SbbPerson

Yes, it is. It is actually because the transport temperature for whole blood, RBCs, and plasma is 1 to 10 degrees celsius.  After 30 minutes, the internal temperature of the units go above 10 degrees which may promote bacterial growth.  Basic 30 minute rule is that if the unit is outside of a controlled temperature for 30 minutes or more, it must be discarded. 

Do you have an on-call lab person?  Most hospitals with an emergency room have a lab person on-call when the lab is closed.  They can come in and issue the blood. If not, call the lab manager/supervisor and make them come in and issue you the blood.
There is the HaemoBank that is fairly easy to use and perhaps can be used to store just uncrossmatched emergency blood.  Maybe you can get one of those. I know some smaller hospitals that use it.  It's like a small refrigerator/vending machine for blood products.  Good luck

We only use Hematrax just in the event that our LIS is down and unavailable. You have no LIS for your lab? So your lab results are handwritten? I can give you instructions on how to use it but I would need time to dig them up. I will if you still need help. Good luck. 

Hi mpmiola,
I apologize for my late reply.
Grifols just confirmed the phenomenon that was described in the discussion above as the cause of the ABO discrepancy. They stated that the probe in Erytra analyzer goes down to 2mm from the bottom of the tube to pick up red cells. in this case, the transfused cells (group O) are more heavier (more dense) than the patient's own cells (group A) and therefore they occupied the bottom of the tube after centrifugation.  Since the probe only takes cells from the bottom of the tube, it only picked up the transfused cells (group O).
Hope this makes it  clear to everyone.
 
 
 

We have the compatibility question on the pre-transfusion checklist in Meditech TAR.  We were also cited for this several years ago and have not had a problem with this since.  Whether the RN understands is another question though.

I was wondering how other facilities are meeting the requirements for CAP TRM.41300 and AABB BBTS 5.28.3 regarding the bedside verification performed by nursing staff before transfusion.  We were recently cited for no documentation that nursing staff was reviewing the interpretation of crossmatch testing and if special transfusion requirements are met (CMV, Irradiated, etc).  We have that information included on the transfusion report that goes with the product to the nursing unit.  We use the Bridge administration system and it records all of the other required information by scanning the patient armband and the blood product.  Also the nurses have to answer questions in Bridge before they start the transfusion, such as  1. consent form signed? 2. physician order reviewed?  along with some other information.  
I am wondering how other facilities document what information the nurses are checking.  I can add an additional question in Bridge to document that the nurse has checked for special transfusion requirements ordered by the physician but I am not sure how to proceed with the crossmatch interpretation.  Nearly all of our crosssmatches are compatible and the RN could document that in Bridge, however what do you all do if you have to give least incompatible units as in the cases of warm autos?  It is marked that way on our transfusion reports but I am imagining some of the nurses not understanding the situation and not wanting to take responsibility for giving the unit.
Any suggestions, advice or how you handle these situations is greatly appreciated!

We vertically audit ten transfusions a month, reflecting different departments and floors. We ticked each criteria box as it was done correctly. If missed or done incorrectly another box was ticked and we educated the RN. The form was signed by us and RN. The BB kept a copy and original went to the RN supervisor. Not sure what they did with it. Not ideal system but showed us willing. 

There are hospitals now that has switched their verbiage from "least incompatible" to "most compatible". Which is true! This blood is the BEST blood possible considering the patient's situation. There is nothing you can do about the patient's auto, but you can make sure to provide the "best" compatible unit to the patient.  Of course you do this by making sure there are no underlying clinically significant alloantibodies in the patient's plasma.
 
Some places just straight out say "incompatible" on the transfusion report/tag.  The physician is then notified and made aware of this.  Some places make the doctor sign a form acknowledging the "incompatible" units and the risks involved, but where I work, a verbal "ok" would suffice.   We are all on the same team, working towards the same goal, the welfare of the patient.  We are not trying to "pin the blame" on anyone for possible hemolytic transfusion reactions.  We all want the same thing. 
 
Here is a really good podcast on the subject from the Blood Bank guy. It is really interesting and goes deeper into the subject and "what to do when everything is incompatible".  Good day. 
https://www.bbguy.org/2020/06/17/085/
 
 
 
 
 
 
 

Here we have a list of requirements that the tranfusionist completes by checking off that they performed the task. This is on the transfusion tag that is attached to the unit. 2 of the items are Verify Interpretation of Crossmatch Tests if Performed and Verify Special Transfusion Requirements. Inspectors have been ok with these.

Oh my!!!  We used to have a flowsheet row in the Epic transfusion module that the nurses were to mark that they checked the blood bank band number and it matched (then we dropped using a BB band).  It wasn't a required field, but I suppose you could make it so.  How is Lab supposed to police the work of nurses who are overworked, short staffed, often travelers and over whom we have zero power to change their behavior!

Our specimen rejection rate was 1-2% when we still used a separate banding system.  We dropped that last year for full use of the Epic electronic ID system.  I need to pull statistics now, but I am sure it is much lower.  Our main rejection reason before was almost always that the band number was left off.

I think the transfused cells were at the bottom rather than the top.  The analyzer samples from the bottom, I think.

At my hospital we don't use bands. I think this is great, because our rejection rate is pretty low.  There are too many travelling nurses we need to train if we were to use the bands.  And even when trained, nurses still get them wrong. 
Now all they need to do if to make sure the specimen has at least 2 unque identifiers , along with collectors's info, date, and time. Simple. Also for each type and screen, a testing request form is filled out. All patient information must match between the form and the specimen.  That's it.  Nice and simple. 
 
The band is great, but not everyone knows how to use it, and training takes up alot of time, especially with all the travelling nurses we have. 

