AMcCord

I've used 9 segments from an Rh neg unit plus 1 segment from an Rh pos unit with about 6-8 drops of anti-D. Let that concoction incubate at 37 C for 15 or 20 minutes. I washed the sample once or twice to remove some of the anti-D, then handed it off to the student. When they followed our SOP, the sample worked just fine. I'm sure you could do something similar w/ different antisera, but I've never tried. I just needed to teach the method, not evaluate for a competency.

Mable, if you can figure out a way to convince your providers to skip the O Pos moms, let me know! Our OB/Gyn practice is OK with not doing the O Pos moms (and they delivery 90+% of the babies here), the pediatricians are Ok with it. Our problem is one family practice provider and he's not budging. We offered to make it an optional order - he wants it, he can order it, but that didn't work either.

No elutions here unless DAT is positive and we don't have mother's specimen or the DAT is positive w/ no apparent reason (no ABO incompatibility, mom's antibody screen is negative). In all the years I've worked here, we've never actually needed to do this.

When we still saw antibody screen orders prior to antenatal RhIG administration, the OB providers wanted the patients drawn within 7 days of their appointments. I always assumed that this was a recommendation of the American College of OB/Gyn. They stopped ordering those antibody screens several years ago, so I'm again assuming that there is no longer a recommendation for that testing. That particular practice very much follows guidelines.

And you will fix what they cite - no worries. They expect to find things to cite you for, so don't plan on going through the inspection w/o getting nicked for something, Do the best you can, but don't be hard on yourself when you are cited. Look at it as a learning experience and an opportunity for improvement.

Exactly - patients should self identify, whenever possible, and that would be full name plus birth date. (We have had a few frequent flyers who would rattle off their MR#s when asked to identify themselves, but I think that was more about being a touch exasperated w/ our constant requests for them to tell us who they were rather than anything else.) And I agree that the birth date should be on the armband and the order for ID purposes. We do have it on the labels that go on our specimens, but it is not 'required' as an element of specimen ID. The CAP requirement for patient specimens is: "All blood samples used for compatibility testing are labeled in the presence of the patient with:1. Patient's first and last name2. Unique identification number3. Date of collection4. A method to identify the phlebotomist." AABB Stds say: "Requests: Requests for blood, blood components, tests, tissue, and derivatives and records accompanying samples from the patient shall contain sufficient information to uniquely identify the patient, including two independent identifiers. The transfusion service shall accept only complete, accurate, and legible requests." "Patient Samples: Patient samples shall be identified with an affixed label bearing sufficient information for unique identification of the patient, including two independent identifiers." They further say that the completed label has to be placed on the sample container at bedside; it has to identify the date/time of draw and the person(s) who collected the sample; that specimens have to be completely, accurately, and legibly labeled; and there should be a policy to reduce risk of misidentification of pretransfusion samples. I believe that Joint Commission recommends following AABB guidelines. So, as far as I know, the birth date is not 'required' on patient samples, but it is also not precluded from sample labeling. You can choose what your independent identifiers are and you can always have stricter requirements than standards in order to meet your needs. We choose to use full name, MR# and a separate armband ID for inpatients, giving us 3 independent identifiers - not required, but we've chosen that protocol to meet our needs.

Blood bank specimens here require 2 patient identifiers plus a sticker from a blood bank armband that is directly attached to a patient appendage. Our required identifiers for inpatients are full name and MR#. The labels that print at bedside include the birthdate, but birthdate is not a required identifier. We do, however, use birthdate as one possible patient identifier for outpatients. Specimens from outside clinics for reference work (prenatal panels) are acceptable with the name and a birthdate. We've stuck with our blood bank armbands because we've watched how some patients have gotten armbanded on the floor...staff member walks into room and slaps on band OR staff member walks into room, says 'Are you Fred?' and slaps on armband OR any other similar variation. That is definitely not policy, but it is human behavior. Blood bank specimens are lab draw, with some exceptions from the OR. We have a very strict policy about the removal of blood bank armbands - only we cut them off, or give permission for them to be cut off, unless the patient is being discharged. We've been doing that for long enough that we lose almost no bands. We have the full support of Quality to enforce the armband policy.

