carolyn swickard

We tried clear plastic bags for awhile and the RNs complained about one more piece of plastic to have to throw away (amid an already huge plastic waste burden of trash from the hospital). Materials Management didn't want to buy the paper bags - too expensive they said - and we could not find a contracted source of colored plastic bags (to hide the unit). I hate to waste even more single use plastic trash, but even the packed cells occasionally break if they happen to hit wrong and they are a huge mess to clean up. With Whole Blood coming back in some of the Trauma protocols, look out - they always break!

How long will they be in transit between the various hospitals? PelicanBioThermal has the Credo coolers and they have a series for 22C transit protection. We have one of the soft side ones that we use to move Platelets between our facilities. It works fine. Their website is extremely difficult to work with - just get the phone number and call them, if interested.

1. The AABB Tech Manual, the AABB Standards, Harmening's book is good, Issit's "Applied Group Serology" is excellent; Mollison's "Blood Transfusion is Clinical Medicine" is excellent; Blood Bank Guy - a very useful site; this forum - always useful. The AABB website. National websites (AUS, New Zealand Canada) for their blood services. ARC and UBS (now Vitalent) - our big national blood suppliers. 2. Get a set pattern of working set up that you can follow (within the ways your Blood Bank likes to do things: tubes, automated, computerized, etc.); ALWAYS do the work the same way - keep things in the same order always - your tubes, your results, your units as you work with them and label them. I have trained people who I watch do things in a completely random order, especially as they load the centrifuge - then they had to straighten out every thing to read it and enter it in the computer. Waste of time and very confusing - it will get you in BIG trouble someday when you are in a hurry. At the same time - things will change overtime - new computer, new instrument, etc. - be adaptive to change. If you need to set up a new pattern because it is more efficient or works better with a new instrument (especially computers) - be willing to change and adapt. 3. Always keep an eye on processes - make sure they follow the Standards and are being done correctly. Watch for inappropriate procedural drift - don't just change the procedure to "your" way just because you think it works better - it may be the other way for a good reason. If not - talk it out and see if you can initiate change. Blood bankers can be slow to change, but they follow rules for VERY good reasons. 4. You just always wish you knew more. Patients don't always follow the "rules" and situations can be very fluid in trying to get the right products to the right patient at the right time - and YOU will be the one holding the line on staying within safety rules (and yes, they do scream at you sometimes.) Most Drs and many RNs do not know a lot about Blood Bank - you will answer many questions. Always try to keep learning. Remember always - there is a patient at the other end of that conversation and they need your help. You may be the only one with the right and safe answer, but you have to find a way to help the patient 1st. Best of luck - enjoy the adventure.

I have found that the anti-sera that requires coombs phase testing works well to make elutes, but the monoclonal anti-seras that only require RT incubation, don't work as well. Since that is most of the commercial anti-seras now - it is getting tougher to manufacture this stuff yourself now. AMCord's recipe would work well, but always leaves you with a anti-D eluate. Cliff - do you use a whole syringe of RhIg? How do you mix it?

Quote: "Do you just have it as a check off item on the Maintenance Log and document review there knowing that 1) the Echo won't let you run the test if QC is not performed and passes 2) the actual QC runs are on the archive disks? " This is the process we use. We also "Review and Approve" the QC daily using the "check" button. That shows we at least looked at it each day. Everything is archived too.

I can give you my current one, but it is specific to dataloggers and Credo coolers. Hope it helps Remember also - for the primary validation - the FDA likes to see the testing done under minimum loads (1 or 2 units) and maximum loads (as many as the container will hold). Validation coolers 4.doc

I think one of the threads once mentioned Trypsin - maybe check with a reference lab???

I haven't even heard of this one - what is it used for? What disease or what target that is cross-reacting with RBC antigens? If this is anti-CD47, see the thread on anti-CD47 therapy interference. Might help, unless this clone is one of the ones mentioned in the last post detailing clones that are not IgG 4.

It is a good reminder to generalists who can forget over the years that a strongly positive fetal screen with a negative Fetal stain is not a weird result (?!?) - it is probably just a weak D. Without doing weak Ds regularly, it is easy to forget that as the years pass. Doing the weak Ds as part of the RhIg workup is a different idea. We just do them once on any Rh Neg and put it in the computer history. I am trying to catch the young females and send them out for genotyping - nice to have a definitive answer that gives assurance of the right choices for individual pts. So far, we have sent our genotyping to the UBS Reference Lab - which sends them on the Grifols Lab. We get them back in about 2 weeks, so it goes in computer history for the next time we see the pt. Has anyone been using Immucor's Lab for RH genotyping? How long do they take and how much do they charge? (if anyone knows)

We start with O neg (2u - no more than 4u) and hope we have a specimen before the 2u are in. We then switch to type specific and hope it is not O neg. We are under pressure to switch to O pos by one of the ER docs - may have to go that way in the next year or so as they gear up here to be a Level 4 trauma unit. So far, most of the emergency releases stop transfusing with 2 units.

