting the results from other facilities at face value and acting on them, please let me know, I would love to be wrong.

If you're sharing the CAP PT, I presume you are under the same CLIA number?  Our BB has its own CLIA, sharing for us is a no no.

Fetal Screen in Blood Bank, KB in hematology, RhIg dispensed by BB.
We share the CAP proficiency kit; BB takes ownership of monitoring/submitting (because we're bossy like that )

I'm so jealous - all these labs where the KB is performed in hematology!  Here ours are done in the BB.  To be fair, we are a core lab, so the staff performing the test are the same.  I would just rather not own the test and all the competency that comes with it 

In our hospital, KBs are performed in the haematology department. If positive, the amount of mls bleed is calculated and documented. The RhIG is then given out by pharmacy based on the package insert information and after discussion with the doctor. Would an AABB inspector even look at this process in our hospital as Blood Bank is not involved at all?

KBs are performed in our Hematology Department.  This test is not uncommon as it is run for more reasons than just to figure out RhIG dosage.  I believe, because of this and their more acute training/experience in microscopy, this is the best place for this test to be done.
Competency for KB belongs to the section who is performing the test no matter what anyone else uses those results for.
The only 'competency' determination that I believe is necessary for the Blood Bank is to assure that the BB Tech who is processing RhIG orders knows how to acquire the KB result and how to calculate the dosage using that result.

We no longer have L/D but when we did, Heme performed all KB and would enter the patient results in the computer system. We would base our number of RhIG injections based on the result and the package insert.
As far as PT, the BB would get it first and perform the Fetal Screen. We would enter our results on the forms and then give the PT to heme to perform the KB. That way we both performed the portion of the PT we actually did in our departments. Since heme did the majority of the work, the department lead would enter the results into the CAP website. 
I agree with John. Some inspectors think if you don't do it the way they have been doing it,  you are doing it wrong. There are lots of roads to the same destination, but some are better paved.

Sounds to me like an inspector who is "uncomfortable" because it's not how they do it.  I recommend a nod and smile and a comment such as, "We'll look into it."  As long as who is doing it, are trained and competency is documented it should not matter which department is doing it.  To rephrase what Malcolm said, the procedure is more in haematology's wheel house. (It's kind of fun spelling words with more letters than necessary!)

During the majority of my professional life, Blood Bank has read the Kleihauer tests.  I have NEVER understood why this should be so.  It was INCREDIBLY rare to come across a case that was not, to all intents and purposes, negative (or certainly required no more than the "typical vial", as you say).  This meant that those working full time in Blood Bank were most UNLIKELY to be competent in accurately counting a minority of cells on a smear under the microscope.
On the other hand, the Haematology Laboratory staff were used to looking at slides to accurately assess, for example, reticulocytes and, come to that, malaria slides.  I always thought, therefore, that their staff would be much more competent at looking at Kleihauer slides (this, of course, was before reticulocyte counts were performed by automation), but I still think that those who are used to performing a particular test should be the ones who actually perform the tests on a routine basis, particularly in these modern times when the "measurement of uncertainty" is such a popular reason to give "a fizzer".

we require two types before issuing type-specific blood, and has to be two different samples from two different sticks. we bill for both.  

we require two types before issuing type-specific blood, and has to be two different samples from two different sticks. we bill for both.  

we require two types before issuing type-specific blood, and has to be two different samples from two different sticks. we bill for both.  

We require another sample of a different collection event, prior to transfusion.
Believe this is in the new AABB standards.
The computer automatically orders a no charge forward and reverse retype, if the pt has "No Hx".
 
We actually found a mislabeled BB specimen, once. Discovered when tech did the rpt on a diff sample and got a diff aborh.....
 
 

I just had to share this story...When I worked in a large teaching hospital we had a team of Transfusion Nurses who were responsible for drawing most samples and administering the transfusions. Occasionally, however, physicians (or interns/residents) would draw the samples. One afternoon we received an unlabeled sample drawn by a physician via courier. We contacted the physician and informed him a new sample would have to be drawn. He said he would come to the transfusion service and label it right away. We told him that was unacceptable, however, he insisted. While he was on his way, we put together several samples without labels and placed them in a rack. When he arrived, we presented the rack to him and told him to select the sample to label. He actually tried to feel each tube to find the warmest one and said that was the sample he sent. Obviously we did not allow the sample to be labeled.  The story has been told many times!!! 

2.2.1        Pathogen Reduced Platelets and Cold Storage Platelets are not to be accepted and must be returned to the supplier.
 
 
Why do you not accept Pathogen reduced plts?
We are switching over to Psoralen treated plts, but have never transfused plt to any baby.