Mabel Adams

Anyone else remember when the RhIG used to come with some of it in a separate vial which we had to test against the patient's cells? I guess to prove that they really were Rh negative. We definitely had to do an antibody screen with that. That was before 28-week RhIG or Fetal Screen/rosette tests.

There used to be a regulation that the birth parent not be sensitized to D to be a RhIG candidate. We trust that the baby lacking a positive DAT due to anti-D is sufficient evidence and have not done anything but the needed Fetal Screen in a couple of decades, even when we didn't do admission T&S routinely. I think key is what will we do differently with the results? If you detect anti-D, you will assume it is RhIG and give RhIG again. If the Ab screen is negative, you will give RhIG. The test doesn't change the treatment so why do it? This assumes that a strong anti-D, clearly due to sensitization, would cause the baby to have a positive DAT and therefore any needed workup would be completed for that reason.

Most of our antibodies to gel diluent react only with the pre-diluted reagent cells, but not in cells suspended in MTS diluent 2 (auto control, XMs). There are no antibiotics in the diluent 2 because those suspensions are discarded promptly whereas the reagent cells must remain stable for weeks. If there are antibiotics in the gel itself, we have not seen reactions to that, but it makes sense.

We accept patient (and unit) antigen typing done at our reference lab. I don't see why this would be different. You are there reference lab for anything that is beyond their limited ABID scope, right?

Can anyone share policies regarding transfusing donor units that contain alloantibodies? We just got a unit in that is labeled as containing anti-M. We don't usually get in units with antibodies, but I am not very concerned about using this one as long as we avoid giving it to a small child, because most anti-M antibodies aren't very significant. Am I missing anything? Back in the days before Adsol, we used to get units with anti-D sometimes which we made sure went to D negative recipients. Additive solutions should dilute the plasma somewhat, so there should be less antibody in the unit than in those days. Then it would get diluted further in the recipient. Thanks for any modern guidance.

We used to document no hemolysis at 37 on PEG testing but with EDTA samples preventing complement activation, that's sort of moot. I guess maybe recording a result at 37 helps justify the charging for all 3 XM CPT codes. Or maybe just the fact that we incubate it is enough to charge for that phase. Our computer doesn't expect a result at 37, only IS, AHG & CC for PEG. The "incubation" CPT code description doesn't say it is read at that phase, I guess. Maybe I am splitting hairs.

What CPT codes do you charge for a PEG XM assuming you do an IS phase, incubate but don't read at 37, then an AHG/CC phase? Do you charge for the CPT codes for all 3 phases or only for those phases at which you read the test?

Does anyone know anything about the Sonoclot platform for viscoelastic testing? I know about TEG, ROTEM and Quantra but someone mentioned Sonoclot also. I will also take feedback on the Quantra system if anyone has any to offer.

Yes! Herman Miller! They are modular so can be reconfigured rather than requiring remodeling for analyzer changes etc.

