Antrita

I think it is just to save time, as calling it " a computer asigned blood when there are negative antibody screen results" is too long. Now that we are trying to adopt the "LEAN' system, I can say that we are saving time and not just being a bit lazy.

The computer gets to decide what unit the patient is going to get. Though I do not believe the computer will accept any blame if there is an error.

Do any of you require a second draw by a different phlebotomist on patients that do not have a historical blood type? We have been working towards an electronic crossmatch and have the staffing to redraw them. Our sister hospitals are much smaller and frequently have just one person drawing blood. I have been told we all have to do the same procedure so I can not ask for a second specimen by a different phleobotomist. I think this is asking for trouble. To me it's like proof reading your own work Antrita

It has gone to our Quality Improvement department. Our pathologist is involved in these reviews. In some ways it is easier when the problem is at our end as I have direct input in the corrective action.

I was hoping someone would think it was reportable becuase I was very unhappy with this MD. All they need to do is have their office fax me an order when they have patients with special needs and I can put a marker in the computer. I turned it over to our QI department.

On 10-6 we had a chemo patient admitted thru ER. The ER doc ordered to units of pc and a plateletpheresis. Both the hospitalist who wrote the H&P (electronic only) and the oncologist consultion (electronic only) stated the patient was in a experimental protocol at Stanford and was to get irradiated leukoreduced blood products (all our products are leukoreduced so this wasn't an issue). Neither of them wrote this on the patients chart and nursing does not have access to the electronic reports. Friday evening the oncologist writes on the patients chart that all blood products are to be irradiated. By this time the patient has ahd 4 units of packed cells and 1 plateletpheresis. The patient was transfered to Stanford the following day. I don't think this is reportable as we never had the order for irradiated blood products until after the transfusion. What do you think?

Thank you, I'll turn it out as probable Anti-c.

Thank you, I really don't want to go any farther. It is a little scary to know that we might be missing anti-c. Normally I don't go to using the ficin panel unless the untreated panel results are inconclusive.

I have a pregnant patient that has had a Anti-E that isn't very strong. The last time we tested her she had a negative antibody screen. There is something in her history about a "cold autoantibody" but I'm not sure of the validity of that antibody. When I got a specimen on her today I decided to check everything at once. I did a modified cold panel which was negative. We use gel and have the "C" panels (panel A that has untreated and a ficin treated panel cells). The untreated results showed an Anti-E. The treated cells have an Anti-E with a posible Anti-c or an Anti-f. With the patient having an Anti-E, my only cell that differs a c from an f is that cell. It seems really wierd to me that a Anti-c would not show up in the untreated panel. I have only had 1 patient with an Anti-f. Has anyone had much experience with Anti-f? The patient is c negative. Antrita

You are right, I can't prove that the unit was typed so I will include this with my labeling error. I know when I retyype a unit and I find it was already typed (retype label missing) I put a not in comments on the unit. I see the weakness in my system, I need a second req ordered on a unit that is typed twice to tract this issue. I don't know if this would have caught the error but it would have a least made them think about what they were doing.

This was the one area that is a little fuzzy with everyone. Our computer system will not allow a unit to be crossmatched that has not been retyped. Sometimes the retype labels will fall off and the unit gets typed twice. It is possible that he looked the unit up and thinking it had fallen off and put the information on a new label. He says he did not do this. Do you think I need to write up the possibilty the unit wasn't typed?

Thank you, I thought someone asked about this once before but I couldn't find. Antrita

I found what I consider the perfect storm of an error since it had 5 people involved. I think there is 1 FDA reportable part but if any one thinks there is more than 1 please reply. 1. An evening tech missed several units when bar coding them into the computer. Two of the units involved had the same ISBT-128 number but were 1st and 2nd containers. 2. Three days later a CLS was typing units, found the 1st container was not in the system, typed it but did not look to see if any other units from that same batch were also not in the system. 3. Two days later a CLS set up the 2nd container for a patient and it was transfused. The unit tag that went out with the issue was for the 1st container. 4. 3 days after this another CLS working with the actual 1st unit was unable to issue it as it supposedly been transfused to the first patient. Instead of investigating what happened he decided it was a computer error and released the issue from the first patient and issued it to his patient. Didn't bother to leave me any kind of message. 5. The floor where the first patient was transfused did not return the Issue/Transfuse form until yesterday which is when the error was caught. This was 30 days after the transfusion so now I can not even bill the patient for the unit. I think the FDA reportable is giving the 2nd container to a patient labeled as the first container. I am not sure what the code is. If any one knows I would greatly appreciate the information. I don't think any of the rest of the mess is reportable. Thanks Antrita

Someone from another hospital told me they have a code for "bloody" traumas called Code Crimsom. When they get a code Crimsom they send 3 units of O neg packed cells and 1 Jumbo FFP to the ER. This is separate from a regular code Trauma and a Massive Transfusion Protocol. Does anyone else do something like this? It seems like this would take the burden off the blood bank.

