OxyApos

I am in an area with lots of non existent prenatal care. For liability reasons and the lack of patient history we do an antibody screen on anyone receiving RhIg. Over half of ours is given in the ER for miscarriages and "pre natal" care patients.

It was emailed to me by them. Each account number is supposed to receive technical advisories this way. Check with your sales rep or call Immucor I guess.

By the way, Immucor sent out a Technical Communication this morning regarding interpreting the new kit. Lots of color photos to put with the manual.

I have never had a false positive with the Immucor kit. I have had patients who turned out to be weak D positive that reacted with it but that's not a problem with the kit. A flow test sounds nice but it would probably be more expensive. I'm glad I don't use Ortho products right now. Johnson & Johnson is trying to sell that part of their corporation and the Blood Bank division had sales down 4% last year...which means no R&D etc for those products.

I didn't have to start a new BB, but salvage one that was on the verge of being shutdown. I would start with your accrediting agencies requirements, assuming its CAP. Try to address those with the correct programs and/ or logs sheets, consolidating things when you can. As you go along and find one piece of workflow, report, etc duplicates something else, don't be afraid to change. You will never have enough staff or time to have duplicate duties.

This will be very helpful to you even as you further your studies...We always learn as Blood Bankers. I've worked as a Blood Banker for 25 years but still need a site like this, especially since our hospital alots no money for continuing education opportunities.

That 4 hour is from the package insert to the filters. Our Infection Control department has just about decided that all units get an individual filter because its so hard to juggle 2 units in exactly 4 hours.

I inspected a small hospital that had an MLT running the Blood Bank with an MT close by. They had 6 pages of violations mostly because the well intended MLT didn't have the expertise to know what she didn't know and didn't know who to ask. The lone MT of this lab was overwhelmed with the entire running of the lab and didn't realize there were holes in their operation. But she technically ( ha ha ) met the CAP requirements.

Just another bit of info for the American audience...the most common brand of transfusion filters for red cells and other components states that it is only to be used for up to 4 hours for contamination purposes. This starts the clock on the unit at 4 hours. Doesn't help with the nurses who haven't spiked the unit before then but its been out of the blood bank for over 30 minutes. I've had all of the above scenarios..units out for 10 minutes but the patient room is overheated so therefore, so it the unit...units our 45 minutes but meet temp requirements...etc.

We are also looking at this for our entire system of 5 hospitals, 3 of which are small rural hospitals. We think this is cheaper and more convienient than resticking everyone. Only about 10% of our red cells would need these. I would like feed back from folks out there. Thanks ahead of time.

I too have had 1 real positive patient recently. I have ran her, my previous CAP HBF 03 & 04, Weak D control cells, and previous lot #s of Fetal Screen kits. All have shown very good reactivity.

We were only doing a type and Type/Screen as ordered. THEN a patient busted loose during delivery. The doctor didn't want uncrossmatched & had to wait for a screen. "How will this never happen again?" was the topic...only answer is doing a Type & Screen on every patient, so that's what we do now. We are a low risk hospital that delivers @ 120 infants/ month. Over 3/4 of our patient mix is uninsured so they're all on house $$. We get about 15 Passive Anti D workups/ month. Run Extend II on the Echo and done in 30 minutes. Try calling to confirm Rhig but since most have sketchy history not much help.

Shout out to Immucor: I have to find out from here that a validation kit will exist from you all and then find out from here that some Business Managers are taking care of their customers with a Conversion Protocol. How about full information to your customers so they don't have to go to BLOG sites ( great as this one is ) to find out what's going on with your product.

Immuncor is coming out with a new Fetal Screen kit next year ( FMH RapidScreen) . It is replacing the current kit. Any thoughts on doing validation studies when we get maybe 1 positive patient a year??? Thanks in advance.

Ditto the others advice. I would also add being very organized for the Inspector's benefit. I make a spread sheet with every single question and the "answer" to the question. Page numbers in the procedure manual that address xyz, where in the file cabinet, etc. I have print outs of everything that wants documentation with the TRM # on it so they can reference it on their own. I have had over 10 inspections with this approach and its gone great. This is all in an envelope that I can then just hand them after their arrival. Good Luck.

