suhu

We get a list of patients from HEM/ONC, get a pre-drug sample and send it out for genotype. The if/when screen becomes positive, we would supply phenotypically matched, but havent had this happen yet.

do you use a NEO or ECHO?

We do as Terri does, exceept for solid phase we cant "select" the cells, so a whole panel is run. Also, if the current antibody screen pattern matches the previous antibody we do not do new workups. A new workup is done a) if an unexpected incompatible xm is encountered or (b) the current antibody screen reactivity does not match the identified antibody (ex. prev. anti K, but a K neg screen cell is now positive) or c) if the previous antibody was a non-specific antibody, or clinically insignificant antibody, and we wish to interpret the current screen as cllinically insignificant . Warm auto's are considered on a case by case basis, but in general a workup is done with each new patient admission.

Thank you for your replies. I also consider Solid phase to be an enhancement, so a heterozygous rule cell is okay most of the time. Solid phase does confuse me though, as we've had patients with antibodies that react with heterzygous cells but are negative with a homozygous cell, so I'm never sure if the homo/hetero "rules" apply to solid phase.

Ok, I know I'm asking the same question multiple ways, but... For example, if no homozygous cells are available on a panel, is one negative E+e+ or K+k+ cell sufficient to rule out anti E or anti K by solid phase? Is the rule different for different antigens? Essentially, do you consider solid phase a more sensitive test, therefore one negative heterozygous cell is sufficient to use for rule out? If a solid phase panel demonstrates a clear-cut antibody pattern (no extraneous, unexplained reactions), can a heterygous antigen expression be used for rule outs?

When a new component label is applied to a product our blood bank modifies, for example an irradiated red cell or an aliquot preparation, what FDA registration number and/or US license number is required to be on the product label? The new component label we apply has our FDA registration number, but is it required to redact the supplier's FDA registration number and/or license number?

thanks for your replies. the problem is the graph readings. the lines are quite close together and go by 1 degree increments so the chart reading is subjective. plus its in an awkward position near the floor requiring techs to bend way over or get down on the floor to read it....other charts are near the top of the freezers and are difficult for the height challenged techs to see... the digital readout records to the tenth of a degree. so we have people recording temps as, ie. chart -25.5 digital 27.9...... the freezer is well within proper temp range, but the temp difference is out...not sure how to remedy this...

We have a both a teperature chart and digttal readout on our refrigerators, platelet storage and freezers. Both readings are recorded daily and the SOPs state that not only must they be within range, but the difference between the 2 must be less than or equal to 2. This is no problem for the fridges and platelet storage but the chart and digital readouts for the freezers sometimes differ by slightly more than 2. With the wide temperature range (-18 t0 -30), I'd like to change the difference to 5 for just the freezers. Would this violate any regulations? I cant find anything...we are inspected by CAP, CAP-ISO, and FDA. thanks

We have a both a teperature chart and digttal readout on our refrigerators, platelet storage and freezers. Both readings are recorded daily and the SOPs state that not only must they be within range, but the difference between the 2 must be less than or equal to 2. This is no problem for the fridges and platelet storage but the chart and digital readouts for the freezers sometimes differ by slightly more than 2. With the wide temperature range (-18 t0 -30), I'd like to change the difference to 5 for just the freezers. Would this violate any regulations? I cant find anything...we are inspected by CAP, CAP-ISO, and FDA. thanks

We use one form "Emergency Release Form", with one statement when any products are released before testing is completed. We add a bright Avery sticker that says "Dr. sign and return to Station 118" . We send the form along with the emergency products, docs then sign and return. We rarely have an unreturned form, although this did have a learning curve, as things were not so "quality controlled/managed" in the old days. The signature statement on the form reads "due to the gravity of the patient's condition, I am requesting the release of blood products prior to the completion of compatibilty testing". Techs do notify the patient physician for patient's with known antibodies, or positive/unresolved crossmatches/panel. We keep an inventory of unconfirmed pre-screened antigen typed units- so for the antibody patients we choose those units if we can. If there is time for full crossmatching, we issue the serologically compatible units, but if the antibody id is pending, those crossmatched units are released under Emergency Release process. We are required to notify both the patient physician and the blood bank medical director if subsequent testing finds that an incompatible unit was issued.

Helmer does agitate between washes. I thought that was standard for wash cycles.

For decades we did as the original post. Recently, we changed our SOP and now the techs need to get approval from the Transfusion Medicine physician prior to the release of additonal units for any transfusion reaction. We added a comment to the Transfusion Reaction computer entry to document this. The issue procedure was changed to include a computer check for a recent HTRXN reaction test and if one, they are to look at the results to see how the comment was answered (ie, TRM notified-OK to transfuse). If the comment is pending, they are to resolve before issuing additional units. Surprisingly, this has been working fine

Thanks for your ideas David. To clarify what I wrote, we do have automated cell washers, but with these samples the buttons get super stuck to the tubes and the check cells never work. So techs are instructed to repeat testing and wash by hand so the buttons can be re-suspend between washes and give them an extra wash. Occasionally though, even this doesnt work.

