heathervaught

But there is some quality control testing that is performed on multiple parts of the same donation when dealing with apheresis components.

Denise, I know that blood centers who perform testing do focus on the multiparous female and not individuals who have been transfused. There are some centers that test at 2 pregnancies or more, and some who only test at 5 pregnancies or more. And there are some centers, like mine, that have chosen not to implement testing as part of the TRALI mitigation strategy.

As I understand, Fenwal has a product that is approved: http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/NewDrugApplicationsNDAs/ucm193789.htm and others are working on approval. However, the resulting product does not meet the definition of a low-plasma component, and therefore is not considered "TRALI-safe".

I don't think that there is any regulation that would stop you, but I would caution that you ensure that the donor's temperature, heart rate, and blood pressure have returned to normal levels. I would also suggest ensuring that the donor is pre-hydrated to reduce the risk of an adverse reaction.

I don't see anything on the FDA-CBER website: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/Recalls/default.htm

Thanks for investigating, Malcom. In my institution (and in many others, I am sure), the primary collection bag, the attached bags for component processing, and the test tubes are all labeled by an individual before the phlebotomy is performed. Someone tapes the labeled tubes to the back of the container for temporary storage. Once the donor is seated in the chair, the donor's paperwork (demographic information, physical, consent, and health history) is labelled with the same number. The tubes must then be removed from the bag because the bag is placed on a scale. The phlebotomy is performed, and the first 40 mL or so is sent into a "diversion pouch", which hopefully reduces the risk of bacterial contamination by catching any skin plug and/or skin flora. The pouch is sealed and the tubes are filled. The phlebotomist is supposed to verify that the numbers match before filling the tubes, but there is a possibility that the set down tubes labeled 6234121 and accidentlly picked up 6324121 without realizing it. I do think that the use of the check character with ISBT has minimized the risk of this happening, since those letters or numbers in the little box are very useful when performing the verification.

What am I going to do with my spare time? NOTHING AT ALL!!! I spent 6 1/2 years of my life getting my first BS, another 1 1/2 getting my 2nd BS and MT, and another 2 years studying for the SBB. I'm ready for a break!!! Although, each time I have said that, I have found myself back in school within a year or two . I'll probably come up with something else to go back to school for...at least an MBA...but probably not until the kids are a little older.

We do the same as Kathleen, but we also perform a few welds using fluid-filled tubing and document acceptable performance before we use the device on blood products.

We support a few helicopter operations. There is a (temperature monitored) blood refrigerator at the hangar that is stocked by a local hospital with 2 O neg and 2 O pos. The units are rotated frequently to prevent outdating.

Well, I can tell you how this happens...and it's not usually that the test is performed incorrectly... A unit of whole blood is collected. It is centrifuged and the plasma is removed from the RBCs. A filter is attached to the unit of RBCs for leukocyte reduction. The unit numbers on two units get switched and they are labeled with the wrong blood type. Think of all of your WBIT situations in the hospital -- the same possibilities exist during the phlebotomy process. Bags or tubes are pre-numbered, someone removes the test tubes from the bag and sets them on a table, and so does the person next to them. They grab the wrong tubes and fill them up with the wrong blood. At least hospital phlebotomies are either performed in a designated phlebotomy area or in a patient's room! We collect blood in cramped, hot/cold, dark offices, warehouses, conference rooms...and even on busses! Since the advent of electronic crossmatching, I think it is exceedingly important that the types are confirmed by the hospital. -Heather (SBB!)

If you are filtering whole blood, then yes. But remember to also use whole blood as the weight for the post weight as well.

I am strictly talking about units of blood intended for transfusion - the ABO and Rh typings are performed by the collection center. The ABO must be confirmed by the transfusing hospital for all units, and the absence of the D antigen needs to be confirmed only on those units labeled as Rh negative. There is no requirement to confirm that the D antigen is present on units labeled Rh positive. I am told that there is no way to modify the testing performed by the Echo device to not require D testing when confirming types on blood units that are received.

According to AABB Standard 5.12: "...The ABO group of each Whole Blood and Red Blood Cell component and the Rh type of such units labeled as Rh negative shall be confirmed..." For those of you who use the Echo in your facility, do you also confirm the D status of Rh positive units, or only Rh negative as required?

Hello fellow blood bankers- I want to share my joy with you all. On Friday, I sat for the SBB exam and I PASSED IT on the first try! It was very stressful and intense, and I am so glad that it is over. For anyone out there who is considering taking the test, I wish you all the luck in the world! There is another thread out there about tips for passing the exam...I went through a CAAHEP program, used the Technical Manual, Denise Harmening's "Modern Blood Banking and Transfusion Practices" (5th ed), and the Blood Group Antigen Facts Book as my primary study materials. I also want to say what a valuable resource this website is -- especially the case studies! http://www.indianablood.org/educationtraining/Pages/SpecialistEducation.aspx :hooray::hooray: -Heather

So can I change my answer? Hindsight is always 20/20! To investigate this discrepancy, you need to identify the antibody. You have an antibody that is reacting at IS phase with an antigen that is present on the A reverse cells. This could be an anti-A1, but you have to prove it (see above) because it could also be an antibody to another antigen that is present on the A reverse cells, such as anti-M.