The most likely answer has been given above: newly formed autologous red cells have a lower gravity than transfused cells and will concentrate at the top of the re cell pellet whereas transfused cells will seat at the bottom. I hereby attach a paper describing that phenomenon. I hope Grifols will thank you for giving them the answer :-)     20230301142735376.pdf20230301142735376.pdf

Hi all,
We had recently an ABO discrepancy on one of our patients (front typing  groupO; back typing  groupA) using the automated gel instrument Erytra (Grifols). When testing was done by tube method and manual gel (same manufacturer of gel cards and antisera reagents), the patient typed as straightforward group A (anti-A reacted strongly 4+ by both tube and manual gel methods). The same results were obtained again with a different sample collected from the patient. Testing on Erytra was repeated for first and second sample, again same results.  it goes without saying, all the daily QC of the gel cards on the instrument were fine and we had other patients that were typed corrected as groupA, except for the discrepant sample. The patient does not seem to have a subgroup of A (at least based on the results of tube and manual gel methods). I wonder if anyone else has had similar ABO discrepancies by gel. Thank you in advance.

Also, fetal bleed screen testing on a spun sample.  Those giant fetal cells will be on top.  Mix well before testing!

I strongly suspect that you've got your answer. Echo/Lumena probes are calibrated to go to a specific depth after level sensing at the top of the plasma of the specimen and I would think that is true for other analyzers as well. Another (opposite) problem that can happen is failure to pick up a red cell sample if the Hct is extremely low. With the 'extra' plasma in the tube because of the low Hct, the probe doesn't go deep enough after level sensing the specimen to reach the red cells.

marketlab.com has been a staple for lab supplies for as long as I can remember

Bg antibodies are antibodies directed against HLA Class I antigens.
These antigens are expressed quite strongly on virtually all nucleated cells, but are poorly expressed on red cells.  This is purely down to the number of antigens sites on the various cells.  For example, a T lymphocyte will express some 100, 000 such antigens on their surface, whereas a red cell will only express from 40 to 500 such antigens.
It was originally thought that Bg antigens on red cells were adsorbed onto the red cell surface from the plasma, but it now seems that these antigens may be intrinsic, having been formed during the time when the erythrocyte precursors actually had a nucleus, but, that notwithstanding, they can easy be removed from the red cell by chloroquine treatment.
Bga is analogous with HLA-B7, Bgb is analogous with HLA-B17 and Bgc with HLA-A28, but there may be cross-reactivity with other HLA antigens.
Bg antibodies are very common in pregnancy, having been stimulated by the foetal HLA antigens, but have never been implicated in clinically significant HDFN, so neither you, nor the expectant mother need to worry (they are "nuisance" antibodies).
For more information, try Geoff Daniels, Human Blood Groups, third edition, 2013, Blackwell Publishing Ltd. Chapter 32 (pages 512 - 514) - so there is not a lot to read!

Also this test should only be performed on Rh negative moms. And do not use any other Anti-D reagent, use only the one included in the kit.  
 
Anyways, I attached the AABB procedure to this test. I hope this helps a little. Good luck. 
AABB_FBS.docx

Does your sister hospital uses the same Lot numbers of Immucor FBS kit? If yes, then you guys must be doing something wrong.  When was the last time your cell washer/centrifuge was calibrated? RPMs? Amount of saline dispensed? 
If they are not using the same Lot #'s, perhaps give them one of your kits and see if they get the same result. If the kit's QC passes for them, then there is something wrong with either your procedure or maybe equipment.  This is really strange. Good luck. 
 
 

We used the Sure Tech kit when we were doing Kleihauer Betkes. They offered a 'training book' of KB stain photos, good and bad stains, that included info about troubleshooting the staining process. It wasn't terribly expensive. I found the photos very helpful in getting my eye 'calibrated'. After that I had zero problems hitting the CAP survey results. I tried to use it to educate staff, but I couldn't get them zeroed in - they always overcalled (better than undercalled). I think our major problem was that we did so few patient KBs that it just wasn't possible for anyone else to become proficient. That's when I approached our medical director about switching the test to a send out. We are able to get specimens to our reference lab within 24 hours, usually much less, so it hasn't hindered patient care. I still use the book for student education.

We refer our positive rosette screening test to Hematology for K-B stain. Results are reported as % fetal cells.

Has anyone seen a specimen where the red cells were above the plasma after it was centrifuged?  The patient was in cath lab and then went for a CABG.  I asked our Pharmacy intern to research what meds he got that were more dense than red cells and they said, "the only two agents that are denser than RBCs on the patient's MAR are Calcium chloride (100 mg/mL) and Isovue".  The Isovue contrast material is not charted for before the specimen was drawn but later during the CABG.  I suspect that is the culprit. His Hct here looks to be about 25% but the redrawn specimen had a Hct of about 45 so I think there was very dense IV fluid in this specimen.   Does anyone have similar experience?  BTW, this plasma created very junky reactions in gel and interfered with the tube reverse type.
  

I work at a children's hospital and we use WellSky and Epic/Beaker.  We built an orderable test called "Isohemagglutinin Test and Titer" specifically for reporting out the presence and strength of Anti-A and Anti-B.  This test is not affiliated in any way with the regular patient Blood Type test.  It's mainly ordered at my facility to monitor and follow patients with immune deficiencies or who have had an ABO mis-matched bone marrow or stem cell transplant, but it sounds like it would also meet your needs with heart transplants.  I've attached our procedure and worksheet.  This is how the results display in Epic.  If you're interested in building something like this, I can put you in contact with our WellSky & Beaker IT gurus who built this for us.  My contact is sgoertzen@valleychildrens.org 
 

TO-310 Isohemagglutinin Workup - Test and Titer__uncontrolled_copy (1).pdf TO-310F01 Isohemagglutinin Test and Titer Worksheet__blank_copy_id_7905995.pdf