We occassionally have problems with PeG testing where the check cells fail. These are the high protein plasma's that turn super cloudy when PeG is added. Handwashing and "flicking" the cells off the bottom of the tube inbetween washes helps some, but some are really stubborn and just won't check. Does anyone else see this and what do you do? thanks.

Problem is when we thaw plasma for apheresis. The waterbath can be loaded with 8 plasma's over 300cc and they dont completely thaw under 30 mins. Techs are wanting to just set the timer to 45 mins. because they dont have time to keep checking them. I'm okay with this if they are still cold after 45 mins. but what if a couple smaller volume units are mixed in that will thaw sooner? Is this extra time acceptable for those units?

We store our thawed plasma in fridge for 5 days. To thaw, we use a Helmer waterbath set at 36.5 C. up to 30 minutes, then check for complete thaw. The time of course varies according to the volume of the units and how many are being thawed. Is there any information as to how long plasma can be kept at 37 C, or at room temp after thawing, before being placed into refrigeration? ie. if the plasma lifted out of the waterbath and it wasnt refrigerated right away... or say the timer was (inadvertently) set for over 30 minutes...... are these units acceptable?.

LIz, It was suggested to us that the indicators be stored "pre-activated" off units in a refrigerator or freezer. I believe they said they could be kept under refrigeration for up to 1 year after activation. Maybe that would be something for you to try for your irradiated products? so I guess that answers your question too Townsend. The problem we are having is that the indicators sometimes turn just slightly blue and stay that way (a thin blue line) during transport. We use a pneumatic tube for delivery, but the whole process of xm/delivery is under 4 minutes. They are white when they leave the blood bank, but have a thin blue line by the time they arrive at destination. Ideally, it'd be great to have an indicator that turns a certain color if temp goes to 10-12 for example and for under 10 minutes . Another color to indicate it went over 12 degrees for over 10 minutes for units that were truly out of refrigeration. something to solve this slightly over 10 degrees in transist/handling issues that we are having trouble solving.

Hi byfaith~ it'd be great if you'd post how your trials with your indicator go. did you mean Deltatrak?

temp check works fine, but we use coolers for extended storage in the OR. there is no way to know if units were removed from the coolers at left at room temp, not used and placed back in the cooler....temp would be fine upon return in such cases. This is why we are looking at an irreversible indicator. wondering if others have experience with this indicator. thanks.

We received some of these indicators to try out. We currently use a TempCheck to determine the temperature of returned units. With the shock watch, when do you consider the unit over 10 degrees? Is the temperature breached (over 10) at the first sign of a blue color in the window ie. a skinny blue line, or when more of the window turns blue, or when its completely blue? On some of my units, the blue color starts to appear around 9 degrees, and the window isnt fully blue until between 11 and 13 degrees (variable results). TIA.

for rbcs, are you irradiating the syringe aliquot or do you irradiate the parent unit? If you irradiate the parent unit, how long do you use it? ...the whole 28 days? we sterile dock, but interested in knowing if the shelf life of an irradiated rbc should be shortened for the NICU babies...thanks

DeeMc Do you use those irradiated units up to 28 days for the really tiny babies? The K+ leak isnt a concern? Sometimes they only transfuse less than 10cc. should I be concerned about the K+? I'm stuck in that old mindset when we were required to wash units if more than 24 hours after irradiation, . ...do you use reserve only a certain type anticoagulant? thanks

Looking for what is standard practice? Is there a certain birthweight below which a baby should receive irradiated rbc/plts? Once a unit is irradiated for a neonate, how long do you use it? thanks.

Brenda, Looks like I need to do a pilot using the Safe T Vue's. Most of what I've read about the Safe T Vue is that application and activation is tricky to avoid color change. Did you keep a supply of blood stored with the monitors already attached for OR use so all that was needed was the activation prior to sending? Or did the techs apply the monitors to each unit at time of request? If the latter, did this significantly slow down the time to issue units? This also just seems like overkill and an unnecessary additonal expense since the temp of the returned units is so close to acceptable (11-12 degrees) and the Twinbirds/TempTrak continuous monitoring was so costly. And yes, we do have dedicated routes between blood bank and the OR rooms. Does anyone have an acceptable return temp using a SD deviation of +1 or 2 degrees for this type of situation?

We retrieve the returned units from the pneumatic tubes and use a TempCheck instrument to take their temps.