John C. Staley

The general concensus is that anytime within 3 months after a transfusion or pregnancy an antibody can be produced. If, after 3 months, there is no antibody the patient is highly unlikely to produce an antibody do to that transfusion or pregnancy. Every transfusion or pregnancy is a new opportunity and resets the 3 month clock.

Our SOP is to release the remaining 2 units and re-crossmatch on a new sample. Logically it doesn't make a lot of sense if your patient has not been transfused or pregnant during the previous 3 months but sometimes it's easier to stick to the easy rule than identify all the exceptions. :abduction

I'm with Mabel. We do the best we can within the limitations imposed on us. You can't "fix" the computer system so you will have to figure out an acceptable way to work around it. If it makes you more comfortable add a third identifier to the two you already require, maybe Name, Medical Record Number and Birthdate. If you have 80% of the name and the other two match then I would think that would be acceptable and as Mabel suggests, you should be able to confirm the full name in the computer. It might be interesting to do a study and see just how many of your patients have names that exceed your 23 character limitation. You can then decide how much time, effort and anxiety you want to spend on the issue. :fingerscr

It is the physicians first and the nurses second to make sure their patients receive RhIG if they need it. We can not be responsible for every woman that walks through the doors. They order the testing, we do it. We can not be the RhIG Police. I helped the nursing staff along with risk mgt come up with a system they follow to assure their patients needing RhIG are identified and tested and provided with the injection. It's their patients let them be responsible. These are not just deliveries, they come through the ED and perinatology as well. It is impossible for the transfusion service to be responsible and at my facility I have refused to be responsible. It's time for the docs and nurses to be accountable for caring for their patients.

MaryJo, what's this move to Oregon stuff??? Does that mean when I get back to Ann Arbor the first week of June you won't be around?

Franklyn, I'm curious, what do you mean by "RFID is not yet approved for use with Blood Products."? What's to approve? You put the transmitter on the cooler and you can track the cooler. If you apply the RFID devise to the bood bag then the concern about sticking something to the bag comes up but that is not unique to RFID.

I'm with MaryJo and David. We switch back as soon as we can. That is usually once we get a sample and a blood type on the patient. The other side of this coin is how soon do you switch back from Rh positive to Rh negative in an Rh neg patient? This is the one that has always bothered me. Usually we switch due to Rh negs being in short supply and switch them back once the current episode is over but I don't have a good answer when asked. Anyone else have any ideas on this part of it.

A warm environment could cause the patient's body to want to increase peripheral blood flow away from the core to aid in cooling. This in turn may be good for the blood bank business in a trauma patient. Interesting that in heart surgery they want it cold. I guess the old "some like it hot, some like it cold" philosophy must appply.

Bob, I'd like to see the data making it "real". Got any good references?

Our QA group has informed us that if a lable is placed directly on the plastic bag of a unit of blood the adhesive must be approved by the FDA for such use. Therefore, we no longer stick anything directly on the plastic. Being a transfusion service this is not difficult. I have no reference for where they come up with this but as I am lead to believe, it is a fairly common understanding. Apparently the concern is that there may be chemicals in the adhesive that could leach through the plastic and effect the safety, purity and potency of the blood product.

But Bob things have changed since you left.

I keep the panel sheets for 5 years. That's the interpretation of the regulations made by our QA group.

My understanding is the same as Linda's. It appears that the FDA considers labeling to the "lowest common denominator" to be an acceptable practice. The problem may come if your facility has limitations on what product can be used when. If you say you can only use FFP for neonates then you can't provide them with a product labeled as thawed plasma but if FFP, 24 hour plasma and thawed plasma can be used interchangably then labeling every thing as thawed plasma after thawing should be acceptable because all three meet the requirements for thawed plasma.

Our second ECHO at the moment is only a possibility if the first one can't keep up. Since it's a new instrument that does more testing we are not sure how it will handle our total work load if we are having it do everything it can. The second one is just a back up plan if needed. Currently I have no plans of ever completely doing away with manual testing. The paranoid hysteric, blood banker hidden deep within me is not quite ready for that leap. The strips are complete different on the ECHO and can not be used interchangably with the ABS2000. Functionaly they are essentially the same, solid phase is solid phase but how they are identified by the instrument is very different.

