[MEDITECH 5.67 LIS DOWNTIME... HOW DO YOU BACKUP/DOWNLOAD PATIENT FILES?]

We have a database that downloads with or without network connection, all blood bank data 24/7. We also have an "iPeople" link that displays a downtime EMR Viewer icon during Meditech downtime.  The downtime EMR viewer shows BBK history and transfusion history.

[Fake blood products]

I use large saline (2L) bags from dialysis and add a small amount of yellow food color. For fake blood, I got a powdered fake blood that I made a concentrate from and then add a small amount to the 2L bags. I then use smaller bags (300mL) and spike the large 2L bags with the smaller bags to make the individual components.

[Addition of sterile saline when pooling cryo]

Unfortunately in Canada, we cannot get pre-pooled cryo from our supplier. AABB Tech Manual does mention adding saline to aid in the pooling process which is what we do. I haven't done studies, but I would guess a substantial amount of cryo would get left in the bags without the help of saline to "rinse" it out.

[ECHO D typing Discrepancy]

I have seen a Rh positive patient transfused 3 Rh negative units and subsequently tested on the Echo. Echo reacts negative with both Anti-D4 and D5. When taken to the tube, get a 2-3+ mf reactivity with Anti-D reagents.

[Grifols Erytra]

We are going to RFP this coming year for some new automated analyzers. We did a quick look this spring at what is out there. I am surprised no one is speaking about the Biorad analyzers:  newly released IH 500, IH1000 (Gel based) and Tango Infinity (4th generation solid phase analyzer) along with stand alone  Gel readers and centrifuges. Although we are not sure which direction we are heading, I think they are certainly worth mentioning.

[Biohit eLINE Electronic Pipettor 10-300ul]

I have a Sartorius electronic pipette that I have brought in to trial. It seems to function just fine. It has programmable volumes that can be stored into memory. Cannot speak to its long term durability.

[Any one look at Grifols Erytra?]

I think those who are in the market for automated blood bank analyzers also need to look at what Bio-Rad is coming out with. I think both their Gel and solid phase automation platforms should be compared to the other vendor products.

[Ortho MTS Gel Pipette]

I use the Vista Ovations and they are much precise and accurate then the overpriced Tipmaster. Make sure to get the one that is rechargeable (they sell non-rechargeable and rechargeable)

[Dilution of Ortho QC Confidence antibody for antibody screen QC]

We do 1:20 dilution of ortho QC for gel using Gel diluen. If you are not diluting then (in my opinion) you are not going to catch problems b/c the antibody is so strong in the QC kit. By diluting it down to give you a 1-2+ reaction, you are more likely to see problems should they occur.

[How do you issue?]

RN responsibility to look in computer to see if blood product is available

If avail they enter "order" to release product which creates printout (in duplicate) in Transfusion Dept

We issue products based on this printout and send 1 cc of product release paperwork with product. We make a phone call to # appearing of paperwork letting RN staff know product was sent

RN staff is responsible to return this product release paperwork to Transfusion which lets us know product was picked up at tube station. IVIG and neonate syringes not sent by tube

[Echo Issue]

We have seen Anti-D being ruled out when there is also an Anti-E or Anti-C present. We now test Rh neg patients by Gel if they are shown to have Anti-E or Anti-C by Echo. But usually our Anti-Ds show up ok on Echo.As for the weak reactivity vs Anti-D reagent on Echo, we do see a 1+ or 2+ lower reactivity of the Anti-D vs tube. At one point, we had even weaker reactivity on one of our Echos with the Anti-D reagent (we have 2 of them) and Immucor replaced the camera and reactivity increased. I also know "tweaking" the belt on the strip carrier arm can also change reactivity

[Weak backtypes on Echo- why?]

Tightening or loosening the belt on the strip carrier can optimize the strength of the reverse cells. On the Echo I have found the strengths to normally be at least 1 grade less than tube strength. With regards to Gel vs Echo, I have found approx equal number of clinically signficant antibodies on either method that were not found on the other method (We use both Gel and solid phase methods)

[PeG and failed check cells]

Some patient samples just don't work with PEG. We would switch testing to, perhaps, tube Saline IAT.

