dmpollock

The easiest way to do this is without software. Create a folder "panels." Scan each patient's panels and save as a file using the patient's name and/or medical record number as the file name. Examples: SMITH JOHN.PDF SMITH JOHN FYA K JKA.PDF SMITH JOHN 150115.PDF (this is year month day for sorting chonologically) SMITH JOHN.PDF This system makes it easy to do a file search.

We have a clipboard in our signout area. Whoever picks up blood must read and sign the document as a one-time training event: A copy of the file is attached. At the top left is a place for a logo or facility ID Blood Transporter Training By signing below I signify that I understand the following requirements for transporting blood components: Blood must be transported directly to the area where it will be transfused (no side trips).Blood should never be put anywhere where it could be heated or cooled.If blood is issued in a cooler it must be kept in the cooler during transport.Do not leave blood unattended at any point.Hand blood over to an appropriate staff member immediately.Blood must be returned to the blood bank as soon as possible (no more than 30 minutes) if it is not going to be transfused.When the Blood Bank tech reads patient and blood information you must verbally read back the followingUnit number Medical Record NumberPatient’s name. Blood Type of unit and patient. Date Printed Name Signature BloodIssueTransporterTraining2.doc

I recommend NOT separating plasma from red cells. All that does is create an opportunity to mislabel the aliquot. I can tell you from having performed about 100 AABB and CAP inspections that the number of blood banks separating the plasma is definitely a minority. I was concerned about stability of our samples for PAT testing, so I made it a project for one of the MT students. I had her take 100 samples, run them on the ECHO on the day of collection, then rerun them on day 21. The comparison was made on ABO/Rh reactions (since I was concerned about using them for immediate spin crossmatch. This was prior to electronic crossmatch.) In 100% of the samples the ABO/Rh matched after storage. By running these on an analyzer it removed bias in the readings. There was a slight drop in strength of the back type, but not enough to cause an ABO front type/back type discrepancy. The specimens evaluated were all EDTA. Of course, the procedure for testing must use samples that meet the specifications in the package inserts for the reagents being used. They typically will give a 7 day limit for testing refrigerated specimens without separating plasma. Be sure to check all the inserts, since the reagent cells might have a different time limit than the antisera.

Your current method will not pick up most cold agglutinins in group O patients. We had a problem with this and it turned into the Spanish Inquisition. I still refer to this as the "Cold War" which started more than two years ago. After several months of turmoil we are now in a state of dètente. I never did find a published procedure for this. My only "revenge" for having to do this was to use a single reference, an article by John Judd, "How I Manage Cold Agglutinins," that states: Cold agglutinins and heart surgery There are conflicting opinions expressed in surgical journals. Our approach is “don’t screen for them; don’t report them.” We discourage requests for titration and thermal amplitude tests and recommend use of room temperature crystalloid instead of cold cardioplegia. Here is what we ended up with: Cold Agglutinin Screen Principle and Clinical Significance Principle - An autocontrol tube is tested at room temperature for cold agglutinins. If agglutination is found at room temperature the sample is retested at approximately 4° and 15° C. Clinical Significance - Cold agglutinins may cause problems during open heart surgery when the patient's body or blood temperature is lowered to nonphysiologic temperatures. Specimen See Specimen Acceptance procedure. The specimen must not be refrigerated prior to testing. If refrigerated, a new sample must be collected. Reagents Isotonic saline Equipment and Supplies 12 x 75 mm test tubes Calibrated centrifuge Ice Dishpan Test tube rack Indelible marking pen Calibrated thermometer Quality Control Reagents must be tested each day of use with appropriate controls. See Daily Quality Control tprocedure. Procedure Cold Agglutinin Screen Label two tubes with patient/unit and test identification as described in the Tube Labeling procedure. One tube will be needed for the patient's cells and one for the autocontrol. Prepare a 3-4% suspension of patient cells for testing, as described in the Preparation of Cell Suspensions for Testing procedure. Add two drops of patient serum to the autocontrol tube. Add one drop of 3-4% patient cells to the autocontrol tube. Mix well and centrifuge the test tubes for the amount of time specified on the Serofuge (usually 15 seconds). Resuspend and read for agglutination. Grade and record test results immediately ("Immediate Spin" reading). Incubate at room temperature 10 minutes. Centrifuge the test tubes for the amount of time specified on the Serofuge. Resuspend and read for agglutination. Grade and record test results immediately ("RT 10'" reading). If the room temperature result is positive at either immediate spin or after incubation, perform the "thermal amplitude test." Thermal Amplitude Test Set up a 15°C water bath (Wet Ice in a basin covered with tap water). The temperature will be an approximation. Label two tubes. One tube will be needed for the 15°C test and one for the for the 4°C test. Place 1 Auto tube in the 15°C basin. Place the 4°C tube into Serofuge Carrier Head & place it in a refrigerator at 4°C. Incubate for 10 minutes. Centrifuge the test tubes for the amount of time specified on the Serofuge. Resuspend and read for agglutination. Grade and record test results. Reference Judd, John W, How I manage cold agglutinins. Transfusion 2006;46:324-326.

