John C. Staley

If this is such a rare happening my suggestion is, if it ever does happen, simply do the best you can with what you have. If you come up with some procedure then you will have to review and train with it on a regular basis and I would suggest that once per year is not enough. Bottom line, you cannot prepare for every eventuality your fertile mind can come up with. The key in the rare circumstances is to not panic or get bullied into doing something you know is not correct. You can drive yourself crazy with all the "what ifs". I am all for preparation but it must be reasonable and realistic.

I'm just curious but are any of these people, Transfusion Safety Officer, Blood Utilization Manager and Blood Utilization Medical Director, part of the Transfusion Service with a blood bank background? If not, what is the Transfusion Service's involvement in the process?

It's always safest to follow manufacturer's instructions but, generally, it's OK to set your own expiration dates as long as they don't exceed those set by the manufacturer. The easy thing to do if you feel the need to have one sample expiration date for antigen testing would be to check all of the antisera and set your date for the shortest listed.

I did not calculate blood bank TATs from order to completion. I started the clock when the sample arrived in the blood bank. I had no control over what happened between order and sample arrival. For the rest of your quest for info, I have been out of the loop too long to provide any current info. I'm looking forward to hearing what others have to say. Oh, my reference for my limited response was a 350 bed, level II trauma center.

I had never heard of it but it sounds like a great idea to me. Wish I had thought of it!

We started using the "current edition" designation quite some time ago and never had any problems. It made life much easier.

Been there, done that, thank God since I retired I'll never have to do it again.

We considered the AHG crossmatch as "additional testing". If any antigen negative units to previous identified antibodies, showed an incompatibility then a full panel was completed and more if indicated at that point.

I can't help you with the basis of your concerns but I do have to say that in Emergency Release situations I certainly consider the physician's signature as an integral part of the transfusion documentation and not a separate issue. Now, how to consistently get that signature has been an issue since the dawn of time or at least since the dawn of transfusions.

I'm stretching the memory cells here but I believe that if there were no changes in the antibody screen and the AHG XMs were compatible we did not do a panel and this met the AABB Standards AT THE TIME. This may have changed and it would not surprise me if it did.

At my previous facilities LPNs and CNAs could assist an RN but the RN was 100% responsible.

Scott, I mostly agree with you but I would add one more caveat, adequate training, oversight AND practice/consistent use of the skill. If you have staff that seldom to rarely rotate through the department their skills will diminish and as far as oversight, no one likes working with someone constantly looking over their shoulder. To respond to Cliffs comment, you are absolutely correct, no technique is perfect. If it were everyone would be doing it the same way. One technique will fit a certain situation better than another but not technique addresses the needs of everyone.

I could not agree with you more especially since I was one of the first in the intermountain west to bring automation into my transfusion service in 1999. It was quite a battle then. I sure hope it's easier now.

Welcome to the WONDERFUL world of retirement. I highly recommend it. I once heard that the US and Great Britain were two countries separated by a common language.

Why????

I remember reading this paper in 1997 and sharing it with my Transfusion Service Medical Director (the best medical director I ever had). We had recently gone to immediate spin crossmatching and had switched to a 3 cell screen as a stipulation of going to the IS XM by this medical director because it made her more comfortable with the that decision. After reading this article she considered it a valid argument but was unwilling to go back to the 2 cell screen. Her peace of mind, real or imagined, was more important than the money we would have saved.

I fought against using a blood bank specific armband my entire career. In the two 300+ bed hospitals where I was the Blood Bank / Transfusion Service supervisor spanning 25+ years, both utilized the armband system from a company named Biologics. Their armband system was a plastic armband with a sleeve. There was a small plastic tag that was embossed with all pertinent patient information at the time of admission. This tag was attached to the armband and stored in the sleeve. The company supplied a hand held label maker which utilized the plastic tag to make labels with the patient information which was utilized by all hospital departments including lab and blood bank. The arm band and tag was attached to the patient at the time of admission. The only time we had problems was when a patient borrowed someone else's medicaid card and lied during the admission process. This system was simple and worked very well. I'm not sure if it is still available but I imagine it is with all the upgraded technological bells and whistles invented since I last used it. I hope I painted the picture well enough for anyone to be able to visualize it.

Congratulations Malcolm and well deserved. Very happy that you chose to share this with us. It's gratifying when some one in our profession is truly recognized.

Wow, out of the business for a couple of years and I don't have a clue what most of the acronyms in this thread mean!!

For me this would come down to how either you or an inspector chooses to define prepare realizing the inspector will change with every inspection. It will be interesting to see how an current inspectors/assessors will respond to your question. Personally, for a small facility that does nothing more than the occasional thawing of FFP, I would not worry about it.

This started being a hot topic 10 - 15 years ago. It started in the AABB and they were fine with calling the coolers transport but then the FDA got involved and their stance was that it was storage and to my knowledge they have not varied from that stance. That was when I started looking into the "vending machine" blood band refrigerators for the OR. Sadly they were too expensive for our penny pinching administration so the OR had to be satisfied with blood delivery via pneumatic tube that was measured in seconds! They were devastated!

Had the nurse "spiked" the unit prior to laying it down? Was there any other possible source for the blood? I'm sure you asked these questions initially but I felt inclined to put them out there. One more question, how bloody was bloody? This is indeed and odd situation!

Fatal septicaemia? The injection is IM not IV. Malcolm don't you think that a septiceamia is a bit of a stretch. I would think that a nasty cellulitis is more likely and if left untreated could be very serious or even fatal depending on the bug involved. I appear to be feeling just a bit argumentative today, good thing my lovely wife is off visiting family for a few days.

Just out of curiosity, how has this been working out for you? Any significant problems or negative patient outcomes do to this practice? What caused you to pose this question? Also, how big and/or busy is your facility? Is your testing manual or automated? On the surface I would have to answer your question with a NO but a little more info would help. I've always been a "if it ain't broke..." kind of guy. If your system is simple and works well for you why seek to complicate it.

Just a side note, my wife's anti-K would show up at immediate spin, go away at 37oC and then come back strong at AHG. Her anti-D was detectable only at AHG. Her anti-S disappeared completely after about 1 year. She's a nurse, you can't expect her antibodies to be normal!!