carolyn swickard

Does your system allow you to "GROUP" all of the individual products(codes) under single headings (RBC, FFP, CRYO, PLTPH, etc)? If so - then that is probably how you then build the Ordering screens to limit the Drs to the seeing the Groups only. Anything special they have to put in comments - or your system may allow some questions and answers in the Order screens. That is how Meditech does it and I think that is how Safe-Trace did it too. You see all the product codes in Blood Bank - but the Order screens don't - that would be complete chaos!! The system on your side also has to recognize the Groups so you don't have to line up each special product to a special order - also chaos!

This is such a complex question - I don't even know where to start. Meditech is a basic system (DOS based) that ties the unit to the patient after ordering and resulting. The system then "issues" the unit that has been crossmatched in an ISSUE screen that lists the patient, the unit, the date/time (and who crossmatched the unit) of the crossmatch, the date/time and people involved in the issue process and then transfers the unit to transfused status in the system - all tied to the patient. So I guess the basics of what you need would be: Patient - full ID (name, DOB, system IDs (medical record #, etc.); Pt's group and type - ideally, the system should also list any pt. antibodies on the tag also. Blood Bank ID band numbers (if you use one of those systems) and/or any other required identifier for your hospital Unit number and Group and type - the system should be built to help you restrict units to type specific/compatible units only Ideally the system should be able to list any antigen testing on the units. Who did the crossmatch and when (so you can keep track of expiring crossmatches) When the unit is issued- by who and to who Our Meditech Issue/Transfusion tag is also built to print out a blank form (this is the bottom half of the tag) for Nursing to list; Transfusionists (transfusing RN and secondary ID check RN), the times and vitals for pre, 15 min, 1 hour and End for the transfusion - but if you do this some other way - say in the computer itself - you may not need that. Does that help? In any computer system, this data has to be linked to so many different areas in a Blood Bank system that getting that data to a new form is where the challenge comes it. Best of luck.

Been there - done that - still can't make any headway with the neonatologists! Not even when we brought our Blood Distributor"s Medical Director with all the facts and figures. They still want CMV neg. On the plus side - everyone else is OK with leukoreduced cells as CMV safe now.. I think leukoreduction is the best production step that has ever been added to blood - especially the pre-storage leukoreduction we get now. Now - if we could just get some more donors....

How many of you are giving Hgb S neg (tested) blood to your neonates services? Any problems with not doing it? I know it is an AABB recommendation for neonates and we have been doing it, but are getting very mixed responses in the region on continuing it. Also, our regional supplier is noting anecdotal evidence that Hbg S positive units (for trait) will not generally flow though a leukoreduction filter - they fail the filtration step. Any feelings on this either way? We get one pediatric unit every 2-3 weeks and we must be able to use it for either small volume transfusions or the rare exchange transfusion. Malcolm - good post - I always wondered about babies and Rh Pos units. It is so difficult to get a CMV negative, Rh neg unit in this region (US southwest) that we have often thought about having an O Pos unit for pedi stock - never been brave enough to try it though.

I don't think the posters in this thread were talking about "repeating" panels - they were talking about "running" a panel with the same method when you get equivocal results on your primary method. If using solid phase - run a solid phase panel. If running gel - run a gel panel, etc. Don't just step down to tubes (or a weaker method) without giving the primary method (and usually more sensitive method) a chance to show you what it is trying to show you. For your next question - working with the specimen might have some validity if you have centrifuge problems or are running clots (red tops) for screens instead of EDTA (purple tops) specimens. Make sure your spin speeds and times will clear the white cells in a EDTA tube. Make sure you follow Immucor instructions on degrees of lipemia and hemolysis that are allowed. Otherwise - if you are running the same lot # of strips on 2 different ECHOs - I would be surprised if they give different answers. Does that help?

Years ago, when we had a case of a 3rd B baby to an O mommy with high titer IgG anti-B - the OBs would not let her breastfeed her 3rd child because they knew it would contribute to the baby's problem. With fore knowledge of the problem, Bilirubin light therapy, heavy hydration (I don't know how they did that) and no breast feeding - the 3rd baby did not have to have an exchange transfusion as the 2nd baby had to have. Interesting case. I do wonder how the IgG gets from the baby's gut to the RBCs in the baby's circulation though? Is that a normal process anyway? Any articles on that?

sorry - fighting a cold - at least I got it right once!!!!

What are you referring to with "95% of recipients of AB plasma have antibody to the soluble antigen present"? Even with low titer O Pos WB units aren't you going to see just as much formation of antigen-antibody complexes as you do with a non-type specific platelet pheresis? The volume of plasma will be about the same and will contain anti-A, anti-B and anti-A,B, correct? What about the Trauma centers that are using A plasma - is that any better?

You should probably get used to the DTT procedure. Hemo-BioScience offers the reagent in small aliquots that can be used easily without bothering with trying to manufacture the stuff. There are several threads on this already on this site. Do a search and see the discussions. I had posted our procedure in one - let me know if it is not accessible now and I can send it to you. The cord panel method would be nice if you are doing a lot of pts, and at least the cells will last a while. DDT treated cells will not last long at all.

