Packer Banker

We've never had a unit break, or had any hemolysis issues related to the translogic system. But, our hospital is MUCH smaller than the one you're building. Are the translogic speeds higher when the travel distance is longer? We also don't send body fluids anymore, but it's more so they don't get stuck somewhere and because people don't know how to put caps on:rolleyes:. (too bad we send urines...)

My thought exactly! However, I do see the value in antigen typing the patient to be safe. (Provided it's not an Anti-e!!) I was thinking the amount of antibody present couldn't be that much, but I guess I'm not sure if they titer it out at the blood center. In which case, yes, the possible subsequent antibody work-up could be a pain (I don't think you could charge for that?). Hopefully the Ab positive txn would be well documented, so you'd know exactly what you're working up- that would be a little faster. It would be interesting to see if, legally, you'd be required to transfuse Ag neg units after the detection of that antibody- even with a previously documented negative patient Ag type.

Same here- we type patient for c first. If negative, we only transfuse E & c negative units. (We did not do this at the hospital I worked at previously.)

Thanks for your input. I'm hoping to come up with a flow chart that all can use easily, and at the same time help our pathologist see that all paths lead to the same result!! I only work weekends as a generalist with bare bones staff, of course, so am thinking this is a home project while kids are napping. I want it to be perfect (ok, close anyway) before presented to her, so she doesn't just dismiss it as nonsense. We waste SO much time with this- when we only have 2 techs on staff in the entire lab, it's a little ridiculous to have blood bank take up our time with this mess. I used to work at a large university hospital (left 6-7 years ago), where we did the IS phase of the screen also. I'm curious to know how many don't now- anyone??

I'm hoping someone is bored this Christmas/New Year's vacation, and can help me get a jump start on a project. I've been sitting on this one for some time! Our current procedure states that if Ab screen results look as though a cold antibody may be present (Immediate Spin screen positive, AHG negative or positive), a "cold mini panel" with cord cells, etc. must be done, in the room temp, 18 degree C, and 4 degree C phases. This is in addition to a regular antibody work-up. The theory is that "you have to know what you're pre-warming away". It seems it's necessary to determine whether it's Anti-I, Anti-IH, etc. . They're also concerned that an Anti-E might be pre-warmed away. I know that happens, but how does ANY procedure cover that??!! The current procedure obviously is a tedious process that to me, has no merit. Our pathologist is typically VERY cautious, not wanting to miss anything. But I think the major reason this is done, is that our staff is mostly a cross-trained staff that doesn't work too often in the blood bank. Many don't have the basics of blood banking deeply ingrained, so they're trying to avoid a missed antibody. Just a guess?? Does anyone have some sort of flow chart already made up, that guides you through what to do, starting with Ab screen results? Oh- did I fail to mention we also do patient auto controls (patient serum with patient RBCs) with every screen? So, one of the possible scenarios is that only the auto is positive. (I'd also like to delete THAT from our procedure. Wouldn't we rather not know??) Please forgive my negativity here, but this has been a thorn in my side for some time!

We are also just CAP accredited due to the high cost of AABB accreditation. (It is a 180 bed hospital.)

Sorry- that was a pretty much a duplicate (although I hadn't the stats to back it up like that!)- I hadn't yet made it to the end of the thread...

I'm thinking that the incidence of the low incidence antigens, and the even lower incidence of the antibodies, would make it MUCH LESS of a problem. I think homozygous expression of the antigens on the screeing cells is by far more valuable when it comes to the safety of the transfusion. Our policy at our hospital is to do IS XMs- of course only when there is no history of a positive screen. Most people there, however, feel uncomfortable with that and do a coomb's XM. Where I used to work, we did electronic XMs. I do miss those- especially in hurried OR or emergency release situations.

I wonder if this is the same one we had- maybe it's a common thing?? Shock and surprise, with his frequent tranfusions, he did have some antibodies!! Jennifer

At step four, the units need to be Kell typed and crossmatched. At steps five and six, just a few cells can be picked out that rule out all other antibodies. Usually patient is Kell typed as well, to verify that he/she is in fact Kell negative. (This step only if they haven't been transfused in the last 90 days and may have donor blood in their system) Then when your ag neg units are crossmatch compatible, you're done! Hope that helps-- Jennifer

We just started that at our hospital about a year (or two? time flies with 3 kids...) ago. I thought it was the most ridiculous thing in the world at the time. But after much thought, we do have a blood bank band ID# which is of course unique as well. Our medical record numbers are 6 digits, just like a BD, their old system (therefore still used all the time!) was to separate the numbers with 2 dashes, just like a BD. You can imagine, that some are JUST like a BD, and therefore get mixed up with birthdates. Anyway, I think we have far fewer errors in filling out blood bank bands, as well as when collecting info to issue products. I agree with one of the previous posts, that the patient is much more likely to notice an error too, with a BD rather than MR#.

Most of our OB MDs like to do Type & Screen on their C-sections when they come in. They all have Type & Screen as well with their general pre-natal work-up (with hepatitis, glucose, etc.).

Not only is there tech error, phlebotomy error, but insurance fraud as well to consider. (where a patient comes in with the insurance card of another person) I don't know that I could necessarily trust a hospital across the country and their identification procedures. This is a second type of course, but we all know that mistakes have been made... (Just another thought to throw out there!)

We do what ever the physician orders, unless they order nothing and the mom is Rh negative. As to cost savings, I suppose it depends who your clients are. If you're doing testing that private insurance companies are paying for, I would guess there is not a cost savings to be had but rather a gain. Are the majority of your clients are in a health plan from your facility? At my previous workplace, it was a university hospital that did not deliver babies, so can't give any further references. I personally think cord testing is not fun, and would love to decrease it as much as possible!

We currently identify every cold antibody (IH, I, P, etc.) when we have an antibody that reacts at immediate spin. We do a cold mini panel with cord cells, etc. in addition to a full panel when indicated. The major reasons we do this are so we "know what we're pre-warming away" and so we don't miss a Vell. I personally don't see the value in the actual identification of the panagglutinin antibodies. I would love to present our pathologist with some concrete reasons and facts to support giving up our labor intensive identification procedure. I'm thinking some kind of flow chart that splits the auto control when neg or pos. I understand there are antibodies that could pre-warm away, but I don't think those (like a weak E) would even be picked up when there is a strong cold covering it up. I also realize we do want to ID the P's, M's, etc. So, what do you do, and why, if you don't mind adding??? Or if you have a good reference source, that would be great too. Thank you!!