John C. Staley

To questions just out of idle curiosity. What's the antibody and where on earth are you getting whole blood?

I'm confused here. Isn't placental blood mom's blood? I guess it depends on which side you get it but then the other side is cord blood so why would anyone want to use placental blood for pretransfusion testing? What am I missing here?

I've put off weighing in on this topic for as long as I can. I really hate impossible "shall have" rules and regulations. First you would need to know/calculate the body mass/blood volume of the patient. Then you would need know the level of activity of the incompatible ABO antibodies in each unit of plasma going into that patient. Then you would need to know the volume they are bleeding it back out. All this to give you an accurate estimate of the volume of incompatible plasma you could "safely" give one specific patient. I'm sure I've left out a factor or two but you get the gist of what I'm saying. My minor level of OCD really whats me to do it right if I'm going to do it at all. I had a non-technical lab director (BA in business) throw me out of his office for trying to explain why the request for certain data by a VP was not only impossible to accurately provide but was a stupid, worthless waste of time. This is one of those times where you and your lab director will have to make something up based on your best guess and basic instincts because there is no one size fits all answer to this.

Since I'm relatively lazy I remember doing just the electronic checks once we had units that had that as an option. I don't recall ever having an issue with an inspection. I think it goes back to the old matra of "follow the manufacture's directions grasshopper" and I don't recall Helmer recommending the old ice water trick.

I'm fairly certain the chat could last well into adult beverage time. Once that started the stories will get even better!

I'm curious, have you identified the root cause, (I really hate that term but it was in vogue a few years ago) of the erroneous result? Was it really the tech or could the sample have gone bad or some other problem? Just wondering.

Malcolm, while philosophically I understand the rational to avoid potential future problems, as a general rule I didn't worry about it if it wasn't there. Of course if an antibody had been identified and then had dropped below detectable levels it was honored (excluding RhIG injections). I always figured I would worry about it when it showed up. Like you, this is a personnel opinion. I know lots of blood bankers in the US that would c type (little c) a patient with and anti E and provide c= blood if the patient was c=. A few facilities even had it written into their protocols. We had only the rare patient that would require long term transfusion support so unlike areas with a large number of sickle patients it was really not an issue for us to worry about matching phenotypes to avoid future problems. We simply played the odds.

In this day and age it can be very easy to offend people and while I don't mind offending them I just want to make sure they know where I'm coming from. Your right Mable, it's been a while. I've met some great people online and especially here on this site. Some day I would like to meet you and Malcolm and Cliff, Dave, Ann, Steve and all the rest in person over coffee. I'll bet the stories would be entertaining.

I want to preface the following remarks by saying that I am, or at least spent over 35 years, a blood banker in various capacities. I am one of you. Blood bankers, with good reason, can generally be described as untrusting to the point of paranoia. No one can do the job as well as we can and that includes other blood bankers. I have never known one of us who would willingly trust a sample drawn at another facility. It's hard enough to trust our own phlebotomy staff! I don't even want to get into nurse draws! We are this way because we understand the potential dangers and in all honesty most of this comes from a true concern for patients we never personally see. I had one staff member quit a blood bank day shift to work as a generalist on the night shift because she was convinced that the use of the new automated analyzer would result in the death of all of her patients because she would not personally be doing the testing. Granted that's a little extreme but it is an example. So to answer the original question of this thread, I am fairly confident you will find little or no support for "using a blood bank sample drawn and tested from another facility".

As you describe the events, these are not mistakes. They appear to be wanton disregard for procedures and protocols. Most facilities have a training period, usually 3 - 6 months wherein a new employee can be discharged without jumping through the usual hoops. I suggest you use this escape route if it is available. Just out of curiosity what is this person's back ground and how well was it checked out?

I know I've been gone for awhile but I have to ask. What is KPIs?

Early in my career we had a tech working in chemistry who was, shall we say, a tad bit arrogant! I figured he had measured 5 mls while making up reagents enough times he could do it without a graduated cylinder. He just "eyeballed" it. It was requested he seek employment else where as one set of CAP Proficiency testing was failed miserably and his reagent prep was determined to be the cause.

This is a very interesting discussion and one that could bite you depending on who is asking questions. A number of years ago I was called down to the billing department to have a chat with an insurance person reviewing the billing for a patient. The patient had had a TURP performed and as was the norm back then the doctor had ordered and we had crossmatched 6 units of blood. As luck would have it the patient did not us a drop of blood, one of the fortunate few. The insurance person was going to deny payment for the crossmatches on the grounds that they were unnecessary. Initially I tried to very calmly explain that this was a common order for this procedure and in most cases the patient used some of the blood if not all and this case was unusual in the sense that they had not been transfused. The insurance person could not let go of the fact that the crossmatches were unnecessary expenses because the patient obviously didn't need them. I finally gave up and told the insurance person that it was a very sad day when insurance companies began practicing medicine. I was able to escape the room just before her head exploded! I never did follow up to see if we were paid for those crossmatches or not. Bottom line for me is, if they question testing that was ordered do not be surprised when they question testing that was not specifically ordered regardless of how much sense it makes to us. The antigen testing is easy to defend, the additional crossmatches, not so much. We would screen units by crossmatching but not charge for them until additional units were ordered. This is a little more difficult to achieve in the computer environment.

It probably makes some doctor some where feel better.

Depends on the inspector! Back in the day when I was inspecting, and yes it was called inspecting back then, I would not have even given it a second thought as long as the sample was acceptable and the unit was issued and hung prior to the expiration of the sample. I have met those inspectors who would have been quite distraught over such a perceived infraction. The best advice I can give you Mabel is, let your conscience and best judgement be your guide.

Just curious but did they indicate what the penalty would be for not complying?

Pretty sure that every blood supplier out there is already doing this both locally as well as nationally depending on the size and reach of the organization with plans of actually utilize the info for planning for the future. The govt on the other hand.......... well, not so much. Just keeping bureaucrats employed. You are right Malcolm, am very cynical as well as pessimistic. The thing is, when I'm wrong it's a good thing!

I have always wondered what is done with the information from such surveys. Are decisions made and action taken or simply are heads scratched and eyes rolled? Are they undertaken simply for the "that's interesting" factor of the information?

Just a little free advice and it's worth every penny. Pick your battles carefully and make sure they are worth fighting and the potential cost of losing. Good luck.

Merry Christmas to everyone. I would like to especially say Merry Christmas to all of you whole are working today saving lives and stamping out disease. May your work load be light and your friends and family be understanding. You are all in my thoughts today.

I can not answer your questions but would like to ask a couple of my own. I've been away long enough that I've not even heard of the Immucor Bioarray HEA system. When and why would you send patient samples and donor units for this testing?

Smoke and mirrors. Never under estimate the value of smoke and mirrors!

I don't need them anymore but they are still fun!!

This is news to me but then things do change with time. So my questions are, first, are the alarms set at the factory or by the facility? Second, at what temp is the lower alarm set?

It has always been my understanding that you can not issue blood based on previous history! I don't have the reference available but that was a standard we lived by for my entire 35+ years in the blood bank. All too often we had people come in sharing ID/Insurance information and the first way we were alerted was when the blood types didn't match with the history we had.