msmc

I was hoping I could get some feedback on charging for antigen typing. Currently I bill the patient per antigen typed (corresponding to the patient's need) per unit ordered. For example the patient needs 2 E negative units we bill for 2 antigens. However, I recently found out that some hospitals are billing for the the antigen according to the number of units screened regardless of the number of units ordered by the physician. Could anyone offer some guidance as to which is correct? Thanks.

Hope this helps... 1. Do you retype a specimen everytime it is touched. For example if day shift does the crossmatch and you come later and do a add-on do you retype the specimne? If so is it documented? If a 2nd tech does the crossmatch then a retype is done. On the other hand if the same tech that did the original type and screen also does the crossmatch then the second type is omitted. 2. If you are doing this are you also doing some sort of documented second type?An internal order is generated and resulted in the computer. The patient is not charged and the test does not appear on the patient's chart. 3. Do you do a DAT on all crossmatch specimens? No. 4. What sort of facility are you? We are a 700+ bed hospital.

So basically the team keeps track of any mislabeled samples and implements training and competency for those employees who draw samples? Sounds like a great plan especially since you have the data showing your success in reducing risks and patients are no restuck. Our lab has a similar approach to tracking mislabeled samples but I never thought that it was enough the meet CAP requirements. Thanks for the idea!

The plan is to use samples that were drawn before the BB sample. If those are unavailable then a 2nd phlebotomist must go a restick the patient for the 2nd type. We have not yet implemented this. I was hoping to gather suggestions from the postings so that maybe we wouldn't have to have multiple sticks.

Mabel, you are right. CAP item #30575 strongly suggests a second type. What I plan on doing is if we have a CBC or H/H sample in the lab then that sample will be used as the 2nd ABO provided that it is properly labeled. Other than that a second phlebotomist would have to be sent to the patient for a second sample.

I am currently reviewing our SOPs and am wondering how others out there perform compatibility testing on neonates. For babies born in house we type the cord and complete a DAT. We choose washed O red cells and crossmatch with the mom's plasma. For babies born elsewhere we type and perform a DAT as well as a total crossmatch on a heelstick. My experience at another hospital was to type the cord and a heelstick (second ABO/Rh) and issue type specific red cells(also testing for passive ABO antibodies where appropriate) using a computer crossmatch (if mom's type and screen available). If the baby was born elsewhere we would do a type and screen including a passive screen when needed from a heelstick and a second ABO/Rh from a separate draw. I would like to convince the staff here that this is appropriate and less time consuming. What is everyone else doing out there? Thanks

We also interpret as B neg but would footnote to explain the discrepancy

I agree with DANDERS, why can't this baby be AB? Maybe the baby has less A antigen on his cells then expected. Or maybe a subgroup of A.

I have actually found the rationale behind performing an elution on DATs positive with only anti C3. Anti Jka is a strong activator of complement so some patients that are making anti Jka will actually have cells mostly coated with C3 but also with some anti Jka (IgG variety) early on in their immune response. The textbook (Fundamentals of Immunohematolgy. Turgeon, 1995.) I found this in states that if only the C3 is positive and the patient has recently been transfused then antigen type the patient for Jka. If negative then an elution is appropriate. I suppose they antigen type the patient using retics since typing the cells in a recently transfused patient is unreliable.

When is it appropriate to perform an elution on a patient with a postive DAT? I know if a patient's DAT is postive with Anti-IgG and he has been transfused withing the last month then an elution is done. But I am a little confused when it comes to DATs postive only with anti C3. I have read that elutions are also appropriate but I am not quite sure why since it would be negative. Can anyone offer an explanation? Thanx

Does anyone know if the coolers have been pre validated by the manufacturer for the transport and storage of red cells would I still have to validate in house or does yearly QC suffice.

I am curious to see what the average dosage of cryoprecipitate is. At my hospital we currently dose depending on the weight of the patient but we are looking into standardizing the dose. We feel that on an average we transfuse pools of 6, any other doses out there? Thanks

How do you all deal with patients with warm autoantibodies? We recently had a case where the patient had never been transfused, DAT 3+, and plasma reacted with all panel cells at a 1+ strength in the tube with PeG. Also, in capture reactions were the same. An elution was done and all cells had 4+ reactions. Since the patient had never been transfused, no surgeries, or pregnancies, I was wondering whether an auto absorption is really indicated. Is it safe to say that in this particular case units that are weakly reactive can be issued as least incompatible and no further testing required? If, after the current sample expires, additional transfusions are required and the DAT remains the same or decreases in strength is an auto absorption still indicated? Any thoughts out there?

I just received a TempCheck and am in the process of validating it. My question is, do I have to take temperatures in triplicate of one product (ie a unit of RC) or do I take triplicate temperatures of 3 products?

Well, at the moment we only have 10 but will be purchasing more in order to cover all of our OR's as well as ER. We should have about 30 or so. I also have another question to all, What is actually better to use gel packs or regular wet ice? My experience has only been with wet ice but I am considering using the refrigerated gel packs.