To Goodchild: An unrelated question: I assume you have a busy transfusion service to do 1003 panels in a year. How many provues do you have to manage the workload? How many RBC units do you issue in a year. I am curious because our management is considering switching from Immucor to Ortho (which we really don't want to do).

I compiled some regulatory references for this not too long ago. See attachments.

One side of the equation is generally missing from discussions of this type: the patient's need for transfusion. There are times when a patient actually needs a transfusion, and delaying it contributes to morbidity and mortality. Hospitals vary in policies, patient population, resources, etc., so the best practice will vary. Often the circumstances are such that performing extra workups will delay blood availability for the patient with the antibody problem. In many cases it also delays blood availability for other patients because the time spent on the antibody delays completion of other work. If there were some way to measure this, I would not be surprised if we found more aggregate harm to the overall patient population caused by delays in transfusion vs. the benefit of finding a rare case where an antibody undetectable by Coombs crossmatch causes harm. I suspect that programs such as SHOT and Biovigilance are biased in doing a better job of detecting an adverse transfusion event, but do a poor job of measuring adverse effects of delay or failure to transfuse.

When we adopted the approach suggested by John Judd, I called Univ of Michigan and confirmed that that was their practice at the time. We have transfused 45,000 units since then without any problem. Univ of Michigan practices have always been based on good data. Many things are "possible," but that doesn't mean they will happen. I think it is improbable that a patient will have a "delayed haemolytic transfusion reaction, leading to renal failure" due to an antibody undetectable with a coombs crossmatch. We had one patient with an antibody to a low frequency antigen. Often the antibody screen was negative. One in a while the screen was strongly positive with one cell and the panel would often have a single cell reactive. If we worry about preventing everything that might happen, we should perform a panel and full crossmatch on every patient so we don't miss something like an anti-Wra. In front of me is the antigen profile for our three-cell antibody screen. It doesn't have a homozygous cell for K which is probably the most commonly formed antibody. Does this mean we should find a homozygous K cell and screen every patient with that so that we don't miss an anti-K that only reacts with homozygous cells? If the concerns posted in this thread were valid, we should be seeing more problems with delayed transfusion reactions caused by anti-K.

We use a 3-cell screen (Immucor ECHO)

We have been using this for the last few years without any problems: For patients who have a history of previously identified antibodies, it is not necessary to repeat the antibody ID when they come back for subsequent transfusions, provided that ALL of the following conditions are met: 1) The antibody screen fits the history. For example, if the patient previously had Anti-K and Anti-E, the screen cells that are positive for E or K are currently positive, and the screen cells that are E neg K neg are not reacting. 2) Donor units are phenotyped negative for the patient's antibodies. In the above example the donor units must be negative for both E and K. 3) The phenotyped donor units are crossmatch-compatible at the Coombs phase as well as immediate spin compatible. Reference: W J Judd, S H Butch, Repeat Antibody Identification Studies: How Much Is Enough?, Transfusion, 2002—Vol. 42, Supplement.

Be careful of using proficiency testing samples for any other purpose, such as correlations, training, or competency. This is one of the things I look for, and frequently cite, when I inspect blood banks. If you use survey samples in this manner prior to the due date of the survey, then you are creating an opportunity to detect an error in performing the proficiency test. CLIA requires testing the sample the same way as a patient. Are you running all your patients by two methods? (Correlations)? Are you having multiple techs running patient samples? (Training/Competency Testing). If you must use the CAP samples for some reason, I woud recommend having a policy not to use them until after the due date of the survey (not the date you submit the results). Don't violate the CLIA rules! I know of a hospital lab that recently lost its CLIA license due to a proficiency testing violation. Don't end your career for something like this!

I have attached some labels for you to use for testing or validation (ISBT only). Also a copy of our procedure. We hand write the new expiration date on the lower right quadrant. Each sheet is appropriate for a specific product code. We print them on Avery 5163. (set fit to page to "none".) If you print these labels you must be registered with ICBBA.

Is the order number being printed with a "*" on each side, like: *1234*? If it is, the problem may be with a font not being available. Code 39 uses the * as start and stop signals. If you not seeing the *, then you should contact the software vendor for help with configuration, because it is likely the instructions to print the barcode aren't being sent.

The simplest way to convert to 5 day plasma is to discuss it with your medical director, put it in your policy, and start doing it. The important thing is to label it correctly. If you are issuing a unit that has been thawed for greater than 24 hours, then it needs to be relabeled as "thawed plasma." If you label the unit properly, then they are being informed of what is in the bag. Some places go from the frozen state directly to 5-day "thawed plasma". Others go through a conversion step. We thaw it first with a 24 hour outdate. If the units aren't used within 24 hours, we relabel them as thawed plasma with a 5 day date. The units go to the first "FFP" order that comes up and is ABO compatible. We are using ISBT labels. We have pre-printed labels. We apply the correct ISBT-coded component label (which depends on the original FFP product code) and hand write the new expiration date on the unit. For the original question about the 6 hour expiration for FFP per FDA, that is correct. FDA will provide you a waver to use a 24 hour expiration. Most transfusion services do not have this since they are not used to seeing FDA inspectors.

How are you printing. A blood bank system? ISBT or Codabar? When you print, what are you getting on the paper where you expect the barcode?