I tried hard a few years ago to find evidence for this but found nearly nothing in terms of evidence-based guidelines. I will try to add here what I came up with, but it is fairly arbitrary. It is part of our MTP document. It loses a lot of formatting here. Sorry. Broselow Tape is used in ED to estimate the size of a child. Maybe see if your ED can share what this looks like. This information is intended to be of practical use as a loose guideline for the poor blood banker working on the unusual day that we get a pediatric hemorrhage in. I am very open to improvements. Good luck! Broselow Tape Patient Size Correlation: Grey 3-5 kg Pink 6-7 kg Red 8-9 kg Purple 10-11 kg Yellow 12-14 kg White 15-18 kg Blue 19-23 kg Orange 24-29 kg Green 30-36 kg Wt. in Lbs. 7-11 13-15 18-20 22-24 26-31 33-40 42-51 53-64 66-79 Approx age < 3 mo. 3-9 mo. 4-15 mo. 1-2 yr. 2-3 yr. 4-5 yr. 6-7 yr. 8-9 yr. 10-11 yr. 1 unit Platelet order at SCHS = 1 apheresis platelet = 6 units of whole-blood-derived platelet (6 pack) Product = any and all types of blood component therapy, to include RBC, plasma, platelets, and cryoprecipitate. Bend only: Group A plasma may be used as universal donor plasma for adults and children over about age 5. Blood Products Grey 3-5 kg Pink 6-7 kg Red 8-9 kg Purple 10-11 kg Yellow 12-14 kg White 15-18 kg Blue 19-23 kg Orange 24-29 kg Green 30-36 kg Adult MTP Round 1 10 ml/kg is ~equivalent to 1 unit RBCs to an adult. Red Cells 1 unit * 1 unit * 1 unit 1 units 1 units 2 units 3 units 3 units 4 units 4 units Plasma 1 unit † 1 unit † 1 unit † 1 unit † 1 unit † 2 units † 2 units 2 units 2 units 2 units Platelets ‡ ‡ ‡ ‡ ‡ Cryoprecipitate 1 single cryo as ordered or if Fib <100 1 single cryo as ordered or if Fib <100 1 single cryo as ordered or if Fib <100 1 single cryo as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 MTP Round 2 Repeat Round 1 Repeat Round 1 Repeat Round 1 Repeat Round 1 Repeat Round 1 Red Cells 1 unit * 1 unit * 1 unit * 1 units 1 units 2 units 3 units 3 units 4 units 4 units Plasma 1 unit † 1 unit † 1 unit † 1 unit † 1 unit † 2 units † 3 units 3 units 4 units 4 units Platelets ‡ ‡ ‡ ‡ ‡ 1 1 1 1 1 Cryoprecipitate 1 single cryo as ordered or if Fib <100 1 single cryo as ordered or if Fib <100 1 single cryo as ordered or if Fib <100 1 single cryo as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 MTP Round 3 Repeat Round 1 Repeat Round 1 Repeat Round 1 Repeat Round 1 Repeat Round 1 Red Cells 2 units 3 units 3 units 4 units 4 units Plasma 2 units † 3 units 3 units 4 units 4 units Platelets Cryoprecipitate 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 1 pool of 5 as ordered or if Fib <100 Continuing Rounds Repeat Rounds 2 & 3 Repeat Rounds 2 & 3 Repeat Rounds 2 & 3 Repeat Rounds 2 & 3 Repeat Rounds 2 & 3 * If < 4 months old (grey & pink) · Irradiated blood & platelets not required unless specifically ordered by physician. · Continue to give only O RBCs & AB plasma regardless of baby’s blood type. · Unless AB platelets are available or they request otherwise, wait to give ABO-incompatible platelets until the baby has had a partial transfusion of O RBCs to reduce ABO incompatibility. Avoid giving O platelets on a non-O baby. · Syringes with filters issued with RBCs and platelets in case preferred over blood administration set. · Still must use blood warmer for massive transfusion if syringes used. · All blood products must be filtered, either by blood administration set or syringe with filter. † Thaw AB plasma as universal donor on all peds under ~18 kg (40 lbs.—around age 5). Don’t use A plasma for them as universal donor without physician/pathologist approval. ‡ Issue platelets with instructions to give only part of the unit or run it as needed over 4 hours (or can aliquot if time). These are the fractions of a unit proportional to the RBCs being given in each round. Communicate this information to nurse. Grey 3-5 kg Pink 6-7 kg Red 8-9 kg Purple 10-11 kg Yellow 12-14 kg 1/5 1/5 1/3 1/3 1 This policy does not apply to exchange transfusions of neonates.

Oh my!!! We used to have a flowsheet row in the Epic transfusion module that the nurses were to mark that they checked the blood bank band number and it matched (then we dropped using a BB band). It wasn't a required field, but I suppose you could make it so. How is Lab supposed to police the work of nurses who are overworked, short staffed, often travelers and over whom we have zero power to change their behavior!

