jhaig

In cases like this, we have obtained a new sample after 72 hours from the first draw. Our computer allows us to charge units crossmatched under the outpatient account to be moved to the inpatient account. This only applies to the charge for the unit and not the crossmatch itself since the crossmatch was performed under the outpatient account. It does make life easier to be able to 'merge' both accounts under one common account. If the patient stays for more than 72 hours, then we would obtain a new sample and charge accordingly under the inpatient account.

How many hospitals out there are going to spend hundreds of thousands of dollars to implement a mechanical barrier system just because CAP says so? If it comes down to a question of money, I think we all know how that's going to end up. CAP can't even give any clear information as to what 'mechanical barrier' they want us to implement anyway. They only want us to work on a system that minimizes patient risk. I'm in the process of developing such a plan which will help me sleep at night. I am leaning toward performing a retype on a second draw if there is no patient history available in the computer. On the night shift where there is only one tech, the tech can only issue group O products until a second draw, such as the morning CBC, can be obtained. Many times a CBC is ordered before the blood bank work is needed. As long as both specimens are labeled properly, this should be satisfactory. In the end, it will amount to a few more minutes to confirm the blood type and stocking more group O products. We also use a separate blood bank wristband for all transfusions. We're still working out the kinks, but hopefully this will be a huge step taken to prevent a possible mistransfusion. I'm much more concerned about whether or not the correct patient has been drawn rather than if the tech has performed the ABO/Rh correctly. Performing an ABO in blood bank is kind of like breathing - it should be done without thinking. If a tech has a problem performing this simple task, then they should reconsider their career path.

They must have been running late this year because ours showed up about four months later than expected. They have their own schedule, but still it was four months of nail-biting and waiting for the hammer to drop. Everything went fine, but I think they were late just because they can be - they're the FDA, after all. Did anyone else notive a huge emphasis on tissue bank requirements this time around?

Isn't it funny how nurses know it all? I don't know about regulations, but when our state inspector visited us last year and saw that when we issue blood products they all go into a clear biohazard bag for transport to the floors, he was pleased to see it. We had one unit get dropped on a elevator years ago when it slipped off of the top of the chart that the nurse was carrying it on top of. Needless to say this made a gigantic mess, so since then all units leaving the blood bank are placed in a clear biohazard bag. It may or may not be a strict regulation, but it's good practice and easy to do.

On behalf of all AB Pos ladies over 104 years old with red hair, we would be honored if CAP thought enough of us to legislate our transfusion needs:D We do charge for the second blood type. In fact, the blood cannot be released without a confirmatory ABO in the absence of a previous blood type record. Now about the B Neg men with no hair at all...:cool:

If we were to institute a second re-draw, how should I go about investigating whether or not it is being followed? I would anticipate having similar problems with my some of my phlebotomy staff drawing two purples at the same time then changing the time on one of them and submitting that specimen as the "second draw". If this happens, then I've got a policy which does accomplishes nothing. I could also see a potential problem on our night shift where there's only one tech and one phlebotomist available. If the phleb draws a patient with no history in the computer, the tech cannot go draw the patient for the retype since they are not allowed to leave the lab unattended. There must be a happy medium somewhere.

Sounds like this would work. I'm wondering, however, when this second type would be performed. Would a previous draw done before the blood bank order was placed be used? Or would you wait until another specimen is drawn later, after the crossmatch has been completed? And if so, would you hold the units until the blood type is confirmed? Or does it even matter as long as you have a properly labeled specimen when you actually do the second type? It sounds like CAP is leaving it up to each institution to figure out a system which can reduce the possibility of misidentification. It would be nice if the patient wouldn't have to be drawn twice just for a blood type. Until CAP says we need two separate draws to confirm ABO, I'd prefer a method similar to this one being suggested, as long as the specimens are properly labeled.

We also offer Rh only and have had no issues with the test as far as compliance. If the doctor wanted to know the ABO, it would have been ordered. I may run one for my own knowledge in case an RBC transfusion is needed later (this would give me a head start as far as preparing units for crossmatch), but that result is never reported to the physician unless there is an actual order. What the doctor doesn't order, the doctor doesn't get. :cool:

This is one of those checklist questions that CAP seems to specialize in, a question that is vague at best and leaves the standard open to multiple interpretations. We'll continue to do retypes as we have but it seems like they want more. They give suggestions like an electronic ID verification system. I don't know if anyone has noticed, but a barcode system is extremely expensive to adopt, especially in a medium to smaller sized hospital like mine. As long as each institution can figure out how to monitor their own transfusion system, then CAP should be happy. And how does having a separate blood bank wristband (Hollister, Typenex, etc.) with another independent blood bank identifying number on it not satisfy this requirement to reduce risk in transfusions?

So the bottom line is... CAP and AABB have requirements for retyping only if the blood bank performs electronic crossmatches, and if the blood bank performs a serologic crossmatch, there is no specific requirement for a retype.

