Bet'naSBB

my hospital security will not let me access the survey.....

This morning we tested with DTT treated screening cells - reactivity was still there. If it had been an Lw - it should have been negative.....

We have an Rh neg patient who has received 4 units of Rh neg RBC's and has made what looks to be a perfect anti-D. We do not have a pre-transfusion sample - so the C typing is mixed field (in gel- not strong......more negative cells at the bottom of the column compared to positive cells at the top - like you might imagine in a patient who is C neg and received 1 unit of C pos blood......) leaving us to wonder if they're C pos or C neg..... We typed the 4 units they received and one is C pos. We "want" to say this is an anti-G - but, there's absolutely NO anti-C reactivity. Not even with enzymes. DAT is negative. We've also scoured the few lit. resources we have and none of them address that an anti-G could / would do this..... We even repeated the weak D's on the units...........all tested weak D neg. Any insight?? Side note: We've checked about IVIG, other drugs - nothing. They did get 2 units of A pos FP24 - but that, IMHO - shouldn't have caused any of this. @Malcolm Needs??

expired red cell or plasma units

@jshepherdYES! Totally agree! We actually had staff meetings yesterday to catch almost all staff and this was one main topic of discussion! Our manager explained it very well (I'm the Asst. manager) and the hope is that they - especially one of them - will get the message!

?? Maybe mom has an antibody to a low incidence antigen that could not be detected with routine testing ?? That would be my first thought, at least.

Our facility is a large academic medical center and we transfuse A LOT of patients. (Level 1 Trauma center, large hem/onc service and stem cell transplant program) Unless patient hx /treatment dictates otherwise we don't ever worry too much about ABO compatibility for platelet transfusions. If we did we would waste way too many platelets. That being said - our newbies are having a hard time selecting abo incompatible to people.....even though they are trained to do so......and we are seeing our wastage increase. (we are currently training 7 new people - 4 of which are BS grads self taught by us in our in house BB program) Anyone have any good CE resources / literature about the risks / benefits of giving out of group platelets???

In a sense our hospital is somewhat unique in that we used to have a hospital based MLS program. I was the BB instructor. Because we had about 9 openings we were forced to be "creative". We started pursuing BS grads who met the criteria for our MLS program when it was still in existence. Because I was the BB instructor - I still had ALL my lectures which I had since recorded for our Pathology Resident program. After at least 2 interviews each - giving them information about basic BB'ing that they had to study to answer questions during future interviews - we have hired some of these BS grads, Their 1st month is "School" where I basically teach them BB as I would have taught my students. They are not working the bench at all - just student samples, etc. I also give them ALL my tests. Once they complete our internal BB program - they move on to training at the bench. After working in our BB for a year, they will be eligible to sit for the BB(ASCP). Our first 2 came in February and the 2nd 2 started in August. So far 3 of the 4 seem to be doing fairly well. The 4th isn't "bad" - they just came for working in the research environment and their research perspective isn't really a good fit (although we hired them because we thought that would be a great asset!) but it's getting a smidge better day by day. We did have 9 openings at one time with at least 4 on 3rd shift.....we are now looking at 2 openings for which we are being "picky" and are looking specifically for techs with at least 1 year BB experience. We are a very busy - very large transfusion service and also do just about all of our own reference work. Really the only thing we send out is genotyping.

@Baby Banker - sign on bonuses - unfortunately - are NOT the answer. Our hospital offered a $10k sign on bonus and $1500 moving expenses.....ALL of the people who were hired for our BB in those positions are all gone. They worked their "required" time to get all their $$ and then they were gone - not to mention the people it attracted were less than ideal candidates for our BB - but we had so many openings we pretty much couldn't NOT take them.

So - just curious to hear from current Sunquest users......(it's changed names - but not sure what the new name is..... Clini.........?) We had Sunquest years ago and then moved to SCC (SoftBank). SCC offers things like Transfusion Reaction documentation capabilities, Reagent QC documentation, supply inventories which - back in the day - Sunquest did not. Our facility is most likely going back to Sunquest.......not really by "our choice" but, through our hospital network choice. The question is, does Sunquest now offer the above listed capabilities in any form or fashion?

For your facility in the UK - this may be common practice and I can only speak for OUR facility - but we have to do eluates on ALL our pos cord DAT's...... We didn't have a Labor and Delivery unit for many many years - so I can't say this is being done "because it's always been done this way" this time... Our L&D opened up maybe 4-5 years ago.

What eluate kit do you use? If you use one with a "working wash" - try repeating your eluate, washing with normal saline instead...........usually takes care of it. We see this quite a bit - especially with Rh's and K's. Our Medical Director refers to it as the "Ogata Phenomenon" https://www.bbguy.org/education/glossary/glm06/

@exlimey if a Lewis antibody is identified - we type the patient...... it's just how our protocols are written. The only time we would be required to provide Lewis antigen matched units would be if the antibody demonstrates hemolysis at AHG otherwise just XM compatible. Do I know why? not really - I've just been doing what I was told......for almost 35 years.

As for temps - we use the REES system and print 24 hour reports daily. Tech checks them for outliers and then they get filed in a book. Manual Daily temps are taken of ALL temperature related equipment daily on a monthly sheet. both the manual monthly sheet and the REES reports get reviewed by management monthly and then are stored. Our inventory is also available electronically. Our techs can access the report without printing it and then fill out our inventory form manually which has optimal levels, etc on it which they use as guidance for ordering. Inventory is performed once per shift and each shift inventories a different combination of products (platelets are separate). These manual inventory forms get kept a month - if that - and do not require a manager review. Hope that helps!!!

Have an O neg, CPDA-1 or AS-3 irradiated unit (no mannitol) on hand and give it. The fresher the better. - Could maybe set up some sort of standing order with your supplier for 1 fresh O neg AS-3 every 10 days so that you can rotate the older O neg into regular inventory and keep 1 fresh set aside for the off chance you'll need one?????