Mabel Adams

If the nurses gave cryo one unit at a time, couldn't they run IV saline into the bag to flush the cryo out? I know they used to do this to increase the flow rate of red cells.

Another member that I had made contact with via the AABB discussion groups emailed me about this site.

I am working on getting Meditech live with this but the issues are similar in Mysis it sounds like. Only problem with using the ISBT codes is that you might want them to make sense to nursing or billing. I plan at this point to lump my product codes together as long as they have the same basic characteristics and the same expiration, but one thing I have realized is that every one of them that might be relabeled via aliquoting, irradiation, pooling etc. need to have the accurate original product description carry through on the label you put on the bag. Thus plt pheresis (7 day exp) part 2 of 3 has to have a different code than part 3 of 3 of the same donation number. Likewise CPD 450 ml and 500 ml. Either that or you limit which products you allow to go through modifications. This is a nightmare if you can't do on-demand printing. We may just stop pooling and aliquoting since we only do either a few times per year. That only leaves irradiation for needing 6 different product labels for plts and limiting the red cells we would irradiate to LR AS-5, our supplier's main product. I am open to suggestions on the folly of my plans. Sorry to hijack from Misys only.

I thought the fetal blood volume supposedly won't exceed 30 ml till about 20 weeks gestation. Is there some reason I haven't thought of that would make you do a KB at 7-8 weeks?

Apparently our oncology floor is not performing BP with the other vitals during transfusion of severely thrombocytopenic patients. I believe they do them some of the time but not pre-, 15 min, 45 min, hourly thereafter and at completion, which is the hospital's standard protocol. I guess I can see their concern regarding bruising in the thrombocytopenic patient. What is the minimum frequency for BPs during transfusion? Does anyone else know of a special protocol for patients with no plts?

I bet they don't credit the patient for half a bag of IV solution.

I always like to look at the CAP survey results broken down by method. It gives me a feeling for how many labs are using a method. This isn't much to go on, but can be useful.

Is there anyone that is already live with ISBT on Meditech (or far along in the process) that would be willing to be contacted with some questions? Thanks.

Yes, and once we go to ISBT I expect everyone will be whining if we run out of stickers on a unit because accurately writing those long things will be tough. We do antigen typing on paper because our BBIS is hopeless for it. I prefer the barcoded stickers so we can scan the data into the computer later. Nurses use them in charts. Those are the main uses now for us.

An auto control in gel (IgG) was quite negative so we didn't do a DAT. My experience is that the autocontrol in gel is a lot more sensitive than the tube DATs that we do. I guess I could have looked for complement. We have to keep our samples for 7 days post-transfusion, which is 10 days post-collection so we still had his pre-transfusion specimen. That is what we typed for the Kidd antibodies. I also typed the unit that we gave him then and it too was Jkb neg. I need to try to get another specimen on him and see if anything has changed by now.

We sometimes collect more sample for problem antibodies but conserve the original that had the screen done on it for all crossmatches. Maybe you would want to consider getting bigger tubes drawn initially.

We haven't stocked the RhIG shots for at least 10 years. The doctor's offices have their own. I am sure they give it sometimes without any testing. It isn't like it would harm anything but the pocketbook of an Rh Pos person if it was given by mistake. What value--except economic--is the antibody screen after a miscarriage?

TPN is total parenteral nutrition-an IV soup of proteins, lipids and glucose for patients that can't eat for a long period. They seem to give it over many hours per day so it is hard to get a sample without it being contaminated with it. I used to occasionally see positive DATs due to it. I don't know if it would affect gel or not. In the US, the only gel system is MTS gel marketed by Ortho. I am using Ortho's prediluted 0.8% screening and panel cells in the new diluent formulation. Does that help?

They may feel the effects of the limitations on transportation for months. People won't go donate if they have to fight traffic snarls and I understand this was a very major route. What a terrible tragedy!

This week I had a 36 yo head injury patient that recieved 1 unit 10 days prior show hazy reactions in gel. The weird thing was, there was a pattern to it! Certain cells were quite negative and others were really quite hazy with a sort of topline. There was no rouleaux detected in tube typing (patient A pos). The panel almost fit anti-Jkb so I erred on the side of caution and got in Jkb neg units for him. I got a new specimen the next day for comparison and got the same screen results although weaker (pos in cells 2 & 3). It turns out he is Jka+b+ so I did not need the Jkb- units but I didn't know that at the time. A tube screen was negative but I worried about a newly forming antibody that was partly IgM or something--especially in the Kidd system. He has been on TPN. Has anyone seen this sort of reaction in a patient on TPN or any other patient? We can usually get rid of haze by respinning the sample. That didn't work.

I think I would feel better sending it back. I don't mind if I don't know about it, but once I know something might have shortened survival in the recipient I would feel funny giving it. Maybe this falls under the FDA's "potency" requirement. Back in the days of all AHG xms we used to find such units a few times a year. Of course they would never have been compatible with anyone so it was easy then to decide to send them back.

Do you allow this over the whole 3 day life (or whatever) of the specimen, and if so, do you still keep the original expiration of the sample?

So for places that do lot-to-lot on ABO typing reagents, have you ever seen any meaningful difference between lots?

So how do you deal with sending out fetal cell quantitation for deliveries on weekends? Can you send specimens out on weekends? A Friday evening delivery that needed a second dose would be beyond the 3 day limit by the time the results came back the next Tuesday.

I remember this also, but searching this site for Thomas Nojek doen't bring up any other matches. AABB is down still so I can't search it.

I always explain to them why it is so and thank them for questioning us because I would much rather explain to them why it is okay than file a fatality report with the FDA because they assumed the lab must be right.

You can also do something as simple as place a tiny colored dot on the base label that your procedure designates as signifying visually that the retype was done. We used to do this with a half inch round label which we dated and initialed.

Usually I would say that only one vial needs to be QCd but with these current problems, different vials behave differently. I talked to Ortho and they think it is because the cells are at RT too much so we will be refrigerating between uses more. They also suggested rotating the vials to me (daily I think) but I don't quite see the logic of that. It seems to me that they would spend just as much time at RT but it would be spread out over a longer period. And it would be a lot more confusing keeping track of QC and such. We will just put our rack in the fridge more than we were doing; I realize some places may not have that luxury. If that doesn't help, I will see how all of you that tried rotating vials thought it worked!

Why do you suppose it is more likely to be screen cell 2--even on different lots? Just coincidence? I remember years ago reading of some ultra-sensitive method (polybrene maybe?) picking up anti-E antibodies that were not detectable by other methods that the author said were naturally occurring. I keep wondering if the cells can change with RT storage to somehow enhance the E antigen. Has anyone reported this to Ortho yet?

CAP has a question asking if we are preparing for it. I imagine next year the question will change to require it and maybe some others with specific requirements.