AMcCord

I agree 100% with David. There are some antibodies that cannot be ID'd with gel (reaction too weak)that can be with tube/PeG. Many warm autos have to be worked with in tube - they love gel too much.

We also use a Blood Bank ID # good for the entire admission - cut off the armband and we start over.

We also send ours out - same problem, more survey samples than patients and competency was tough to maintain. We get a turnaround time of less than 24 hrs most of the time, though weekends are a trick and holidays are worse (transportation issues). We issue the first vial of RhoGAM before we get the KB results back, with a comment that additional vials may be indicated, making sure that the patient's nurse understands fully. Blood Bank takes the responsibility to make sure that the KB results are back in a timely fashion and that additional RhoGAM is issued if necessary. It felt a little weird doing it this way at first, but we haven't had any complaints from medical staff regards fetal bleeds and our patients are getting the RhoGAM they need well within 72 hours. At our facility, if a serious fetal bleed is even suspected, the mother is on a chopper headed to a bigger facility very quickly. We do not have a neonatal intensive care unit.

As to labeling cord bloods, since the type is baby's, our primary label info is baby's. The cord blood panel is ordered on baby's visit ID. The label does also include mother's name and med record # so we can cross reference for possible RhoGAM.

We run a DAT on Echo.

Was the first sample a line draw? Did you have one sample tube that was used for both tests? Could there have been a contaminate present in the sample that gave you the AB results?

Sue makes an excellent point with refrigeration when not in use.

You do "know" that the silly rules (Blood Bank's) don't apply to OR, don't you? And of course ER doesn't have time for those silly rules during a trauma...... Every year the stats for fatal ABO hemolytic transfusion reactions come out showing that the majority of cases come about because a unit was hung for the wrong patient and many years several (or most) of these cases happened in ER or OR. I always have a strong urge to blow up the information to huge poster size, highlight the pertinent stats and hang it in ER and OR staff areas! It's a constant battle and we have to keep fighting it for the sake of the patients. There, I've vented now...I feel better.

Surgery cuts off Blood Bank ID armbands at will. I don't like it, but we have reached an agreement. The bands are cut off only by anesthesia in OR. The band is put on the patient's chest (we don't have any chest cutters here) or forehead. Before the patient leaves the OR, anesthesia (same one who cut the band off) must put the band back on the patient. If the patient reaches PACU without the band, the crossmatch and all specimens are null and void, no exceptions. We have lots of anesthesia locums coming through but this still works pretty well for us.

Complement Control Cells can also be adversely affected by shipping conditions. Once every couple of years I have a lot # that does not work because they came in when the temperatures were 100 F + . Reactions are extremely weak to non-existent. In the winter time, they have come in too cold, showing traces of hemolysis. Those cells need replaced as well. I agree with the previous poster. The maximum agglutination you should expect is 2+ with 1+ reactions quite normal. The agglutination is fragile. I, too, find them to be a good test of the shaking abilitiy of my techs and students.

We hand label.

We use a take home card, blending the procedures that Swede and Eoin report. It has worked very well for us for years. We reinforce with the patient that if they don't have the card when admitted that they will be redraw, surgery could be delayed (though really probably not), etc etc. They seldom forget to bring them back.

We never did buy a specific worktable for Gel. We use the little throw away holders the cards come in cut in half for our strips and put our tubes in an ordinary tube rack. The half holder will sit on top of the rack if we want to set that patient aside for some reason. When the strip holder gets nasty looking, we throw it away - lots more where that came from. You can call us recyclers or you can call us CHEAP:tongue:.

We also use the same one that the rest of the lab uses. (Our lab manager and our QI person are chemists so sometimes I have to make some creative entries on their forms to force them to work for me.) [ATTACH]134[/ATTACH] Discordant Result on Survey.doc

The QA department of my blood supplier shared information about platelet storage/rotation with me. And they didn't have a lot. It seems to be one of those areas where everybody knows there has to be references for the rules but nobody can quite put their fingers on those references.

ABO incompatibilities are not reliably detected by AHG methods of any kind. That is where the immediate spin crossmatch comes in (or the electronic crossmatch).

