AMcCord

I second the Echo suggestion. I have had zero issues getting reagents through the whole Covid/supply chain problem period (which is ongoing). We are geographically isolated customers but still receive good support service when we need it. Pricing for tube reagents is much cheaper when your facility is in the automation pricing tier.

And I am loving the Christmas lights again!

We haven't been having problems with our kits, but investigations for two survey failures for false positive results a few years ago pointed to the wash step as critical. Maybe start there. What works for us is a 12 x 75 tube filled to near the top, decant well after each of the 4 washes, make sure to break up the cell button prior to adding saline, and make sure that the saline addition is well mixed (uniform color throughout the tube). We had problems when we were using NERL saline. We now use unbuffered saline with pHix added (same that runs on the Echo). I had techs that tended to fill the tube only 2/3 full with saline for the washes and who weren't making sure the saline/cells were well mixed. Changing that habit seems to have helped.

I would ask that this question/answer be reviewed by the CAP Blood Bank expert. And if she is it

I had a CAP inspection years ago with someone who was also an AABB inspector. He made a 'recommendation/suggestion' that we include our facility name/address on antibody panel sheets even though they were not (and are not) scanned to patient EMR's. He had experience with an FDA inspector requiring that and joked that they (FDA inspectors) must have been aware of a HUGE black market of filled out antibody panels available for purchase. I had a stamp made with our facility name/address and we plop that on those forms. It's silly, but we do it. Looks good if we send those worksheets off to a reference lab with a specimen I guess.

I agree with the challenge. I got the same response from CAP as above within the last year or so. The person I talked to recommended that I include a statement in my SOP for method comparison that states that ABS and AB ID do not differ in methodology/utilize the same system or platform. I also attached a copy of my communication from CAP to my checklist documentation in case an inspector questions what we do.

Mismatched donor red cells (ABO antigens) would be hemolyzed by the patient's antibodies (anti-A, anti-B, anti-A,B), causing the dreaded ABO hemolytic reaction. The patient's antibodies are not going to be as dilute as donor antibodies until massively transfused and the patient is going to continue to produce antibodies to continue attacking donor cells. The red cell stroma from the destroyed mismatched donor cells would do the damage. The rationale with mismatched plasma is that the antibody source of the donor plasma is going to be diluted by the patient's blood volume and the amount transfused is going to be limited by the number of units transfused, enough that the impact on the patient's red cell antigens would be greatly minimized. There won't be as much antibody from the donor to react with the patient's red cells vs the patient antibody to react with mismatched donor cells. Maybe a positive DAT from mismatched plasma, hopefully a delayed removal of affected red cells instead of brisk hemolysis. Better than bleeding to death.

Done! We need something for arthritic fingers, not to mention prevention of repetitive use injuries. Needs to consider cost - budgets are always tight.

I just answered this question. My Score FAIL  

Yes, we built the weak D test as a separate test. The results of that test are not directly linked to the patient blood type. On cord bloods we report that result more as an interpretive comment to help OB nursing staff understand why mom is a candidate for RhIG AND we also tell them with another 'test' that RhIG is recommended if baby's weak D test is positive. Just to make sure we are all on the same page.

I know Joint Commission doesn't allow boxes on the floor. We had to add shelving with solid bottom shelves to accomplish that. We also are not supposed to store anything under the sinks. We were not cited by CAP for that in the core lab or Blood Bank prior to adding the new shelving. Would be interested to see which checklist item is cited for that, something new?.

We report the baby as Rh negative, weak D test positive (if DAT is negative), mother is a candidate for RhIG.

CAP simply requires adequate space, but workload and staff safety are both considerations as a part of that requirement. I agree with pushing the safety angle, as well as instrumentation requirements.

We are currently down by 7-8 in our small lab. 3 travelers. We are expecting 3 H1B visa techs from the Phillipines in the next 6-8 weeks. Hoping to keep a student or two.

Make sure you have access to patient records with special needs/problems in the event of a malicious hacker. Our entire LIS system has been shut down completely twice because of ransom attacks. No computer access of any kind until IT checked each physical computer individually and combed through all the servers and programs. These are not short-term events. I've discussed with IT backing up records to a computer that is connected to the network only for that backup but haven't completed that project yet. In the meantime, I keep a paper copy of a snapshot report for those patients.

Espired red cells and SD Plts.

Agree with John also.

Just another thought (and I'm sure you also considered this), we see a positive DAT which doesn't seem to make sense a few times a year that is resolved by washing the cells an additional 3-6 times or by obtaining a capillary specimen on baby.

Same at my facility, although for inpatients there is supposed to be a quick check with an MD hospitalist or specific indicators in the chart from an MD for some patients (some Onc patients, active bleeders,etc.). We found that some of our mid-level providers were more 'liberal' with some transfusion decisions than our MDs - more units, higher Hgbs.

We run those units one at a time so we can select the matching unit in utilities to bring the results in. THEN we run the 2nd unit. Kind of a hassle if you don't notice that you have a double red. And since we don't often get both units from a double red collection, we usually don't notice until the Echo yells at us about a duplicate specimen. Gotta have something to keep us on our toes I guess!

I am jealous! Windows!!!

We are currently bringing in 3 techs with H1B visa sponsorship. We've had one or two at a time a few times in the past with a generally good experience. We've been so short for so long that this was a necessity.

I would upgrade both of my blood storage refrigerators to the Helmer i-series and set them up for downloading temps so less paper trail. I would bring in a new Echo (ours is upgraded, but old). I would remodel Blood Bank (knock out a wall) to give us a little more room and a more ergonomically friendly space to work, maybe add another spot to flex to workspace for MTP events and for our students. Actually, I want a whole new Blood Bank with more room and windows! I don't want much really............

I agree. You do the best you can with what you have. Unless your blood supplier or a large neighbor who can transfer product is close by, you are not going to be able to ship in product in time. It is cost prohibitive for us to stock product routinely for an event that occurs very infrequently (and your blood supplier may not be very enthused about the constant rotation of product). We are 150+ beds, have a NICU, and are one of the 'large' hospitals in our rural area, but still transfer our critical neonates/kids to Children's 150 miles away. We only transfuse babies and small children 1 to 3 times over an average year. Our facility sees quite a few Onc patients, so I do stock a small inventory of irradiated products including 2 O neg Irrad on top of our normal O neg stock (if we can get O neg - fun times!). If we have time to crossmatch, we provide the freshest type specific unit (if we know mom's type) on the shelf, irradiated if requested and we have it in stock. If not, we provide the freshest O neg unit on the shelf, irradiated if requested and available. Children's gives LR as CMV neg equivalent, so that's the policy we follow. I don't stock syringes because we would outdate almost all of them and our software is not set up to split/label units. (It would be very rare for us to even have the possibility of pulling blood off that unit a second time, so not worth setting up.) We hand over the entire unit and the pediatrician/nurses pull what they need for transfusion in the 4 hours after issue.

If we were still doing titers I would definitely plagiarize your form.