clmergen

We have a patient with an Anti-U and no other antibodies.

I know that automated instruments and tube testing will give different D typing. What is <2+ in tube will be negative on the Echo.

Our supplier has been proven to be very reliable. And they are doing actual testing not historical types on units that we order. Given the option, generalists at smaller hospitals, who may be covering more than one department, are happier ordering in antigen negative blood. So we pulled most of the anti-sera since it was getting wasted any way. We only type patients not units for the smaller hospitals but we all share the same computer system so it is easy for us to do the tesitng and result it. If a patient has been recently transfused, we evaluate the need to send to the reference lab for antigen typing. For a simple antibody workup we won't but in the case of a recently transfused sickle cell disease patient who needs a complete phenotype then we would.

Our smaller hospitals have limited anti-sera. They order antigen negative blood from the supplier and send patient cells to the main hospital for antigen typing. They do their own crossmatching.

We are in the same boat. But I really like the new format and it has worked out very well with the technical (cook book) procedures. We are just now starting to translate the other procedures into the new format. Hopefully we will get some good outcomes.

We QC our full tube testing reagents because in cases of traumas or massive transfusion, we revert to the quicker tube testing. And we don't ever want to be caught unaware.

We send many units through our system daily for the last 4 years and have never had one break.

I have to admit, our corporation has done okay. They gave us a nominal raise last year and did not cut any benefits. We avoided layoffs but did cut jobs through attrition. They had a goal to cut many millions of dollars out of the budget and succeeded. We haven't heard if we will get raises this year but we are expecting bonuses through our Performance Improvement initiatives for 2009. They held us to a hard line of 100% productivity with flex scheduling a must. If no one was on vacation, people got mandatory days off (paid or unpaid was their choice). And we just merged with another hospital so I give our higher management good marks for aggressive business sense. Now lets see if Medicaid reimbursement decreases further and takes into a downward spiral.

I had an extensive talk with AABB last week on this topic. Each cooler should be validated upon receipt to verify that it can perform as expected. Each cooler should be QC'd at regular intervals, as defined by the facility, to ensure that they are still in working condition. And the impression I got was this should be done as they are in use (ie ED or OR, not on counter top in TS). We haven't defined QC yet, I am having a meeting in a few days with representatives from all my hospitals and this is on my agenda. I don't see doing QC more than quarterly but still haven't figured out exactly how I am going to do this. We do visual inspections quarterly now so that is why I am considering temp QC quarterly also. This will be a pain in the rear with 20 coolers but must be done.

Our purchasing department does the initial weeding out of non-relevant recalls and then assigns the pertinant recalls to the appropriate departments based on acutal purchase orders and lot numbers. The only problem I had was purchasing didn't know that the different Transfusion Services "shared" reagents. So I have it set up now, that every Transfusion Service gets every recall that applies to any of the other Transfusion Services. It is uncommon for us to get recalls. Some people will submit the Immucor Technical bulletins so I have to answer those, but I usually see those before they get on RASMAS. The system seems pretty happy with RASMAS, I know I don't have any problems with it.

We use Rasmas for our medical devices and will not be using it for blood supply. Since each unit is recalled individually, it seemed like a waste of time to submit them online. ARC has their automated system, we use a paper trail.

I think someone overthought that process. We only do temps once per day like the rest.

We do the cord bloods. It is better to catch the problem before the bilirubin may actually rise.

Prosorba columns are no longer being used in the US as of about 3 years ago. I know our Apheresis department had a patient that it worked wonders on. I think the patient had Myasthenia Gravis.

Centrifugation is based on density not mass (I believe) so fetal cells are less dense and would be at the top (just like retics).

Our emergency release protocol overrides anything the doctor may actually order.

I haven't noticed a smell but we definitely have growth on the waste lines. I asked 2 of 3 field service reps (ongoing problem, hopefully fully resolved) that were here this month about it. I thought it would be changed with annual PMs. They said to not worry about it and it won't cause problems (party line). It would be nice if we could take that tubing off and run a little bleach through it and rinse it thoroughly but of course we aren't allowed to do that.

Merry Christmas everyone.

I never do partial D testing nor do we do weak D testing, except as required. If the patient is D neg on immediate spin or on the Echo, we call them D negative and give Rh Immune globulin.

Welcome Tiffany. Are you studying on your own for the SBB or are you doing a course?

Her phenotype is C-E-, K-, M+N+S-s-, Le(a-b+), Jk(a+b-), Fy(a-b-). We assume c+e+. She has only formed the Anti-U. For a typical SCD patient with this phenotype we would give blood that is C-E-K- and sickle negative. She had her 6th exchange for the year last month. She usually has a 6 unit exchange, most of which come through the Rare Donor Program. Luckily we tend to get 2-3 weeks notice of the procedure.

We have a sickle cell patient with an Anti-U that gets exchanged every 6 - 8 weeks. For her we ignore our Sickle Cell Protocol which is to give antigen matched for the Rh's and K. We have about 10 patients that do get RBC exchange transfusions on a regular basis. In fact we keep a log to track them.

We don't bother with identifying antibodies to low incidence antigens. We do a Deviation Report that our Medical Director signs.

We do charge it but only the ABO and I am not sure how how business manager justified it, because we didn't charge until recently.

Adiescast, that is EXACTLY the reasoning I was using. And as I told my AABB assessor friend, that is my story and I am sticking to it.