Patty

We now use MediaLab.  We loaded all of our current procedures into it.  To edit you download and make the change.  Once the new version is uploaded and approved by manager/Med Director major changes are sent to all personnel that use the procedure for review. Each step is documented electronically along with a note that you can add to describe the update. The person making the change is notified to remove old paper copies from whatever manuals you have it living in.  You can make links available to the Intranet for nursing, etc.  Every 2 years if no changes are made each procedure is sent to manager/Med director for review.  It is a great system and user friendly.  The old procedures are archived. 

Well, if you follow Petz and Garratty, the "bible" of auto-immune haemolytic anaemias, first of all performing a titre is a total waste of time as, although most clinically significant "cold" auto-antibodies are high titre, this is by no means a universal n, and so, if you ignore an antibody because it is low titre, you could be in trouble (more to the point, your patient could be in trouble).  Secondly, determining the specificity of the antibody is even more of a waste of time.  If it is an auto-anti-I, are you going to give adult ii blood?  No.  If it is an auto-anti-H, are you going to give Oh blood? No.  If it is an auto-anti-HI are you going to give blood from a donor who is OhAND an adult ii?  Well, if you can find such a donor anywhere in the world, you are a better serologist than anyone who has yet existed.  Is the thermal amplitude useful?  You bet your bottom dollar it is!  The human body will never reach 4oC or 22oC, so performing tests at those temperatures is a waste of time, BUT, the extremities (fingers, toes ears, nose, etc) can go down as far as 30oC., and this is why Petz and Garratty recommend that tests are performed STRICTLY at 30oC, as, if the antibody reacts at 30oC or above, it is clinically significant as an auto-antibody.  Tests at 37oC are only really useful if you are cross-matching blood for the patient, in order to see if there are any clinically significant alloantibodies present in the plasma.

Same here!

Our SOP requires that newborns, who test negative with anti-D by immediate-spin test, must be tested for Weak D using anti-D antiserum formulated for Weak D testing.  If the Weak D Control is agglutinated, we report Rh type of the newborn as "Indeterminate" and "RhIG indicated" for the mother if the mother is Rh negative.

We do the same as above.

We review the time from release to transfusion end for all transfusions.

Same in Canada. 4 hours from when it leaves the lab.

Same in the US.  4 hours from when it leaves monitored storage.  Pretty sure that is clear from the regs.
Scott

In our case (the UK) it is from the moment the blood is issued from a controlled fridge.

The AABB Circular of Information for the Transfusion of Blood Components requires blood products to be transfused within 4 hrs.
We do monitor this is and write up cases where the 4 hour limit is exceeded.
Scott
Scott

FDA and AABB had gone back and forth over the years on storage vs transport.  In the past few "Ask the FDA" sessions I've been at during the AABB Annual meetings both FDA and AABB have said coolers are transport.  People even brought up newer cooler technology reminding them that coolers can be out of the blood bank for an extended time.
We validate our coolers to hold temp at 1 - 6.  We do not take temps every 4 hours.

Yes.  Our OR nurses document every four hours.  If the cooler temp reaches 6 degrees C, they call and request a new cooler with fresh blocks.  We have quite a few cases that easily exceed four hours.  We also put temp indicator stickers on each unit to make sure they weren’t left out of the cooler.  We validated at RT, Trauma Bay (warm extreme), and CV surgery suite (cold extreme).  We did those for both maximum (6 units) and minimum (1 unit).  Message me if you need more specifics!

It is my understanding that CAP requires Lot to Lot on Fetal screen Kits only, not commercial reagents since it is not a kit.  You must compare the old QC with the new lot of reagents and the New QC with the old lot of reagents before use.  Kit tests in the rest of the lab are handled the same way per CAP.

Ortho On Demand has a three part series on Titrations that you might like.
Ortho Clinical Diagnostics is pleased to present a Spotlight Series focusing on Standardization and Validation of Titrations in Perinatal Clinical Situations.
https://presentations.akamaized.net/Shows/OrthoONDEMAND/Microsite/LoginPage.html

We used to do eluates but with the infrequency of need and competency challenges we decided to send to our reference lab. We request eluates on patients who need a transfusion (or investigating a TRRX) and are DAT + and who have been transfused within the past 14 days to rule out newly forming antibodies that could be completely absorbed onto the donor RBCs and may not be found in the plasma.  Our reference lab has recently changed from 14 to 21 days post transfusion for eluate testing but we have not yet changed our rule.  I believe the thought process behind this is that after 14 (or 21) days the newly formed antibody has had sufficient time to spill over into the plasma and can be identified in the ABSC/ABID.  On patients that are transfused frequently we sometimes opt to give phenotypically similar blood for transfusion instead of sending out for an eluate with each transfusion event as this is time consuming and expensive. 

They also said they would update the wording in this standard in August, but for now to update our policy so we're in compliance.

When we called CAP, we were told we could perform electronic crossmatches as long as our policy defined an ABO discrepancy as one that is unresolved. If we know why there is a discrepancy, we can do the EXM.

Agree with all above.  (And I believe there are many older threads here that exhaustively cover this sort of thing regarding units out of monitored storage. )
In general, there are two things that are clear to me: a unit must be transfused within 4 hours of release from monitored storage, and that a unit returned to the blood bank for storage must be documented as being at an acceptable temp.
Scott

Thank you for the clarification Malcolm.  By the way this came right out of the current CAP standards.  Maybe they need to be schooled too     
COMPUTER CROSSMATCHES
A computer crossmatch is an electronic method that is used to confirm that the unit is appropriate for transfusion
to the intended recipient through the use of validated software logic to determine compatibility, rather than
serologic techniques.
For
laboratories that employ computer crossmatching, serologic crossmatch techniques must be
employed when ABO typing discrepancies are present (e.g. mixed field reactivity, missing serum
reactivity, apparent change in blood type post hematopoietic stem cell transplant).
 

All in fun!!  I do appreciate the feedback as I need to address this at some point, like yesterday. 

Thank you for the clarification Malcolm.  By the way this came right out of the current CAP standards.  Maybe they need to be schooled too     
COMPUTER CROSSMATCHES
A computer crossmatch is an electronic method that is used to confirm that the unit is appropriate for transfusion
to the intended recipient through the use of validated software logic to determine compatibility, rather than
serologic techniques.
For
laboratories that employ computer crossmatching, serologic crossmatch techniques must be
employed when ABO typing discrepancies are present (e.g. mixed field reactivity, missing serum
reactivity, apparent change in blood type post hematopoietic stem cell transplant).
 

Malcolm, you make me laugh.  Just like a bull dog, once you get hold of something you just can't let go.  I think the moto from a place I once worked is appropriate. "An exercise in futility is better than no exercise at all!"  

Thanks for the quick reply.  Somehow I knew that would be to good to be true. 

I asked this question at a Cleveland ARC seminar. It was explained to me by Dr Gerold Holtche who at the time was with CAP that the fetal stain is considered a special stain and did not fall under the BB QC guidelines but under Histology standards.  The QC slide that had both adult and fetal cells was sufficient to show the stain worked.  This was several years ago so you might want to check directly with CAP. 

I asked this question at a Cleveland ARC seminar. It was explained to me by Dr Gerold Holtche who at the time was with CAP that the fetal stain is considered a special stain and did not fall under the BB QC guidelines but under Histology standards.  The QC slide that had both adult and fetal cells was sufficient to show the stain worked.  This was several years ago so you might want to check directly with CAP.