Mabel Adams

Some define the retypes as forward only and others do a full retype. I validated (because the typing sera insert was vague) using blue top tubes for blood types. I like that I am not ruining the specimen for add-on tests like I do the CBC tube. We have done it so far due to our new requirement to have a blood type for the current admission for FFP transfusion. We are still trying to decide on a retype policy. I think we would match the Rh so as not to deplete the Rh neg pool. I liked the suggestion of sending out a marked retype tube so no one is drawing two tubes the first time and sending the second one for the redraw.

We not only don't get any paper back from nursing, we don't provide the record for the chart in the first place. Our units have only a compatibility tag. (Less chance for mix-ups.) Nursing was using a transfusion flow sheet even when we still got papers back so they didn't need a transfusion slip for thier documentation. They used to put the slips in the chart but then they were in the Labs section and the flowsheet was in Graphs. Now the ID check etc. are part of the flow sheet and everything is in one place. (Well, the computer record of BB is still part of the Labs section.) They do their own auditing.

One of our frustrations is that our reference lab still uses tube so it would do no good to send out weak gel reactions as they would seldom find anything.

These patients must have been transfused a bunch to accumulate exposures to that many low freqs! Or they have very bad luck.

There is no "acquired A antigen", just B, so I'd guess that couldn't explain the case presented. Clerical/ID errors are quite a bit more common than acquired antigens. Probably bone marrow transplants are more common, but you can usually get that history by asking.

After making sure that all the antibodies for which commercial antisera is readily available have been ruled out (with a double dose cell if at all possible), repeating the gel tests with longer incubation and doing a gel xm, we transfuse. Occasionally I drop back to LISS when I am convinced I am dealing with a weak warm auto or HTLA-like antibody. I work really hard to rule out Kidd system antibodies because weak ones often won't react with one cell that they should but the only cells reacting are pos for the Ag and the patient is neg. I don't worry so much about non-Kidds. I will admit, if even Kidds are that weak, they still probably won't do that much damage. Kidd has such a reputation, I'm careful, but I have never seen it do its delayed TRX thing.

I have just asked that the peds committee review our policy for keeping cords. We hold them a week, but no one ever seems to request that we do any testing on them so it seems like a waste of energy. Of course we keep those we tested for RhIG determination in with our other samples for at least a week.

One problem that I once had like this was when admitting used a historical patient for a new patient with the same name. All the data (except blood type) matched between history and current, it just didn't match the actual patient that was in. Also, I hear reports of uninsured patients borrowing someone's ID so they can use their medical insurance coverage. Does your admissions office do photo ID checks and compare history carefully?

Why would washing cells help with a warm auto? Just removing other possible sources of reactions???

Scan a unit on a flatbed scanner--assuming you still have codabar units.

Doesn't FDA just have one code for LR red cells, regardless of preservative etc.? Are they changing that?

Wally Flegal at the Rh site in Germany is a very nice person and might be able to help you find D antigen variants. I think it is still the "Rh site" online.

Do you have any other words for "grume"? That one doesn't mean anything to me. Oh, wait, let me go to dictionary.com and look it up. grume noun1. a thick viscous liquid 2. a semisolid mass of coagulated red and white blood cells I hope I am not the only one that had never heard that word. OK, Yanxia, thanks for teaching me English!

Our outpatient transfusions are usually on recurring accounts. Maybe that is why I haven't had any issues with this.

Root cause: Why does your billing dept reject these? It would be possible for crossmatches in other situations to be done on a day different from the specimen draw-date. For example: Special screened units that took awhile to find or order in.

I was thinking of doing antigen typing using traditional antisera in gel just to use smaller volumes of it, but once I realized we pay about $6 per IgG gel card, I am not sure if that will be a cost-effective answer for the most common antisera we use.

I keep hoping someone will test thawed FFP (and its varied cousins) after 30 min at Rm Temp. for factors and bacterial contamination rates so we know whether we really need to use the same issue/return rules for it.

Look at the critical ID steps in the process: nurse has to ID which patient she plans to transfuse with what; she needs to transmit to BB patient ID and product; BB needs to get the right product for the right patient out to send; BB needs to make sure the paperwork on the unit is right, plus check outdate, inspection and pt. needs (irradiation etc.); unit needs to go to right floor; nurse must positively ID both patient and unit before hanging. Make all these airtight and you will prevent many problems. However, nothing works if those involved don't believe it is important.

I would wonder if a certain body weight might be more meaningful. Children, especially sick ones, can have a huge difference in body size (and therefore blood volume)--or is weight too hard to consistently get in a timely fashion? It is recorded in our computer system once it is established.

I guess I should say that Christina admits to deliver on Monday and phone calls to the BB asking if there is blood available for her by name only are answered Yes. Then lack of positive ID at request, issue and transfusion could be fatal. Everyone working cares about doing a good job, but not everyone understands the risks.

John has the right idea--to solve the root problem--timely ID bands on the patients. Here is a scenario: 2 OB patients, say named Christine and Christina Dodd. Christine delivers on Saturday and has blood xmd because she was a previa. All well, no tranfusion, discharged Sunday. BB still has units set up on Monday for Christine. No one working Monday realizes there were 2 patients with almost identical names. Follow it through and see what disasters await.

Joint Commission has some pretty clear regs now on hand-offs. Nursing usually listens to them.

Joint Commission regs should back you up. Nursing usually pays attention to them. They have some pretty clear ones now about patient hand-offs. Then you need to look at the process for where the greatest risks are: 1) the nurse IDs the patient for whom she needs blood. 2) a request that positively IDs the patient goes to BB by whatever means you use (usually at least name, an ID number & what product) 3) BB staff has a way to make sure they get the right product for the right patient out of the fridge 4) BB staff has a way to make sure paperwork is attached to correct unit and all info on it is correct, that the unit is indate and meets needs (irradiation etc.) 5) The unit goes to the right floor 6) nursing makes sure the unit being hung is the correct product for the patient being transfused. Generally at least two identifiers are required for every hand-off. There are myriad ways to do this, some more efficient than others. None will work if the people involved don't believe it is important and worth their time. Sometimes plausible but frightening stories help people see the risks in the process. If you don't have any real near misses, write some scenarios based on your current policies that show how one small assumption in the process can be fatal to the patient. Then ask them if it is okay if that patient is someone in their family!

Yanxia, "cold aggs" is short for cold agglutinins. Didn't the Cleveland Clinic publish useful data a few years back showing testing for cold antibodies was unnecessary?

Does anyone know how long it currently takes after submitting ISBT registration for the number to be assigned and then for it to be on their website? One of our hospitals that does irradiation of units for their patients was supposed to have submitted thier registration quite awhile ago, but they don't seem to think they've got it back and last time I looked it wasn't on the website.