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PamD: Did you perchance test the mother for this antibody?

We also found them difficult, but there is a more pressing problem. The irreversible indicator is for 10C for 30 minutes or so. The AABB now has a new standard which specifically defines storage. Now we are looking for an irreversible indicator reactive at 6C for off-site transfusions. We tried Safe-T-Vue and Trans-Vue, but found those also somewhat lacking. We have ordered WarmMark indicators from Dry Pak Industries (drypak.com). If this does not work, we will go to data loggers.

When we extend the crossmatch to the 7 day limit, we dispense only those units crossmatched. Our rules are that the sample must be less than 48 hours old to do a type and screen and antibody identification and that crossmatches may be done up until midnight of the third day after collection. On extrended crossmatches, Surgery knows to get us a fresh specimen if more than the orginal number of crossmatched units is needed.

Since Blood Bank tests are usually only graded positive or negative the term correlation cannot be applied. The inspectors will want you to QC both methods, to investigate all discrepancies, and to describe the methods in your procedure.

The most common reasons for a reaction to these products are 1. A high titer of Anti-A or more commonly Anti-B; and 2. A deficiency of IgA in the Patient with or without a concomitant Anti-IgA and a normal or elevated amount of IgA in the unit. Since platelets are frequently and sometimes purposely given out-of-type, do a DAT on the Patient, and if positive then do an elution, preferably by a Lui (freeze/thaw) elution. For plasma reactions request a quantitative IgA. If value is low and Patient needs more plasma, select IgA deficient or at least low level IgA units - these will be from healthy older donors (>60 yrs old).

One of the best things about using Ortho gel (or any microcolumn) is the ability to see dual populations. When you get referred Patients, you don't always get histories immediately. Finding dual populations gives you an early clue.

Tthe Patients here who have taken the longest to convert have been from Type O Pos to A Neg and from O Pos to AB Pos. Both og these Patients are still doing well and have not needed further transfusions, so I really have no long-term follow-up Blood Bank results.

PammyDQ In the cross-type bone marrow transplants we've had, the MDs have been more concerned about the final conversion of the reverse type. The forward type converts failrly quickly, and we usually give type O and Rh specific until the reverse type reacts at AHG like the forward. At that point, the need for transfusions drop off to nil.

You are correct in that there is no regulation stipulating such secondary containers. We use a cheap zip-seal bag here as institutional policy. We can't be sure how clean the transporter's hands are. The bags are not only fragile, they are also porous - two reasons to use a secondary container.

To go back to the first post in this thread, JerryB asks about using 3 homozygous cells. The Fisher statistic refers to 'heterozygous' or better expressed as single dose antigens. A double dose cell or homozygous cell would be counted as 2 expressions of the antigen. We use the Fisher statistic, but always include a double dose cell. We make exception for K because of its rarity in panel cells. This system has worked well over the years, allowing us to 'prove' such rare antibodies and Anti-Lua, Anti-Kpa and Anti-Kpb.

A company named Genesis also makes a sterile tube welder. Genesis sometimes advertises in this forum, which is how I know the name. We have the Terumo TSCD-II and have no problems; and, it is almost 10 years old. The interesting fact is that is that if you plug sterile tube welder into Yahoo or Google, the only name you get is Terumo. So, Terumo is probably the 600 pound gorilla of sterile tube welders, and probably deservedly so. No one complains about their machine or their service.

We had been culturing platelets received from our blood supplier because their testing was only valid for 24 hours (please don't ask). The supplier has recently converted to one of the FDA-approved testing methods and we no longer need to re-test. So now I have 4 cases of Cardinal Health's Plasma/Fluid Transfer sets (Stock No: 03-220-BC). If any of you would be willing to pay the shipping, I'll be glad to send them to you. You can e-mail me at boudreauxn@lourdesrmc.com or contact me here. Good luck.

Those who are billing for the second ABO might want to re-think that. Medicare does not allow billing unless you have demonstrated the test is medically necessary. They will simply deny the claim in the usual cases; but if you ever have a major problem with them, they will add these 'inappropriate' claims to their argument. We instituted second ABO in the early 90's, but have never charged for it.

Thanks Nancy L. Cerner does not allow two identities for phlebotomy, but htere is always the comments section. I thought I might have to make a form that I would have to permanently file. Tying it to the phlebotomy in the computer is far better. I don't believe the AABB will be satisfied with two techs testing the same sample - that does not eliminate the misidentification of the Patient issue, unique arm band number or not.

We do the two week retention. It was easy to set up a rotation of 14 days by the day of the week (This week and last week). We pull and label segments at xm and store them in 12x75 mm tubes along with the pretransfusion sample. Retrieval for Transfusion Reactions is facilitated and comparing segment numbers with number on the returned unit is one of our clerical checks. The two week retention also simplified one other circumstance. If someone must extend a xm (no more than one week prior to surgery, i.e. four days longer than usual), the two weeks means not having to chance premature discarding. Not having to remember to do something works best. When we had a donor center we retained samples 3 months until the NAT West Nile Virus test was made available, then no longer had any reason to retain donor segments. We kept the pilot samples (re-capped) for one month post collection. Good luck.