Some of the discrepancies you are seeing with D typing may be the result of using different blends of anti-D monoconals, not because you are getting an error in testing. The clones in anti-D Series 4 and Series 5 may not be the same as the clones in your tube testing reagent. Rh typing for donors vs transfusion is kind of comparing apples to oranges really. The 16th ed of the Technical Manual has done a pretty good job discussing this issue in Chapter 13. In particular, you might want to refer to pgs 396-399, Testing for D (Reagents, Donors, Patients, D Typing Discrepancies, and Clinical Considerations).

The manual with my new Helmer i-Series recommends a monthly check on display temp top and bottom. Doesn't take very long. (I will admit to also having bottles in my fridges:redface:. Old habits die hard.)

I've picked up 2 nice Anti-Ks with Echo over the two months. 3-4+ with Echo and 1-2+ with Gel. Echo has produced 'eye-readable' results for a couple of anti-Es and 1 anti-Fy(a) that showed nicely in Gel. I also picked up an anti-E that Gel missed entirely and an anti-Jk(a) that was almost too weak to see in Gel (and unidentifiable with Gel or PeG). Keep in mind that no one system or method is going to catch all antibodies. That's a fact of life that we blood bankers have to live with. Select the method that you think will work well for your patient population. And also remember, you have most likely missed an antibody or antibodies with Gel and just don't know it (and with any other method you have used routinely).

The Circular of Information states "assume 80 IU of Factor VIII and 150 mg of fibrinogen for each unit of Cryoprecipitated AHF indicated on the label". If your pool is 5 units...5 x 150 mg fibrinogen. This would be minimum potency.

A merged file would be great.

Almost all of our specimens are drawn by phlebs with a tech (not a blood banker generally) helping out when they are overloaded. We accept specimens drawn from lines by nursing or ER physicians only when someone from lab witnesses the collection and IDs the patient at the time the specimen is collected. If we arrive to find a syringe laying on the patient bed or a nearby counter...redraw. I make sure that I have a serious 'chat' with all new phlebs about labeling Blood Bank specimens and go over the policy with them. They also know that they will be held accountable and required to fill out a variance for any errors found in their specimens. We are not large but there is no way Blood Bank or even a tech could draw every Blood Bank specimen.

Our Bio Med department contracts with a company to come in and check the calibration of their thermometers (and other stuff) once a year. They notify us when the company rep is coming and I deliver the 2-3 thermometers, tachometer and stopwatch I want checked. BioMed returns my stuff when they are done and brings me a printed report for each item from the company. The report includes points checked, the ID of the NIST standard checked against, etc, etc. From there I check all my other thermometers and centrifuges. Works well for us.

I'd report it as too weak to titer and recommend a repeat in a month. Is it clinically significant? Maybe yes, maybe no. I would treat it as if it were, especially until you see what it does over the next couple of months, and let the doc decide how he wants to play it. I think a visual exam of all apparently negative wells is a good idea, because I've seen several antibodies that showed up just the same way, below Echo's cutoff but definitely there. We've even ID'd one in a recently transfused patient that way. All the fuzzy wells were a perfect match for anti-Jk(a) double dose cells. It will be interesting to see what's there the next time we see her.

Surg used something similar to what you described in the past for orthopedic cases. We also found out about it by accident and after it had been in use for quite some time. The Blood Bank Medical Director does have responsibiity, so we used that muscle to insist that they write up a formal procedure following the manufacturer's instructions - they hadn't thought there was a need for that. We also insisted on a label on the device/reinfusion bag - you know, something silly like the patient's name and ID. We also required that standard transfusion protocol be followed for reinfusion (i.e. close observation of patient, vitals documented, etc.) and that complete documentation was on the patient chart. We didn't have much difficulty persuading them to comply. I think that it had honestly not even occurred to them that they should think of the process in terms of transfusing a blood product. A reminder that Joint Commission could be watching was all the encouragement they needed. There was no QC done. The shed blood was not washed and it was supposed to be a closed system so we didn't insist on cultures. The surgeons didn't really care what the Hct was. It was obvious to us within a fairly short time that most of the patients were not really deriving much benefit from use of the system. The reinfusion volumes were rather small in most cases. In a significant number of cases, there was not enough shed blood to reinfuse (can't remember what that magic number was). The transfusion rate for patients using the system was very similar to the rate in patients where the reinfusion system was not used. The system got used less and less, then dropped altogether. In addition to culture and Hct, you might also think about evidence of hemolysis.