Does the O.R ever tell you that the Pt's armband is "inaccessible" because it is "under the patient and contained within the sterile field"? We use an armband system for our BB patients and we get told that occasionally when we need to transfuse in O.R. and they didn't get the armband number before they covered up the pt. The RN usually winds up crawling under the pt's table. What does your O.R do in that case? Especially since they are having to do a barcode read of that band? We use coolers for our O.R. deliveries (one pt per room) and I never want to even discuss the introduction of an O.R. refrigerator. Anything giving in the O.R. is documented in the anesthesiologist"s records, which are also part of the electronic record.

What is the rational for Whole blood vs. FFP and RBCs, especially with the blood mixers used at trauma bedside? Are there no problems with the decreased Coag factor levels with the older plasma in the WB units? I know some trauma centers are using liquid plasma so there is no delay in response - is WB even better than that? In what way? What about platelets? Do you still have to add them into the mix?

We have two forms I could send you if you want to message me your email address. Most of ours is now in the computer also, but the forms have more instructions, both for Nursing and the techs. Good start.

Since we use CP2D units for both our exchange transfusions (reconstituted with FFP) and small volume transfusions, we do not spin the unit down. We just measure the Hct and provide to the Drs.

Malcolm - would you be able to share what happened to "improve" the titers? What changes were made in the procedure/ cell choices, etc that made them more reliable? Was it something specific or just more practice? CAP has introduced a "Universal titer procedure" - but peer results are still all over the place.

Amen! Our nurses take vitals before, at 15 mins, at 1 hour, and at end (<4hrs). Don't know where it came from but that is our policy.

We use the Helmer D4 and have had it for years - it doesn't have speck of rust anywhere. We only fill it with distilled water and use the Helmer CleanBath Would the dry heat thawers work well for Plasma exchange transfusions? The 4 well waterbath we have is not going to get through 16 units very fast.

We have an irradiator on site, so irradiate 1 aliquot at a time. For the infants, we will not use an older irradiated unit. I can't give you any data on how fast the K+ builds up, but I wouldn't stretch it to 10 day for neonates. Since no one else answered - you might have to do an internal study to see how fast the K+ rises (and it DOES rise). Good luck. The other hospital in town does not have an on-site irradiator and I think they are now ordering at need - a tough job in this neighborhood.

1 per year or 1 every other year. Nightmare to maintain competency and training on! We get the little ones transferred here now - about a 200 bed hospital with maybe 10 neonate beds. (and to think we have a Children's hospital and a second huge pedi/neonate service 50 miles to the south of us - it is all a prestige thing, I swear).

All the DTT treated cells were still positive so that should rule out Darazalex. I wonder about the new one anti-CD47? Has anyone run into it yet and do we have any way of coping with it yet? Does it have a name yet? I was thinking anti-Fy3 or anti-U because of the ficin testing results, but the phenotyping is wrong for that, isn't it?

I wonder if the committee that came up with the recommendations for treating Rh weak Ds - Type 1, 2 and 3 as Rh pos had access to this data?? I wonder if this is going to change this recommendation any time soon?? I wonder if this is worse than the allo-anti-Ds we are going to see with the now widespread policy of starting all traumas (except children and females of child bearing potential) with RH pos blood before getting a blood type? That is not a benign policy either. We were just starting molecular testing and were just starting to call these patients Rh pos and not giving RhIg - now I don't know which way to go!

. At what temp do you call it a Febrile reaction? we use temp increase - unless the pt is already hot and they had to transfuse anyway - then we would still look for temp rise beyond start point 2. Do you also use temp increase from the baseline? If so what is? start temp with 2F/ 1C temp rise 3. Do you use other criteria with Temp increase for culture? If so what are they? any symptoms that indicated bacterial contamination - shock, hypotension (significant drop from start point), high fever (from start point), chills, vomiting, diarrhea - are what we list for RN 4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?) - no definition 5. Same with Hypotension, any numerical definition? - no - significant/noticeable drop from start point

Just when we thought it might be safe to say we had a somewhat definitive answer..........

There is also clotting to worry about. I have had to watch for and account for clotting in every ABORh slide test I have ever performed from a fingerstick (healthfairs and quick ones done for "can you tell me what my blood type is, pleeeease?"). How does the company recommend performing the test? If from a fingerstick - how much blood is needed, where does it go, how fast might it air dry and give erroneous results, what happens if it clots? All questions that would have to be answered before it could be put into service.

We are starting to phase in the molecular testing for discrepant RHD testing. (Rh neg/Weak D pos and/or weak reactions with standard FDA approved Anti-D reagents (- which may be what Sunshine is doing - only we put them in the computer as Weak D pos)). We are going to be taking the recommendations of the 2015 workgroup ("time to phase in RHD genotyping....)" and getting a more definitive answer for ourselves and our OB doctors that is safe for our patients and less of a strain on our Rh neg blood supply. Can anyone share a procedure with some of the correct technical terms to help us get through this morass? AuntiS? or JoyG? - seems like you already have it working. We may go a head and build it in the computer reflex testing too, but that will be for another day since Meditech may take some convincing!?

We are not yet charging the patients, so are sending out under our pathologist's name to the Immucor DX Reference Lab. We place the results in the history comments of the patient's computer record. If we start charging, we will also have to scan the lab report into the pt's chart for the electronic record.