AMcCord

When we did them (nursing does now...Yahoo!), the pathologist reviewed the patient's diagnosis and labs with the first visit and then I took the cases back to him yearly when the standing orders were renewed. We also had parameters set for temp, BP, HR, and H&H. If the patient's numbers fell out of those parameters or if there was something new going on with their health (new diagnosis, not feeling well that day, etc), then the pathologist had to aprrove that day's phlebotomy. It took about 1 minute of his time for most cases, maybe a phone call to the patient's attending in a few cases per year. It really wasn't a major burden. The documentation always passed inspection with flying colors.

We do it like adiescast.

I know that Ortho gets their fetal screen kits from the other side of the pond for US use. The beginning of the big volcano eruption delayed a shipment by a couple of days until they rerouted it through Spain and then on to the US. I think the vendors have been doing some creative problem solving. It wouldn't hurt to ask them what their emergency plan is - I think it's been a wake up call for a lot of companies in our global economy.

Some blood centers supply antigen negative units based on historical type. Some transfusion services prefer to recheck the type in that case. (We have huge medical malpractice lawsuits over everything and anything here, so that drives a lot of what we do.) It is not uncommon for larger hospital labs to stock 'routine' rare antisera such as anti-Jk(a). However, one cannot recheck for antigens to which one does not have antisera (such as anti-Lan)- kind of crazy, isn't it?

Good advice from all. Seeing them in use with users who are comfortable with them is an ideal way to see what the workflow is and to see what you might have to do to your process to make them work well for you. I would also recommend switching to the pink tops ahead of time. You may see some non-specific nasties trying to use frozen serum with Echo and gel, as compared to the original tube test Any fibrin in the sample will goof your gel and solid phase tests up and freezing seems to cause it's own weird problems, though not in all samples - false positives and false negatives are possible, including with tube testing. I have no experience with Bio-Test, so I can't offer an opinion there.

We still do it, but we do not have a Blood Bank computer system.

You go girl! It's tough, but you sure do have a feeling of accomplishment when you've done it.

Our two are model EBA 21 - their heads do come out. In fact, there are several different heads you can get for that model for a variety of purposes.

In day to day work it gets really easy to space off that those reverse group cells have other antigens on them. It gets in your head - that's an A cell or B cell, etc - and the other antigens just get swept under the rug until they jump out and surprise you, like this patient did. It's something that is really stressed in the teaching materials I get for my Medical Technology students. They get several exam questions about just that sort of situation. Makes me wonder if the person who wrote the materials had an interesting experience with this kind of patient.

We have been using 2 of them - first one since 2004. They are smooth and quiet, no problems with either of them. They do have a bit larger footprint than what we were using before. The older one has a flat top, which means that the buttons and readout are on the top and you can't see them very well from a sitting position unless you are tall (which I'm not). They improved them by putting the controls and readout display on a slanted 'bump' on top, much easier to see and use - which is how our newer one is set up.

Have you done an antigen type on the reverse group cell for c?

That is truly evil! I've been accused of enjoying student torture too much, but that tops me...keep up the good work!

Maybe a good research project for an SBB student???

I would say it is reportable. The important phrase is 'the potential to affect the purity....etc'. Mistyping the patient certainly has the potential to affect the safety of the transfusion. It was fortunate that the Rh neg unit was compatible and caused no harm, but the potential for harm was present.

I've also seen pos DATs on babies due to RhoGAM. It's always been weak, but definitely there.

Better to be safe than sorry. If you cannot quantify FMH, I would give more RhoGAM.

Ozark Biomedical.com is another place to check, especially for product models that have been discontinued.

This is not an oddball experience. You will find an antibody now and then that is detectable with solid phase that is too weak to ID (or even detect) with tube testing. We've seen anti-Jk(a), -E, and -Fy(a) this way. I just picked worked up a patient specimen with an anti-Go(a) that is not reliably detectable with tube testing - PeG or LISS.

Multiple births - twins, triplets, etc. - can result in the need for more RhoGAM.