Individual C/T ratios are not important. Check the Technical Manual. It is more important to prepare a list of recommended number of units for specific types of surgery and to establish a threshhold for transfusions (Hct: 30, Hgb: 10 for example) and to have these approved and promulgated by the Transfusion Committee. Once established, the Blood Bank sould monitor individual transfusions. For example, Orthopedic surgeons who do knee replacements will not do surgery without 2 units on hand, but then seldom use the two unless they were autologous. This is not a burden on the Blood Bank, and is naturally commendable. Finally, you do not want to take an antagonistic approach to individual infractions. It would be better to request clarification of a specific circumstance. After all, you probably weren't there, and the clinician probably was or else was given infromation from someone who was, the nurse who observed the blood in the dressing, or the Patient's blood pressure or color. Once your Medical Director gets the details of the response, the Transfusion Committee can decide how to proceed. Of the things presented here, the most involved is the list of recommended units for surgery. You would need cooperation from the head of surgery and the leading surgeons. On the other had, the threshhold for transfusions is an accepted level; although there are studies that show we should use lower numbers and different threshholds based on age, sex and condition.

A cheap alternative to two samples is to have the Patient identified by two people and for both of them to sign the tube. Even in the OR this is possible. What is this national database keyed to the SSN? Is this military, government or private? And most important, does it include antibodies? and antigen testing?

This is a case of semantics. CAP requires the Lab Director and Technical Supervisor to have the qualifications you state. Most places circumvent having CAP challenge their personnel choices by using terms like Section Head, Team Leader, Coordinator, Lead Tech, etc. With CAP, you will not be asked for qualifications (even in the Blood Bank) if you avoid the term Supervisor. You will have to list the qualifications, but you will not have to defend them. This is not a short-coming of CAP. They are allowing individual facilities elbow room in filling positions. Smaller communities would naturally have fewer MTs to choose from.

emadib You calculate the C/T ratio from totals, not for each transaction. The C/T ratio is well known to nurse managers, so it is part of most hospitals QA program. For your blood bank it is important, but he numbers from which it is derived are even more important. The total number of crossmatches reflects your workload for the month. The totals number of units transfused reflects your bill from your supplier. if you are setting up a QA surveillance, you may want to also track the total number of plasma and platelets transfused, the number of units re-typed, and the number of transfusion reactions. These are the essentials. Good luck; and belatedly, welcome.

We tend to use upright freezers in the Blood Bank, mostly to be able to sort our products. But what helped us tremendously at another donor center where I used to work was using a small home-style chest freezer to freeze the products overnight. We'd then transfer the products the next day after labeling. Remember those days when labeling was only one day after collecting. I would still recommend the chest freezer since they keep the cold in better. We had no problem installing an alarm and chart recorder for AABB compliance.

We do the albumin calibration, partly because we always have. Since centrifuges have gotten so consistent, and we have our spin times down to 7 to 10 seconds versus the 15 to 20 we used to see, we probably don't need to do all three phases anymore. But the thinking here seems flawed. Yes, we spin in LISS and don't spin with PeG, but in each of these we have serum (or plasma) - that's what the albumin represents. By keeping LISS and PeG I infer you are doing some tube testing with serum (7-10% protein) like the albumin in the calibration. You need to do saline phase because this represents ABO and Rh reagent testing. You obviously need to do AHG phase. But the check that has creeped up on us is the washing. One of two serofuges bought at the same time is now showing poor washing at the earlier determined time of 30 seconds. We now must use 45 seconds. I will replace both serofuges and will check my wash times more frequently in the future.

donnawac is correct about the threshholds probably being the cause of biases. You can determine this from the mean platelet volume on correlation samples. There is probably no need to have the manufacturers adjust the threshhold to improve the correlation, a diffeence of 30,000 is not significant. I disagree about linearities; they must be done periodically, but six months is too short an interval. I would suggest biannual. Be sure to put it in writing.

No; you must do the albumin calibration also. The albumin phase also represents your PreWarm screens, panels and crossmatches as well as tube tests to resolve problems, such as taking reverse typing to AHG when testing Patients with out-of-type bone marrow transplanting. The latter can be done with gel but not the PreWarms. The point is, if you use LISS or PeG, you should do the albumin calibration.

Warming Anti-A and Anti-B reactions is ill-advised. These reagents work best at room temperature or colder. We just had a donor with similar reactions, taking the Anti-A to AHG gave a 1+ (Anti-B=0, A1 Cells 2+ by IS and AHG, B Cells 4+ by IS and AHG). Donor's cells did not react with Anti-A,B (IS or AHG). My guess was that she is a chimera, producing souble A antigens which coat the red cells if not few frank type A cells. The amount of A antigen is probably sufficient to reduce the production of Anti-A hence the weak reaction with A1 cells. We created a Patient file on this donor to make sure she gets Type O blood and type A or AB plasma if she needs a transfusion.

The warm auto will come and go, as will the Anti-E. The odds are the Anti-E is the result of a stimulus from a non-immune source (a natural ab), which puts a history of Anti-E of minor significance; however, it means the Patient is in the minority of the population who react to an antibody stimulus. These Patients must have an AHG crossmatch. They have already demonstrated they will produce an antibody, so should be tested through AHG.