Mabel Adams

Marilyn Moulds is trying to create a blood bank museum. I don't know if it is mostly virtual or not. She can be found on FaceBook these days.

We have an opening for a coordinator to support our SafeTraceTx 4.6 system plus several other roles in the transfusion service in our level 2 trauma center. It's a fun and beautiful place to live and a good lab culture to work in. Please message me or use the link below to share about or apply for the position. https://stcharles.wd1.myworkdayjobs.com/External/job/Bend-OR/Coordinator-Blood-Bank-Information-Services--Full-Time--Days-_R1013336

I was hoping you would share your experience. Thanks.

The Blood Group Antigen Fact Book says HDFN risk of Anti-Kpa is mild to severe. Apparently ACOG says this antibody causes only mild HDFN. Does anyone have any references or know why the book includes "severe"? Our patient has a titer of 32 and we want to manage it like anti-K, but maybe it doesn't affect the red cell precursors like anti-K does.

For gel 2+ or less, we ask provider to allow us to send out for molecular typing if patient has childbearing potential. Otherwise, we usually interpret them as D positive but add a note that their type is weak and atypical so they may sometimes be reported as negative and other times (other places) as positive. If they have anti-D or some other reason (anti-C & anti-E?) we will choose to call them D neg.

If we get in a directed donor unit with a D00 at the end of the product code, and we want to give it to a different recipient than originally intended, do we relabel it with a V00 product code or can we leave it as D00 and cross it over to regular inventory?

I think AABB requires that stored blood products be maintained in a way to reduce errors. The old tradition (maybe there are still rules) of keeping specimens below blood products suggests that specimens spill in the refrigerator. I can't recall every seeing that happen. I've seen a few doozy spills out on the workbenches but not in the refrigerator.

Update: apparently AABB is changing this standard to an interim standard. Proposed Interim Standard Focusing on Sterile Weld for the 33rd edition of Standards for Blood Banks and Transfusion Services (aabb.org) If the integrity of the weld is complete, and the compo­nent is in a container approved by the FDA or Competent Authority for storage, then the original shall have an expiration date/time shall apply, consistent with the storage requirements for the blood or blood component. assigned in accordance with the FDA- or Competent-Authority-approved package insert for the storage container. Standard 5.1.4 applies. Regardless of the integrity of the weld, if no storage time limit is specified in the package insert or the package insert is not available, the component shall have an expiration time of 4 hours after transfer from the original container. Confused yet? I am.

I just got information back from Fresenius (now maker of Fenwal transfer packs) that their bags are good for red cells through the unit outdate but that they are not approved at all for platelets. Do you know if Charter Medical says that their bags are approved for platelets? We use their 60 ml syringes and they are listed as okay for platelets so I assume their 150 ml syringes would be but wasn't sure about their bags.

One thing we require, before using a pre-warmed technique, is proof that there is room temperature reactivity. You had this with the reverse type but that is often lacking in group O patients. It's not perfect for the anti-Vel etc. but it prevents the habit of doing a pre-warmed technique just to make reactivity disappear. It is a saline method so less sensitive, after all. Using it when you are pretty sure you have a cold can be a reasonable risk to take. Using it when you don't have a cold antibody, means taking an unnecessary risk.

Does anyone know a manufacturer of transfer packs that stipulates expiration times? I find nothing online for Fenwal bags and the box doesn't list expirations. Four hours isn't even enough so the product is still in-date at the end of the usually allowed 4 hour infusion time.

What is the expiration used for platelets that are divided into a transfer pack/bag using a sterile welder (closed system)? Do you use the original expiration or does the plastic of the transfer bag not allow oxygen transfer like a platelet bag so they have to have a shorter expiration? If the latter, how long of an expiration is permitted?

Do you know if they assessed the results based only on recipient blood type? I would think that group O patients would be much more likely to get ABO-incompatible platelets. Group O patients are known to have different bleeding tendencies for other reasons. I would like to be sure they accounted for this possible confounder, or understand why it doesn't matter.

If IS XM can be a test on the Vision, I would think it could go through the interface like the AHG XM does. Might depend on your BBIS.

How is your final product labeled? I didn't notice that in the document.

I think Texas is studying this. I have heard that the cold-stored platelets are already activated so are thought to work well for rapidly bleeding patients. I don't think activated platelets last well in your average oncology patient.

IS XM in Ortho gel uses the neutral card, while IAT XM requires the IgG card. We don't currently stock the neutral gel cards. Our small hospitals are gel-only so any IS XMs needed there are done by using the neutral wells in the ABD/Reverse card that were intended for the reverse type. They do these maybe once a year at most.

We have for IgG XM but not IS. The latter is very fast in tube and we don't do it except during computer downtimes and some rare occasions. We use the electronic XM for most.

