monroe

You are not really "typing" the cells for D antigen. You are using the same principle of D antigen detection stated in the procedure. You are simply testing a specimen to see if D antigen is detected just as you are doing when testing the Mom's cells. If the screen is negative, would that not mean "D antigen is not detected" in the mixture of cells that was tested" and that would be the test interpretation. As for the AHG phase for the weak D type, with so many Rh typing products out there on the market, Rh types vary among the labs depending on which product you use. Thanks for your input. this is what I am looking for. Points I may not have considered.

Is anyone using or thought about using the Fetal Screen Kit for FMH (kit by Immucor) to detect D antigen on infant red cells with a Positive DAT? This would be a direct test on the baby cells (not using mom's specimen at all). It would be an alternative to Du testing by AHG. There is no modification of the procedure. The baby cells are just not in the mom when you test them. The Positive DAT does not seem to interfere by the testing we have performed. Cord blood testing is the situation where this use would be most applicable. Any thoughts on this?

Have you thought about using the fetal screen kit directly on the baby's specimen not the mom? On priniciple, the kit detects D+ cells regardless where they are at. the Positive DAT does not interfere with testing (by the testing our facility performed) You might think about using this principle in conjunction with the degree of positive DAT in the baby. I have read of others doing this. We use Immucor fetal screen kit and currently trying to get more info on this use of the kit. Just a thought!

yes, we have an IR thermometer and it is very finicky. If you are not careful, you may find yourself discarding more units because of how the IR thermometer reads.

i feel your pain or rather I felt your pain when we went live. your sentiments were exactly ours down to the keystroke comparison! i would like to say it gets better but i can't. Cerner is just not a blood bank friendly system. We still hate it after a year. but if you have questions on how something works, i will be more than happy to let you know how we handled it. by the way, i had to add an extra person to my staff since Cerner came on the scene. My lab director felt so sorry for us, administration added another FTE to our staff.

I have spoken to FDA and the FDA inspector said that a facility must be registered if the facility prepares "reconstituted whole blood". this process calls for the combining of 2 very different products to create a third different product. I also was able to find this info at the FDA web site in one of their "Ask the FDA" sessions. We are not trying to get out of supplying a product. We just want to do it within regulatory requirements.

thank you for this reply. this is an issue our facility is struggling with again. we dropped our FDA registration a few years back with the intent of issuing the 2 items separately, but our neonatalogist seems to have forgotten the process. so here we go again.

it is required by FDA that if you mix 2 different components to make a third component, a facility must be FDA registered. exchange transfusion is specifically stated and that was FDA's answer to me. That is why I am trying to find out what other facilities do if they are not registered. Also we would make the calculations for the physician and nursing staff so that the 2 products combined would meet the intended hematocrit.

Does anyone out there prepare reconstituted whole blood for exchange transfusion? our facility is not FDA registered and we are looking for an alternative to this product. we tried just issuing the red cell unit and a FFP unit as individual components that could be combined at bedside by physician, but physician did not like this solution. Any other suggestions, besides, getting FDA registered?

we issue with attached tag. we debated the issue, but decided against having no attached tag. This is needed for tracking. to make sure the patient designated on the emergency release is the patient designated on the uncrossmatched unit (in some manner, such as name, unique #,etc) . We have had multiple traumas and I hate to say it but our ER might give the uncrossmatch unit to another patient if no patient designated on the unit. there are other scenarios i could come up with. the tagging of the unit I feel is a patient safety issue. I am sure there are other ERs very efficient in handling traumas and record keeping, etc. , but ours is not quite there.

thanks for the info! is a blood bank unit tag generated in Emergency Dispense?

Yes, this is still a great big problem with Cerner. Currently, we are having to print the Review Que daily, check to be sure the duplicated accounts are the same patient, place the Blood Type in the Blood Bank comment section. this is a temporary fix and does not address the issue what to do for patients who need the 2nd type verification and actually had it in their history but Cerner wiped it out. I am not a Cerner fan!!!!!

we recently switched from Sunquest to Cerner Millenium. We were actually added "on" to a system that had been designed for use by our sister hospital. we are two very different facilities in our patient mix and in our processes. They chose not to use Emergency Dispense app and continue with a paper trail. We were use to Emergency Issue in Sunquest which generated forms and associated patient with unit. We are now requesting this "build" but a concern is raised by the other facility that if the system recognizes "uncrossmatched" as a valid state for a red cell unit, an "uncrossmatched' unit could accidentally be issued as crossmatched without the system generating any warnings to the user. Does anyone use Cerner Millenium Emergency Dispense? And if so, is my scenario possible?

We are currently on Sunquest. Our BB policy is to perform Type, Screen, and DAT on new admits. If there are no abnormal findings we will issue Oneg without further testing until the neonate reaches 120 days old. We assign the Oneg units as needed and keep the infant on the same unit until the unit expires or is used up. Since not every baby requires transfusion we do not assign a unit to each baby at the time testing is performed. We will be converting to Cerner Millenium and we have been told there is no way to assign units to the baby more than 3 days after the original testing. I know you can extend the xm date of a unit that is already assigned, but is there any way the system will allow the assignment of units at a later date? How are other Cerner BBs handling NICU transfusion?