aafrin

I have a related question.
We received blood bags with expiry of November 2013 in March 2013. If we use them and make FFP, it will have expiry date March 2014, i.e.approximately 1 year expiry. Is it OK to use these bags until March 2014 or will the FFP also expire in Nov.2013 according to Manufacturer expiry. What are your thoughts on this?

Yep. Accrediting/Regulatory agencies will instead see how your policy was developed (under guidance/direction by Medical Director?) and see if your institution is followig your policy.
Our original policy simply stated rise of 2°F and we would run into issues where the patient in the PACU whose temp is 95.2 goes up to 98.1 after the bair hugger or whatever and the literal interpretation of the policy says they needed to initiate a transfusion reaction workup, which is kind of silly.

Working in blood bank is like walking on a tight rope, a little imbalance and off you go taking everything with a toss. Getting motivated techs to work with is like a myth. With generalists -small & silly annoyances have to be put up with daily and rectified. That said, it is still the only place I love working in.
 
Great suggestions from everyone and thanks Kathy for summing them up nicely.
 
As an aside -- going through all these posts I was reminded of a story about Anybody, Nobody, Somebody, and Everybody
 
You’ve heard that story ?
 
"An important job had to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody’s job. Everybody thought that Anybody could do it, but Nobody realized that Everybody wouldn’t do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done."  

Working in blood bank is like walking on a tight rope, a little imbalance and off you go taking everything with a toss. Getting motivated techs to work with is like a myth. With generalists -small & silly annoyances have to be put up with daily and rectified. That said, it is still the only place I love working in.
 
Great suggestions from everyone and thanks Kathy for summing them up nicely.
 
As an aside -- going through all these posts I was reminded of a story about Anybody, Nobody, Somebody, and Everybody
 
You’ve heard that story ?
 
"An important job had to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody’s job. Everybody thought that Anybody could do it, but Nobody realized that Everybody wouldn’t do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done."  

Working in blood bank is like walking on a tight rope, a little imbalance and off you go taking everything with a toss. Getting motivated techs to work with is like a myth. With generalists -small & silly annoyances have to be put up with daily and rectified. That said, it is still the only place I love working in.
 
Great suggestions from everyone and thanks Kathy for summing them up nicely.
 
As an aside -- going through all these posts I was reminded of a story about Anybody, Nobody, Somebody, and Everybody
 
You’ve heard that story ?
 
"An important job had to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody’s job. Everybody thought that Anybody could do it, but Nobody realized that Everybody wouldn’t do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done."  

Malcolm, thanks for answering the query I had in mind.
 
Since the baby was grouped from cord blood I was  wondering whether there could be contamination with mother's blood which was giving this result or something else masking the anti-H reaction.We had asked the father as well as consultant to get the baby's blood checked at two years age (preschool), but wonder whether he will?
 
I know the consultant wouldn't be bothered much since both the mother & child have been well & discharged from the hospital.

aafrin, thanks for that.
 
One thing I would question though is, if the baby is group A, how could she also by H negative?  If the baby was genuinely H negative, the A antigen could not be expressed.  Could it be that the baby's H antigen was actually positive, but that the alpha-N-acetyl-D-galacosamine was sterically masking the H antigen, and that the H antigen could, in any case, be weakened, as the baby's L-fucosyl transferase would not be working to its full capacity until a bit later in life?

Malcolm, what a co-incidence we had a pregnant Oh patient for delivery just 3 days ago. They asked for 2 units of PRC to be kept ready. The best thing or worst thing (as you look at it) was that this was her second delivery and they didn't know her blood group. The first delivery was done elsewhere.She already had a 4 year daughter. We spoke to the consultant as well as her husband (he was A+) and stressed about importance of knowing the blood group of their first daughter as well as the propositus's siblings (3 sisters & 1 brother) & parents. He said he will inform them as they were elsewhere, but would bring their daughter for blood grouping next day, which he did not. They just didn't bother. The baby she delivered was A-ve and she was also H Ag negative. Really that time of the year

Interesting how somethings just resist change no matter how hard we try. It is a very difficult mind set to overcome that errors and mistakes must result in punishment. Most of the above comments come from very enlightened folks but there are still far more out there in positions of authority that are not so enlightened. (one of the primary reasons I left my previous employment but that is a story for another time) Over the years I found that by getting my staff actively involved in the root cause analysis and the corrective action they were able to come around to the idea that the goal was process improvement and not punishment. They became aware of the "down stream consequences" of errors and became active in helping fix any problems. I emphasized that since they were the ones doing the work they needed to be the ones to identify where corrective action was needed. This did not happen over night but as the culture slowly changed and new staff came on board I could actually see the culture changing. Patience is the key.
Wow, that's awful long winded for me. Just keep working at it and setting the example, those willing will follow, the rest will be left behind.

