John C. Staley

I'm just curious but what do you weigh on this scale that would make a range of +/- 5 gms unacceptable?

Something to consider. If the charge drops at XM you might get paid for it. If it drops at transfusion and the blood does not get transfused you will definitely not get paid for the XM. Something to think about. We dropped the charge when the XM was completed. Another little story from the past. Us old guys like little stories from the past. I was called to the billing office to "discuss" a billing issue with someone from the insurance company. She wanted to know why we charged for the XM when no blood was issued or transfused. I told her that the DR. had ordered the testing in the anticipation of needing the blood because the surgery routinely required transfusion. We did the work and charged for it. Her contention was that since the patient did not use any blood the testing was unnecessary! At about this time I asked to see her license to practice medicine. She became quite incensed when I told her that insurance companies had no business practicing medicine. That's when our conversation came to an abrupt end.

Sounds simple and easy! I prefer simple and easy. Helps prevent ingenious people from getting creative and trying to circumvent a complicated process.

A little personal experience here. As I've mentioned in the past, my wife was a labor and delivery nurse so you can guarantee that any pregnancy she had would be complicated. When she was pregnant with our son, baby #1, we were not following her closely because of the Anti-K I had detected while still in school because I am K neg. She had donated some blood for me to test during one of my blood bank classes. It was the result of previous transfusions. Anyway, back to the story. Jason was delivered 6 months prior to the start of antenatal RhIG injections so that never happened. The delivery was via C-section and the physician thought there was very little bleeding so only one vial of RhIG was issued post delivery. At the time the facility she delivered at, where she worked, did not routinely perform FMH determinations. I worked at another facility was I was not involved. Fast forward to a couple of years later. I had been using blood from Janice for students. Her anti-K was a little unusual in that it showed up at room temp, went away at 37o and then returned at the AHG phase. A student submitted his workup indicting an anti-D as well as the anti-K. Needless to say I was surprised and repeated the test twice using 2 different panels and confirmed that the anti-D was there. She had fallen while skiing when she was about 6 months along so our best guess that she had either received her RhIG injection to late or to little was provided. The anti-D became a bigger issue 4 years later when our daughter was born but that's a story for another time.

Thanks Malcolm, it did answer my question. Apparently while their blood is circulating these people maintain normal levels of K+. It is only upon storage that they leak the K+ at higher levels than normal. It appears to be a genetic cell membrane "defect" "Familial pseudohyperkalaemia (FP) • dominantly inherited, asymptomatic • characterised by an increased rate of leakage of K+ from red cells at refrigerated temperatures • usually caused by the minor allele of a non-synonymous single nucleotide polymorphism (FP SNP; rs148211042; R723Q) in the transporter gene ABCB6 (ATP-Binding Cassette, subfamily B, member 6) • codes for a red cell membrane transporter protein • raw chip measurements from a screen of the UKBioBank suggested ~1:400 of the UK population have the FP SNP" "Study – identified FP individuals • screening of the National Institute for Health Research Cambridge BioResource (NIHRCBR) – identified 16 out of 8712 individuals with the FP SNP. • 2 more individuals with the FP SNP were identified when clinical cases of unusually high K+ levels were reported in RCC units that they had donated – characterised in Bawazir WM, et al. 2014" Thanks again,

Just curious Malcolm, how high are your "naturally high levels of potassium"? The top end of the normal values or would they be considered abnormal? At what level is the blood considered not available for paediatric units? This is the first I've heard of testing units for potassium.

As much as I liked to consider myself a nonconformist back in the day, I even was not considered for a job because the medical director running the interview considered me to much of a "cowboy", I must agree with Malcolm on this one. I'm afraid that no amount of logic or rational thought will justify the use of an expired tube. I once heard that the human mind is extremely capable of rationalizing just about anything to fit the need. Now, having said that I would be surprised if a manufacturer could come up with a legitimate explanation for how they came up with the expiration date other than some regulatory agency required one. Hope I'm wrong about that but I am skeptical.

While reading one of the threads today it got me thinking, does the University of Michigan still hold their annual Blood Bank Symposium the last of May or early June? It's been a very long time since I was able to attend but for quite some time I was able to convince the powers to be to allow me to attend every other year. Every year was a little too much to hope for. I learned a great deal, met many terrific people, and made a number of friends. I was able to meet and learn from a few of the greats in the blood bank world at the time. I certainly hope it has carried on and is still available. Thanks to John Judd and Suzanne Butch and the many others who made it possible. I hope their legacy continues.

Just a thought, I have not seen anyone mention in this thread, testing the current sample in parallel with the previous sample. We would start with the very first sample and freeze what was left after the initial titration. We would then thaw and run it in parallel with the next sample. This was an attempt to mitigate the, hopefully, minor differences in technique between techs and give us an accurate picture of any increase in antibody levels.

I had a corporate transfusion service medical director who was uncomfortable with the term "CMV safe" so we were required to use the phrase "CMV risk reduced"! I know it doesn't add anything to the discussion but when I read Ann's post the memory made me smile at the lengths some folks would go.

Personally I think what you have suggested should be adequate. I'm not sure what else you could do that would add anything of value to what you are trying to accomplish which in my mind is simply confirming that the units are functioning to specs and within the parameters you have identified. I assume you keep the information provided by the dataloggers to show any inspectors inclined to ask. Having said this, it's just my opinion but it will be interesting to see what others may contribute. One final thought, does the manufacturer provide any guidance?

Here's to hoping your life has taken a turn for the better going forward and there are brighter days ahead.

And now you are beginning to achieve enlightenment.

