rcurrie

Don't forget to ask the physician about the procedure. We have had cold reacting only anti-M become clinically significant when the patient was chilled down for open heart surgery.

We had one potent cold agglutinin cause problems with the heart pump, but that didn't cause us to begin checking for cold agglutinins again. Too much trouble for such a small risk.

We only set up units on inpatients. New antibodies on outpatients just generated a call from the medical director to the attending physician.

I believe your procedure is correct. Since the units issued did not qualify for an electronic crossmatch at the time they were issued, then you must perform a serologic crossmatch. BC

Ah, the old shakedown problem. I visited my BB mentor one day. He was working on a transfusion reaction workup. I asked him if it was the usual febrile reaction. He said no, it was a real antibody. It seems that the patient had a 1+ reactivity, but the tech that did the type and screen had a 2+ shakedown. No joke. BC

Great job in increasing the safety of tubed blood, Thad. BC

What Mabel said. I have audited many transfusions, and it is sad to say that I found that in many cases the nurses were doing their "bedside" checks with the unit clerk in the unit station. As Gomer Pyle used to say: Shame, shame shame! Don't bother citing FDA, AABB or CAP- the only thing nurses fear is JCAHO. BC

Kip, High bilirubin was noted in each sample, so it is not a color issue. It may not be a donor issue- it could well be a processing issue. Are these SDP platelets? You may need to recalibrate the RBC detector on a certain apheresis machine (see if the units can be traced back to a certain machine). Are the random donor platelets? There may be someone new in the processing center that is being rough on the whole blood units; the units could be over-centrifuged, thus hemolyzing some RBCs; or there may be some other processing problem. Remember the cardinal rules of traceability and trackability, and look at who handled the units in question and what instruments were used in the processing. I bet you have a processing problem rather than a donor problem. BC

We are a bunch of old fogies who have failed to keep up with social practices. Some of you younger techs out there should have presented the most obvious solution: Blood Bank tatoos. Every transfusion service should have a certified tatoo technician, whose job it would be to tatoo the blood bank ID onto the potential blood recipient. Why has no one thought of this before now ! ! ? ? BC

When I started blood banking many moons ago, we would set up 6 whole blood, 6 packed cells, 6 FFP and 12 platelets for all CABG patients- there was no such thing as a redo CABG back then- your only options if there was restenosis were the type of casket and burial vs. cremation. Back in 2007 (before I changed careers back to railroading), our cardiac sugeons were just asking for a type and screen. Most of the patients went home with no transfusion whatsoever. After following cardiac surgery patients for almost 20 years, I have decided that the best transfusion is no transfusion. This doesn't hold for all patients, though. There is just something different about giving blood to someone who has had open heart surgery. We have all seen the studies, and I agree with those who advise against transfusion unless absolutely necessary. BC

Back when I was in the blood banking business, I was a member of our Level 1 trauma team. When the issue was brought up, I said they could have all the type A plasma they wanted, as I was unable to even put a dent in the bucket with AB plasma. They weighed the risk, and agreed. So, we don't automatically supply AB plasma for our traumas- they get type A until proven to be type B or type AB. It sure beats no plasma at all. BC

Mabel, I have always had great luck with the Terumo sterile docking devices. BC

Shily, you beat me to the punch. Sounds like it could be anti-LW. BC

I am with you, Ada. I never agreed with the CAP ABO repeat requirement. I am still waiting on the pictures of your new blood center ;-) BC

I vote nay on automatic elutions. Get a history if the DAT is positive, and consult with the physician. BC