If the patient was an A subgroup, would the cells react that strongly with the anti-A reagent? I would think that a more likely scenario is that the patient has an IS-phase alloantibody, such as anti-M, that is reacting with the A cells. You can (1) just try another lot of A cells to see if you get the same result, or (2) screen some of your inventory for an M-negative unit. If you think that your antibody is anti-A1, then you need to confirm it with at least showing reactivity with one more example of A1 cells, and lack of reactivity with one A2 cell, and one O cell. This will get you at least to a 2+2 level of confidence that the antibody is anti-A1.

Have you tried to enhance the reactivity with the post-transfusion samples to see the anti-A and anti-B? The reactions may be weakened, but they shouldn't be completely absent unless the patient has agammaglobulinemia. Use 4 drops of serum with 1 drop of typing cells, incubate it at 4 deg C for up to 30 minutes and re-test...if the anti-A and anti-B are there, then that should bring them out. Since you suspect that he is a group O, could you also take the typing to AHG phase? The patient should have IgG anti-A,B as well. I don't know if that is a valid suggestion (Malcom, have you ever heard of such a thing?), but it might be worth a try.

It is in the IFU (Instructions for Use) for the bag. Your supplier should be able to share the requirements with you.

Absolutely! Last time I checked, there were no classes offered at my "Med Tech" school for ESP. But it would still be a good idea to have the lab MD talk to the head of the Emergency department to make sure that they are aware that it will take the cooperation of the two areas in order to meet this requirement (i.e. we will gladly perform the testing and issue the product, but you need to educate your staff on when to order the testing).

We are a blood center who does not manufacture whole-blood derived platelets for our customers (and we collect over 130,000 units of whole blood per year). Any hospital who requires a platelet transfusion for a pediatric patient prepares an aliquot from an apheresis platelet product. One advantage to our system is that we label each apheresis platelet product with the actual yield (i.e. 3.4E11) and volume, so the facility can determine how to most effectively aliquot each product that is on their shelf. As adiescast indicated, you remove an aliquot from the original bag and use the aliquot quickly. You have to make sure that you stay within the specifications of the original bag, though. For example, we collect platelets using the Caridian (formerly Gambro) Trima device, and the original bag must contain at least 100 mL. Once you have less than 100 mL in that bag, the product must be used within 24 hours.

I think that most of the discussion has focused on the L&D area of the facility...but not all RhoGAM candidates present into L&D. You must also consider your Emergency unit as well!

In Indiana, our hospital customers start exchanges with FP24. If the patient shows evidence of being refractory to FP24, they will request cryopoor.

Shily, I am a little perplexed. You suspect that the patient has been mistyped. The reverse (serum) is consistent with an AB (no anti-A or anti-B present in the patient's serum). The forward (cells) show mixed field with both the anti-A and anti-B. If the patient was mis-typed and was really an A (with missing anti-, then only the anti-B reagent would show mixed field. If the patient was really a B (with missing anti-A), then only the anti-A reagent would show mixed field. The only thing that would explain mixed field with both would be if the patient was an O, but missing both anti-A and anti-B...and probably not doing so well after transfusion with 4 units of type AB cells! Is it possible that the patient was transfused with O cells? If not at your facility, but at some other facility? That would be a much more probable explanation.

Since the negative cell is U negative, I would go there first (the U var cell expresses some U antigen). You will need to find two other examples of U negative cells to "rule-in" and confirm the specificity. If U is not the answer, then I would look at those high-incidence antigens where antigen-negative status is seen more commonly in African populations. I would suspect Malcom's suggestion of anti-Fy3 if the negative donor cell is also Fy(a-b-). Your Ro U-negative cell is most likely from a donor of African descent. You can refer to the Blood Group Antigens section of this website, the 901 series: http://www.bloodbanktalk.com/bgs/list.cfm?sys=37; and browse through the antigen groups to determine what to investigate next.

We only use the old-fashioned type. In this case, you are comparing apples to apples (they are granny smith and golden delicious, though!). I would suggest that the easiest validation would be to perform repeat BPs (as close as feasibly possible) on the same person; select X number of people who will be tested; expect that your electronic cuff will be within +/- Y systolic and +/- Z diastolic of your current device. If you perform a calibration/QC on the current device, then I would perform it on the new device as well.