Here's a quick update. Our medical director took a suggestion to the OB/Peds committee that they went for, no major discussion, no quibbles (amazing actually!). Having a close call case we could point to certainly didn't hurt our cause. The standard order sets for all physician groups delivering OBs here requires collection of either a CBC or H&H postpartum. An Rh type will be added to the postpartum draw orders, possibly as part of a lab order set with the CBC/H&H. There is no decision process involved for Dr or nurse - it applies to all patients. If a mom is Rh neg, we will check and make sure that baby has been typed. Why postpartum? We knew the physicians would object to 'any extra sticks' . We don't have to worry about knowing who is in to deliver. We don't have to worry about somebody getting the wrong type documented on the chart from the office. And we don't have to worry about somebody forgetting to collect a cord blood sample. Yes, it's a little more work for the lab, but I hope it makes a tighter safety net for our patients. It doesn't address patients seen in ER - that's another project. Thanks everyone, for contributing your policies and experiences.

There is a really long and involved thread about label adhesive but it's probably from 2(??) years ago or so. The endpoint of that discussion was that the adhesive has to meet the requirements for food safety. Ask your label provider for a written statement that their label adhesive meets the requirements (as in Richard's message above). I was able to get that statement from Shamrock several years ago. Interesting point about stickers and adhesive interfering with gas exchange - worse for platelets, maybe?

Malcolm... have you tried the internet or Ebay to get a battery for your elderly friend (your laptop)? You might be able to get a new one that way. My mother got one for a defunct cellphone that way. Anti-M, -U.... at midnight...? Could he/she be a vampire???

If using a sticky label, you should also make sure you are not covering up the unit labels from the blood supplier.

We deliver approx 700 babies per year on average. We used to do about 98% of all Prenatals for our deliveries, now we're down to about 80%. Because of that decrease, we are seeing more and more patients for the first time, when they come in to deliver. OB nursing service has a policy that says they are supposed to make sure that there is a blood type on the chart. This usually takes the form of patient notes from the physician's office, not a copy of a lab report from a CLIA licensed laboratory. IF they don't have a type on the chart and can't get the notes from the office, they ask for an order for a blood type (doesn't happen often). They also remind the physician that a cord blood should be collected. Two big sources of errors right there - the notes from the office could have the wrong type and it puts a burden on nursing service to remind the doc to collect the cord blood - they could forget the reminder on a busy day. If we don't receive a cord blood, we have no way of knowing that someone has delivered. Actually, we don't even know who is in labor. We thought we were doing doing a good job with this, but we had a recent incident where a physican declined to collect a cord blood specimen on an Rh neg mom after several reminders from a nurse. We picked up the omission because mom had a Type and Screen order (these are done only when ordered, not as a routine order upon admission) and an alert tech noted that they never received a cord blood post delivery. She inquired about the missing cord blood and was told the Dr did not collect. This was referred to a pathologist, who called the Dr in question. The answer - " Why, yes, of course the patient should get RhoGAM!" Don't know what happened there, it's still under investigation. We are now questioning our system, obviously!!! Has this happened before? Gives me the willies thinking about it. We need to make sure it doesn't happen again. So...here's the question. What do you do to meet CAP TRM.40780 - is there a system to identify all potential Rh immune globulin candidates? Do you have written policies for physicians at your institution that require a cord blood on all Rh neg mom's? or an order set for physicians that requires a cord blood on all Rh neg mom's? If yes, how do you know who the Rh neg mom's are so you can verify that you have them all covered? Is an office note acceptable on the chart? Is a lab report from a CLIA licensed lab required for mom's chart type? Does lab get a report of who is in labor? or make a report of Rh neg mom's in labor somehow? I know this is a problem many of us struggle with. Has anyone got a really good system? Thanks for your help!

We check temps when a unit is returned and document it. If it's over 10C , we give them a choice...can you get the unit started and infused within 4 hours of the original checkout? if so, then take it back upstairs and do so, preferably holding it in patient room, but don't put unit in the refrig or in an extra warm place while you are getting ready to actually hang it (works for situations like restarting IVs). If you can't get the unit started and realistically infused in 4 hours from checkout, then we'll take it back and the unit will be destroyed. Nursing service policy requires that a unit must be hung within 15 minutes of checkout so they are absolutely ready when a unit is checked out. Because of this, we get very few requests for return. Of those, there are only a couple of instances per year where the unit ends up being destroyed.