jasmine

I hope this will help.

Hi Logan,
I am an AABB perioperative assessor  (and laboratory manager  )that  works at a facility in Boston MA that uses cell salvage on over 3,000 cases annually. We have 11 machines, and although we are not (yet) accredited by AABB, with the work we have done with our program, we are hoping to be accredited for periop by our next BB inspection.
I got involved in this because our SVP for surgical services asked me, as the resident AABB SME, LOL, to evaluate effectiveness of cell salvage at our facility. She wanted us to adhere to the AABB standards and thought I was their best candidate to lead the effort. 6 years later, the past practice is truly history.
To answer your question, we do QC quarterly on each machine that we have in use--- Hgb and Albumin. AABB allows you to decide what and how much is needed, but for quality purposes, you really do need something to make sure your equipment (and operator) is obtaining the best possible product for the patient in between PM's. If you would like more information on our approach, I am happy to share what we do, just message me and I will give you my work contact information.
Between Cell Salvage and other specific PBM strategies, we have reduced our organization-wide transfusion ratio per adjusted patient discharge, from 0.78 to 0.17, in ~5 years time. ( Caveat: The cell salvage program overhaul took some time and was truly implemented last).  I actually like to think it is because Blood Bank is involved, but honestly, it takes a village and I had to build influence up with the surgical services team and make really good use of my role as Transfusion Committee Facilitator to make things happen.
Best,
Linda

Based on an observational study of ABO grouping in Gel I reported at the 1997 AABB Annual Meeting, ABO Plasma Grouping discrepancies occurred in 0.8% (26/3183) adult ABO grouping tests in Gel.  Anti-B was not detected in 24/26 patients, anti-A was not detected in 2/26 patients, and anti-A1 was not detected in 3183 patients.
In comparison, anti-A and anti-B was detected in 19/26 patients by the immediate-spin tube test, and was detected in 7/26 patients after 10 minute incubation room temperature incubation and centrifugation.
Based on this study and 20 years of gel testing since that time have shown me the anti-A1 is rarely detected in Gel and that 70-80% of ABO plasma grouping discrepancies are resolved using the immediate-spin tube test.  
Centrifugation is used quite differently in gel versus tube testing. Centrifugation is used to separate agglutinated cells from un-agglutinated cells within the gel column, but is used to enhance agglutination in standard tube tests by forcing cells together at the bottom of the tube.  This may contribute to the increased sensitivity of tube testing in ABO Plasma grouping tests.

The grocery list below is what is in nursing policy at my hospital, with my notes in italics. This is their reference cited in the policy:  Berman, A. & Snyder, S. (2012). Administering intravenous therapy. In Skills in Clinical Nursing (7th ed., 511-512, 516). Upper Saddle River, NJ: Pearson Education Inc.

A.     Recognize and report any of the following signs / symptoms of a transfusion reaction to the Physician and blood bank immediately for consideration of transfusion reaction work up:

1.     An immediate hemolytic transfusion reaction may contain any or all of the following clinical presentations: 
a)     Fever, chills, or both (specifically 1.5 F increase)

b)     Nausea or vomiting  (also sudden onset of diarrhea)

c)     Headache

d)     Pain – localized to the back (also flanks, abdomen, chest, head, and infusion site)

e)     Chest constriction (also sudden onset of cough)

f)       Dyspnea and cyanosis

g)     Subjective feelings of distress – sometimes reported as a “sense of impending doom” (anxiety, agitation)

h)     Hypotension, tachycardia or both (significant change in BP)

i)       Hemoglobinuria (dark urine, anuria in extreme cases)

j)       Unexpected degree of anemia due to hemolysis of transfused RBC’s

k)     Shock

l)       Rash

m)   Feeling of heat along the vein used for infusion

                                             2.     Delayed Hemolytic Transfusion Reaction (24 hours to 2 weeks post-transfusion) may contain any or all of the following clinical presentations:

a)     Fever, chills, or both

b)     Jaundice (sclera) (increase in bilirubin)