[Echo Users- seeing huge tube vs Echo discrepencies?]

We get a lot of patients reacting like this. Attribute reactivity on the Echo to an autoantibody. Do need notice cold autos coming up that much, so assume it is a warm (Echo supposedly on reacts with IgG). I'm guessing if you do tube DAT it might be microscopically positive for IgG? If saline IAT  tube reactivity is negative we issue blood that is compatible by that method, especially if the patient was not recently transfused. I find autoantibodies love solid phase method.

[Meditech vs. Softbank]

I have used many Lab LIS systems over the years including Meditech and Soft. The set-up and underlying code of the Bank module in Soft is logic based. I am unsure what the Meditech system is based on, but it is not logic.

[ECHO with Manual Gel as backup]

We have 2 echos for our primary testing. As well, we use Gel, PEG and SIAT for secondary methods. We get samples referred to us from other hospitals who almost exclusively use Gel. We notice that the referring hospitals have pos screens by gel and that we identify various antibodies by gel (E, K, S) that are either completely missed by Echo (Neg screen/ Neg panel) or only found on the Echo by panel testing (Neg screen/pos panel). I have brought examples of these to Immucor tech support and they did not really give me a good reason as to why this is happening. Will continue to bring examples to them to see if they continue to give me the same responses.

[Donor Unit ABO/Rh confirmatory test result entry in Meditech]

We are eventually planning on retyping all our units when we move to electronic xm (I'm in Canada so it is a requirement to retype only for electronic xm). When we do start, it would be nice to have it set up like you have it, so I would appreciate getting any info you have on doing your set up.
 

[Transport Cooler]

We got in green coolers from Tegrant (Thermosafe). They do require a bit of duct tape at the seams after a few years of use and they are a bit heavy. However, I validated them to hold 1-10 C for 6 days.

[Fetal Rh Type- Sensigene]

The latest I heard on genotyping mom's blood for fetal Rh typing was that it is not avail in the US due to licensing issues. Maybe that has changed since Puget Sound is doing it (or are they sending samples to Europe for testing?)

[Shockwatch Warmmark 2 Blood bag temp. indicator]

We tested the shockwatch in parallel with our existing SafeTVue 10. At first they seem to compare ok, but then as a little time went on, we noticed that several units (maybe 1 in 5) which never left the fridge remained ok according the the SafeTVue10 but changed color on the shockwatch. We felt confident the temp of the units never actually rose.

[Anti-D alloimmunization after D incompatible platelet transfusions]

I just received a buffy coat platelet that appeared visibly contaminated with rbcs. Pulled a sample out of it and ran a CBC. The hgb was 1g/L meaning there was approx 20 mL of whole blood in that unit. So as others have asserted that there are next-to-no rbcs in buffy coat platelets, I contend that this statement cannot be universally applied.

[Anti-D alloimmunization after D incompatible platelet transfusions]

I'm guessing the amount of blood in either PRP or buffy coat platelets is technique dependent. Both these products, in my experience, have more blood than aperesis, which have an extremely small amount of blood in them.

[Do you use NP, TNP or QNS to override a blood type in Meditech]

A Group and Screen (by Echo method) is automatically added to any product order. If we performed a manual Group and manual (by tube/Gel etc) antibody screen, we will NP the Echo Group and Screen result sometimes. We typically do this if we have a patient using a lot of product. If we don't, every order will create a new specimen since the software will be looking for the Group and Screen result and not find any since the Group and Screen was done by tube method using different test codes.

[Anti-D alloimmunization after D incompatible platelet transfusions]

I have seen Anti-D alloimmunization a couple times after platelets. Of note, in Canada buffy coat pooled platelets are provided. Some of these products contain a visible amount of blood. I measured one and found >1 mL of packed red cells in a pool. We only suggest Rhogam for Rh Pos women of child bearing age after they get a Rh pos platelet.

[Shockwatch Warmmark 2 Blood bag temp. indicator]

We tried them out b/c they were cheaper than the Temp dots we are using (Safetvue 10). The shockwatch did not perform as we had hoped so we returned to using our old dots.