Quote: Again if agglutination cannot be seen with the naked eye, a hand lens, a convex mirror, or the type of microscope in which the contents of the tube are viewed while still inside the tube by placing the tube itself on the microscope slide, IT IS NOT THERE. Were it not for special tests, such as those in which mixed-field reactions may have occurred or when a small percentage of fetal cells might be present in a maternal sample, the microscope should be banned from the blood bank. Is this section clearly referring to rolling a tube on a microscope under a 10X lens?? - As opposed to pouring it out on a slide and using a higher power??? If so, does this quote condone the use of a microscope under certain restrictions and/or for certain tests (notably the Fetal Screen - which it must be used for) - or is it truly interpretable as "a scope should not be used at all"? Just checking ------ And for the start of the thread - Yes - we check our DATs under the scope - tube rolling only; we use Immucor reagents and use CAP and API for various Proficiencies (API for the DATs). I don't know of a Joint Standard that requires microscopic reading, but the inspectors always check that a full DAT investigation includes both IgG and Complement reagents (Polyspecific or the individual monospecific reagents (and you have to have complement dependent check cells too)).

Don't forget that if you make reconstituted units for neonate transfusions - that counts and requires an FDA registration. We irradiate, so already had them coming, but had to add that product after an inspection, so now, may never get rid of them!

Our consent forms are good for the length of stay for our in-patients, but only for each encounter for our out-patients. We require a copy of the consent form each time a unit of blood is picked up (barring emergency and a massive bleed). This has helped us reach (AND MAINTAIN) a 100% 'signed consent form on the chart' standard, but it can be a pain for the RNs and has occasionally lead to loss of the form (Xerox monster) but we can frequently give them back a copy from prior transfusion pickups. Interesting that 2 of you said consent forms for out-patients can last so long. How do you keep track of them and where do they have them stored? How does the RN know the form exists, has been signed and is still good?

Sorry I don't know - but it might depend on what the upgrades were about. Any patient/system safety issues would be high priority. Other stuff, not so much probably.

We get pooled cryo now too, but we did have a procedure where we added a little saline (10 mL) to the first bag and then over time, for the subsequent bags, only added a little of the pool back (10 ml or so) to help with recovery from the subsequent units (instead of a lot of the diluted unit or transferring the whole volume to each new unit, if that is what you are saying). That could save you some time. One does worry about whether either procedure is worth it. Ask you distributor if they have pooled units - marvelous product!!

Love the idea of setting a timer - it is so easy to get distracted and miss the finish of a STAT specimen. The ECHO does not have a loud (obnoxious) alarm when finished and many of our techs are out in the Main Lab anyway when the instrument is running (perpetual staff shortages).

We have had the Hettich EBA 21 centrifuges for years - have never had any problems with them. Speed 3000 rpm, ramp up 9, ramp down 5, for all times (20, 45 and 60 secs). We wash our titers in the Helmer Ultra CW, but spin them in 1 of 2 Hettich EBA 21s. Within reason (and training), we do OK with titers (Cap proficiency is midrange on the bell-curve.)

While it shouldn't be affecting your in-house panel, watch for shipping damage (out of temp) also on the commercial panels. Might cause the damage. We just had one CAP survey for automated Blood Bank that we had to replace 1 out of 6 tubes that was dark (and hemolysed?). Rest were ok.

Fantastic list - now all they need is TACO (Transfusion Related Circulatory Overload) and it's differential diagnosis from TRALI and they are set to go with current recommendations. Seems like there is an increased interest in TACO with regulatory agencies lately.

Interesting idea to try to get the form electronically. We have fought for years to try and get the Admissions folks to get the patient into the computer in a timely manner so the whole hospital has access to pt. information and computer ordering. As we try and transition to a Level 4 trauma center (yes - I know - why bother? We already stabilize and ship), there have been improvements. But we just discovered we still - even if the pt. is in the computer - have problems getting the name in the Lab if we are not receiving orders. We currently have a handwritten Emergency release form - it might help us to have that changed to an electronic form so we get the order, the pt. name and the ordering Dr. - all at the same time. All Blood Bank orders could be entered there to keep the encounter together. For our MTP - the Blood Bank is doing all of the ordering, but an electronic order to start it might help us there too. We are currently counting on a verbal order, followed by the handwritten Emergency release form. We are currently starting our MTPs with 2 units O Neg, uncrossmatched RBCs and have had 2 encounters decline additional units after receiving only those 2 units. (Not complaining - just noting a trend!) Given the problems we are having getting the ER Drs to order Blood Bank correctly - I really don't know if adding even more orders for them to think about will help though. Thanks for the information.

DTT SOP.pdf This procedure is based on the HemoBioscience SOP and the AABB SOP. Works for us. Prior threads on this topic have indicated that the DTT treated cells will not last long, so we do this only at need.

You should be excited - a well deserved honor. Congratulations and well wishes from across the pond.

Try the Blood Type setting for Emergency Issue Units prompts. It says you can define products, etc. We don't have ours set up that way, but will need to consider it for MTP/ Trauma.

Very interesting post - especially given that we are having current problems with Cell 2 also (R2R) with our Solid Phase RS3 strips on our ECHO. We received a new lot# of strips last week and are doing better - just odd that it is cell 2 in both types of systems.