Our Policy also states the same. RCs to be infused within 4 hours of issue time. We also state on the transfusion forms that units must be started within 30 minutes of issue time to offset most of the reactions. Ward nurses are also told that 4 hours is the maximum time for a unit to be transfused, initially the transfusion must be very slow for first 15-30 minutes, but then it must be completed as fast as patient's hemodynamic (HD) condition can tolerate. For patient's with poor HD condition we halve the units on request.
 
If told from wards that a unit was not started within 30 minutes, we tell them to start transfusion immediately and try & complete it within 4 hours. Any remaining quantity after that time must be discarded.

Happy 217th Independence Day to our Blood Bank friends in the USA, & Happy Birthday America. Celebrations Galore...

At our hospital, we don't call these units "least incompatible", they are labelled as "best matched" units. The physician / treating consultant usually refers such cases to a hematologist. Usually they try to put off transfusion as long as possible, but if imminent, one of them must sign a consent for release of such a unit. If they order a next unit then another consent is again taken, just so that the treating physician is in the loop, lest a nurse make a mistake and order for next unit to be released for transfusion based on the previous hb record.

AMcCord, you are absolutely right, a buffoon who gaffe's on patient ID procedure because of no time, lengthy procedure, too much work or who's a smart---s thinking the system is dumb - is a potential for disaster. They shortcircuit the procedure and get away with it a couple of times and then become bold & smug, until their luck runs out and puts patient, blood bank & themselves in grave danger. Computers, electronic gadgets like bar code readers etc. are just helpers/tools with no mind or intelligence which is why they say GIGO about them - user intelligence is what counts....
 
The scenario you depicted has happened once here, but luckily for us & the patient, the second sample requirement saved us all.
 
Sorry, if I got onto your soapbox......getting off now.

The photographs and news about Boston bomb blast killings have rekindled thoughts, horror and nightmare that only those who have endured bomb blast can understand. Although I am not in Boston physically, I am there...been there...
 
I pray for all victims and their families, also doctors and other paramedics, and our BB Talk friends for taking their care. May God bless you all with strength to get through and over this calamity. Our hearts go out to you all - Chris, Linda and Kate Murphy.

So true Kate. It's teamwork, can't be handled otherwise.

The photographs and news about Boston bomb blast killings have rekindled thoughts, horror and nightmare that only those who have endured bomb blast can understand. Although I am not in Boston physically, I am there...been there...
 
I pray for all victims and their families, also doctors and other paramedics, and our BB Talk friends for taking their care. May God bless you all with strength to get through and over this calamity. Our hearts go out to you all - Chris, Linda and Kate Murphy.

Thanks to all for your thoughts.  I'm at Boston Medical Center, we received 23 severely injured.  Cliff is at Brigham and Women's and I think they got a similar number.  As others have said, you never think it's going to be in your own backyard.  All the Boston hospitals were terrific - you are right that no one died after the fact once we got them.  But the real saving grace was the medical tent and a fleet of waiting ambulances at the finish line of the marathon.  All the emergency rooms in Boston brace for dehydrated and hypothermic runners at the end of the race. Without the immediate response of these EMTs, RNs, MDs, many more would have died.
We used 72 units of red cells that first night.  Somewhat more than our trauma room normally uses! 
 
One great point - we practice at least a couple of times a year for a mass casualty event.  Our system was not perfect, but better than anyone anticipated due to the disaster training and planning.
 
Plan for the worst, hope for the best. 
 
The outpouring of support from everyone has been asstounding and humbling.  We utilize the AABB National Blood Exchange for 99% of our blood products.  Blood centers across the country were calling us and offering us O's.
 
Our sports teams - Red Sox, Bruins, Celtics - have had incredible receptions at other city arenas.  Incredible!!
THANK YOU!!    
 
We are not alone.  You are with us.  We are BOSTON STRONG!!

Thanks to all for your thoughts and prayers.....
 
We are strong---BOSTON STRONG!
 
Yes, Cliff and I are BWH'ers (Brigham and Women's Hospital) we had 10 trauma rooms going on Monday evening---an unusual occurrence, to say the least!!!!!
 
----By day I am Blood Bank at a neighboring Boston hospital, by night I am a Chemistry specialist at BWH. We were on lockdown all day Friday----having SWAT teams in your hospital and State Police manning the doors is still surreal to me, but that is what we endured all week last week and culminating Friday night. We are recovering----but it will be a while before we get back to "normal".......we are so fortunate to have had the resources to absorb the influx of injuries. From First responders to the trauma teams to the ancillary services, we pulled together and saved a lot of people.
 
Here's to hoping that no other city goes through anything like what we just did......thanks again for all your support!