We have had several openings for many months. One problem in this tourist town is that no one can afford to move here. We have 3 travelers in the lab in our hospital and several more in our smaller hospitals. One tiny rural hospital in our region has zero lab employees--only some travelers and a respiratory therapist trying to supervise the lab. We have been sponsoring lab assistants and other current lab employees to take online MLS programs for a few years so we grow our own, but we don't have the bandwidth to do the clinicals for more than a few per year and that won't fill all of our positions. The next few years will be rough as the college students who may have taken a pause going to or through college in the past two years will slow the pipeline of outcoming new grads. And this is a smaller generation than any before. I suppose the peak of boomer retirements may have happened already but there are still some of us left.

In other lab testing, we would not expect the reference lab to do additional tests and charge for them beyond what is ordered. I understand the need when doing an antibody workup as these things are interrelated. Why would a reference lab need the ABO/Rh of the father of a baby of a pregnant woman with anti-Kpa? I know that they should do a DAT before using IAT antisera, but to me that is QC, and need not be a reportable test, nor charged for in this case. Molecular would be more expensive than typing for Kpa/Kpb antigens serologically and cost is a barrier to getting the testing done. I have tried in the past so I doubt that I can have any impact whatsoever on the policies of our reference lab but I was wondering if I might find somewhere else to send these antigen type specimens that will do only the testing we order.

Dr. Blumberg, I have long been impressed with your amazing knowledge. I keep some of what I have learned from you in my head even though the mainstream has never accepted it. Thanks for sharing so much all of these years. If we were to use liquid plasma, it would be group A and have an expiration of 26 days from collection (5 days beyond the whole blood it started as). It would be in our small hospitals because they lack time to thaw plasma when a trauma lands at their door. The flight services that serve our area are carrying liquid plasma now along with O neg red cells. As the cost and availability of O red cells has become more of a problem, we are looking for ways to start out our trauma or MTP patients with plasma instead of red cells. The trauma surgeons like the idea of having some clotting factors given first (although liquid plasma on day 26 will have low levels of several labile factors). We would plan to never give more than 2 units of liquid plasma to a given patient. We are a smallish, remote, level 2 trauma center. We currently keep 2 units of thawed, group A, 5 day plasma at our main hospital for traumas/MTPs. Our small hospitals would use it so rarely that 5 day plasma would go to waste too often. We also have MTPs that don't turn out to be massive. The patient gets maybe 3 units of uncrossmatched red cells and then they realize they weren't that bad after all. If we start with 2 units of plasma, they may not even use any red cells. Are you thawing plasma and keeping it for more than 5 days as "liquid plasma"? Another question: irradiating liquid plasma won't necessarily mitigate the WBC issues that you describe, will it? The lymphocytes can't multiply but the WBC antigens, biologic mediators etc. would still be present to wreak the havoc you described, wouldn't they (depending somewhat on leukoreduction, of course)? Sorry to ramble so.

Do those in the US who use non-ARC IRLs get charged for ABO & Rh on every specimen sent, even if all that is ordered is a non-ABO/Rh antigen type? Also, if you order a k type on a patient (say, you have already done the K type but need to see if this father is homozygous for K) does your reference lab test (and charge) for both K and k regardless of how you order it? Lastly, if the order is for, say, Kpa testing (where the antisera requires IAT testing), does the IRL charge you for a DAT on the patient? We are having a hard time passing on these charges for tests that weren't ordered by the provider.

We are ready to consider discontinuing the BB armband. Phlebotomy has worked hard to reduce the number of 'scan overrides' in Epic when collecting our specimens. We still have some work to do on Nurse Collects. That is an important milestone for me. The transfusion side (BPAM) does a good job of accurate ID but I want the specimen collection to be equally accurate before I switch. We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.) Likewise for outpatient transfusions. As of now, we have a blank line on the Epic blood release form that the nurses record the BB band # on before they bring or send it down to blood bank. We have those forms print on the nursing unit. The BB band # is not documented in Epic, but we have a custom flowsheet row where they acknowledge that it was checked and matches.

If you test in gel, I find that many warm auto antibodies seem to react better with D positive cells in gel.

Can anyone explain the justification for irradiating liquid plasma (never frozen) used for trauma patients when we don't irradiate the red cell units they get? I know the RBCs are leukoreduced so don't contain many viable lymphocytes but there were cases of GVHD if LR units weren't irradiated. Our liquid plasma is made using a hard spin so I would think that there aren't many WBCs in it but no one seems to be able to tell me how the number of lymphocytes in liquid plasma compares to the number in a LR red cell unit. Maybe this is because the big places irradiating their plasma have their own irradiators. For us, it would nearly double the price of the plasma unit so I need justification.