sgrovenger

We also require a valid Type and Screen, because we cannot issue a blood product in our system without having an ABORH and Antibody screen result unless we are using the emergency release procedure. We had an instance where a tech wanted to just issue a platelet, so he put in a negative antibody screen result without actually testing it. Then, low and behold, that patient needed blood, and it looked like, in the system, we had already done the antibody screen. After that, we changed our policy to require a current Type and Screen sample for plasma components, even platelets!

Our ED uses the Belmont Rapid Infuser FMS2000. I know that there is a lot less monthly maintenance required (only surface cleaning) than the models they were using before, so the users have less to do. The biannual maintenance is performed by our maintenance department. Other than that, I don't know much about it. I assume they like it since our Labor and Delivery floor is going to switch to the same model after talking to the ED. I do have a copy of the user manual for the model that we use.

SKO681- We do a Type and Screen on all patients that come in to deliver where I work- that is about 90% of our total type and screen work each month. We usually have one or two of those convert to a crossmatch, but usually they just need 1-2 units. However, in the past month, we have had 3 patients who had an antibody upon delivery, but the antibody screen was negative for the initial prenatal workup. So, it can be a good thing, but it can be expensive- especially when you are using gel!

Yes, we did the crossmatch with both pre and post samples, and in both cases, the PROVUE called them compatible. Several different techs have run the same samples, and in all cases, the PROVUE called the units compatible. (DId I mention that the antibody was an anti-e, and that the PROVUE called two out of 7 units compatible? What are the chances of that happening??) We have since done some correlations with antibody screens, and again, the PROVUE is missing the weaker reactions. This time, I saved the cards from the PROVUE, and there is no comparison to the manual cards. We have a tech from Rochester coming to look at this. I will keep you posted. Thanks

I guess I should clarify- Yes the patient had an antibody, and yes the units crossmatched had the corresponding antigen. (Inexperienced Techs did not follow SOP or GMP- thus the FDA issue) SInce the PROVUE called the units compatible, the techs did not question the results, and issued the products for transfusion without antigen testing. But, that is our concern- Why would the PROVUE call these units compatible? Like I said before, the tech got a 2+ incompatible when she used our manual gel process.

Does anyone out there use the PROVUE for AHG crossmatches? If so, have you ever had a case where the PROVUE called a unit compatible, but when the tech repeated it using manual gel, the manual gel card got 2+ incompatible? We just had this happen (long, FDA reportable story ) and we are now wondering why this could happen. Any thoughts or ideas, please respond. Also, if you are willing to share your procedure for using the PROVUE for crossmatches, that would be great. We simply empty one seg into a labeled tube, and program the machine. Are we missing a crucial step? Thank you.

lef5501- Here is the procedure we use in our transfusion services Instructions: The below procedure will be performed every six months (sooner if new lot number). Properly activate and appropriately attach a HemoTemp II to an expired unit of red cells.Using crushed or cubed ice; bring the temperature of a small pan of water to 1°C using the NBS thermometer.Place the ‘expired’ unit of red cells into the pan of water angling the unit so as not to wet the HemoTemp II and allow to stabilize for 10 minutes (add additional ice to maintain temperature if necessary). Gently rock the unit in the pan of water to allow for equilibrium of temperature.After the unit has stabilized, record the indicated temperature of the HemoTemp II along with the color of the numbers and the color of the irreversible ‘flower’ (should be blue at this time) in the column marked 1°C.Gradually warm the pan of water to 5°C allowing the unit to again stabilize for 10 minutes (gently rock to allow temperature equilibrium).Record the temperature indicated and the color of the numbers and the irreversible flower in the column marked 5°C.Repeat this procedure at 8°C, 10° and 12°C allowing the unit to stabilize 10 minutes at each change in temperature. Record the temperature indicated on the HemoTemp II and the color of the irreversible flower each time in the appropriate marked column.With the pan of water at 12°C add ice back to the pan to bring the temperature down to 1-2°C.Allow unit to stabilize for 10 minutes before recording temperature indicated and the color of the irreversible flower in the last column marked 1°C. Acceptability: As the temperature increases, there is a color change in the numbers (reversible area) and the color of the irreversible flower changes from blue to non-blue (temperature reaches above 10°C).As the temperature is decreased back to 1-2°C, the color of the irreversible flower does not change back to blue.