John C. Staley

This is not a popular concept but at some point we have to accept there are things we can not control. Once the blood leaves the blood bank we are at the mercy of other humans and as long as the human factor is involved there will be human error be it unintentional or intentional. Attempting to complicate a process will only provide inventive humans the opportunity of coming up with creative work arounds to circumvent your best of intentions. At some point you just have to step back, do your job and hope for the best. I had a corporate transfusion QA director who could not accept that human error could not be completely eliminated with out eliminating human involvement in the process. Her directives became horribly complex solutions with multiple, redundant checks and balances only resulting in increasing problems. Bottom line, pick your battles and fight those you have a reasonable chance of winning. Make suggestions, offer insight, provide training opportunities but at the end of the day realize that you have to accept some things are simply beyond your control and even your influence. On that happy note I'll step off my soap box and stop my philosophical ramblings.

Just out of curiosity, what prompted this question? In my experience most facilities have a Risk Management Department which is usually headed and staffed with nurses. They would be most interested in any noncompliance in the facility.

I'm pretty sure any of the commercial QC systems will have this covered and I don't remember them being all that expensive. I have used both the Ortho and Immucor systems and don't remember any issues.

I must be missing something here. Why did you do a 16 cell panel if the antibody screen was negative?

I knew this sounded familiar!

JoyG This happened over 20 years ago. I would imagine things have changed since then and to be honest I never did hear if the insurance company paid for it or not. Was just using it as an example. You didn't answer my question, does your billing indicate that these charges are specifically for testing in regards to a potential transfusion reaction?

Just curious but does your billing indicate that these charges are specifically for testing in regards to a potential transfusion reaction? I had an insurance auditor deny a claim for crossmatching when the patient was not transfused on the grounds that, obviously the crossmatch was unnecessary because the patient used no blood. The procedure was for a TURP and at the time the usual order was for 6 units. Very rarely did a patient not use at least a couple of the units.

It should be noted that IgG crossing the placenta is, over all, a good thing in that this is the mechanism by which the mother is able to confer active immunity to many diseases to the fetus which lasts for some time after birth.

Personally I never liked the term CMV safe! We always referred to this as "reduced risk" which, as pointed out many time above, is all you can possibly hope for.

Just giving you a little tweak my friend.

Malcolm, I'm just curious but what may not be reliable, the father or the phenotye??

I would classify my wife in the super responders category. To attempt to answer the first question, it depends on a number of variables. To start with, assuming she has the same father for all her children, what is his genotype? R1R2 or R1r. It makes a difference. On another note, FMH during the pregnancy will only be a factor if the baby is D positive and mom's titer needs a boost. If mom starts with a high enough titer FMH during the pregnancy is not required for sever HDN. My daughter was born with sever HDN and there was no known FMH during the pregnancy and all of the antibody studies suggested that she should not have been as affected as she was. Bottom line, there is no cut and dried answer to your question and honestly, there never is in the wonderful world of blood banking. I suggest you get used to gray because black and white rarely if ever exists.

Years ago we discussed dropping out of AABB but the corporate Transfusion Service medical director could not let it go. She had no rational argument for maintaining the accreditation while still having CAP and JCHO. She just could not part with what she perceived as a great status symbol. Then in the next breath she would declare how much we needed to reduce our budgets. It didn't make much sense to me.

This was a few years ago but when we changed our way of doing things I reviewed every transfusion for 3 months to get a base line and identify any issues with the change such as nurses needing more training or stronger threats. After the initial 3 months I reviewed every transfusion for one month quarterly then after a year of that I did the month long review every 6 months. Seemed to work for us. This was in a 300 bed level II trauma center with a 28 bed NICU and active heart program. I'm not sure if there are any new requirements but generally such requirements never seem to be specific enough to really give in guidance. At least that's how I remember things.

I have never heard of any such requirement but like Kathyang I have seen studies indicating that anything over 10 hours was not a good thing. The last 14 months I worked is was Friday, Saturday and Sunday from 1800 to 0600. It was a small hospital and I was not consistently busy by any stretch of the imagination but I can tell you that the last 2 hours were the most difficult. That may have be age related more than anything else. Having spent many years in facilities where the nurses in the most critical areas (ICU and ER) work 12 hours shifts, most of the nurse related mistakes I had to deal with as Transfusion Supervisor were with those nurses.