John C. Staley

And to all of you who will be working the next couple of days, THANK YOU FOR BEING THERE! You truly are the special ones. Over the years I worked my share of night shifts Christmas Eve so my heart is with you.

First off, what is MFM and FOB? I don't think you want me guessing! Secondly, the guidelines coming from someone who has little knowledge is not just foolish it's potentially dangerous. It is not uncommon for the husband, mate, partner or most recent paramour to NOT be the biological father and to assume so has the potential of severe consequences. There is no need to make an issue of it with the mother, just do the testing in the background if the physician is smart enough to understand this.

I must respectfully disagree with Malcolm (a rare occurrence). In my transfusion service we documented the time of issue as the time the blood product left the blood bank and became the responsibility of the nursing service. Maybe this is one of those things where we have 2 countries separated by a common language. From Merriam-Webster Definition of issue (Entry 2 of 2) transitive verb 1a: to put forth or distribute usually officiallygovernment issued a new airmail stampissue orders b: to send out for sale or circulation : PUBLISH cBritish : PROVIDE sense 1a, SUPPLY

In case you were wondering, it's still snowing outside my window.

It is outside my window!!

Each day, when you first see the PLT icon on your computer is your first thought Platelets???

And just how often are you doing the weak D test on theses newborns? Is it often enough to justify the additional testing?

I would think that a 4th option in the poll should be: Routinely perform only D typing on babies from D negative mothers. Why do ABO and DAT routinely on these babies?

I'm curious and have been out of the loop for a while so I would like to know who and why.

I agree with David on the 1st part of his response. New samples would get everything (except known antibodies as David stated) and you reset the clock. As far as the second part of his response, I never had the "pleasure" of dealing with a super responder so I'm not sure how I would have dealt with that.

Based on on of this I would be inclined to believe she never had an allo anti-D. I am tempted to climb on my soap box and spout a heated diatribe on the prenatal practice but I think I'll skip that this time.

Did the "consistent prenatal care" include an antibody screen at some point?? I've seen anti-D drop below detectable levels but not that quickly and not in a young person. If this pregnancy had a negative antibody screen I would question the results from 2016.

Times and focus change.

Just curious but did the inspector mention why you should check the total protein?

Good point David, My first thought was, "why is your tube system so slow?" Granted I have a fairly limited exposure to tubing blood but in what experience I've had I've not seen a tube system so slow the blood would get out of temp during transport.

Can you give us anymore info on what was going on in 2016? Also, what level of prenatal care had she received, if any?

I'm with David on this one. Doing both paper and computer entry just adds one more opportunity for mistakes. If you can't trust some one to put it in the computer correctly how can you trust them to write it down correctly! The key is the ability to enter the results as they see them and not have to walk over to a computer station to do it. Also, if you are entering from an instrument print out I highly suggest you get that instrument interfaced as quickly as possible. Again, you are entering results from paper and that should be avoided.

I think I missed something. Did you really imply that you are putting platelets in the same cooler as the RBCs??

From my experience a lot depends on the team of surgeons and their philosophy and training in respect to transfusion. In the last facility I supervised the blood bank in we had a group of surgeons who believe the less transfused the better and they rarely transfused anything. About the only time they actually used any blood products was during a "redo". It didn't hurt that my blood bank medical director was married to one of the lead surgeons. On the other hand, a sister hospital in the same corporation about 60 miles away used a lot of products on virtually every procedure, especially platelets. They would use more platelets in one procedure than we would in over a year. The suggestion to be involved in the initial meetings is an excellent suggestion. It's the only way to find out the surgeon's expectations ahead of time.

I have to ask, how many times when the DAT is negative and you can elute the antibody from the babies cells does the infant show symptoms of a significant case of HDN (old guy, old nomenclature) resulting in an exchange transfusion or even phototherapy? Seems to me you are doing an awful lot of work for little, if any, benefit. See Malcolm's technical discussion above.

If you put "Secondary Blood Bags" in the search box you will find a past thread on your question.

As long as you validate/verify the digital, I believe annually is the requirement, you should be fine without a second thermometer hanging around waiting to get broken.

So...... utilizing the same scenario, are you going to screen every pretransfusion patient to determine their K status to determine if you can use those K+ units or just throw them away, it might be cheaper or just let them set on the shelf until a suitable patient comes along to use them on or are you going to extensively antigen type every patient with one antibody to determine what else they can make and then screen every unit for them for antigen compatibility??? I never had enough staff to accomplish this kind of CYA!

Scott, you are kind of contradicting your self here. In one sentence you are advocating avoiding the production of anti-c which can only be accomplished by screening units and transfusing c= units. Then you say it would be nice if you did not have to screen for units. I see a conflict here. Bottom line, it's a gamble. Either you screen for c= units now to prevent anti-c or you take the chance they won't make anti-c and if they do you start screening units then. The latter was always my choice.

Just curious but are you referring to a single patient massive transfusion or a mass casualty situation? I would classify Malcom's examples as mass casualty while a single patient massive transfusion could be the result of any number of things. Then there is everything in between. In the two facilities (both approximately 350 beds) I supervised I left it up to the staff involved to decide what and when they needed help. When help was required I was usually the first one called. Even got a call while fishing in Alaska once. Wasn't much help with that one.