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We do not have a time frame. As David, The specimen for our FMH (or K-B Stain) is usually drawn 8-hours post-delivery (or with the next CBC specimen in the morning.) Donna

Welcome to Pathlabtalk, tburl!

Ahh.....such a young pup!! Hope you had a great birthday! Donna

Along with everyone else's appropriate comments............Surely your computer system has a "Training" or "Test" system, right? What the heck does whoever is making these changes think the "Training/Test" system is for?? As Teri said....You make the change in the Training/Test system, validate the change, train the users, THEN implement the change.

Minerva, I'm not sure I will be able to explain my logic here, but I'll try......Here we go... You thaw the FFP and put in in a cooler with adequate ice (or some type of appropriate cool-pack) in a validated cooler. If they return the unused FFP within a reasonable time (say an hour or 2), isn't it reasonable that the cooler temp may be out of the proper range just because the 37C FFP is on its way to cooling down? If that's the case, the FFP is just as safe to use as the 37C FFP that you thawed and placed in your blood refrigerator until it expires in 24 hours (or 5 days, depending on your policy.) However, if the FFP in the cooler is warmer than the acceptable temperature range because there was not adequate ice (or coolant) to get and keep the FFP within the proper temperature range, then I would consider it unacceptable to return the FFP to the Blood Bank/Transfusion Service for reissue and I would destroy the unit. (Example: If the FFP is returned 6 hours later and it is 13C, I would destroy it.) Exactly how long does it take the thawed 37C FFP to come down to 6C? You will find out when you thaw some FFP and do your cooler validation. Donna

This is probably a stupid question...........So if the KB Stain indicates that the baby has bled into the mother, exactly what action is the doc going to take? (Assuming the baby is not mature enough to allow the induction of early labor and assuming that the situation does not involve RhIG.) Donna

Nice pictures, AuntieS. Thanks!! Donna

I agree..........I bet they will still give platelets. Donna

We are like you, pbaker..... not a high risk OB facility. We did so few Kleihauer-Betke Stains that we discontinued doing them and started sending them out to a nearby hospital around 3 or 4 years ago. I don't have statistics on how many we send out, but I have noticed that there has been a significant increase during the last couple years. Apparently our Maternal Fetal Medicine Physician now orders a battery of tests on OB patients who have experienced a fetal demise, and a KB Stain is one of those tests. Donna

Mabel......Thanks so much for the info. Donna

Personally, Brenda, my first suspicion would be your initial explanation. I think that you might see the pattern that you have described if the baby was Rh Negative and had just a very minor contamination with Mom's Rh Positive blood. (I could see that the Weak D might be very weak if there is only a very minor population of the Mom's Rh Pos red cells,) I have seen this scenario. Donna

Thanks, Kimster. OK.....So now I get it. I can see the application In situations where a woman has Anti-D and has mated with man who is likely heterozygous for the Rho(D) gene. If this new test can determine the Rh0(D) type of the fetus as early as 10 weeks of gestation, some individuals may use that information to decide whether to terminate the pregnancy.

"The midwife's small hospital does the test."...........Hmmmm....Sounds fishy to me. I wonder if she's all confused and is really talking about our regular old Fetal Maternal Hemorrhage (FMH) Test, since the FMH Test does pick up Rh Positive Cells (but in a post-partum specimen, not a pre-partum specimen.) .....Just a thought..... Donna

We often issue non-specific group & type plateletphereses to our patients if we do not have group & type specific plateletphereses on hand. Therefore...(here comes the gasp).......we do not repeat the ABO/Rh testing on the patient before issuing platelets. We have also, fortunately, not encountered a hemolytic transfusion reaction due to a high titer Group O donor. Donna

Yes. Has worked fine so far.

No, the Transfusion Service does not need to receive a written order from the physician to transfuse. If the doc writes the order in the patient's chart or places the order directly into your EMR, that is adequate. Yes, it is nice to know all that information about the patient (diagnosis, transfusion history, etc), and you can develop a set of requirements and review to be implemented at your facility, but I do not believe that there are any regulations that require that the Blood Bank has access to this information prior to issuing blood for transfusion. Donna

Terri, David, & Ann - All of those citations are amazing! I hope I never get that inspector! I'm under the impression that The Joint Commission and CAP are changing their focus more towards the processes and outcomes (rather than the minute details such as those citations mentioned above.) So it will be interesting to see how our inspections go the next couple of years. Donna

I agree with Malcolm and Anna. Donna

Another comment: I don't think most inspectors would consider it acceptable to use antisera beyond its expiration date just to save money. My experience is that they consider this practice as acceptable only if the antisera is considered to be "rare" or unavailable. Donna

Interesting....Thanks for sharing this info with us, cbaldwin. Donna

Awww, come on Dr. Pepper........That would be like looking at the directions... Donna

NOTE: The author is an internist (not an intern.) I wonder if he always believes everything that he hears in every lecture he attends, particularly in a situation like this where there is no evidence that the lector has any advanced training or credentials in Transfusion Medicine. As John pointed out, a transfusion is not without risk, and I do think that not all transfusions are warranted. However, I would greatly appreciate it if the author would provide the reference(s) for the "research studies" that arrived at the conclusion that "blood transfusions do not improve oxygen delivery to the body at all." I would be very interested in seeing the design of the study and the data it yielded. (I'm also a little "miffed".....how come my "profit margin" doesn't go up if we issue more units from our Transfusion Service???) I'm sorry, Amber, that I haven't really given you any techniques to deal with the "fallout" that you may experience other than to do as John recommended and be able to cite statistics and references from reputable researches. Donna