jhaig

For retypes, if a patient does not have a verified blood type on file, a second specimen is drawn after testing of the first specimen is complete. This re-draw is done, preferably by a second phlebotomist, at a different time. Anything else, other than a second draw at a second time, is pointless if you want to verify a patient's ABO/Rh. DAT's are only run on patients that have been transfused within the previous three months, positive antibody screens, or patients with a previous antibody history. We're a 295 bed facility in upstate NY with no maternity but an active OP and dialysis dept.

Our blood supplier has notified us that they will not be ready for the ISBT conversion until at least Jan 1, 2009. They have a variance from AABB and say that each of their facilities also have to have their own AABB variance. Can I take care of this on line and is it a lengthy process? My FDA variance took less than a month, so I hope it's not much longer than that.

Immucor gave their presentation to hospital administration yesterday regarding the Echo. We are currently evaluating the Echo vs. Provue. We've seen the Echo in action and the users said they couldn't live without it. I want to also see the Provue (due diligence), but I was very impressed with the Echo's flexibility with adding STAT's, turnaround time for type and screens, ease of use overall which the off-shifts will love, and customer-changeable parts. It seems like this instrument would suit our needs very well. The only down part I see is that we use Meditech and their interface is still in beta-testing. If we get approval to purchase the Echo, do I still follow through and at least give Provue a shot? My organization is not known for approving large purchases like this, but they seemed very receptive, especially when I mentioned how much money we'd save in reference lab costs.

To quote Ferris Bueller's Day Off - "They bought it!":cool: I got my retype policy through transfusion committee with little problem. The only question that medical exec. had was along the corporate compliance route (of course). Does a re-draw for confirmation of ABO typing require a physician's order?

I should have added that the heme tube should be labeled correctly. I also am waiting on our blood supplier to approve my request to ship me a few more O neg units. I'm still a little fuzzy on the Rh issue. If the current specimen is Rh positive, how can I give O Pos if it hasn't been verified? Am I being too careful, if that's possible? Would this only apply to females of child-bearing age? I'd rather give O Pos because of obvious potential inventory problems, but at the same time I don't want to have patients create Anti-D if not necessary. We don't have a maternity unit here, so the neonatal issue isn't a problem.

I'll be proposing my retype policy change to transfusion committee and hospital administration in a couple of weeks and just wanted to have a few more sets of eyes look at it. Proposal: Any patient requiring transfusion of packed red blood cells that does not have a previous ABO/Rh history on file will have a re-draw done at a different time to confirm the ABO/Rh. The blood bank tech can use a previously-drawn specimen from hematology if it available. If transfusion is needed before the patient's ABO/Rh is confirmed, the patient will be issued group O negative packed cells. This policy change will increase patient safety in receiving a red cell transfusion and will further limit the possibility of a mistransfusion. Most of our patients either have a previous history, have already had a CBC tube drawn prior to blood bank orders being placed, or do not fall into the emergency transfusion situation. The amount of actual re-draws that will need to be done should be kept at a minimum. Any emergency orders would still receive uncrossmatched O-neg. This is the easiest and most cost-effective way we've come up with to meet CAP standards. We are not a trauma center and most of our transfusions fall into the non-emergent category (routine inpatient, OP dialysis, etc.), so there shouldn't be much of a reason not to get a re-draw if needed. Any other ideas of ways to enhance or edit this proposal would be greatly appreciated.

Stopping I.V. fluids could also lead to an increased Hgb, but I agree that a 2gm increase certainly needs to be looked into. I first check into whether or not the correct patient has been drawn, then I'll look at their chart and look for things like I.V.'s, weight,etc. Case by case is the way to go. Remember this is only an average increase, and those little old ladies tend to throw off the curve.

If we don't get an ID in gel, we usually will send it out. While the specimen is being worked up by the reference lab, I will use my back-up panel to see if there are any specific cells to do rule-outs on. We just don't have the time or the staffing to do elaborate work-ups involving anything more than a repeat panel or an eluate.

How do we know this is a 'one-time' increase? Is there anything stopping these companies from doing this again? Another 100% increase next year will start to affect what services some institutions, including mine, can offer. They seem to be able to increase their prices at will citing things like 'increased production costs' or 'decreased raw material' blah blah blah. Yeah, it's business, and it seems like every time we get stuck with an absurd price increase, blood banks are being given 'the business'. :mad:

My senior research project was on differentiation of megakaryocytes in rodent bone marrow, but unless you've got some rats handy, you're out of luck.:cool: Great Vande-jerk reference. That playoff shank couldn't have happened to a better person. What about something like a family genetic study? Maybe drawing a family's blood and phenotyping them out, a family tree-type thing? Here's some projects I'd like to see myself: 1) What STAT really means 2) How nurses got so much smarter that blood bankers 3) Who financed the pyramids (obscure 80's comic reference - bonus points to whoever knows where it came from)

We keep a supply of Anti-C, E, c, e, K, Fya, and Jka. I recently discontinued Anti-M and Anti-S since they cost the most and got used the least. These cover the majority of our transfusion problems. Our reference lab is able to provide us with S-negative units if needed, so I ditched the Anti-S. Anti-M is usually only significant if it reacts at 37C, so crossmatch-compatible units are usually OK for patients with documented Anti-M, and I can get M-neg units from the reference lab as well, so I said bye-bye to the Anti-M. Jka is next on my list. I hate to spend that much for something I'll mostly use only on surveys, but I'll probably keep it around just in case.

