ChrisW

Yes, we do FMH screen on all Rh neg mom's who deliver Rh pos infant. What I want to do is discontinue KB's and opt for flow for those that need quantification or for those ED abdominal trauma patients who have not delivered.

I understand the 72 hours. We often have patients in the ED who experienced abdominal trauma and will not be in house for 72 hours. Nor can we guarantee they will follow up with a provider to receive additional doses. In addition, many of our samples are reference samples from remote locations where treatment is being delayed until (currently) the KB results are delivered. I really don't want to continue to offer KBs for times flow can not be accomplished in a timely manner.

We would like to discontinue performing KB stains in our laboratory and perform all fetal bleed determinations using flow cytometry. However, our flow lab is not 24/7. How do others address this issue of turn around time for results?

When we first started using Microplate methods with automation, we saw this also, and had developed a method to deal with and explain discrepancies between tube and automation. Now we seem to be back a square 1 again with discrepancies! YUK!

For those who have switched testing methods from Echo, Neo or Tube to Gel, do you find discrepancies in D antigen typing with Gel vs. historic results from other methods? How are you addressing those?

Thanks for your reply. We looked at our setting and the automatic images synch was inactive so we have switched that to active to see what that does for us. So far Ortho and our IT folks have not been able to get any back ups to write to our network drive. Not sure where the issue lies but am pushing for them to resolve.

For Ortho Vision users - which reports do you save to a back up or archive file? We currently use Immucor Neo for which we perform a weekly archive that saves copies of all the QC results and the testing results to a CD. I'm trying to figure out how our current process compares to what we can do with Vision. Are there requirements to save the automated results if we are entering them into the LIS?

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen. If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA, and internal auditors.

- Do you administer RhD pos platelets to RhD neg patients? In what situations (always, only when there is a shortage of RhD neg platelets)? To which patient groups do you not recommend RhD incompatible platelets (women < 50 yrs, patients who receive frequent platelet transfusions)? We avoid Rh + platelets to Rh - recipients in pediatric patients and females of child bearing age. If we have to use Rh+ in younger women, our policy is to give RhIg. - Do you have a different policy for apheresis and whole blood derived platelets? We only transfuse apheresis - Do you administer prophylactic Rh immunoglobulin to these patients (everyone, or selected patient groups)? Yes - to women of child bearing age And now for something completely different... - Do you have a policy concerning Kell positive donors and plateletpheresis? Do you defer these donors, or do you have a policy of not actively recruiting these donors for plateletpheresis? We are a transfusion services only so do not collect any donor products.

We are a Level II Trauma Center and dispense uncrossmatched RBCs to the ED multiple times daily. When we deliver the first 2 or 4 units in our Trauma Cooler, the MD or a designee for that MD signs the release form and we return the to Transfusion Services. The Designee is usually the RN that is the recorder for that case. Our form has two spaces - one for name of requesting MD and one for a signature. Our policies describe this process and it has worked well for us for 20 years. The form is signed regardless if the units are transfused or returned to us.

Do you look at the values for the equivocals to determine if you will call it pos or neg or just base it on the observation of the tech looking at the image or well?

We are considering using the edit function on Neo to manually review and interpret equivocal reactions on antibody screen tests performed on Neo. We have been getting many, many equivocals over the past several months and all instrument and reagent solutions are temporary. We are repeating a significant number of tests which is requiring extra resources of reagent and time, not to mention delay to patients. All of the antibody screen repeat test results are negative so we are looking into thoughtfully editing the Neo result. Is anyone routinely using the Edit feature and what is your algorithm for interpretation? Thanks!

Thank you, Malcolm, for being the voice of reason.

We currently have Immucor Neo and are getting proposals form both Immucor and Ortho for our contract renewal. We also are Cerner Millennium so I would be interested in how the Ortho interface process goes for the Vision.

We are trying to move away from CMV seronegative products, except for neonates. Our Pediatric Hematology physicians - about a year and a half ago - stopped ordering seronegative products for their patients following a literature search for current best practices. They found that leukoreduction was at least of equivalent risk of CMV transmission. We are encouraging our adult hematology oncologists to do the same or at least test patients for CMV before ordering.

We have multiple hospitals in our system. One hospital does antibody work for all the others, including providing crossmatched blood ready to transfuse. We do not re-confirm blood type on units when we transfer; receiving hospital does not re-crossmatch the units. This is clearly spelled out in the procedures shared by all the facilities. Each facility has different CAP # and only the largest one is also AABB.