Wow, just wow. I can't even imagine a blood banker in the US considering this as acceptable. Our usual assumption has always been, if we didn't do it then it's probably wrong. Our paranoia runs deep and swift. Now, before anyone gets too upset with me please know that I was one of you for 35 years so I can play the what if game with the best of you. I'm just noting what I observed over many years. If anyone in the US is actually accepting the results from other facilities at face value and acting on them, please let me know, I would love to be wrong.

Sounds to me like an inspector who is "uncomfortable" because it's not how they do it. I recommend a nod and smile and a comment such as, "We'll look into it." As long as who is doing it, are trained and competency is documented it should not matter which department is doing it. To rephrase what Malcolm said, the procedure is more in haematology's wheel house. (It's kind of fun spelling words with more letters than necessary!)

If the cancer center does not have a blood bank refrigerator for storage and the blood will remain in the bags until used I recommend validating them as storage devices and not transport devices. This could save you some future headaches. This has been an issue for as long as I can remember.

That doesn't make any sense to me but I've been out of the loop for awhile. Is the outpatient surgery center a "stand alone" facility separate from the hospital or is it incorporated into the hospital? I'm not sure if that would make a difference, just a thought. It still would not make sense to me to have two separate but identical procedures on file. Do you have a good enough working relationship with your pathologist that you could ask him to explain his thinking to you? I've had at least one medical director that I would not even consider questioning but on the flip side, I've had a couple that I had no qualms about asking for an explanation and one I didn't even have to be careful about how I phrased it! A close working relationship with your medical director is the best thing you can cultivate. Good Luck

Somebody was sure digging through the archives to find this one! Glad to see. This was probably one of my first posts. To be honest, I don't remember if we ever went with the second type but I imagine we did knowing the corporate QA team at the time. I do believe that anything short of a second draw is little more than smoke and mirrors to show compliance with some mandate.

That's a new one to me. I'm with Kelly, positive is positive as long as it matches the forward type. If not, let the investigation begin!

Personally I don't see a problem here but I sure can't site any regulations, rules or even precedence that would help. Of course it bothers all the blood bankers, I would be very surprised if it didn't. It involves a change and that always makes us uncomfortable. I suggest sitting down and trying to come up with what, exactly, makes everyone uncomfortable if you haven't already. Then weigh those concerns on the real vs imagined scale and see what you come up with. Just thoughts from an old guy that's been there.

At one of my facilities we had a group of O neg donors that would come in on a regular basis and these folks were designated as out Neonate Donors. I think at the time we would set them aside exclusively for the neonates for a week and if they were not needed during that week we would move them to the general population. We would ask regular O neg donors if they could come in on a schedule so they could be used for the babies. When most understood that their blood would be designated for the newborns little else had to be said to get them on board.

Just a thought. With an issue like this you have to come to a point of realizing that you can only do so much especially when much of the process is out of your control. You can drive yourself crazy playing the "what if " game! Once you've done the best you can for your situation then accept that there will probably be a fallible human somewhere in the process who will come up with a creative work around. A nurse will put a unit in the medication refrigerator until she's ready for it or they will put it back in the cooler in OR after it's been setting next to the patient during the procedure, just in case! Accept that you don't have complete control and never will, you'll live longer!

Interesting topic, we had a 32 bed NICU and I don't remember ever transfusing platelets. I'll be interested in any responses.

I used something similar but about 30 years older!!! Glad to see it's been up graded. I had a number of inspectors that did not like it because they had never seen anything like it. They couldn't say to much about it, I had all the records showing it was verified just like all the rest of my thermometers on the same schedule.

I've been searching for the powerpoint I made of the occurrence I wanted to share but I must have stored it on an external hard drive that crashed and was unrecoverable. (That's my excuse anyway.) Consequently it was long ago and my memory is fuzzy on the details but in this case the details is not the point I'm attempting to convey. Bottom line was that 2 units of blood were sent via pneumatic tube to ICU for 2 different patients. No, the units were not in the same tube, they were sent 10-15 minutes apart. The units went to the wrong patients and the proper patient identification protocol was not followed. Both units were transfused and the paper work was sent back to the transfusion service. I do remember a very white faced staff member coming to my door to tell me what they had discovered. Luckily both patients were type O+ with no problems and recrossmatching showed that each was compatible with the unit they had received. We had dodged a bullet! The ensuing investigation discovered that the patient identification protocol used by the ICU nursing staff had morphed into something I did not even recognize. A couple of years earlier the nursing department had taken over all training of new nurses as well as annual reviews for current staff. They basically told me my services were no longer needed in a training capacity. When the details of the occurrence came out the assistant CNO (chief nursing officer) who was filling in for the CNO on sick leave wanted to severely punish the two nurses involved and then sweep everything under the rug. Heaven forbid that word got out that a couple of HER nurses had made a mistake. Much to my surprise and delight I was able to convince the ICU nurse supervisor that the problem was much deeper than just human error and the protocols the nurses were following were deeply flawed. We did extensive retraining for the entire ICU staff. When the CNO returned to duty I had a long talk with her. I had always had a very good relationship with her and she trusted me. From that point on I was actively involved in the training a new nurses as well as the annual refresher courses for current staff. During those training sessions I was not surprised that other areas had "adjusted" the pretransfusion patient identification protocols to be easier and quicker for them. Using this occurrence as an example I was able to convince them of just how critical patient identification was. As a side note, I one time had a labor and delivery nurse tell me that it was impossible for her to transfuse the wrong blood to her patient and nothing I could say would convince her otherwise. Some times I wonder how I ever got out with my sanity intact! My wife (a nurse) reminds me that I didn't!