Philip Thornton

You are not alone in your assessment of certain PAs,RNNPs, and CRNAs. Like physicians when a PA practices within a health care facility they must practice in accordance with the policies of the health care facility. At my particular hospital we decided as a matter of policy not to allow PAs the athority to perscribe any blood product or order the transfusion of such. It was difficult at first (with some hard feelings) but over the years it has become accepted as routine practice.

GREAT POST!! You explained that very sufficiently.

I would definately consider the patient a candidate for RhoGam due to the possibility of an antibody made to antigen missing in the mosiac pattern if such is the case. Had there not been a Rh type discrepancy, you would have given the RhoGam without a thought.

We have had a Helmer PC400 for years and are very pleased.

We do not repeat the screen since some antibodies do drop below detectable levels. The patient is considered to retain that antibody or the proclivity to produce it for life so the corresponding antigen negative blood is always indicated.

YES If this patient were to receive an E positive unit they would immediately make anti-E due to the immunogenic predisposition of having made anti-E in the past. We have patients exactly like yours with a history of Anti-E which are currently Ab screen negative that need antigen E negative units for each time. Just imagine if this patient traveled to another state and needed a transfusion. I would not wish to be the Blood Banker on duty during the probable massive hemolytic transfusion reaction.

We just updated to v5.63 and plan to install eTAR in 2009. We have no interface but may be getting a Proview in 4th q 2009. My email address is pthornton@wchosp.org if you have questions.

In 2005 we purchased a REVCO (Thermo Fisher Scientific, Inc) Ultima II Model UFP430A18 under the counter component freezer and like it very much. We store roughly the same quantity of plasma and cryo that your facility does and the freezer is only 5 cu ft. It has a digital display readout to the tenth degree Celcius, range from -10C to -40C with preset temp setpoints of -20C and -30C. It also auto defrosts, alarm is easy to test, has remote alarm capibility, and keyed door locks. Visit www.thermo.com and search for REVCO Ultima II freezers.

Tony, We have a Laboratory label maker that we use to label the shelves of our refrigerator. Philip

We rule-out exclusively with homozygous or a rarely the combo of 2 to 3 heterozygous cells. This practice eliminates much of the ambiguity in antibody diagnosis.

You can use multiple options to reduce the risk of mistransfusion in non-emergent red cell transfusions in addition to or in lieu of drawing a second sample on patients with no history. According to CAP "Among options that might be considered are: (1) Documenting the ABO group of the intended recipient on a second sample collected at a separate phlebotomy (including documentation in the institution’s historical record); (2) Utilizing a mechanical barrier system or an electronic identification verification system that ensures that the patient from whom the pretransfusion specimen was collected is the same patient who is about to be transfused. The use of a second manual banding system, while currently acceptable, is probably not as effective as the above two options. Other approaches capable of reducing the risk of mistransfusion may be used." It sounds like you've implemented the electronic identification verification system within the lab. If you could get ER and the rest to implement you would be well on the way to mistransfusion risk reduction. Other options may also be considered. We are implementing the electronic identification verification system. If you've had major issues with identity verification in the past, you may wish to implement multiple options.

Thank you for your quality input and blood bank experience that was shared with the rest of us. I hope you continue to post.

Welcome to a great site for Blood Bankers. You will love it.

At our facility irradiated products are given at the specific direction of a physician's order. If a physician does not order irradiated products on a patient for which irradiation is most likely indicated, we contact the physician to suggest consideration of this option. Even if the physician is unsure irradiated products effectively reduce the chance for GVHD and associated complications. In addition, all of our Red Cells and Platelet products are ordered irradiated leukoreduced for most oncology, all potential transplant candidates, and all post transplant patients.

We do the same; the last wash should be performed with screen cells as a negative control to ensure that the washing was effective.

Have you considered using only the healstick sample for newborn screening instead of the cord blood as opposed to doing this procedure twice? You would have an accurate ABORh and still be able to detect a positive DAT.

Exemplary justification! I've printed this off for the new techs. Our facility like yours only does an elution if recently pregnant or transfused.

Our facility chose not to utilize this feature due to the exact issue you are having. If you come up with a rule or other solution let us all know. I'd be interested in what you find.

We use one homozygous or in the absence of one at least two heterozygous for K rule outs.

Welcome to BBT. This site is newly discovered by me too and it's great!

To Bill Sinn: Cited? I think you should contest that. CAP clearly states that 'Other approaches capable of reducing the risk of mistransfusion may be used.' The intent is to reduce the fatalities due to mis-transfusion from misidentification of the intended recipient. Giving type "O" units to any patient type especially type "O" patients fulfills the above intent. The only way you should have been cited is if your procedure stated that all first time ABO patients would be subject to a second ABO type (which would include type "O" recipients) thus causing a deviation from your stated procedure.

We use a cut-off of </= to 1+ and call these patients 'weak D' Rh POSITIVE. NOTE: Our policy specifically requires the use of Rh Negative Red Cells with patients classified as 'weak D' Rh positive because of the possibility of Anti-D production due to sensitization of the recipiant's partial antigen. This policy covers both tube and gel at our facility; tube because of the advent of strong reacting monoclonal reagents and gel because of the increased reaction sensitivity. Cord and neonatal samples used for Rh immune globulin candidacy that display a weak or partial D are again called 'weak D' Rh positive but the mother is a candidate for RhoGam. This is also due to the possibility of Anti-D to a partial antigen.

Hey Marilisa, It's Philip from Wooster Community Hospital in Wooster, Ohio. I also just recently joined this site and it's great. Welcome.

It looks like an excellent resource.

Looks like a great forum for Blood Bankers! I look forward to discussions and correspondence with fellow colleagues.