1) Do you still use charts? No, we discontinued charts after several months of validation. 2) Do you take daily recording? The system captures temp readings about every 5 minutes, so we do not manually record any temps. 3) If you take manual recording, which readings? Not for any remotely monitored equipment. 4) How do you monitor your CTM? Each quarter we check function by setting off alarms and confirming we obtain alerts as expected. We also confirm that we receive daily temp reports. 5) What kind of reports do you print? Our CTM sends us Alerts on our BB computers if temp is at threshold; the CTM generates a report daily for the previous 24 hours with current, average, high, low and # of alerts. The reports is emailed to key staff and also written to a designated file. We note on a daily checklist that the report has been written to file. Manager reviews reports, signs electronically and saves to monthly file. at end of month, Manager copies the files to flash drove for backup to save for AABB required time. 6) Do you run into problem where you do not have readings and do not have charts? I the system is going to be down for maintenance we have a manual back up process in place. We also have a stash of temp charts that we could use if off line for > 4 hours or for troubleshooting. In our two years of CTM, we have not had any significant issues with temperature recordings. in fact the system is much more accurate that charts and our manual temp records as it eliminates the human error factor.

We are working with our Pharmacy and Oncology teams to develop a process where we perform T&S and antigen typing of patient prior to administration of the drug so we have baseline info if the antibody screen becomes positive. We will be able to give antigen matched RBCs and treat similar to our patients with warm autos. So far we have not had any patients present who are on this drug - but it is only a matter of time!

As David said - we subscribe to the CAP survey for antibody titers. In addition, we freeze an aliquot to test in parallel with the next sample so that we can accurately identify titer increases vs techniques variations. We only perform antibody titers on pregnant women up until delivery.

Does your Institution routinely perform a Type and Screen on ALL women coming in to deliver?the OB unit at our facility has procedures in place to evaluate the risk of the Mom at admission and order accordingly - Low Risk - HOLD tube only; Moderate Risk - Type and Screen; High Risk - Crossmatch 2 RBCs Does it routinely perform a Type and Screen only on c-sections (then other patients, only if Physician feels a need to for some reason)?C-sections are included in our Moderate Risk category Is the testing at delivery, totally a case by case protocol (so nothing standard)?Will update orders as needed as status of the patient changes during delivery. The OB docs can activate the OB Hemorrhage plan (our established Massive Transfusion Plan) is patient meets that criteria for ongoing or uncontrolled bleeding.

We do target but wonder if we need to look at specific charts or if reporting the number that fell out per Service Line would be sufficient.

We do have reports for transfusions with pre- and post- lab values; but again, it requires a lot of manual intervention to review those reports and the carts to determine if the hgb of 8 was for a ischemic cardiac patient or a general surgery patient. I'm wondering if it would be acceptable report, for example, the number of RBCs transfusions for patients with hgb above 10 or the plt transfusions with plt count >10,000 with and normal platelet function test results. Or do specific cases have to be reviewed and reports? What are your experiences with CAP and AABB regarding peer review?

We are an 800 bed hospital that transfuses in excess of 24000 products annually. We are reviewing the processes we use to report to Transfusion Practice Committee in an attempt to make it more efficient and more effective. We do not currently have a formal Blood Product Management program so all data collection and chart review falls on Transfusion Services – with chart review being the most labor intensive. We are looking for ways to streamline that process while still meeting the AABB requirements for peer review of transfusion practices of all categories of blood and components. For those facilities that are 500 beds or more, how do you perform peer review of transfusions? How do you gather information as to which charts to review? Do you choose charts by individual physician, service line, or some other method? And what do you do with those results? Any and all ideas will be greatly appreciated!

Our procedure spells out that the Medical Director will review promptly, normally within 24 hours of completion of investigation. We also include specific criteria for notification of the MD when an immediate response is indicated.

Our policy is to perform antibody screen. If the pattern matches the historical antibodies on file (positive cells are for that previously identified antibody) and there is at least one negative cell, then we crossmatch antigen negative units. We do not repeat the panel unless there is evidence of a new antibody - positive screen cell that is antigen negative for the known antibody; or incompatible crossmatch with antigen negative blood. Then we have option to run entire panel or do selected cell panel. An antibody screen result from a current sample has to be entered into the LIS in order for us to result crossmatches in the LIS.