John C. Staley

I would make the argument that the blood was inspected when it was issued to the remote storage unit. At that point the transfusion service had completed it's obligation. I am assuming (and we all know how that goes!) that the remoted storage unit has been exhaustively validated and monitored with documentation to confirm my assumption. As well as any training required for those accessing the remote storage unit. I'm always more worried about the blood going to the wrong patient in these situations than I am for the quality of the unit. Personally I always enjoyed challenging such citations.

My experience, though it was a while ago, was that during those events the vitals are being monitored constantly whether transfusion is occurring or not. The documentation may or may not reflect that but it is being monitored. Personally I think the blood bank/transfusion service should start being in the loop concerning vitals when the crisis is over and transfusions are slowing down or stopping. Then the vitals will be come relevant. Just my 2 cents worth.

I know that tech! She left a day blood bank position for a graveyard generalist position so she would not have to use the new automated instrument because if she didn't do the testing it was probably wrong.

Too late! They already have, it's just that they won't admit it!

I know it's been awhile since I was writing SOPs and things change but I don't remember ever having that info on the individual SOPs. At most they may have had the name of the facility in the header but I sure don't remember having anything more.

Someone one time tried something once and achieved the results they were looking for and told someone else....... That's usually how it appears to work and in all my years working in blood banks and transfusion services I have discovered that inertia is the most powerful force in the universe!

Malcolm we can do this for ever!! The antibodies CAUSE the hemolysis by activating the compliment. Here's my analogy, without my finger pulling the trigger the gun doesn't go off and I don't get a bird in the bag. When I do pull the trigger did I kill the bird or did the lead shot kill the bird? Or did the gun kill the bird? To address the hemolysis of autologous cells with the same analogy. Occasionally 2 birds are close together and both are killed with the same shot. One was intended the other was not but I still pulled the trigger. Take one of the factors out of the equation and the end result does not happen or is significantly altered so the answer to all the questions is YES. I think what we have here is a case of semantics. Every step could be said to have CAUSED the end result. This is fun. Let's discuss it over a pint some day.

I may be mistaken but I seem to recall being taught that it was the ABO antibodies interaction with incompatible RBCs which caused the activated complement so without the ABO antibodies you don't get the hemolysis.

For the immediate time frame, with the mother in mind, consider the baby as D+ and provide RhIG. On the other hand, with concerns for the baby, D= is how I would treat the baby.

To my knowledge, there has never been such a rule, regulation or requirement (the 3 "Rs" that rule the blood bank). In two blood banks / transfusion services I worked in, one was in a separate room but certainly big enough. In the other, we were part of the lab but separated from the rest of the lab in the same way chemistry was separate from hematology. The only department that had it's own room was microbiology.

I don't think you can go wrong following the manufacture's directions/recommendations! Besides, it's easier than inventing your own. The only time I would consider otherwise is if the manufacture's directions/recommendations are way over the top and burdensome.

At my last large facility they built a new hospital (we moved in in March 2002). Lab supervisors were able to design their section. As a fluke I put windows in my design. I was shocked when, on our first walk through the Transfusion service actually had windows!!! Wish I had put a couple in my office!

I must be getting old and slow because I really don't understand the question!!

Over my many years I have come to realize that inertia is the most powerful, driving force in the universe and the most difficult to over come!!!

Personally, I would go for the all electronic documentation. Just have some form of backup procedure for down time. You may have to justify it to some inspector but you have a good case for it. If the inspector still insists on citing you then take it higher and contest the citation. It the only way to get things changed.