pdavenport

We've been using the Raycell irradiator since 2002. The installation isn't much of a problem. You do need a water line, a drain, and a 220 electrical line. The vendor provides a water pressure guage and booster to make sure the water pressure stays in the required range. Calibration is performed by the vendor during installation. We perform dosimetry every quarter. Two dosimetry kits are provided by the vendor, and we purchase the other two from MD Anderson. Very little is required by way of maintenance. We follow the manufacturer's instructions and run a warm up cycle if the irradiator has been idle for 4 hours or more. We attach an irradiation indicator to every product. We haven't lost an xray tube, but have blown a power supply a couple of times. The power supply does seem to be their weak point. Now that the manufacturer, who is in Canada, is keeping a supply of parts in the USA, repairs don't take as long as they used to. It's nice not having to deal with all the issues surrounding use of isotope these days. In our state, the irradiator is licensed by the state as a freestanding industrial xray devise. We irradiate about 10,000 products a year.

How strong were the reactions on 11/3 and 11/13? What's the patient's history?

We use Sani-Cloth germicidal wipes we get from central supply. They do a pretty good job with the surface grime and have been approved by our Infection Control committee. The only down side is they require a 2 minute scrub. Not sure what you can use for the cloth covered one.

At our children's hosptial we once had an infant 3 months of age who presented with a strongly positive DAT and 3 gm Hgb. Antibody identified in the plasma as Anti-U. Both partents and the baby were heterozygous for S. We called it an auto with U specificity. The infant required transfusion. We used U neg RBC. Baby had a rip-roaring CMV infection. Once the infection cleared up, so did the antibody.

We're using Sunquest 6.3. It's terrrible.

I work at a children's hospital with 130 bed NICU. When we're lucky enough to have the cord blood transported with the infant we use it for antibody screen and antibody ID if needed. It facilitates rapid identification of the antibody without having to obtain large amounts of blood from a baby the size of a kitten.

Ronald Strauss has published several papers on this topic. It boils down to "do the math." While the potassium on a unit of blood at 42 days may appear to be extremely high, it's mEq/L of plasma. When you calculate the K level in a small volume aliquot, it turns out to be significantly less than the infant's maintenance dose of K. The benefit of using a single unit until it outdates is decreased donor exposure. The majority of neonates who are "feeders & growers" get all their transfusions during the first month, if you assign them to a fresh AS-1 unit for the first transfusion, you can get them through the entire stay in the NICU with only one donor exposure.

Sunquest (Misys) does not currently support the production of ISBT labels. And it does not appear that they're going to be able to do this for some time. If you modify products or make aliquots, and are on Sunqest, you have to purchase a stand alone system. That makes double data entry for your already busy staff. The process to issue uncrossmatched blood on Sunquest is so time consuming, that we do it on paper and then enter in the computer after the fact. The system for results recording of patient or unit antigen typing is really awful. The good people in Tucson actually suggested we record our reactions on paper and enter only interps in the system. The data items that are automatically sent to the patient history file are hard coded. If you want to include something (like an Rh phenotype) that isn't on their list, you have to manually enter it. We joke in our blood bank that Sunquest won't approve any modifications to the software until it's been through the maximum keystroke committe to build in as many gratuitous keystrokes as possible.

The same is true in the US. The expiration of platelet products is not effected by irradiation. I believe the primary concern with red cells is the increase of extracellular potassium following irradiation.

There are several different schools of thought on this. At my facility we obtain a new specimen every four days. The standards say the sample must be drawn within 3 days of the transfusion and that the day of draw is day 0. When we get a fresh sample from a patient with a previously identified antibody we run a mini panel of selected cells to determine whether any new alloantibodies have been formed. We don't bother to confirm the presence of the previously identified antibody because we're going to have to honor it anyway.

The only xray based unit is still the Raycell by Nordion. But I recently saw a press release that Nordian has sold that segment of the company to Best Medical. Best Medical is mostly in the US, so hopefully the turnaround time for parts and service will improve.

It's against the CMS rules to bill for a product the patient did not receive. You can bill for any testing or processings such as thawing or pooling, just not the product it's self.

The FDA requirement is found in CFR 606.65. But what that boils down to when FDA comes to call, are you following the manufacurer's product insert?

We use 24 hrs for red cells and 4 hrs for platelets based on the manufacturer's (Charter Med) product insert.

We're in the process of modifying our report form and SOP. The form will ask for documentation of hypoxia (pulse ox, FiO2). We can check the computer to see if an ABG was done. Hopefully that will help us detect TRALI. The biggest part for us has been physician education. We did a presentation of TRALI at grand rounds, and got a lot of positive feedback from the physicians.