We have cubicles and workbenches made by some company that is a guy's name, Howard something? That's useful information, right?

I don't know of data suggesting that patients are particularly likely to have repeat reactions, but I don't read everything. Would you include everyone for whom you did a reaction workup or only those interpreted to be a true transfusion reaction? I would hope that hemolytic reactions seldom recur! I think FNHTR and allergic reactions are the most common (after "probably unrelated to transfusion"). FNHTR aren't usually severe, although they do cause additional workups and stopped units. Allergic reactions are safely treated after symptoms start. Even anaphylaxis is treatable, and RNs are well versed in managing it. There used to be a significant movement to reduce overuse of pre-treatment for transfusions and it seems like flagging patients would make it more likely that they would be pre-treated. Please educate me if I have missed some information.

Our specimen rejection rate was 1-2% when we still used a separate banding system. We dropped that last year for full use of the Epic electronic ID system. I need to pull statistics now, but I am sure it is much lower. Our main rejection reason before was almost always that the band number was left off.

It would be sweet if you could share the CPT code you are using. It seems like it would be awkward to use a regular cryo because the price of cryo and this are probably so different. Or maybe it is a code like that for Riostap instead of cryo. Will you have to have a blood services agreement with Cerus? This product has a blood type, right? Thus, it would have to be in our computers as a blood product not a derivative, I think.

I think the transfused cells were at the bottom rather than the top. The analyzer samples from the bottom, I think.

There used to be Hemobank and Hemosafe and one was Wellsky, I thought. (One or both may have used the British spelling.) I don't know much about the software app that lay between the BBIS and the vending machine, but Blood Track fills that role now.

Is anyone using INTERCEPT®Fibrinogen Complex? The Cerus reps are contacting me and our trauma surgeons. It's hard to get a clear answer online on what the product is. I think it is pathogen-reduced, concentrated, pooled cryo that is good for 5 days post thaw. It looks like a pool of 4 comes from 8 whole blood donors but I am not sure. It appears to have a blood type so is not processed to removed ABO antibodies. Does it have ISBT product codes yet? Is any US blood supplier carrying it? CPT codes? How is it best used for MTPs?

We have tried various things over time. With the current machines, we just measure that the Hct achieves at least what the manufacturer says it should. We in BB don't operate them but used to years ago. That is probably why we still have an oversight function. Tradition!!!!!!

Also, fetal bleed screen testing on a spun sample. Those giant fetal cells will be on top. Mix well before testing!

Mediware/Wellsky used to have one.

There is an Epic report for scan overrides. We had to tweak it so it covered patients who were already discharged but our phlebotomy leaders used it to increase compliance and they made great progress to the point where we dropped our separate BB banding system last year. It does require that your organization have a strong policy for using the electronic ID and doesn't tolerate extra ID bands lying on the desk etc. Our phlebotomists are now reporting instances of ID bands being misused and one recently got a hospital award for her efforts.

We have a statement on the order in Epic that they click. It's a slightly abridged version of the AABB regulation. I don't think the signature ever made them think twice where I have worked. They didn't usually sign it until after the fact anyway. We still have the paper version if needed but seldom do.

We do it. We were texting the RN to tell the MD but that kept failing to be documented so this week we are starting to contact the providers directly. I don't think it is very smooth yet. The system we use is an app that is only on supervisors' and providers' personal phones. Otherwise it is on hospital issued phones and workers sign into them when on shift. The calls/messages go to the app for the provider which then rings/texts their personal phone. The text messages are only within the app, not on our regular phone SMS. It is tied to the Epic patient database so you can select the patient within the app and find their current caregivers. It's pretty slick. I think the company/app is MH Cure and Mobile Heartbeat. We renamed it Whistle.

That's what we have been doing but we are wondering if we have to keep the signature in the permanent record. We were planning to go to an electronic documentation process and then there would be no signature. Is it any different from asking a patient for drug allergies and recording them? They don't sign for that.