[Facility location on SOPs]

23 hours ago, Baby Banker said:

I could not agree more.  I believe that, if unchecked, some of the accrediting agencies will eventually regulate themselves into irrelevance. 

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

[Facility location on SOPs]

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.

[Weak Backtype Resolution]

13 hours ago, RRay said:

I often wonder how certain practices got started.

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!

[ABO confirmation testing required for red blood cell transfusion not platelet or plasma transfusion?]

23 hours ago, Malcolm Needs said:

That is true John, BUT it is STILL the complement (specifically the Membrane Attack Complex of C5b, activated C6, C7 and C8 molecules and about 6 activated C9 molecules) that causes the haemolysis, which is why autologous red cells are also destroyed.

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.

[ABO confirmation testing required for red blood cell transfusion not platelet or plasma transfusion?]

21 hours ago, Malcolm Needs said:

Sorry, but I disagree.  In most cases of ABO haemolytic transfusion reactions, it is not the ABO antibodies that cause the haemolysis that destroys the incompatible red cells, but activated complement that, in most cases, also causes "innocent bystander haemolysis", whereby the autologous red cells are also haemolysed.

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.

[Weak D]

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. 

[Separate room for Blood Bank Department]

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.

[Manufacturer's Instructions]

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.

[Dream equipment/products/supplies?]

On 9/28/2022 at 6:24 AM, AMcCord said:

I would upgrade both of my blood storage refrigerators to the Helmer i-series and set them up for downloading temps so less paper trail. I would bring in a new Echo (ours is upgraded, but old). I would remodel Blood Bank (knock out a wall) to give us a little more room and a more ergonomically friendly space to work, maybe add another spot to flex to workspace for MTP events and for our students. Actually, I want a whole new Blood Bank with more room and windows! I don't want much really............

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!

[Blood components for Patients with positive antibodies]

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

[Do you antigen type for the entire group?]

11 hours ago, Bet'naSBB said:

@exlimey Do I know why?  not really - I've just been doing what I was told......for almost 35 years. 

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!!!

[Temperature and Inventory tracking and review]

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.  

[Has anyone dropped CAP? Pros/cons??]

Malcolm, my very 1st AABB inspection came about 2 months after taking the Blood Bank supervisor job.  After it was over I contacted AABB and told them that I would never let that inspector in my facility again and if they tried to send her I would drop our AABB membership.  YES, the inspection/inspector was really that bad and luckily I never had to carry through with my threats/promises.  

[Has anyone dropped CAP? Pros/cons??]

17 hours ago, Cliff said:

I'd be in favor of keeping both CAP and AABB.

If one of them is doing your CMS inspection, then the other can be used as "practice".

Personally, I never minded inspections/assessments.  My blood bank and transfusion service were "visited" no less than twice every year by inspectors.  Either FDA (we were licensed to ship blood interstate at one facility I supervised), AABB, CAP or JCHO.  Being inspected that often meant we never had the opportunity to let things slip unlike other areas of the lab that were inspected less frequently.  On the other hand it did become very expensive paying memberships as well as buying materials required to stay current on the requirements of each agency.  When cost cutting measures were called for reducing in this area was always discussed but for some reason was never acted upon.

 

[Has anyone dropped CAP? Pros/cons??]

A number of years ago in a meeting of the corporate transfusion service supervisors we discussed the possibility of dropping our AABB membership.  After much discussion the corporate transfusion service medical director decided that we would not be dropping the AABB membership.  Her reasoning, the prestige of being in charge of a group of facilities fully accredited by AABB was very important to her.  She actually told us that!

[ED type and screens]

I'm curious, can those 25% that appear to be "order abuse" be linked to specific docs or is it random through out the ED?  With current computer technology this should be discoverable.  Over the years of my career I realized that not all ED docs are created equal and some have a much lower threshold for CYA than others.  Just a random thought.

[? what's your practice - regarding moms with RhIg on board and Rh-pos babe needs product]

23 hours ago, Malcolm Needs said:

Yes John,  With higher dose anti-D immunoglobulin, the DAT of a D Positive baby is quite often positive.  In the UK it is now quite common to give a dose of 1, 500 IU of anti-D immunoglobulin at 28 weeks of gestation and, as a result, many babies have a positive DAT, but I have never heard of clinically significant HDFN as a result,  Physiological jaundice is also quite common in newborns, whether the mother was given anti-D immunoglobulin or not, and whether the baby is D Positive or D Negative.

What I was trying to get at is if the DAT is negative and the antibody screen is negative why would anyone consider it necessary to provide D negative red cells.   Another thought/question just occurred to me (odd, I know), why are they transfusing the baby?  Is it due to excessive blood draws or is the a hemolytic process going on?  That would make a difference as well.

[? what's your practice - regarding moms with RhIg on board and Rh-pos babe needs product]

Just curious but does the baby have a positive DAT due to the RhIG?  Is the anti:D demonstrable in the baby?  

[Remote temperature monitoring]

21 hours ago, TMGal said:

 The lab is staffed 24/7 so if the equipment alarms in the lab, it would be heard and attended to. 

So, why, pray tell, does the alarm even sound at a nursing desk?  This is quite unnecessary and obviously inconvenient for all involved.  If the reason is, as usual, "that's the way be been as long as anyone remembers", it's time for a change.  Hopefully you can get this easily rectified.  Good luck.

[Remote temperature monitoring]

I'm curious on what you consider a 3rd party outside the lab.  The engineering department within the hospital could be considered a 3rd party out side the lab but I personally would consider them acceptable because they could react immediately to the alarms.  If you are referring to someone far outside the facility that would be considered a subcontractor I would be hesitant to consider this acceptable but that's just my opinion.

[Segments post-crossmatch]

I never considered keeping the opened segment used for the crossmatch.  While I can understand the idea behind it I personally consider it over the top in our blood bank paranoia.  Each segment in the line can be positively linked to the unit transfused and that should be all you need.  

[Dr Larry Petz.]

Thanks Malcolm.  It's sad to see the passing of another Blood Banking great.

[Storing Saline Cubes]

I'm going to be blunt.  This is ridiculous!!  You have the potential of causing far more problems by removing the cubes from their protective container.  

[QC of reagents on receipt]

On 5/13/2022 at 8:53 AM, David Saikin said:

I QC reagents before I put them into use; usually not upon receipt.

Just a thought but, might that not be a little problematic if there is an issue with the reagents? 

I know it's one of those "what if" questions that never happens but I couldn't help my self.  To be honest, it's been long enough I don't remember what we did but something tickles the back of my brain making me think we did some form of on receipt QC but I'm certain it was not overly extensive or burdensome.

[Automated and Manual Bench QC]

Personally I always considered the human interaction to be part of the equation for performing QC.  I don't recall anything that specifically stated that but I could not see where the human was not an integral part of the process.  So in my lab the manual method would be QC'd as well. Your secondary methods only need to be QC'd on the day of use.