Mabel Adams

I once listened to a teleconference by Teresa (sp) Harris that said that 2 pos and 5 neg gives essentially the same statistical accuracy as 3 pos and 3 neg. Somewhere more recently I heard it said that the same is true for 5 pos and 2 neg. I have not seen actual statistics.

Hieu, www.Shamrocklabels.com can show you examples of many blood product labels, both codabar and ISBT. Click on Products, then Blood Bank tapes and labels. Even if you don't order them, you can look at the examples.

What do you mean by "antibody confirmation"? If you mean a patient that is known to have anti-Fya returns and you are doing another panel then the generalists are right; if this is the first time an antibody is ID'd then, 3 & 3 or 5 & 2 give you the good statistics for ID. If the antibody was previously known then you have a different issue about what you require to rule out (as oppososed to ID) additional antibodies--a bigger concern since you will always be giving Fya neg units anyway. I like to run enough cells that react negative so that I can rule out new antibodies with the same sensitivity as I have with my usual antibody screen--i.e. double-dose cells for all the antigens that usually have double-dose expression on my screening cells. C & E in the presence of anti-D are specific exceptions. If very few cells are expected to react negative, obviously judgement comes into play, but usually the generalist have handed it off to a BBer by then. Sorry I ramble on so.

What computer system is it? How many aliquots will you make? Will you make them all at once from the primary unit or will you split it once to make the first aliquot, then split the remainder again and again to make additional aliquots?

We have had a policy to give 2 doses of RhIG if we get a pos Fetalscreen but find no fetal cells on the Kleihauer. I can't find any reference for why we started to do this before I came. Does anyone else do this? If so, do you know why? This is more of an issue since there have been more apparent false positives with the Immucor Fetal screening test this past year.

John, we were using chart recorders but they seem to get out of adjustment or the charts aren't changed on time. I also just learned that the FDA considers Floseal and Tisseal to be blood products, not tissues, even though floseal is RT storage! I emailed "matt " and got the official word. Now I hope we can turn them over to pharmacy like Factor VIII etc. but if not I suppose we have to deal with both the continuous monitoring and the alarm! Of course, they want to store these all over the hospital. The long-term solution is a centralized system, but we might need something in the interim. Sigh. Thanks for all the ideas.

Another wrinkle to this topic. Some patients are using blood salvage and others aren't. Six units issued from the blood bank are not equal in determining a "massive transfusion" in these 2 cases, are they?

Now that the education is going out about using FFP earlier in massive transfusion cases, I am wondering how others are applying this concept to scheduled surgery cases that end up using > 10 units of red cells. (Our recent case was a back surgery.) I think these differ from traumas in that they should lack the tissue damage and hypovolemic shock of the trauma massive transfusions, but I don't know enough to know what we should suggest in these cases. 1. Ignore it and let the docs decide if they think the bleeding is sufficiently out of control to require the massive protocol. 2. Urge them to move promptly into the MTP after 6, 8 or 10 units and start giving FFP & plts then. 3. Urge them after 6 units transfused to order a coag screen and give FFP etc. based on the results. We are not a big trauma center nor a big teaching hospital so we have a wide range of knowledge (and misinformation) among our docs regarding MTP. Does anyone know how these patients would differ in their clinical needs from those in the "vicious bloody cycle" of traumatic injury? Does anyone have a sensible approach that doesn't cause docs to use FFP inappropriately jsut because they have a surface knowledge of massive transfusion protocols? Should we use different approaches for vascular surgery gone bad than for orthopedic?

Is there any chance your Good Book is available online or via email? It sounds like a great resource.

All of a sudden, we have a cardiac surgeon requesting blood < 14 days old for adult pts. Has there been a new study published? What's the latest on this topic?

I like to make sure everyone knows about anti-G and when you can ignore it and when you should remember it exists. I have never seen a Bombay but I think it would be good to present it how it would look to the average tech--like a reallly strong cold agglutinin. I also drum on the inheritance of the Rh antigens so we understand that a hemorrhaging patient with a known anti-E can pretty safely be given Rh neg blood--plus understanding the risks of making anti-c and why you don't screen the O negs for c when you have gone through all the O pos units. It is also good to understand that even incompatible blood carries oxygen and you shouldn't let a patient bleed to death just because they have antibodies. Techs sometimes get asked by docs and have to give a split second answer and that drives how the patient gets treated. Then there is interesting stuff like hemizygous Duffys.

I think I got a nice one from Biotest.

Even if it is a dilution, that's the same dilution that one drop of cell suspension and 2 drops of sample always have given us--including whomever did the original research that set 16 up as a critical titer for anti-D. This method is just measured volumes so it is more consistent. It looks like it is less work than Judd's method of making a 2% suspension.

If all you need is a log, you can scan into Excel. It is searchable, sortable and cheap.

Type O people have long been known to bleed more and they finally found that there was a measurable difference in their coag factor levels.

We need to monitor remote storage of room temp. tissues. We are thinking of getting some data loggers for this that we bring back once a week or month to download the temp data. Are there any issues I need to consider in choosing which one and which features I need? I assume we still need a human to record the temp daily also at these sites. Eventually we would like to get an integrated system that collects data wirelessly into a computer from many fridges, freezers and RT storage areas, but the money isn't available right now for anything that big.

Wonder how those risks compare to the number of patients that die every year due to drug errors. Not that we BBers want to take increased risks, but it gives some perspective.

We used to put labels on our ID panels. After about 10 years, we had to go tape them all on because they were falling off. I won't be there in 10 more years when the tape comes loose. The problem is validating that the labels will stay stuck for the required storage period of the record without dying of old age first! Maybe some company sells labels validated to stay stuck.

CPD & CPDA1 are still indicated for exchange transfusions I believe.

The data above about O plasma at 1 day having the same coag factor levels as other types at 5 days seems to me a useful argument.

Yes, we billed for "each antiserum" as the CPT codes dictate. Thus, in the past, pos patients ended up paying for 3 CPT codes, while negs paid for only one. Now everyone pays for 2. Since positives are not all that common, it probably costs the patients more as a group. Of course, since your costs are reduced and your reimbursement better, you could lower the price of them all to make it come out even.

You should be able to get positive samples from someone else--I was thinking ARC recently volunteered this. Maybe they could even send some weaker ones for your comparison. I'd get D, E, K at least, maybe Kidd (even though you will only be validating screens) to be sure there is no difference between methods with different specificities.. You could always ask for a warm auto just to be sure you will be able to detect it adequately. ARC probably also has neg samples. Maybe you could just get a batch and do it all at once.

I seem to remember reading here some time back that some places use the fridge readout for their internal thermometer and do not also have a thermometer inside the fridge that is checked every day. This seems logical to me. Since all we need is a NIST traceable temp that is recorded every day, we could easily check the readout agianst and NIST reference thermometer periodically and record the readout every day. Then we need to make sure the chart recorder reads accurately. If you are doing this have you had any issues with FDA or AABB inspectors? How often do you check the readout against the NIST reference? For storage units requiring top and bottom thermometers, one could be the readout and the other a bottle, right?

Remember, minute amounts of bleach can destroy the S antigen. Hence the alcohol the manufacturer suggests, I imagine.

We just sent out a notice to the docs saying that when they ordered DAT they would get both results every time. That is required for the billing rules. The info they get from the test is no different: either the patient has no antibody/compl. on his cells, he has IgG, he has complement, or both. Whether you start with poly or not, they get the same info.