rae221

I am very interested in this topic as our surgeons have recently expressed a desire for us to extend to 45 days for elective surgery patients. Our current extension for elective surgery samples is 7 days (no transfusions/pregnancies). I'm interested in the logistics of saving samples and pulling samples for the addition of crossmatches. Then having to save an additional 7 days post transfusion. How do people handle the logistics of saving samples? Is a sample that is 45 days old still ok refrigerated for testing? It seems this would be easier with the electronic crossmatch. We are considering a routine type and screen at 45 days then having the patient return within 7 days of their surgery. This would satisfy the second ABO/Rh sample requirement and would not alter our current process of saving samples for 14 days. We would have advanced notice of any atypical antibodies and we would be able to confirm transfusions/pregnancies closer to the date of surgery and the current sample drawn. Also, we utilize a blood bank recipient wristband. I cannot see a patient keeping that band on for 45 days. We have difficulty with our Hem/Onc patients removing their bands after just a few days. I would appreciate input from others who have moved to these longer sample extensions. Thanks

Thanks for your imput Malcom. What you say makes sense, although I think there has to be some consistency set.. Would you recommend submitting to the laboratory manager documentation of all variances that have occurred in the blood bank, regardless of FDA reportability? What would you think of a monthly report to the manager listing the nature of the variances and what corrective action was initially taken. If the manager wants more then they can get back to you and ask you for further follow up. This way the supervisor is not taking the sole responsibility for what happens in the department and the laboratory manager is fully informed and this is documented. If they don't respond back then this is documented also. Also, would you submit the FDA reportable issues to management and let them perform the root cause analysis using the supervisor as the resource for whatever information is needed? Then when they have finished and given you their report you can file this with the FDA. Do you think this process has validity and helps support the supervisor when policies are not too clear?

I would be interested to found out from blood bank supervisors what criteria is established in your laboratory or hospital that gives the supervisor guidelines for categorizing errors and what the nature of the follow-up should be. Is there a concrete standardized system for the supervisors in dealing with issues that come up. How many do you allow before they must have retraining? Do you prevent them from reporting results until the retraining happens? It seems like the system in place should be known to both supervisor and staff member. Everyone always wants to know what the expectations of the job are but what are the expectations if you make an error. People are placed into supervisory positions who don't necessarily have management experience and tools are needed to guide them in dealing with these issues.

I am wondering what general advice would be given by most Blood Bankers when asked by a physician what would be the expected rise in platelet count with the infusion of 1 unit of apheresis platelets. This may seem like an interesting question for a blood banker to ask but I am interested in what the general response would be, both theoretically and realistically.