Oniononorion

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

Does anyone utilize the physician notes that mention the need for blood and are electronically signed in the EMR to satisfy the documentation required for emergency release of units?

21CFR606.151(e) states "Standard operating procedures for compatibility testing shall include the following: Procedures to expedite transfusion in life-threatening emergencies. Records of all such incidents shall be maintained, including complete documentation justifying the emergency action, which shall be signed by a physician."
We keep them regardless of whether or not the units are transfused.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

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It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

srichar3, do let us know results of other tests and if the patient was treated as AsubB for transfusion. I’m curious as to why the patient would have such a strong reaction with A reverse cells if they are a subgroup (I have only seen 1+ in reverse with A cells in subtypes but of course YMMV) and wonder if perhaps there is some pertinent clinical information causing false positive results with anti-A in gel, such as pH- or reagent- dependent reactivity. Especially since it was just BPos in tube method.

Things must have changed dramatically as they so often do over the past 42 years but I recall that immunoheamtology received no less emphasis or time than the other disciplines when I was studying in a MT program.  Maybe the program I was in was the exception at the time but I hope not.  Having already completed a BS in Microbiology when I entered the MT program I assumed that would be my area of expertise but after one year after graduation working as a Generalist, I found myself as a full time Blood Banker and never looked back.  While the bulk of my knowledge in Blood Banking was attained "on the job" I always felt the foundational  information I received in class certainly prepared me for my future.  
Wow, we sure hijacked this discussion!!   

This is where having a transfusion service director who knows something about clinical medicine and hematology comes in very handy.  It shouldn't be the medical technologists' job to triage requests.  Many transfusions do more harm than good, so it's not that difficult to figure out which patients urgently need transfusion and which can wait, but this requires a knowledgeable and tenacious physician to handle the individual requests and screen them.  As a field, pathology has paid little attention to the need for those who can do such tasks, as compared with surgical pathology skills, cytopathology, etc.  You may need to involve your institution's hematologist(s), intensivist(s), surgeons and anesthesiologists to help make these decisions if your lab physician(s) aren't up to the task.

Oniononorion, I would tend to agree with you that blood transfusion as a whole, and immunohaematology in particular, are always the "bridesmaid and never the bride" in terms of the amount of time devoted to the subjects in taught courses, however, i do have some sympathy with those trying to plan such courses, particularly the practical courses, even when attending a course at a Reference Laboratory, simply because some of the cases are so rare that it cannot be guaranteed that you would see such cases, even if you were in a Reference Laboratory for several weeks.

Oh gawwsh I wish we could count on school to teach us the intricacies of immunohematology but it seems these things are truly only taught by 1) loads of experience; 2) engaging with those who have loads of experience; and 3) reading seriously in-depth reference texts.
A bit off topic, but traditionally MLS schools teach immunohematology as one, one-semester course with lab plus clinical rotation. While the clinical rotation solidifies the theory a lot more than the class, I believe our graduates would benefit from a second “Immunohematology II” class covering practical basics such as the types of things similar to OP’s question and things related to more in-depth troubleshooting and discrepancy resolution, and in addition, advanced theory for selection of appropriate components for transfusion for problematic patient needs and emergency situations. Sorry for the slightly untimely ramble....but chemistry, hematology and microbiology get the dual-course treatment, BB should too.

Oh gawwsh I wish we could count on school to teach us the intricacies of immunohematology but it seems these things are truly only taught by 1) loads of experience; 2) engaging with those who have loads of experience; and 3) reading seriously in-depth reference texts.
A bit off topic, but traditionally MLS schools teach immunohematology as one, one-semester course with lab plus clinical rotation. While the clinical rotation solidifies the theory a lot more than the class, I believe our graduates would benefit from a second “Immunohematology II” class covering practical basics such as the types of things similar to OP’s question and things related to more in-depth troubleshooting and discrepancy resolution, and in addition, advanced theory for selection of appropriate components for transfusion for problematic patient needs and emergency situations. Sorry for the slightly untimely ramble....but chemistry, hematology and microbiology get the dual-course treatment, BB should too.

Ya, Malcolm.  I can think of a few other situations where this may not be the best policy.  When requested by physicians, we have done eluates on compliment-only positive DATs where we ID antibodies, showing that one can have a "false IgG negative" DAT in certain situations. 
Anyway, in most cases we would repeat the eluate if, in the first place, we identified that an allo-Ab was present on the patient's cells.  But as for initially negative eluates, if a repeat DAT is still positive but not stronger than the previous, we would not bother with another eluate. The idea being that if the patient is producing a significant amount of antibody, the DAT reaction would be stronger.
Scott