So the same tech can perform another ABO on the same specimen if the patient has no prior history present in our computer (Meditech) system? I guess I'm a little confused on the 'computer crossmatch'. Is this the same as an electronic crossmatch? We perform all of our compatibility testing in gel unless an emergency presents itself. In reviewing the AABB standards for electronic crossmatch (5.14.2.1 - 5.14.2.5) our system meets all of these requirements. Maybe I'm just confusing myself with terminology or it's just too close to the weekend...:cool:

We're in the same situation. We usually have only one tech in blood bank and the off shifts cover the rest of the lab as well as the blood bank. If a patient has a type already on file in the computer, we accept that history check as the first 'type'. The second type is performed on the current draw. At the present time, if the patient has no history, the blood bank tech performs a repeat ABO off of the same draw. This is done out of necessity since on the off shifts not all techs are trained in blood bank. On night shift, where there is only one tech, they have to have the ability to release units and can't wait for another tech to check their work. My main concern is that the right patient gets drawn. Our phlebotomy team performs all of the draws at our hospital (nursing has all the power and doesn't have to do anything they don't want to do). In my experience, if a phlebotomist can cut a corner, they will. So asking them to do two separate draws for a repeat blood type is asking for trouble and would not serve any purpose for us. They could very well draw two tubes on the first draw and then send you the second one later, saying that it was a redraw. So we really rely on phlebotomy to draw the right patient the first time. They cannot draw a patient without a hospital wristband and they will then place a blood bank wristband on the patient as well. I'm just not sure how CAP/AABB will interpret our policy as it relates to the new standards. Because of our staffing situation, I feel like I'm stuck between the proverbial rock and a hard place.

How does everyone handle retyping of patients with no previous blood type history? I've heard of doing two separate blood draws, two techs doing typing from the same tube, two aliqouts from the same draw, and others, but I'm just trying to get a overall idea of what is the easiest way to do this.

We wouldn't rule out the possibility of HDN in a case like this because of the Rh incompatibility and the positive DAT. I've only seen this happen once before and in that case there was no clinical evidence of HDN (hemolysis, etc.) so we sent the final report out with a comment stating that the infant's anti-D is most likely due to passive anti-D from the mother's Rhogam injection and that due to the lack of clinical symptoms of HDN that the anti-D is most likely clinically insignificant. It is possible for the anti-D to be detected for up to 24 weeks after administration in the mother, but I'm not sure whether that would apply to the infant as well. Check the AABB Technical Manual 15th ed. pg 548 for more info on Rhogam and antepartum administration.

AABB Standard 5.11.2 refers to blood samples being labeled with two independent identifiers. We use Meditech and all of our specimens have the patient's full name, date of birth, medical record number, date and time of collection, and the initials of the person drawing the specimen. Which of these identifiers, in accordance with the standard, are needed on the blood bank wristband (we use the Hollister system)? Right now, we put all of the above info on the bands, but it seems like overkill. At the same time, how safe is too safe? As long as there is a mechanism to assure the blood bank that the correct patient has been drawn, we should be in compliance. I just can't find a standard regarding blood bank wristbands.

We had a patient the other day come in for autologous donation with a very strong cold agglutinin. The CBC tube had to be incubated for around an hour to get a valid H & H. My question is: what effect will this cold agglutinin have on this donor's autologus unit which will be in cold storage for at least a week? Can it simply be reinfused through a blood warmer which will allow the agglutination to disperse or will the unit be unable to be infused?

I began my preparation by downloading the implementation plan from the AABB site and have begun to review it. I have also learned that our blood bank system (Meditech) should already be equipped to read the ISBT barcodes. Can I basically use the AABB document and tailor it to our institution to satisfy the Nov. 1st deadline or is there a better course of action to follow?

PEG is a good option to increase the possibility of picking up an Fya, but using PEG with a warm auto will possibly cause you to miss it as well as any other underlying alloantibodies.

I'm having trouble finding information on when to quarantine an RBC unit when lipemia is seen in the plasma. If a unit is grossly lipemic, I will not issue that unit to a patient. I realize that lipemic patient specimens can cause difficulties in reading serologic results, but what difficulties do lipemic units present?

We have used the Hollister R# system for many years now and do not transfuse any blood products (except albumin) without the R# wristband being present on the patient. The hospital armband includes the patient's full name, medical record number, and date of birth. I do not accept any specimens into the blood bank without the tubes having the R# on them. This gives the patient an extra identifier which also gives the blood bank an extra layer of security. You can't ever be too careful.

Is there an actual SBB exam review guide? I had been under the assumption that there was no such thing, at least through ASCP. Who is the author and/or publisher?

I am looking for some information on certain procedures for which my MSBOS may be in need of updating. Specifically, I'm wondering what other hospitals are doing regarding surgical orders for total knee arthroplasties (single or bilateral) and total hip procedures (arthroplasty, Austin Moore, etc.). We have a group of orthopedic physicians which just can't seem to get on the same page regarding what to order. As of now, our MSBOS requires a type and screen for a knee and 2 units of either packed cells or autologous units for surgery. Some doctors insist on having either 2 units of packed cells or 2 autologous units for a knee arthroplasty. My last study indicated that when the patient's pre-op hematocrit is 40% or more, 9 out of 10 auto units collected for surgery are not transfused and are ultimately discarded. This is a tremendous drain of time and resources. The Transfusion Committee is trying to not so much refine our guidelines but to enforce them without irritating the physicians. I realize that every patient is different, but the numbers ususally don't lie. Any ideas?

I took the SBB exam last year and didn't do too well, at least not well enough to pass. I thought I had prepared as well as I could have, but when exam day came I had no luck. Am I crazy or did a good portion of the exam deal with topics and other things that I'll never see or use? Should I have expected not to pass the first time? I have a 4-year degree in biology with 14 years of clinical experience with the last five as a blood bank supervisor (five of the fourteen years were not in blood bank). I thought I was prepared but I must have missed something. I couldn't find very much information on preparing for the exam so I tried to prepare on my own. I'm looking for advice for those of you who have passed this thing. Any information or advice would be helpful. Thanks.

Greetings and salutations. This is my first post, so hopefully I'm doing this all correctly. My name's John and I am the Blood Bank supervisor of St. Joseph's Hospital in Elmira, NY. I've been here about five years and have never had a dull day on the job (well, almost). Hopefully I can use this forum to get some questions answered and also help some of you.