c)     Pain-localized to flanks, back, abdomen, chest, head, and infusion site

d)     Dyspnea

e)     Sudden unexplained fall in hemoglobin 7-14 days post transfusion

f)       Continued anemia despite transfusion therapy

g)     Hemoglobinemia and/or hemoglobinuria

                                             3.     Febrile Nonhemolytic Transfusion Reactions (occur at the end of the transfusion or up to 2 hours later) may contain any or all of the following clinical presentations:

a)     Fever – occasionally

b)     Chills, colds

c)     Discomfort

d)     Rigors – occasionally

e)     Headache

f)       Nausea – some patients may vomit

g)     Dyspnea

                                             4.     Allergic Reactions (occur usually seconds to minutes after initiation of transfusion) and may contain any or all of the following clinical presentations:

a)     Intensely pruritic, localized or disseminated urticarial eruption (well circumscribed, discrete wheals with erythematous, raised, serpiginous borders and blanched centers)

b)     Generalized pruritis may precede eruption or generalized erythema or flushing of the skin.

c)     Angioedema, a more severe form, consisting of localized, nonpitting, deep edema of the skin.

                                             5.     Anaphylactoid and Anaphylactic reactions (occur usually seconds to minutes after initiation of transfusion) and may contain any or all of the following clinical presentations:

a)     Upper or lower airway obstruction or both

b)     Upper – laryngeal edema causing hoarseness or stridor (lump in the throat)

c)     Lower – Bronchospasm generates audible wheezing, tightness in the chest or substernal pain. Other associated symptoms include dyspnea, cyanosis, feelings of anxiety (“a sense of impending doom”)

d)     Profound hypotension

e)     Tachycardia

f)       Severe G.I. symptoms present from onset-abdominal cramps, nausea, vomiting, diarrhea.

g)     Erythema and urticarial eruptions are prominent and typically involve confluent areas of the trunk, face, and neck.

                                             6.     Transfusion Reaction Acute Lung Injury (TRALI) (symptoms arise in setting of recent transfusion of plasma containing blood components [ Red Cells, Whole Blood, Fresh Frozen Plasma, Cryoprecipitate, Granulocytes], always within 1-6 hours and usually within 1-2 hours of infusion): 

a)     Acute respiratory distress which may first be manifested as dyspnea or cyanosis

b)     Severe bilateral pulmonary edema and severe hypoxemia

c)     Tachycardia

d)     Fever (1-2 C increase)

e)     Mild to moderate hypotension, usually unresponsive to IV fluid administration

f)       FDA regulations require all cases of TRALI to be reported.  If TRALI is mentioned and/or charted by a physician as a differential diagnosis, the Blood Bank must be notified.

Increase in temperature alone should not always constitute justification for a transfusion reaction work up. Nursing judgment should be used in evaluating symptoms and notification of physician.

I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year.  It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK.  Sorry if this sounds egocentric, but I am very excited.

A 5 months pediatric specimen received and these are the results obtained :
‘forward and reverse blood grouping are 4+ reaction including Rh and ctrl  (using ortho cards on autovue )
antibody screening and identification all cells are 4+ reaction  (using ortho cards on autovue )
‘antibody identification 4+ using bio rad cards
DCT 4+ with IgG specificity 
no history of transfusions ! 
Medication ( not clear but suspecting steroids )
hgb 6g/dL
I will appreciate any help or suggestions 
Forgive my poor English 😔

Well, I had a simply wonderful time, thanks to Candy Williams and her colleagues.  Thank you for inviting me Candy.
 
I met some great people, including Marilyn Moulds (whom I "married", as you will see if I can manage to upload the photograph), Dr. Lawrence Petz (who was gracious enough to sign my copy of his book, coauthored with the late, and much lamented George Garrattyy, Immune Hemolytic Anemias) and Lara Thetford (LaraT23), for whom I have a huge amount of respect for the wisdom of her posts.
 
To say I am jet lagged is the understatement of the year, but WOW!!!!!!!!!!!!!!