Laura Mc

Malcolm means variation in antigen expression on the cell used to perform the titer. Thank you Malcolm. I should have also included that in my explanation.

Historically, laboratories have performed alloantibody titers in pregnancy in parallel meaning the current sample is tested concurrently with the previous sample. The intent is to accomodate for variations in technique and technologist. In my experience we very rarely see a titer that is more than one tube different from the previous sample. Has anyone dropped performing titers in parallel? What has been your experience?

We issue RhIG (Rhophylac) from our Transfusion Service. For the OB clinics we give them 10 RhIG vials,they log who got those vials and return the log sheet to us. There are different codes for RhIG. CPT code 90386 Rho(D) immune globulin (RhIgIV), human, for intravenous use and a HCPCS code J2791 Injection, Rho (D) immune globulin (human), (Rhophylac), intramusclar or intravenous, 100 IU. Which code should we be using to be billign the patient.

We are a large tertiary care center with a Neonatal intensive care unit. We assign an infant to a unit of blood until the unit is used up, expired, patient has gone home or expired. We currently keep the parent bag and draw off aliquots as needed using a sterile connecting device and a syringe set from CharterMed. In the codabar world I have made this work but making up our own codabar syringe codes. However in the ISBT world I will not be able to do this. How do you assign the product code when the parent bag still exists and you want to keep making aliquots? I cannot do A and B then Aa and Ab as this only works twice. I have made up to 20 syringes off one unit of blood. If your facility is doing this and have implemented ISBT or you know the answer I would love to hear from you.

In order to move from 5 to 7 day platelets your blood supplier must be a participant in the PASSPORR study. 7 day platelets are only FDA approved if you are participating in this study. What this study entails is... Platelets must be cultured 24-26 hours post collection using an aerobic and anaerobic bottle on the BacTalert. The platelets must be held an additional 24 hours when the first reading of the bottles occur. If both bottles are neg the platelets can be labeled with 7 days and released to inventory. The bottles are incubated for the remainder of the 7 days. Our institution is participating in this study. We have seen a dramatic decrease in our outdating. You may think that you are not going to gain many days by having a 7 day outdate with this study but in essence you do gain at extra day.

We use plasma frozen within 24 hours just like regular FFP. It was approved by the Transfusion Committee and was not discussed with the medical staff. In fact when we started using it we got no questions at all. Plasma frozen within 24 hours does have a different product code than FFP. The description is Plasma, Frozen within 24 hours after Phlebotomy. The product code is 18101.

You may want to think of items that improve your current processes. For example, we monitored units out of the bank too long, FFP outdating (we shouldn't have any as we changed to thawed plasma), labeling errors on blood products, computer entry errors. We did audits which could lead to a long term monitor. Some audits we did: were techs following our solid organ crossmatch policy, our conditional release policy, were we getting variances for issuing low yield platelets. Find areas where you are perceiving problems and see if there is a problem. Look for areas where you think there are no problems, you may be surprised. We were with one of our audits that lead to a monitor being put into place until the problem was resolved.

The Therapeutic Apheresis Unit is a part of our Transfusion Medicine Service. It is staffed with 5 RN, clerical person and an RN Supervisor. We perform about 750 TPE, 165 RBCEx, 170 PBSC Collections, 10 cytoreductions, 33 LDL Immunoadsorptions and several research protocols in a year. In addition this area also collects autologous WB and performs therapeutic phlebotomies. The nurses take call for emergent and after hour procedures.

We also issue tissue to the OR but decided to use the thick styrofoam inserts that come with the tissue or can be purchased separately. We did not try to use the igloos. We were concerned about cracking if they got too cold.

We are in the process of working out processes and validating SafeTrace TX for our computer system. How have other institutions that use TX handle RBC syringe aliquots? TX only allows the use of Std Prod Codes and I can make up fake ones, however, we can make up to 15 aliquots from on RBC product. (We assign an infant to a unit of RBC until it OD)

We collect apheresis platelets in our institution using the Gambro equipment and the BactiAlert for bacterial detection. We will be applying for the variance and hope to have 7 day platelets by the end of the summer or early fall. In regards to pH and glucose the original studies were done using those methods on platelet concentrates only and not on apheresis platelets. The article in Transfusion has to do with using the pH and glucose method on apheresis platelets.

All the suggestions submitted are great. Another idea is to take the self assessment tool or the checklist and give each staff member a section. As them to answer the questions or the checklist items including noting the SOP in which it is located. This also provides another set of eyes and gives the staff member an idea of what an inspector may look for. We have done this for many years and are always surprised (pleasantly so) when a staff member points out an item that we could be doing better at.

We keep skin in our lab as well. We have not had any problems with inspections as we are only storing and distributing. We do treat it like a blood product and receive it into our computer system, assign it to the patient and issue it along with a bag tag to be put in the chart.

We use a 6 hour outdate. No references but mainly a preference. We have a SCD but felt the potential risk of bacterial growth should limit the syringe time. Our other argument was the syringe is hard plastic and did not have the same characteristics as the original storage bag. For platelets we are also using a 6 hour OD and have validated that with pH and swirling.

We wash apheresis plts on the 2991 using Plasmalyte. The pH of the final product will always be in the pH range of the washing solution. This has been much more successful than using normal saline which has a lower pH.