They are just jealous that they can't play, too.

I would rather deal with the unlikely event that my male trauma patient develops anti-D, then presents again as a trauma, than deal with having to give a young Rh negative woman Rh positive blood because I ran out of Rh negative units transfusing an adult male or a 50+ year old female. My stock of O neg red cells is 8 with full stock and my blood supplier is 150 miles away. A trauma situation could very quickly deplete that supply.

Most of the techs I train are fresh out of school or MLTs whose blood bank experience is minimal at best (bench time at small facilities where almost no blood bank testing occurs). I expect to have them for a minimum of 3 months. We have a full test menu (automation + tube testing w/ mulitple enhancement media available, antibody ID, antigen testing, fetal bleed screens, crossmatching, emergency release/MTP, cord blood testing, etc.) that they are expected to be competent to perform. Our facility sees a wide range of patients. I want them to be comfortable with what they are required to do and I want to be comfortable with what they are required to do. Fortunately management sees things my way.

Yes, a Kleihauer-Betke would be performed plus we would indicate in the patient record that Kleihauer-Betke is required for all future deliveries if the patient is weak D positive. We would not repeat the weak D testing. And as a side note, if the patient's baby was weak D positive, Kleihauer-Betke testing would be performed.

Great ideas for fake products using stuff that's easy to get your hands on. Thanks for sharing.

Where do you get your fake blood powder???

We would do weak D on a post-partum patient only if the fetal screen is strongly positive.

I've been looking forward to them...busted all of them already this morning. Just to get in practice .

John - you can keep your silly snow. We've already had more than I want.

We start with O Pos, though I would have to say that if we had history and knew the patient was Rh Neg, we would probably give Rh neg unless/until it looked like mass transfusion.

I use their QC kit for tube testing and will be adding complement control cells. In the case of the QC kit, I did parallel testing for a 2 weeks and compared results with the kit/process I was already using. Everything looked great. Complement Control Cells from Quotient are good for 4 weeks, instead of 2 weeks, so I'll be checking them in parallel against two lots of my current CCCs to make sure that they will react reliably at the end of their outdate. I've also got some of their anti-Fyb monoclonal, which looked very good when I played with it. I'll run that in parallel with my current antisera on at least 25 specimens, including some known antigen positive and negative cells from an ID panel.

Agree on the 2nd fridge if you can swing it and have space for it.

Helmer fridges actually heat and cool the probes, so I only do a thermal challenge once a year and push the buttons the other three quarters. I think I will have to add chart response to the test in order to be compliant with this requirement.

I like Credo coolers. They hold temp very well. A bit pricey, but if you are looking at one or two, it probably won't break your budget.

I'd say that you have to consider the capabilities of your staff. I do ask my techs to use the microscope for DATs. They are all generalists and their time in blood bank is limited. Some of them shake too hard, in spite of my best efforts to fix that problem. They use a mirror, but some don't use a mirror well. So, in order to not miss weak positive reactions they use the scope with a tube roller. We also have a definition for microscopic agglutination (right out of the Technical Manual) that says it is a clump of 4-5 cells (though I do tell them that they should be cautious with this - if tests look suspicious, check them out, don't blindly ignore what you see). When I train, I stress the difference between a clump of cells that are friendly/kissing and a clump of cells that 'love each other' (agglutination). They do very well - false positives are rare. I don't see a lot of unnecessary work being done.

Pre-transfusion, 15 minutes after blood starts infusing, post-transfusion. I would like to see vitals hourly, if applicable to the infusion, but haven't gotten anywhere with that.

I run a positive and negative control for everything that comes in except the elution kit. As an example, anti-A would be checked against the current lot of A1, A2 and B cells in use. New screening cells are run against the positive QC antisera in use and a current patient sample w/ a negative antibody screen. Determine what is acceptable - results have to match +/- one grade level, or whatever works for you. We test the fetal bleed screen kit by parallel testing of the cells from the old kit (pos and neg controls, indicator cells) with the antibody from the new kit plus testing the cells from the new kit with the antibody from the old kit. That's 4 tubes. Set an acceptable range of rosettes counted for the controls to match from the old kit to the new kit. Keep it simple.

Agree! and they were always handy.