My concern with this patient was, she was here for 1 hour before she started to bleed. They gave her 4 units of packed cells and then shipped her out with 2 more units in the ambulance. Her coag tests were never repeated. If slightly abnormal INR and PTT were the start of a coagulopathy from trauma, giving her 4 units of blood with out FFP wasn't going to improve the situation. We have a massive trauma protocol which includes FFP with every 4 units but the ER doc did not call for the protocol. I think we are going to start issuing FFP along with orders for uncrossmatched blood. This patient did not survive. I think at our facility we are quick to look at the trauma patient's hemoglobin when they get here. We have always looked to the MD to order the right products. The massive transfusion protocol was established to help this process along but when they don't make that call we are in limbo.

We had a trauma case last week that had slightly elevated INR and PTT and a borderline normal fibrinogen. The patient had 4 packed cell units before they shipped her out. I thought she should have had FFP or at least a repeat coag tests, which she did not. Her results weren't that bad but in a trauma I thought it was a bad sign. The trauma RN said they MD is to busy working on the patient to check the coag results. Great response. Do any of you have trigger values that would require either repeat coag tests or automatic FFP when dealing with trauma patients? Antrita

We had a patient come to the ER today for "possible staff infection" antrita

We have a 14 year old girl admitted to the hospital with a hgb of 5.0. In gel her antibody screen is 3+ in all cells. Her direct coombs in gel is 4+. In tubes her antibody screen is negative (using LISS) with a 2+ auto control. Her direct coombs in tubes is 2+ IgG and 1+ C3. I crossmatched units in tubes and they are negative. Is it safe to transfuse? Antrita

I have also e-mailed the FDA twice when I was not sure if something was reportable. I find their website a little confusing. Both times they answered me within 24 hours. Antrita

I have a question. Do you have to report a blood type computer entry error when the test is not connected to a transfusion. A sister hospital asked me and I said no but now I'm not sure. It was an out-patient order just for a blood type. The error was caught the next day and corrected. Antrita

When we back type this patient he has an Anti-A but no Anti-B. Our computer system doesn't like it when our forward type (in his case = O pos) and the back type (in his case Anti-A no Anti-. So part of our problem is it can't calculate a blood type and it (the computer) knows this patient as B positive. I think it will let be override the lack of Anti-A on an O positive patient. I wanted to just change him to O positive but my pathologist wants to wait till he comes back in (I am not sure why). Thank you for the information about the FFP, it just made me nervous because of the B positive history. We are not a large hospital and this is the 2nd blood type change from a bone marrow transplant I've seen. Antrita

We have a patient that we transfused last year that was B positive. He recently had a bone marrow transplant and now forward types O positve and back types B positive. I understand that the O positive is from the donor's bone marrow and the lack of Anti-B is own. I am unsure what type to call him now. We were thinking of calling him O positive. We want to give him O packed cells but B or AB FFP. Is this right? What do the rest of you do? antrita

The patient's diagnosis is TIA vs Stroke with history of coronary bypass surgery and GI bleed. His hemoglobin has stabilized (10.0) so I don't think they are going to transfuse him. He is caucasian. He got 2 units of B positive here in 2008. He is not being seen by a oncologist and his primary care is a family doctor. Since we don't need blood our reference lab is not working him up in a hurry but, as soon as I get something from them I will let you all know what they say. Antrita

I forgot to mention that this patient does not have thrombocytopenia and has not had WinRho. Antrita

It has been 2 years since we transfused 3 units of Rh positive blood. He does have a positive direct coombs so a auto anti-D is possible. We had a patient with an auto anti-e that when crossmatched with e positive cells the reactions were negative. This patient we have now had 3 + reactions with D positive cells. If it was an auto anti-d would the reactions be this strong? I will let you all know what the reference lab says, it will probably be a few days since we don't need them to find us units. Thanks, Antrita