At this point, I would stock up on products that have good expiration dates and order heavy in June. I wouldn't expect Immucor to honor anything at this point after dropping this collective bomb on us.

I haven't seen Ortho's list, but there's no way I'll spend $1000 for one 5ml vial of Anti-S. That's ridiculous. Hello, reference lab......:cool:

My guess is that they're trying to push their Capture technology. Notice how much cheaper the automation prices are. That's not a coincidence. Looks like the hospitals (like us) that don't have the resources to spend six figures on automation will have no choice but to suck it up. Too bad Immucor has decided to stick it to the little guys and let the big boys with their big toys run the playground.:mad:

We double-check everything at the time that results are entered into the computer. Included is the patient's full name, date of birth, medical record number, the unit's ABO/Rh and the patient's ABO/Rh, the donor number, expiration date, and the patient's R# (we use the Hollister wristband system). When issuing the unit, a blood bank tech is required to check all of the above info with the member of the nursing service personnel. The nurse is also required to bring physical proof - something with the patient's name on it, like a cardex stamp or the patient's blood bank report - so they can prove who the transfusion is for. No ID, no blood. Sometimes they try to say something like "Oh, I was just on the way back upstairs and thought you'd be able to give it to me". Sorry, sweetie, it doesn't work that way. We also only allow nursing service personnel (RN, LPN, or nurse's aide) to pick up blood products. Unit clerks and students cannot receive blood products. We do make exceptions for students if they're accompanied by a nurse that will co-sign.

I'm also more concerned about ABO mismatch than Rh. Not that Anti-D stimulation is wonderful, but Rhogam will take care of that. We also don't stock a huge amount of O neg so I couldn't just give out O neg like Halloween candy to everyone without a confirmed ABO/Rh. Thanks for the info. My brain has gone into vapor lock today trying to complete AABB assessment material and doing an NCAA tournament bracket during lunch. :cool:

This may have been covered in one of the many threads about obtaining a second blood type on a new specimen, etc. - but - our policy on retypes requires that a second specimen be used if there is one available. If there's not one that has already been drawn in the lab, then a second aliquot of the previously tested specimen is used. I want to change this policy to include only transfusing group O red cells until a second specimen is drawn and the blood type can be confirmed (on patients without a historical blood type already in the computer system). I don't trust either phlebotomy or the nursing staff to draw another specimen to confirm a blood type. I think they would try to draw two specimens at the same time and hold one back. Maybe it's me, but I'm going on past experience. So - I need some information on switching back to a patient's original blood type after they have received group O cells. Say a B-Pos patient receives 2 units of group O then has another specimen drawn to confirm the B-pos blood type. Is there a time frame for giving the patient B-pos? We don't have this situation come up very often. Usually a patient getting blood at our facility either has a previous blood type or has a specimen that has been previously drawn over in hematology, and of course we give O-neg. in emergencies. I want to protect patients getting routine transfusions.

I'm trying to find some ideas for my annual process improvement project for this year. Right now I'm auditing transfusions for the nursing staff, auditing blood bank wristbands for phlebotomy staff, and checking transfusion vital signs for possible missed transfusion reactions. I'm in a rut and need something else new to do in addition to these projects.

Any information on this topic seems to be more myth than actual fact, sorta like Bigfoot. There may be an actual standard, but there's no physical proof.:cool: We always wait a minimum of 1 hour after the transfusion has been completed before trying to measure any hematology values that may be affected by a red cell transfusion. The only exception is when we're looking for a platelet response measurement and will draw a specimen 10 minutes after platelet infusion.

You'd be surprised at how effective it is to write up a nurse that has removed a tag during transfusion and have that write-up reviewed by an inspector. As a result of more frequent transfusion audits, this practice has been drastically reduced at my facitiliy (at least as far as I know). We also use a pre-printed 3-part form in which nursing records all information about the transfusion, including vital signs. The form is attached to the unit with a tagging gun. A copy is returned to the blood bank for our records when the transfusion is complete.

If you can't see it in gel, it's probably not clinically significant. AHG crossmatches in gel should be fine, but still do the procedure even if the current antibody screen is negative. Tube testing? What's tube testing?:cool:

Here we go again! The last time this issue came up it sure got some attention. What we do as far as FFP is give AB if no current or historical type is available. Platelets, well, they'll probably get whatever is available and can get to my hospital the fastest since we don't store them in-house. Retypes - our policy states that if a properly labeled second tube from a separate draw is available, that tube is to be used for the second type if no historical type is found. If there's no second tube available, the current specimen is re-tested using a different aliquot. I'd prefer a second draw or to issue only group O red cells until a re-draw is done. Baby steps count as long as they're forward...

Leuko-reduced does not equal leuko-free. Always irradiate to prevent GVHD.

If you're meeting the Standard's standards, then there shouldn't be an issue. We do a clerical check, hemolysis check, and pre-/post- ABO/Rh and DAT. The doctor always has the option of ordering a haptoglobin, urine dipstick for bilirubin, blood cultures, etc. but they're usually satisfied as long as the inital workup shows no discrepancies. I wonder if this 'observer' is a chemistry tech trying to boost testing volumes:cool: