Mabel Adams

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.

Since the "modified by" labels need not be barcoded, why not print your own on standard Avery label stock? Even those that don't accept David Pollock's answer about the adhesive could make them small enough to fit on the lower right quadrant of the existing label so they would not be in contact with the bag plastic. You just need to make sure they stay stuck under the conditions of use.

We don't do heart surgery, but I wonder if those that do would find AB+ and B+ patients much more likely to be given older blood and whether that will further impact the supplies. Then do you cross blood types for the fresher blood or is that a bigger risk (according to other posts on this site)?

When I tried to chase down this info a few years ago, I found it very hard to get a clear answer. It depends on the size of the patient, muscle mass, probably how active the muscle is after the injection, the time between injection and blood draw and probably some other variables. The only thing I was able to do was follow the patient over time and make sure it was getting weaker.

We don't do weak D testing anymore except on babies so eventually some weak D mom will get RhIG. Our OBs were informed when we changed this policy and were OK with it. We have been doing this now for over a year and have yet to see a "diffusely positive" fetalscreen due to weak D.

Computype is the other company

Fresh blood for neonates is a bigger concern for exchange transfusions than for small volume transfusions, right?

Kay, Long time no post! Welcome back.

I don't believe I have ever seen a reaction to IM RhIG, although I doubt allergic reactions would be reported to us. Anyone else have experience with this? Since this practice of not doing weak D testing on pregnant women is becoming widespread, many of them must be getting RhIG. I guess if the reaction rate goes up, that will answer the question. It will take a long time to get any data on whether the D sensitization rate for them goes down, since it was so rare to begin with. As we've said elsewhere on these pages, most of us that have seen anti-D in an Rh pos person have seen in the patient that types 4+ with anti-D.

How much bang for your buck do you get from doing a second type by a different method? Rh is known to vary somewhat, but any ABO reagent that meets bureau of biologics standards should give pretty much the same results shouldn't it? Has anyone seen any differences? I guess it would help because it would separate the testing in space and time. Gel would require a different cell suspension than tube, I assume, so your techs couldn't "cheat". To have the biggest impact, we need to start with the biggest problems--blood administration, then specimen collection, then "in the BB." But how many of the latter are clerical vs. technical? Most that I have seen were clerical, although I did see one newbie mix the tubes up in his hand and read the reverse tube as the forward B tube and vice versa turning an O into a B. If we are not going to test a separate draw then we need to make sure whatever we do will address clerical errors in the BB.

We have never done TPs. If they aren't done at the blood center, nursing does them. The closest we get to them is answering the phone call, "Do we get the blood bags from you?" with "call central supply."