Huntilla, here is my attempt to answer your questions. We are very close in size to your facility. We have just over 300 beds (depends on who's counting and why) and last year we transfused just over 5000 RBCs. We ran about 6500 Type and Screens on the ABS2000 and expect to do more on the ECHO because it's faster and easier. 1. Was solid phase testing your original platform before conversion to the ABS instrument? No. PEG is our primary manual method. We have never done solid phase manual testing. 2.Do you plan to keep reagents for performance of tube testing for ER trauma or STAT surgical samples? We will maintain our ability to perform manual testing but the STATs from OR and ER are not the reason. The ECHO TAT for a type and screen on the analyzer is 22 minutes. That's fast enough for us. This is an instrument, it will have down time, we must have a backup method to do the testing. Until we get a second analyzer we will keep the manual testing available. 3. Also, for the performance of eluates, PEG testing in the tube, or enzyme treatment can these processes be incorporated onto the ECHO? Currently it appears that eluates or enzyme treatment are not available. I don't understand what you mean by the PEG testing in the tube since the instrument is designed for solid phase testing why would they put PEG on it?

This is for those of you who load syringes through a filter for NICU. What do you use for the outdate of RBCs loaded into syringes through a filter and how did you arrive at that outdate? I think this has been discussed before but I don't remember or find what was said. Thanks John

I was on vacation happily romping in the fields of central Saskatchewan hunting birds when it arrived so I got the following after the fact from some one who was here. If I remember correctly, the shipping company actually took it out of the crate, and placed it on the counter. This was on a Wednesday. On the following Monday two delightful gentlemen from Immucor showed up and began setting it up. On Tuesday at noon these same two gentlemen started training my 2 "super users". That training was completed on Thursday afternoon. Friday we started our validation. We did not touch the instrument until after the folks from Immucor arrived and instructed us on the proper touching.

Mabel, I can still disagree with the opinions expressed above because that's what they are. Even the inspectors are expressing their opinion/interpretation of things and I've seen a number of discrepencies between individual inspectors and their opinions. Everything is a crap shoot and depends on if your interpretation is in line with the current inspector's. So, we do the best we can with what we have to work with. Heaven forbid if logic and common sense ever gets in the way. The opinions expressed here are mine and mine alone and usually shared by very few if anyone. But hey they are mine and all I have.

So far, 3 weeks into the validation, we've seen no software issues. Installing 20 per month might be a little ambitious but they are only onsite for about 5 days so 20 /mon is 5 /week. That would require 5 installers that are working or traveling all the time. I'm fairly certain they have more than 5 installers so I would think 20/month is possible if a little optimistic. Now selling 20 per week is a whole other issue.

Welcome Franklyn. I wish I had thought of adding a disclaimer but it's too late now. I'm sure that if something came up my facility would "disavow all knowledge of me" and be very certain that I had never existied. :shakefist

We started automation in 1999 with the Immucor ABS2000. At the time it was the only fully automated, walk-away instrument for transfusion services. Our ABS2000 is getting old and ready to retire. I don't like gel (personal bias) so Ortho was not an option and the Tango, in my humble opinion, still has a ways to go. The ECHO was an easy install, it has a realatively small foot print and does not weigh very much so it is much easier to find some place to put it. So far my techs are very surprised and excited on how fast it is. Type and screens in 22 minutes and a 14 cell ID panel in 22 minutes. The service/support is first, a call. Second, a direct computer connect from service. They call this BLUD direct. Third is a vist from the closest service person within 24 hours. This is not free but it is reasonable. We have not had to go to step 3 yet. All problems, mostly operator error, have been delt with either over the phone or the modem. Immucor spent 4 days here training my 2 "super users" who are doing the bulk of the validation and all of the training for the rest of the staff. So far we are very happy with it. It is a little more complicated to operate than the ABS2000 but by no means difficult. It just can do more and doing more is always more complicated to one degree or another.

For those of you who visit the AABB forums please forgive the redundancy but I wanted to reach as wide a group as possible. Apparently one of our Intensivists has decided that all transfusions occurring in our ICU, with the exclusion of platelets, are to go through a blood warmer. Has any one else encountered this as a standard practice or seen any recent literature advocating this practice? I've spent the morning searching and not been able to find anything. Thanks John

If the two expiration dates are visible and easy to read, in a small facility like Mabel's, it should not be too tough to train everyone that the shortest date/time always wins. I don't see a problem with what you want to do especially with the tag being computer generated. If someone asks explain that the longer outdate was for the frozen product the short outdate was applied when thawed. That way you can prove you didn't thaw an already outdated product.

Actually I have one and we are three weeks into the validation and should be reporting out patient results in the next 3 or 4 weeks. If you have any specific questions I would be happy to try to answer them as best I can.

Oh sure, rub salt in the wound. "I'm leaving for more money, shorter hours and less stress." Just what we needed to hear. There's nothing that says you can't stop in and visit now and then. I did appreciate your unique perspective on the law and it was quite helpful on occasion. Stay in touch. John