Then keep the phone number of your service people for freezers close by. Our Maintenance and Biomed folks don't actually fix the freezer, just tell us its broke, like we didn't know. Mine is less than 5 years old and has numerous visits from the Carrier people here.

I have a local ARC with a reference lab so if there are multiple antibodies I let them do it. I found out that our center pulls known e and c negative units and keeps them for the reference lab, so the chances of me finding one from my inventory , even if >25 units, is slim. CEK and single others I try to find, if we have the tech time.

We do 10 days because that's what our doctor's requested. Perform type and screen day drawn. No preg/ transfusions in 3 months. File tube by future date of surgery. Set up blood the morning of surgery. We have to change their billing account number so that the crossmatch charges and possible charges for the components themselves will not be billed on a pre op charge from earlier. It works out quite well for us and the OR. Only 1 tech in our dept so having all the first cases show up at once for workups would be bad. If the patient doesn't return with their armband, its all repeated on a new specimen. We switched to the Typenex barcoded armbands for these patients and the compliance rate has been really good. I wouldn't go keeping specimens beyond 10-14 days and I wouldn't do what some places do...freezing plasma and thawing day of surgery so they can be kept for a month.

I wish I would have stood up to management's cheap ways and gotten a Helmer. Our other Helmer products are great. We have a NorLake freezer and its terrible. The last time I had to call their "customer service" it was terrible also.

A couple of things to consider. We have "test patient" protocols in our system ( Sunquest) so the result would never be confused with a real patient. The relatively few Type and Screen & XM results over a year are not an issue with skewing our statistics. I have the results entered into our LIS so that I am proficiency testing our staff on results entry per our protocol also. BUT, in theory, we have multiple hospitals , so one of our other sites could try to look up one of these "test" patients and see our results. This is something I do for in house competency. Inspectors have been happy to see my master list of surveys, staff members, and who performed what to be compliant.

So why is it so hard to pop the cap and inspect for foam in the patient specimen? We have lots of these, probably due to all of our specimens being drawn with vacutainers. Aspirate the foam or respin. The techs should be checking for short draws and hemolysis anyway. An antibody shouldn't be missed from foamy reagent...the LISS doesn't bubble up, like the Anti D typing reagents sometimes do.

We just launched the EPIC hospital EMR system and I was wondering if anyone out there lets BB info go to the FYI option in EPIC. We thinking of using it for select patients with severe blood bank problems, like Mulitple rare antibodies. We wanted to put in a generic warning to look up the patient's previous BB information or to call the Blood Bank so that the physician would not assume emergent situations could be dealt with swiftly. Any experiences??? Thanks ahead of time.

I've had an Echo for almost 4 years. I have had 3 service calls and our guy is 6 hours away. I use the Manual Capture for the few times the instrument is having maint. The former gel users that come to work here, including myself, think the panels IG has are awesome and make workups so much easier. We run all antibody IDs and TYSC on the Echo. We have learned to batch in 2's on day shift when the volume is heavier and there's always a routine specimen "waiting on a buddy". Other shifts have almost all stats are run one at a time if necessary. This method has proven much cheaper in the long run than tube or gel. We were having less experienced techs sending specimens to ARC reference lab off hours because they didn't know how to interpret their reactions. The Echo has really empowered them and we now send maybe 1 warm auto a month off. ( We have too few to justify the reagent cost and workups ). We run about 60 panels a month on the Echo and appx 30%of those are passive anti D. Most antibodies only require 1 panel if you learn how to evaluate the 3 cell screen and run the appropriate specialty panel in the first place. The ? reactions are judgement calls Blood Bankers make just like "sticky" and +/=wk reactions in tube have been made for years. I see virtually no colds, I, or rouleaux with the Echo. It is NOT cost effective to retest donor units, run babies, weak D, or do crossmatches on the Echo for us. We do tube AHG crossmatches after getting antigen negative units.

Echo takes 30 minutes to run. Rest of the time is techs checking specimen, spinning specimen. Of course, the time from order by the floor to receiving by the lab is our big black hole.

This is a cost cutting question. I would like to approach my pathologist about allowing us to report out Presumptive Passive Anti D on L&D patients that have the cells on our 3 cell panel reacting on the D+ cells. We have hundreds of panels a year on patients who deliver w/o needing blood & have a documented HX of prenatal RHIG. Has anyone out there tried this scenario and if yes, what were the stipulations?